Fighting Anorexia: No One To Blame

While adults can drift along in a state of semi-starvation for years, the health risks for children under the age of 13 are dire. In their preteen years, kids should be gaining weight. During that critical period, their bones are thickening and lengthening, their hearts are getting stronger in order to pump blood to their growing bodies and their brains are adding mass, laying down new neurological pathways and pruning others--part of the explosion of mental and emotional development that occurs in those years. When children with eating disorders stop consuming sufficient calories, their bodies begin to conserve energy: heart function slows, blood pressure drops; they have trouble staying warm. Whatever estrogen or testosterone they have in their bodies drops. The stress hormone cortisol becomes elevated, preventing their bones from hardening. Their hair becomes brittle and falls out in patches. Their bodies begin to consume muscle tissue. The brain, which depends at least in part on dietary fat to grow, begins to atrophy. Unlike adult anorexics, children with eating disorders can develop these debilitating symptoms within months.

Lori Cornwell says her son's descent was horrifyingly fast. In the summer of 2004, 9-year-old Matthew Cornwell of Quincy, Ill., weighed a healthy 49 pounds. Always a picky eater, he began restricting his food intake until all he would eat was a carrot smeared with a tablespoon of peanut butter. Within three months, he was down to 39 pounds. When the Cornwells and their doctor finally located a clinic that would accept a 10-year-old boy, Lori tucked his limp body under blankets in the back seat of her car and drove all night across the country. Matthew was barely conscious when he arrived at the Children's Hospital in Omaha. "I knew that I had to get there before he slipped away," she says.

With stakes this high, how do you treat a malnourished third grader who is so ill she insists five Cheerios make a meal? First, say a growing number of doctors and patients, you have to let parents back into the treatment process. For more than a hundred years, parents have been regarded as an anorexic's biggest problem, and in 1978, in her book "Golden Cage," psychoanalyst Hilde Bruch suggested that narcissistic, cold and unloving parents (or, alternatively, hypercritical, overambitious and overinvolved ones) actually caused the disease by discouraging their children's natural maturation to adulthood. Thirty years ago standard treatment involved helping the starving and often delusional adolescents or young women to separate psychologically--and sometimes physically--from their toxic parents. "We used to talk about performing a parental-ectomy," says Dr. Ellen Rome, head of adolescent medicine at the Cleveland Clinic.

Too often these days, parents aren't so much banished from the treatment process as sidelined, watching powerlessly as doctors take what can be extreme measures to make their children well. In hospitals, severely malnourished anorexics are treated with IV drips and nasogastric tubes. In long-term residential treatment centers, an anorexic's food intake is weighed and measured, bite by bite. In individual therapy, an anorexic tries to uncover the roots of her obsession and her resistance to treatment. Most doctors use a combination of these approaches to help their patients get better. Although parents are no longer overtly blamed for their child's condition, says Marlene Schwartz, codirector of the Yale eating-disorder clinic, doctors and therapists "give parents the impression that eating disorders are something the parents did that the doctors are now going to fix."

Worse, the state-of-the-art protocols don't work for many young children. A prolonged stay in a hospital or treatment center can be traumatic. Talk therapy can help some kids, but many others are too young for it to be effective. Back at home, family mealtimes become a nightmare. Parents, advised not to badger their child about food, say nothing--and then they watch helpless and heartbroken as their child pushes the food away.

In the last three years, some prominent hospitals and clinics around the country have begun adopting a new treatment model in which families help anorexics get better. The most popular of the home-based models, the Maudsley approach, was developed in the 1980s at the Maudsley Hospital in London. Two doctors there noticed that when severely malnourished, treatment-resistant anorexics were put in the hospital and fed by nurses, they gradually gained weight and began to participate in their own recovery. They decided that given the right support, family members could get anorexics to eat in the same way the nurses did. These days, family-centered therapy works like this: A team of doctors, therapists and nutritionists meets with parents and the child. The team explains that while the causes of anorexia are unclear, it is a severe, life-threatening disease like cancer or diabetes. Food, the family is told, is the medicine that will help the child get better. Like oncologists prescribing chemotherapy, the team provides parents with a schedule of calories, lipids, carbohydrates and fiber that the patient must eat every day and instructs them on how to monitor the child's intake. It coaches siblings and other family members on how to become a sympathetic support team. After a few practice meals in the hospital or doctor's office, the whole family is sent home for a meal.