This month, I have the pleasure of introducing you to Harriet Brown - a mother whose older daughter Kitty became anorexic and nearly died. In the following interview, Harriet talks about her family's initial discovery of her daughter's anorexia, how they helped Kitty recover and how other parents can help their children recover as well. "Thank you, Harriet, for your time and for sharing!"
1) Tell us a bit about yourself.
I'm an assistant professor of magazine journalism at the S.I. Newhouse School of Public Communications at Syracuse University, and live in Syracuse, NY, with my family. I have been an editor and writer for more than 30 years, writing for the New York Times, Health, O: The Oprah Magazine, Glamour, Vogue, and many other magazines and newspapers. I'm also co-founder of Maudsley Parents, and creator of Project BodyTalk (
www.projectbodytalk.com ) — a website that features (and collects) audio commentaries on body image, eating, and related issues from anyone who cares to contribute.
2) Your older daughter Kitty suffered from anorexia. How did you, your husband and your younger daughter help her recover?
Kitty was 14 when she was diagnosed with anorexia. We honestly didn't know much about eating disorders at the time; I thought you had to drop a lot of weight to have anorexia. I didn't realize that some people, like Kitty, simply fail to gain weight when they should, falling further and further behind the curve. I also didn't recognize one of the major symptoms of an eating disorder, which is increased anxiety and obsessionality. That's what we saw first with Kitty. She was anxious, obsessed, and worried; she thought she might have OCD at one point. It didn't seem particularly food-related at first. But we also didn't realize how little she was eating, because like many people who have this illness, she was very adept at hiding it from us for a while. She was on a gymnastics team that practiced every night, so she ate—often alone—before practice. We didn't realize how little she was eating. Often she told us she had a stomachache, she'd eaten at a friend's house, she wasn't hungry—these are all warning signs that something's not right in the eating department.
I knew she had anorexia before the actual diagnosis. She dropped some weight, and suddenly she went from looking thin to looking way too thin. Things unraveled pretty fast after that. She landed in the hospital for dehydration and bradycardia, and the ICU doctor wanted to tube her. That was a terrifying low point for all of us.
My husband and I flailed around for about a month, trying unsuccessfully and with increasing anxiety to get Kitty to eat. As a journalist, I was doing a lot of research. I stumbled on the notion of family-based treatment and we decided immediately to try it. That’s when we started to make progress.
3) Tell us more about the family-based treatment of anorexia: the Maudsley approach.
FBT (Family Based Treatment), or the Maudsley approach (
www.maudsleyparents.org ), was developed in London at the Maudsley Hospital (hence the nickname) in the 1980s, by several therapists there, including Ivan Eisler and Christopher Dare. Eisler and Dare observed that patients in the hospital were able to eat when nurses supported them through meals—sitting with them, encouraging them, rubbing their backs, etc. Once patients went home, they usually backslid. They took some of the work Salvador Minuchin did on family therapy and applied it to treating adolescent eating disorders outpatient. That is, they hypothesized that families could play the same role with their teens at home as nurses did in the hospital. The method turned out to be much more effective than any other treatment, and it still is; the most recent study found that 90% of adolescents treated with FBT recovered fully or made very good progress. Those results hold true five years later, too.
There are 3 phases to FBT.
- Phase 1 is weight restoration—typically the most challenging part, because parents must find ways to get a teen with anorexia to eat, and eat a lot, to reverse malnutrition and foster recovery.
- Phase 2 is a gradual return of control over eating to the teen. This comes after the teen is fully weight restored and has been for a time, and happens slowly, with lots of oversight by the parents.
- Phase 3 is resumption of normal adolescent development, and I think what's meant here is that eating disorders take over a teen's life, and so normal development doesn't happen in other areas--social and emotional, mainly. Phase 3 is when normal life resumes.
The method is considered controversial by some, but it's becoming more and more mainstream. If you know anything about eating disorders research, you know there's precious little research that's been done, and most treatments do not prove successful when looked at closely. FBT is the rock star of treatments for teens and young adults. It works for far more families than not.
4) What advice do you have for parents whose child is struggling with an eating disorder?
Four things
1. Full recovery is possible. Many professionals will tell you that once you have an eating disorder, you’ll always have it. That it’s like alcoholism, something you can learn to manage, something you’ll “be in recovery from” for the rest of your life. The evidence suggests that full recovery is absolutely possible, especially for teens. Don’t settle for anything less.
