"This is a little 9-year-old, and the devil was coming out of her because we were making her eat," Orlando, Fla., mom Lauren Zimmerman says, recalling the time her home became a battlefield because of a new, no-compromise policy of three meals and three snacks a day.
Holly's family was using an obscure, family-based treatment known as the Maudsley approach. Developed in the 1980s at Maudsley Hospital in South London, the method has demonstrated empirical success combating a condition that affects approximately 10 million females and 1 million males in the United States. The American Psychological Association reports that the mortality rate for anorexic patients is 10 percent - one of the highest of all psychiatric disorders.
"The cornerstone of the Maudsley approach is what we call an agnostic view of the illness, which means we don't know what causes anorexia and frankly we don't care," says psychologist Dr. Sarah Ravin, one of South Florida's few Maudsley practitioners. "This is very different from traditional treatment, which focuses first and foremost on what caused this illness."
Maudsley treatment consists of three clearly defined stages.
Phase one - lasting from weeks to a year - hinges entirely upon weight restoration. Whereas traditional anorexia therapy often excludes parents from treatment, Maudsley parents' active involvement is seen as essential to their child's recovery.
"If a 15-year-old had a bottle of vodka before school every morning would you say, 'Well, that adolescent is asserting her need for control, so parents back off?"" Ravin said. "No, because drinking alcohol before school is not OK."
Leaving the child out of the decision-making process, parents serve three meals and three snacks a day, and then wait however long it takes for their child to clean the plate.
Once weight is restored and food is consumed without resistance, control over meals is gradually returned to the patient in phase two. Phase three - traditional therapy's first step - addresses the psychological, environmental or family issues that contributed to the disorder.
Ravin sees futility in trying to treat a child's psychological issues until they've reached a normal weight.
"Once kids start eating more normally and become better nourished, their brain starts to work better and they start to become more rational and ... are able participate in their own recovery," Ravin says.
Traditional treatments often involve what Leslie Long, parent of a recovering anorexic daughter, describes as a "parent-ectomy." The child is often placed in a residential treatment center, where "there is a nod and a wink that something has gone wrong in your family and that the parents are not to be trusted," Long says.
Parents who elect inpatient treatment for their child often worry about what will happen next.
"They do well in inpatient care but what do we do when they come home?"" said Elena Kruglyak, whose daughter Rebecca, 16, improved in the hospital but relapsed when she returned home in Delray Beach, Fla.
Because Maudsley is not widely available, many families must seek treatment far from home. The University of San Diego and Rush University Medical Center in Chicago have prominent programs.
Zimmerman, Long and Kruglyak found Maudsley through desperate online searches for alternative treatments for their struggling daughters. All three met with resistance from their children's physicians: When Zimmerman turned to Maudsley, Holly's pediatrician sent a letter withdrawing as Holly's physician.
Long brought her daughter to Miami from Connecticut for treatment with Ravin in December. Long describes her daughter, now 25, as healthy for the first time since she was 12.