“The teenagers I treat and their families are so amazing; they have so many internal resources. They’re motivation, compassion and commitment to be well and to be rid of this torturous illness keeps me passionate about my research.”
So says Gold Coast Health Senior Psychologist Kim Hurst who has spent more than six years researching the power of Family Based Treatment (FBT) for children and adolescents who have anorexia.
Kim presented at a Gold Coast University Hospital Allied Health research forum this week with a specific focus on the role FBT can play in anorexia patients who also have high levels of perfectionism.
“I provide a particular type of therapy for children and adolescents who have anorexia and it’s a family based treatment, so the whole family come into the therapy and we utilise them as the key motivator for change rather than the young person,” Kim said.
“What I’ve found over the years I have been in my position is that although treatments outcomes are better that what they were using this type of therapy, is that there is a sub group of adolescents in particular that are presenting with obsessionalities, perfectionism, high achieving underlying traits that continue to be symptomatic even though there weight is restored. So a kind of obsessional thinking that lasts.
“I just felt there was a slight gap in terms of what we could be provided and that lead me to decide to do my PHD and see how we could be innovative in this domain. I was looking at the research and it was telling me the same kind of thing – yes we were seeing good recovery but there was a group of kids that weren’t getting well, so that’s where it all started. “
As Kim explains, perfectionism is linked to several diseases. It is not unique to anorexia or eating disorders but when a young person has high perfectionism and anorexia; it can fuel the anorexia and make it more problematic and more severe.
“Before FBT was widely used, our service used to see young people individually and the results often were quite poor because we were asking teenagers to be in charge of their illness and in charge of their behaviours,” she said.
“A lot of the time an eating disorder serves as a function and so teenagers don’t want to get rid of something that is helping them in mal-adaptive ways. We needed to shift the focus and bring in parents because parents used to be blamed and criticised. I think this particular treatment has really tried to shift that stigma and that view of the family. We see the family as an enormous supportive environment whereby they have all the resource skills and expertise to get the young person well and rather than expecting the young person to do that, so it’s really about saying ‘this is a family problem, let’s all get through this together’.”
Kim says a core aspect of FBT is temporarily placing parents in the role of managing food and eating.
“In other areas of the young person’s life they can be functioning quite well but in this domain, they need an enormous amount of help, so we bring the family in and we see them as the experts. So while I’m the therapist I say to them you know your child and you want the best outcomes for them, I am just going to assist you to achieve this,” she said.
While Kim acknowledges her research has not been a small undertaking, seeing the results of the shift in treatment is motivation to keep propelling her work forward.
“I have one paper published which was a case study of three participants and at the moment my final paper is under review and that’s with the completed 21 participants. My dream is to submit my thesis in the next couple of months,” she said.
“I know treatment works now. I’m really convinced we are on the right track towards getting effective treatment. I don’t think we’ll ever eradicate the illness but I think we are getting much closer to reducing the duration and the severity. We need to keep looking and find solutions to these problems.”
Kim drove home the importance of early intervention before stepping into her presentation.
“As soon as you get a sense that someone you know has an eating disorder, absolutely seek treatment. Do not wait,” she said.
“Even if you’re not 100 precent sure, go ahead as the quicker young people are treated, the better the prognosis and outcome.”
Kim Hurst is member of the Australian New Zealand Academy of eating disorders. Information about eating disorders and how to manage them is also available at http://www.nedc.com.au/ – the National Eating Disorders Collaboration.