5 Questions: Lock on eating disorders

James Lock

Eating disorders can confound parents and medical professionals. But they're not impossible to overcome. Science writer Krista Conger discusses the causes and treatments with James Lock, MD, PhD, co-author of the recently published Help Your Child Beat an Eating Disorder. Lock is director of psychiatric services at the Comprehensive Eating Disorders Program at Lucile Packard Children's Hospital and an associate professor of child psychiatry. For video of Lock, go to med.stanford.edu

1. Who suffers from eating disorders?

Lock: They can occur in any age group. Although most sufferers are young white women, eating disorders can affect younger children, boys and all cultural and ethnic groups. Symptoms of the classic eating disorders--anorexia and bulimia nervosa?usually start during early and middle adolescence and include highly restrictive dieting, binge eating, purging and over-exercise. Estimates are that between 1 and 2 percent of the population suffer from classic eating disorders. About 8 to 12 percent of people with chronic anorexia will die of their disease. However, if the illness is detected early and treated quickly, there is good reason to be optimistic about the possibility for full recovery.

2. Why did you write a book?

Lock: During my 13 years treating adolescents with eating disorders I've discovered that the information available to parents is either not helpful, out of date or conveys what I feel is an inappropriate message of guilt and helplessness. I wanted parents to know that they are probably not the cause of their child's eating disorder and that they can and should find ways to help their children. I also wanted to take the mystery out of eating disorders by explaining in ordinary language what happens when someone is developing an eating disorder: How their body, thinking and relationships change. I hoped to illustrate how serious and all-encompassing eating disorders can be and underscore the need to get treatment.

3. The family-based treatment described in the book urges parents to get involved in their child's treatment. Why? Isn't this a medical issue?

Lock: Eating disorders can have related, sometimes life-threatening medical consequences that should be managed by medical professionals. However, the psychological aspects of eating disorders are generally out of the purview of most internists, pediatricians or family doctors.

In the past, professionals re-fed and supported patients who stayed in the hospital for months on end. This may still be needed at times, but it turns out that parents, with appropriate professional guidance, can be pretty good at these tasks without subjecting their child to long periods of separation from their family, friends, school and usual activities. In other words, family-based treatment uses and augments the parents' own skills to treat the symptoms of anorexia, rather than focusing on family problems that supposedly caused the disorder.

4. How can you force someone to eat if you don't know the root cause of the disorder?

Lock: I would like to re-word your question a bit. How can you help someone to eat who is afraid, angry and confused?

At the heart of it, the person with anorexia nervosa is suffering. She or he may appear determined and resolute in dieting and weight loss, but there is usually also some guilt about how their family is suffering and anxiety about the effects of the illness on their schoolwork and long-term health.

Family-based treatment helps parents to leverage their commitment, love and knowledge of their child to use this ambiguity to create change. Although parents accomplish this task in many different ways, their methods always rely on persistence coupled with a resolute, caring and loving understanding of how their child really feels.

Also, since we don't know what really causes anorexia, as a therapist you can end up spinning your wheels for a long time in the quest for possible reasons the illness started while the patient is just getting sicker and sicker. In contrast, focusing attention on changing symptomatic behaviors--in this case self-starvation--can be life saving.

5. You've just published a paper about family-based treatment for anorexia. What have you found?

Lock: The paper is the first major U.S. study of family-based treatment, which was developed in the U.K. It showed that, contrary to most published literature, most patients improved relatively quickly when they received family treatment. About two-thirds of the patients recovered fully and most others improved significantly regardless of whether the families received 10 treatments or 20. Our overall findings are similar to those in a few smaller studies and provide important support for this approach for adolescents with anorexia.

Although family-based treatment is the only empirically supported treatment for anorexia, a lot still needs to be done to conclusively decide how best to treat these disorders. We are beginning a large randomly controlled trial to compare family treatment to individual therapy for adolescent anorexia. Hopefully this will help us to understand why some people do better with one treatment and others with another.