Thursday 6 March 2014

I agree that 'one size does not fit all' when it comes to treatment, and here's why...

... which is why I do, in the main, agree with Cathy's comment to yesterday's post (which I really appreciate). Here are my thoughts...

Cathy says: Who says James Lock and his treatment is the 'right' treatment? Who says James Lock is 'right'?

I say: Yes, I agree. Eating disorders are notoriously difficult to treat and one size can never fit all. But, in tests, Lock-style FBT (for adolescents) appears to come out on top of traditional methods of treating eating disorders - according to the findings he showed us on Sunday from the States and in Scottish trials, which is presumably why Scotland is making FBT (Family Based Treatment) available to those that request it. (By this I guess they mean that other methods are still available to families that would prefer not to use FBT?)

Cathy says:  I personally feel that FBT can do more harm than good for some families (and the sufferer themselves). It would NEVER have worked for me, in part because my anorexia nervosa (AN) was 'atypical' and probably not AN at all; despite the low weight. FBT is massively stressful for families to engage with and it would have tore my family apart. 

I say: Yes, as I say above, there should be choice. The difference is that, in Scotland, families DO get choice. Here in England, apart from in certain areas, families don't get any choice; they simply have to take what is on offer, whether from a specialist eating disorders team or a more generalised CAMHS team. I also recognise that FBT is mega stressful to put into practice, and it may not have worked for our family either. But I would have liked to have been given the option, supported - as good FBT should be - by a very hands-on team that visit and train the family at home.

Cathy says: Furthermore, how many parents can realistically take time off work to care 24/7 for their sick child? To resign from one's job would be a huge risk if FBT turned out NOT to be the best treatment for the child. 

I say: No, not all parents can afford to take time off work. But, in the case of a serious eating disorder, sometimes at least one parent is forced to give up work, at least for a period, in order to care for their child - whichever treatment method. I was lucky in that I worked from home. Having said this, I found I had to cancel much of my work, resign clients or be very creative about how I planned in work because of the demanding, exhausting and emotionally-draining nature of caring for a child where an eating disorder is raging 24/7, FBT or no FBT. Our household income fell by half as a result and at one point my husband was out of work, too, which was a struggle. I wouldn't wish an eating disorder on my worst enemy because, for both family and sufferer, it is SHEER HELL, regardless of treatment model.

Cathy says: I recall reading a very interesting thread on the ATDT form where Charlotte was posting on behalf of Bryan Lask. If I recall correctly, he argued that FBT is not as good as it looks and that the best treatment for AN is one that focuses on the underlying neurobiology, which is not be the same for all people with AN. I write this because I don't like to see you despair, Bev. Your son may have another co-morbid condition that plays a greater role in his eating behaviours and social difficulties than being underweight. 

I say: Yes, again I agree that FBT is not for everyone and families should be given the freedom to choose the most effective and suitable treatment for their child - because all children and eating disorders are different. I also agree that my son may have a co-morbid condition: depression. As I said below, he's always been a 'glass half empty' kind of guy. This underlying depression may possibly have been one of the 'triggers' for the eating disorder. But, since starting secondary school, he had gone from strength to strength - on every front including mood, self-esteem, confidence and popularity. It may be that these positive developments would have continued, had the eating disorder not developed, but who can say?

Thank you again, Cathy, for your excellent comment.


  1. Are you sure that we're going to be offered choices in Scotland when there is so little to choose from now? I could not make it to the conference so I may have this wrong but it sounds to me as if this is going to be the main and possibly the only treatment on offer on the NHS to children in Scotland

    1. No I am not sure which is why I said this above: **(By this I guess they mean that other methods are still available to families that would prefer not to use FBT?)**

      It wasn't clear on Sunday.