Eating Disorders Center for Treatment and Research

Program Description

Family

Anorexia nervosa is often a chronic disorder with symptoms lasting many years or even a lifetime. Early intervention is associated with improved outcomes. When a child suffers from the devastating illness of AN all members of the family and the relationships between them are profoundly affected. Some of the latest research in the eating disorders field points to potentially unprecedented levels of success when families become centrally involved in the treatment process.

The purpose of this unique treatment is to provide parents with an understanding and the tools necessary to successfully interact and manage their child with anorexia at home. In addition, we teach adolescents with AN how to understand the symptoms that they are having and develop more effective coping strategies.

In some cases, this treatment program would be appropriate for those in the early stages of an eating disorder, however this treatment may also be appropriate for patients who are discharging from a residential or inpatient program. Our multi-family groups have included individuals ages 9 through 24.

We believe the UCSD Intensive Multi-Family Therapy Program for treatment of anorexia nervosa will benefit not only the ill child, but also the entire family, with improved understanding, communication, and capacity for growth.

Program Structure

Many families cannot find AN experts in their local communities, nor can they afford long term out-of-pocket inpatient or residential care. In order to meet their needs we developed a one-week intensive treatment program for adolescents with AN and their families. Optimally, parents, the patient, and siblings take part in the program, which lasts from Monday through Friday and involves approximately 30 hours of treatment. Most of the families do not live locally in San Diego. Families typically choose to stay in a local hotel or rent housing for the week.

The 5 days incorporate a number of treatment components including medical examination, psychiatric evaluation, Maudsley based family therapy, systemic family therapy, contracting, Psychoeducation, parent coaching, carers sessions, individual psychotherapy, and cognitive behavioral therapies.

Family Accommodations

Families usually fly in on Sunday before the treatment week and stay at a nearby hotel. For a list of hotels near our clinic, please visit this page and click on “Lodging Near UCSD Thornton Hospital & Per Ambulatory Care Center”.

Medical Assessment

In most cases, we will require that the adolescent be seen by one of our local pediatricians with expertise in eating disorders upon arrival in order to confirm medical stability. This is typically done Monday morning of the treatment week.

In other cases, we may require a letter from your local pediatrician documenting medical stability for an outpatient level of care.

Frequently Asked Questions

What is your success rate?

While we have not conducted a formal research study, preliminary results are very promising as our treatment appears to minimize the need for hospitalization and maximizes good outcome. We have been treating 1 to 2 families per month or a total of 25 families since the start of the program in Nov 2006 (ages 10-17, mean 12.7; BMI range 13-21, mean 17). The majority of the families do not live in San Diego (Mexico, Florida, Texas, New York, Canada etc.). In November 2008 we followed up with the first 17 families to determine progress. The average BMI at admission was 17 which increased to 19.5 at follow-up. The follow-up period ranged from 52-738 days (mean: 236 days). Only 1 patient required a higher level of care and one additional patient required a one night hospital stay for dehydration. Since the majority of patients had chronic courses with frequent hospitalizations, we think this shows that the IFT is successful in breaking the cycle of chronicity.

Will insurance cover this program?

The UCSD 5-Day Intensive Multi-Family Therapy Program is a relatively new program and due to the unique structure of the program, insurance coverage has greatly. Our billing office supports patients by communicating with their insurance companies about their health plan benefits and payment and will work out-of-network insurance companies to obtain a single case agreement, if needed.

All patients should provide insurance information prior to admission regardless of coverage and a claim will be submitted to your insurance company on your behalf. Our services are considered "facility" services and cannot be submitted by the patient.

Some insurance plans have exclusions for eating disorders and/or other limitations that prevent full payment for treatment. Many times, families choose to self-pay for services and/or find resources within their extended family to help with payment.

Contact our Insurance Coordinator Christina Vizcarra at (858) 246-0997 or edintake@ucsd.edu for an list of our contracted insurance companies or for any questions regarding insurance.

What can we get in just 5 days?

The treatment of AN often involves lengthy hospital or residential stays, during which time patients may gain weight. However, many patients tend to relapse after they leave the structured setting of the hospital or residential program. Consequently, for many, AN becomes a chronic disorder, with symptoms lasting many years or even a lifetime, and with significant medical complications. The popular notion is that AN is caused by cultural or societal factors. However, recent studies have shown that AN is highly heritable because it is transmitted by genes. The influence of these genes is first seen in childhood, years before the onset of AN. That is, people who go on to develop AN tend to have certain vulnerabilities that start in childhood before the onset of AN that made them susceptible to developing an eating disorder. These vulnerabilities may include anxiety, obsessionality, and perfectionism. Considerable evidence suggests that these behaviors are due to alteration of genes that affect the brain pathways that modulate feeding, mood, impulse control, and decision making. For example, people with AN have biological disturbances of appetite regulatory centers in the brain. Even though malnourished, their brains do not seem to provide an accurate signal that they should be hungry and need to eat. It is important to emphasize that just getting people with AN to a normal body weight is not enough to “cure” this disorder. That is because such behaviors (e.g. anxious obsessional focus on weight loss) persist after weight restoration, and because the family often struggles to manage their child with AN at home. The persistence of such behaviors after weight gain contributes to the high rate of relapse. Clearly, we need to develop treatment programs with a different focus. That is, not just weight gain, but better means of helping people with AN, and their families, deal with the anxiety, perfectionism, body image distortions, obsessionality, and disturbed appetite that contributes to this chronic illness.

This week is a powerful intervention, but it is not a stand alone treatment for treating AN. Rather, it is an important, previously underutilized part of a comprehensive treatment plan. Simply put, the focus of the IFT to teach parents how to manage their child or adolescent with AN at home. An adaptation of the Maudsley family therapy is an important component of the IFT. It has been shown that Maudsley Family therapy, which is the only proven effective therapy for adolescents with AN provides parents with the knowledge and tools needed to manage their children with AN at home, but does not diminish core symptoms. In addition, when parents learn that their parenting style is not to blame for causing AN (it is mainly caused by biology) they become an ally in treatment and usually become skilled at understanding and managing AN behaviors. While we may not be able to reverse core AN symptoms (fear of being fat, anxiety, obsessions, etc.) we can teach parents how to manage their children and adolescents with AN at home.

In summary, treatment of eating disorders often is long, difficult and extremely expensive. While in some cases costly inpatient or residential stays cannot be avoided, in other situations, a family can be guided through the process of providing care at home. Our intensive, 5-day program is designed to help families determine whether outpatient, family-based care may be a viable treatment option in their unique situation.

As noted above, even after successful weight restoration, it is common that individuals with anorexia nervosa (AN) remain anxious, obsessional, perfectionistic, and have body image distortions, etc. Clinically, we have found that many parents are fearful of their child returning home and our goal is to help the family through the initial period of the child transitioning into the house.

For additional program information please contact us at edintake@ucsd.edu or (858) 534-8019.

Program Components

More Info

For upcoming dates and additional program information please contact us at edintake@ucsd.edu or (858) 534-8019