2. You have more power than you realize. I get emails and phone calls from many parents who say that FBT would never work for their family because their child is too stubborn, too oppositional, too defiant. FBT doesn’t work for every family, it’s true. But the studies done on it so far show that it works in about 90% of families. That’s the vast majority. I think families often count themselves out, in a way; they think they can’t do it, and then they can’t. The most important piece of helping a child recover using FBT is believing that it will work. Because it usually does.
3. Faster is better. Studies show that time is of the essence; the less time a child or teen spends being acutely ill, the better her chance for full recovery. There’s absolutely nothing to be gained by waiting and seeing. You’d never hear an oncologist suggest that a Stage 1 tumor be “watched” rather than treated, yet doctors say that about eating disorders all the time.
4. You don’t have to do this alone. In fact, you shouldn’t—it’s way too hard and stressful. When our daughter got sick, there were very few therapists trained in FBT. Thanks to Drs. Daniel le Grange and James Lock, who started a training institute to certify FBT providers, the numbers of therapists who are trained in this method are growing. Many families don’t want to tell anyone what they’re going through; they feel ashamed, responsible, embarrassed. But secrecy and isolation make recovery that much harder. So look for support. Several other moms and I started a website of resources for parents, Maudsley Parents (www.maudsleyparents.org) which offers information on treatment, recipes, stories about how other families have managed, and links to a lot of useful information.
5) Tell us about your book "Brave Girl Eating - One Family's Struggle with Anorexia."
I wrote the book partly as catharsis for myself—that's what writers do, after all. But my deepest hope is that this book will reach other families and help them. When my daughter was diagnosed and I turned to the doctor, she had few answers. It terrified me that there really was no good way to treat my daughter's mortal illness. My doctor had never heard of FBT. So I hope the book will show parents that there is another way. And I really hope that professionals who read it—whether they're pediatricians, psychologists, psychiatrists, therapists, or internists—will now be able to offer their patients hope and another way to combat this illness.
For more information about Harriet Brown and her work, visit
www.harrietbrown.com and her blog “Feed Me – Talking about Food, Eating, Body Image, and Weight” at
http://harrietbrown.blogspot.com You can also connect with Harriet on Facebook and follow her on
Twitter .
"Thank you, Harriet, for your time and for sharing!"
1) Tell us a bit about yourself.
I'm an assistant professor of magazine journalism at the S.I. Newhouse School of Public Communications at Syracuse University, and live in Syracuse, NY, with my family. I have been an editor and writer for more than 30 years, writing for the New York Times, Health, O: The Oprah Magazine, Glamour, Vogue, and many other magazines and newspapers. I'm also co-founder of Maudsley Parents, and creator of Project BodyTalk ( www.projectbodytalk.com ) — a website that features (and collects) audio commentaries on body image, eating, and related issues from anyone who cares to contribute.
2) Your older daughter Kitty suffered from anorexia. How did you, your husband and your younger daughter help her recover?
Kitty was 14 when she was diagnosed with anorexia. We honestly didn't know much about eating disorders at the time; I thought you had to drop a lot of weight to have anorexia. I didn't realize that some people, like Kitty, simply fail to gain weight when they should, falling further and further behind the curve. I also didn't recognize one of the major symptoms of an eating disorder, which is increased anxiety and obsessionality. That's what we saw first with Kitty. She was anxious, obsessed, and worried; she thought she might have OCD at one point. It didn't seem particularly food-related at first. But we also didn't realize how little she was eating, because like many people who have this illness, she was very adept at hiding it from us for a while. She was on a gymnastics team that practiced every night, so she ate—often alone—before practice. We didn't realize how little she was eating. Often she told us she had a stomachache, she'd eaten at a friend's house, she wasn't hungry—these are all warning signs that something's not right in the eating department.
I knew she had anorexia before the actual diagnosis. She dropped some weight, and suddenly she went from looking thin to looking way too thin. Things unraveled pretty fast after that. She landed in the hospital for dehydration and bradycardia, and the ICU doctor wanted to tube her. That was a terrifying low point for all of us.
My husband and I flailed around for about a month, trying unsuccessfully and with increasing anxiety to get Kitty to eat. As a journalist, I was doing a lot of research. I stumbled on the notion of family-based treatment and we decided immediately to try it. That’s when we started to make progress.
