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September 14, 2018

Leave me Alone, Help Me Recover – Family Involvement in Anorexia Recovery – Part I

Black Woman thinking about child in Anorexia Recovery

Anorexia Recovery

Every family that we work with shares the same three values. They value health, they value education, and they value the relationships within the family. When an eating disorder enters into a family, it challenges how each individual will hold all three of those values and thus plays a role in anorexia recovery.

It also puts a huge strain on family relationships when, for example, the parents want the individual to get help, but the individual is ambivalent to do so.

In seeing this struggle, we wanted to find a way to quantify and answer the question, “what do people really think about having their family member involved in treatment?”

We have found that adolescents with eating disorders are often unable to make decisions that are going to foster recovery and, thus, parents must be empowered to lead the recovery. As such, caring for a child with an eating disorder is an extremely stressful experience with high levels of caregiver stress, anxiety, and depression.

Parent and Adolescent Resistance

Resistance to this comes not only from the adolescent but also from the parent.

The parent may say, “I don’t want to ruin our relationship so I shouldn’t be involved.” Additionally, the adolescent may say, “I want independence, I can do this myself, please don’t be involved.” How do we reconcile this resistance with the fact that we know that family involvement in anorexia recovery treatment works?

We wanted to learn how people feel about their family member being in treatment both before and after it. For this study, we hypothesized that adolescents would report that family involvement was unpleasant during treatment.

Girl sad about Anorexia RecoveryI think that we can all imagine that it would be an unpleasant experience being part of family therapy, you’re in a very vulnerable position and it isn’t something a lot of people have done.

However, we also hypothesized that, after treatment, the relationship with their parents would not be negatively affected and that, after treatment, adolescents would feel grateful that their parents were involved.

We reached out to 64 families that had been discharged from the UC San Diego Eating Disorder Center. They had all participated in our PHP program, and, the majority had also participated in our IOP program.

The average length of the stay was about four months, and we invited them to participate via email.

Family Involvement in Treatment

First, I want to describe what I mean when I say “having your family involved in treatment.”

I think a lot of people think of just SVT or Maudsley therapy techniques, and that is one way that family can be involved, but, for the purposes of this, I want you to think with a wide lens of what it means to be involved in treatment.

So, one is family therapy sessions, and this could be DBT, Maudsley, or Family-Based Therapy. Additionally, it could be DBT skills groups with the family. In DBT skills groups, the adolescent and their parents were together with other families and would all learn, collectively, the same skills.

The rationale here is that learning a new skill or habit is difficult, so, we want parents to be learning skills alongside their adolescents so they could both remind their adolescent to use them. More importantly, they can also model the use of them for their adolescent.

We talk a lot, in regard to skills, about treating it like an exercise in that you have to build up that skill’s muscle. For example, you might want to be able to use distress tolerance and being able to urge surf when you have the urge to restrict, or binge/purge.

Family Eating Dinner

But, if you were only trying to use that skills for high-level behaviors, it would be very difficult, so, we want people to practice with low-level behaviors such as using distress tolerance skills when you’re on the phone and arguing with the cable company or stuck in traffic. Then, we want parents to be able to model these skills as well so that they become a part of the fabric of the family.

I recall a family who, for the winter holidays, the adolescent had woken up and the father had gone out and bought these beautiful glass-like tall vases and filled all of them with squishy brains and different distress tolerance things such as fidget spinners, silly putty, etc.

He put them all over the house and brought the idea of having distress tolerance tools at-the-ready for the family. That is something he got from the DBT lesson of building a distress tolerance box.

Other skills may include “Brain Wave,” which Laura Hill uses. This displays the adolescent and their parents and other family members as different parts of the brain. We talk about how different parts of the brain function differently or the same when someone is struggling with an eating disorder. Another is called “The Gauntlet.”

These are all just groups designed to help parents experience, on a small level, what it might be like to have an eating disorder and be in anorexia recovery. It is also a way to continue to separate the eating disorder from the person who is suffering.



Virtual Presentation by Erin Parks, Ph.D. in the May 17, 2018, Eating Disorder Hope Online Conference II: Anorexia Hope & Healing in 2018.

Please view the press release Here.

Dr. Erin ParksErin Parks, Ph.D. is a clinical psychologist and neuroimaging researcher who is passionate about making scientific research accessible to everyone. Dr. Parks spent a decade using neuroimaging tools to study brain plasticity and development before she began specialized clinical training in eating disorder treatment. Dr. Parks graduated from Northwestern University and UCSD/SDSU’s Joint Doctoral Program in Clinical Psychology before completing her internship at UC San Francisco and then taking a post-doctoral fellowship at the UC San Diego Eating Disorders Center.

Dr. Parks has served as a psychologist in their Adolescent Clinic and inpatient medical behavioral unit, as a manager in their Adult Clinic and Pediatric Clinic, and as a co-lead in their world-renowned one-week intensive programs. Currently serving as the Director of Outreach and Admission, Dr. Parks combines her clinical experience and research knowledge to help the public be better-informed consumers of mental health services.

Image of Margot Rittenhouse.Transcript Editor: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on September 14, 2018.
Reviewed & Approved on September 14, 2018, by Jacquelyn Ekern MS, LPC

Published on EatingDisorderHope.com

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