The Maudsley Approach for the treatment of anorexia nervosa was
developed by Dr Christopher Dare, in 1985, and was subsequently manualised by
James Lock, Daniel LeGrange, W. Stewart Agras and Christopher Dare in 2001. It
is an outpatient based treatment that aims to assist parents in the process of
their child’s recovery.
There are relatively few studies of interventions for anorexia
nervosa, however, for adolescents, of the outpatient interventions studied, the
Maudsley Model, has the greatest evidential support. The evidence indicates
that this treatment is effective for 68 – 70 percent of cases. Continued
research has demonstrated that this model of treatment is also applicable to
adolescents with bulimia nervosa.
The Maudsley approach addresses the common observation that anorexia
can become a chronic illness involving multiple hospitalizations and prolonged
treatment. It is applied to adolescents, aged 18 years and under, who are
living with their families. The treatment involves the family from the outset
of treatment and relies heavily on parent involvement in re-feeding the child
with the eating disorder.
Central to this approach is the view that family dysfunction is not
a causal factor in the development of the eating disorder. It also differs from
other family therapy interventions as the treatment does not address family
problems, rather it focuses specifically on mobilizing the resources of the family
to overcome the illness.
The Maudsley Approach has three phases of treatment:
Phase One: Intensive Re-feeding.
During this phase the sessions are weekly and its duration is
approximately 15 sessions. The aim is to get the young person to 90 - 95% of their
ideal body weight. The focus of this phase is establishing and maintaining
parent control of re-feeding.
Phase Two: Transition to Adolescent Control.
During this phase sessions are fortnightly and its duration is
approximately 15 - 20 weeks. This phase focuses on shifting the control over
food choices from the parent to the adolescent, consistent with the
adolescent's developmental stage.
Phase Three: Adolescent Issues
During this phase the sessions are monthly. In this phase the
adolescent's weight has returned to 100% of ideal body weight. The focus of
this phase to return the family life cycle to that normally experienced during
the adolescent development phase. Relapse prevention and other remaining issues
for the young person or family are addressed.
The treatment is designed to intervene aggressively in the first
stages of illness, and the duration of treatment may be as short as 20 sessions
or six months. However, in some cases it may be of longer duration. Recovery is
most optimally achieved when the eating disorder is treated in its earliest
stages and long term chronic illness is prevented.