Letters to the Editor

Abstract

20 February 2008 Dear Editor, As parents of a child who suffered from anorexia for over 4 years, we read with interest the case report ‘Anorexia, Maudsley and an impressive recovery: One family's story’.1 The authors of this report clearly had success using the Maudsley approach in treating their daughter's anorexia, and we congratulate them for this. However, in our view, the report raises some questions about the Maudsley treatment that require serious consideration, given that this form of treatment appears to be fast becoming recognised as a ‘treatment of choice’ in Australia.2 It appears from the report that the patient in question was aged 15 at the time of treatment. But what of patients who are in their late teens, or early adulthood? It is never easy to get an anorexic to eat, but surely there is more chance of this happening when the patient is still relatively young and more likely to be compliant with parental wishes. We had some success with the Maudsley treatment when our daughter was 13. However, when she relapsed in her late teens, we found it impossible to exert the level of control over her eating that was necessary to subvert the illness. The report skirts around the impact of the Maudsley treatment on other family members. What is the effect of the episodes of ‘physical and verbal aggression’ and the ‘fighting and upset’ at mealtimes on younger siblings? We have three other children, all of whom developed anxiety symptoms as a result of being exposed – for many months – to their sister's severe distress at mealtimes. They have all since told us that the period during which we were using Maudsley therapy was the worst time of their lives. Our 10-year-old witnessed us untying a noose from his sister's neck after she attempted to hang herself in her bedroom. No child should ever be subjected to that level of trauma in their own home. We note that one of the authors of the case report had to give up work for the duration of her daughter's illness and that this was accepted as ‘an inevitable consequence of having a child with a debilitating illness’. But what if family finances are such that this is not possible? What of single-parent families? The rate of relapse after family therapy is yet to be satisfactorily explained.3 We were not warned of this possibility and were shocked by our daughter's severe relapse, less than 18 months after her supposed ‘recovery’. Finally, what options are available for Australian patients when the Maudsley treatment fails? The options offered to our daughter included long-term admission to an adult psychiatric hospital, high doses of antidepressants and antipsychotics and years of psychotherapy to find the ‘reason’ for her anorexia. None of these options were acceptable to her, or to us. Instead, we took her to the Karolinska Institute in Stockholm, Sweden where she was treated for 5 months using the Mandometer model of treatment. This form of treatment seeks to achieve weight restoration through the use of the Mandometer, a computerised biofeedback device that monitors eating rate and satiety.4 In our daughter's case, it also involved the use of heat therapy to reduce the overwhelming urge to exercise that was a key feature of her anorexia. She was also assigned an individual case worker who had responsibility for monitoring her food intake and supporting her through difficult meals. This freed us up to simply be her parents again, rather than exhausted ‘food police’. Since her return to Australia, our daughter has resumed school and a normal teenage life. She has maintained a healthy weight and she no longer exhibits disordered eating behaviour or psychiatric symptoms. The Maudsley model has obvious attractions for governments because it shifts the cost and responsibility of treatment away from the public health system, placing it instead on the shoulders of the family of the anorexia sufferer. But for some families, the costs and responsibilities are too great. Sometimes, weight restoration and recovery cannot take place within the family environment, no matter how hard the family tries. The Mandometer treatment provides a clinically proven, effective form of treatment for anorexia.5 As such, it should be accessible and affordable for all Australian patients. Unfortunately, however, Mandometer treatment currently receives no funding from the Australian government and seriously ill patients must travel overseas for treatment. This situation is unlikely to change until the Mandometer treatment is able to be compared in randomised controlled trials with Maudsley and other forms of treatment used in Australia. The Mandometer Clinic has expressed a willingness to participate in such a trial.6 However, we understand that the Australian medical establishment has not shown any real interest in pursuing this avenue. Why not?