3) Tell us more about the family-based treatment of anorexia: the Maudsley approach.
FBT (Family Based Treatment), or the Maudsley approach ( www.maudsleyparents.org ), was developed in London at the Maudsley Hospital (hence the nickname) in the 1980s, by several therapists there, including Ivan Eisler and Christopher Dare. Eisler and Dare observed that patients in the hospital were able to eat when nurses supported them through meals—sitting with them, encouraging them, rubbing their backs, etc. Once patients went home, they usually backslid. They took some of the work Salvador Minuchin did on family therapy and applied it to treating adolescent eating disorders outpatient. That is, they hypothesized that families could play the same role with their teens at home as nurses did in the hospital. The method turned out to be much more effective than any other treatment, and it still is; the most recent study found that 90% of adolescents treated with FBT recovered fully or made very good progress. Those results hold true five years later, too.
There are 3 phases to FBT.
- Phase 1 is weight restoration—typically the most challenging part, because parents must find ways to get a teen with anorexia to eat, and eat a lot, to reverse malnutrition and foster recovery.
- Phase 2 is a gradual return of control over eating to the teen. This comes after the teen is fully weight restored and has been for a time, and happens slowly, with lots of oversight by the parents.
- Phase 3 is resumption of normal adolescent development, and I think what's meant here is that eating disorders take over a teen's life, and so normal development doesn't happen in other areas--social and emotional, mainly. Phase 3 is when normal life resumes.
The method is considered controversial by some, but it's becoming more and more mainstream. If you know anything about eating disorders research, you know there's precious little research that's been done, and most treatments do not prove successful when looked at closely. FBT is the rock star of treatments for teens and young adults. It works for far more families than not.
4) What advice do you have for parents whose child is struggling with an eating disorder?
Four things
1. Full recovery is possible. Many professionals will tell you that once you have an eating disorder, you’ll always have it. That it’s like alcoholism, something you can learn to manage, something you’ll “be in recovery from” for the rest of your life. The evidence suggests that full recovery is absolutely possible, especially for teens. Don’t settle for anything less.
2. You have more power than you realize. I get emails and phone calls from many parents who say that FBT would never work for their family because their child is too stubborn, too oppositional, too defiant. FBT doesn’t work for every family, it’s true. But the studies done on it so far show that it works in about 90% of families. That’s the vast majority. I think families often count themselves out, in a way; they think they can’t do it, and then they can’t. The most important piece of helping a child recover using FBT is believing that it will work. Because it usually does.
3. Faster is better. Studies show that time is of the essence; the less time a child or teen spends being acutely ill, the better her chance for full recovery. There’s absolutely nothing to be gained by waiting and seeing. You’d never hear an oncologist suggest that a Stage 1 tumor be “watched” rather than treated, yet doctors say that about eating disorders all the time.
4. You don’t have to do this alone. In fact, you shouldn’t—it’s way too hard and stressful. When our daughter got sick, there were very few therapists trained in FBT. Thanks to Drs. Daniel le Grange and James Lock, who started a training institute to certify FBT providers, the numbers of therapists who are trained in this method are growing. Many families don’t want to tell anyone what they’re going through; they feel ashamed, responsible, embarrassed. But secrecy and isolation make recovery that much harder. So look for support. Several other moms and I started a website of resources for parents, Maudsley Parents (www.maudsleyparents.org) which offers information on treatment, recipes, stories about how other families have managed, and links to a lot of useful information.
5) Tell us about your book "Brave Girl Eating - One Family's Struggle with Anorexia."
I wrote the book partly as catharsis for myself—that's what writers do, after all. But my deepest hope is that this book will reach other families and help them. When my daughter was diagnosed and I turned to the doctor, she had few answers. It terrified me that there really was no good way to treat my daughter's mortal illness. My doctor had never heard of FBT. So I hope the book will show parents that there is another way. And I really hope that professionals who read it—whether they're pediatricians, psychologists, psychiatrists, therapists, or internists—will now be able to offer their patients hope and another way to combat this illness.
For more information about Harriet Brown and her work, visit www.harrietbrown.com and her blog “Feed Me – Talking about Food, Eating, Body Image, and Weight” at http://harrietbrown.blogspot.com You can also connect with Harriet on Facebook and follow her on Twitter .