My daughter is 15 years old and was diagnosed with anorexia about two months ago. We had been trying to allow her to refeed herself, and it was not working. We are now beginning to use a Maudsley-based approach. My question in the refeeding process is should we limit the amount of time allowed for her to eat a meal? She eats very slowly, and it can take over an hour for her to consume all of her required food. It seems like by the time she finishes with one meal, it is time for the next.
Katharine Loeb, PhD responds:
I admire that you are immediately trying to find the right approach for your family, and that if eating on her own was not effective for your daughter, you are attempting alternatives such as the Maudsley method. Allow me to say at the outset that while the overarching “mission statement” of Maudsley is clear and definitive - that parents are initially in charge of their child’s nutritional rehabilitation process until the disorder begins to wane – the details of implemtation can really vary by family, and a particular strategy that works for one child may not be useful for or applicable to another. Procedures around meal duration are a good example of this variability. Some parents find that sustaining a meal as long as necessary to fully accomplish the planned food consumption sends a strong message to the eating disorder that nothing will deter their mission of health. Often, as weight is gained and the illness recedes, excessive time spent on meals will become more aversive to the adolescent as s/he re-engages with other interests and activities. For example, as the healthy part of your daughter emerges, she may rather complete a meal sooner and go out with friends than sit at the kitchen table all day. Alternatively, other parents find that imposing a time limit on meals, rather than allowing their duration to shrink naturalistically, yields better functioning for their child. This is especially true when the meal is extended as a function of compulsions or rituals around food or eating (e.g., cutting food into very small pieces, pacing bites at certain intervals). Such rituals represent eating disorder behaviors that parents should tackle along with the “refeeding” process. Empathic but firm messages to your child such as, “I know the eating disorder is making it so uncomfortable for you to eat this way, and that is why we’re here to help you – so you’re not alone in this. If we allow the illness to have any influence over how you eat, we are not doing our job as parents to protect you from this terrible disorder.” A time limit often works best in combination with something to look forward to at the end of the meal, such as a pleasurable or distracting activity.
Katharine Loeb, PhD
Dr. Loeb is Associate Professor of Psychology at Fairleigh Dickinson University, Director of Research at the Eating and Weight Disorders Program at Mount Sinai School of Medicine, and serves as Clinical Advisor to Maudsley Parents.