But the enormity of the commitment Maudsley demands of parents, draining their hearts, minds, and energy, shocked Brown. Mealtimes became battles waged across the dinner table. Confronted with a piece of chocolate cake or a plate of macaroni and cheese, Kitty morphed into an demonic stranger. It was the demon, says Brown, not Kitty, who swore she would starve herself, who screamed, "I'm so fat," who told her parents countless times that she hated them. Says Brown:"The thought crossed my mind many times—'I wonder if we're going to have a relationship after this?'" Her and her husband faced scheduling nightmares, with one parent or the other having to dash home from work to sit with Kitty and feed her. "There was always the next meal, the next snack, the next doctor's appointment," says Brown. "There really was no break possible, we were in crisis mode."
The heated struggles inherent to this approach eat away at the trust between parent and child, according to critics of Maudsley. Le Grange's research rebuts that. He was lead author of a 2007 study in the Archives of General Psychiatry that examined Maudsley's effect on the parent-child relationship in 80 bulimic adolescents over five years. The study found no evidence that the children stopped trusting their parents. "Quite the contrary," says Le Grange. "If a child is out of control to the point of starvation and a parent steps in to save her life, it only reinforces that trust."
Brown agrees. She believes her relationship with her daughter is stronger than before. "When you go through this kind of extreme experience with your child, it creates a whole different level of bonding," she says. "She knows we're there for her no matter what, and that's only been an asset to our relationship."
Mental health specialists say the success of the family-centered approach also is helping to put hoary and toxic stigmas to rest. "There was this old-fashioned notion that children have this problem because of overinvolved and hypercritical parents," says Le Grange. "None of that has ever been proven. The truth is that parents have been shown again and again to be the best agents for treatment."
Blaming yourself for your child's anorexia is not only a waste of time, it's a roadblock to recovery. "Every moment I spent blaming myself, Kitty was getting sicker," says Brown. "What she really needed was someone to stand up to the eating disorder," she says. "She needed me to stand with her and be bigger and stronger than that voice in her head."
Updated on 10/04/10: This article, originally published on September 16, 2010, has been updated to include the most recent research on family-based therapy for eating disorders.