Relationship Skills for Those in Eating Disorder Recovery

Relationship Skills for Those in Eating Disorder Recovery: Assertiveness, Boundaries and Communication

Contributed by Kathleen Someah, New Dawn Treatment Centers

Establishing and maintaining healthy relationships can prove challenging for even the most seemingly healthy individuals.  As children, we are taught to construct boundaries concerning our bodies and our psyche. As we mature, it is assumed that one has mastered, or at least improved upon, such interpersonal skills.  However, this task can become particularly difficult and even terrifying for someone recovering from an eating disorder.

It is not uncommon for an individual suffering from an eating disorder to come from a family dynamic where boundaries are loosely defined and ambiguous.  The term enmeshment is used to refer to this particular family dynamic where boundary lines are violated between parents and children and the notion of independence, individuation and autonomy are not fully explored or established.  In such cohesive circumstances an individual may take on greater responsibility than appropriate, often leading one to feel responsible for others’ feelings, failures, and alike. Thus, codependency can become a common family feature.  However, this does not necessarily infer that an unhealthy family dynamic is causally related to difficulty establishing boundaries later on in life.  Rather, individuals suffering from an eating disorder bear characteristics, which may make them more prone to such challenges.

Previous research studies assert that interpersonal problems contribute to the development and maintenance of eating disorders due in part to the negative effects on self-esteem (Fairburn, 2008).  Such poor levels of self-esteem may contribute to social insecurities and further one’s inherent need to be liked and accepted by others.  Substance abuse and drug dependence are other common factors among such individuals.  Additional research supports the claim that people with eating disorders are more likely than those without EDs to have family histories of substance use disorders (Hudson et al. 1983; Jones et al. 1985).  In such cases one may become the caretaker of the addicted individual, thus compromising their own needs and wants.  This is a commonly told story amongst individuals with eating disorders.

“I grew up with an alcoholic mother and spent most of my kid years looking after her,” said an anonymous individual recently recovered from bulimia nervosa.  “In the process of taking care of my mom I neglected my most basic needs and stopped caring about what I wanted all together. When I started treatment I fell back into that role and was recognized for my support of other fellow sufferers.  But, as I continued working on my recovery I realized that my history of constantly caring for my mother unconsciously taught me to put others’ needs, stressors, and struggles ahead of my own. A big challenge for me during this recovery process has been learning to set boundaries with others and put myself, my recovery first.”

While not all individuals suffering from an eating disorder can relate to this exact story, many continue to struggle with setting boundaries with friends and family, and having their own wants heard above others’.

“I have discovered that it is extremely important to be able to find my own voice and learn how to use it to speak up for myself and to set boundaries in many different aspects of my life,” said a client at New Dawn Treatment Center.  “When I assert myself and am honest about what I need and how I am feeling, I am much less likely to either manipulate or become manipulated, and in return, I am less likely to jeopardize my recovery.”

“Assertiveness and boundary setting is a key aspect of eating disorder recovery, as it is important to remember that you are in treatment for yourself and not for anyone else” said Nader Armanios, Nutrition Assistant at New Dawn Treatment Center.  “Hence, you have to keep reminding yourself of this whenever you feel that you are failing at setting boundaries.”

While learning to assert one’s self and maintain healthy boundaries can prove difficult, it can also prove possible.

“Having established boundaries is like putting up a recovery safety net for me; they will not fully protect me, and I always have the option to ignore them, but they give me something to lean on and they act as a guideline for how I want to be treated by others and also by myself,” said a client at New Dawn Treatment Center. “In my disorder I can be very manipulative so as to get away with behaviors; at the same time, I find that I am also easily manipulated myself and I get caught in situations that I didn’t originally intend to be in. It becomes easy to compromise myself and my recovery for someone or something else. When I have been able to really define myself and my recovery, it forces me to take more responsibility for my own thoughts and actions. I no longer get to blame others and play the victim because when I know what my boundaries are, I have the choice of whether or not to stick to them. I stop depending solely on others for my strength and support and begin to lean a little bit more on myself and my own abilities to reach out and ask for help when I need it. Letting my voice be heard is the first step in fighting for my life; it is the silence that will kill me. ”


Fairburn, C. G. (2008). Cognitive Behavior Therapy and Eating Disorders. New York: Guilford Press.

Hudson, J.I.; Pope, H.G., JR.; Jonas, J.M.; and Yurgelun-Todd, D. Phenomenologic relationship of eating disorders to major affective disorder. Psychiatry Research 9(4):345–354, 1983.

Jones, D.A.; Cheshire, N.; and Moorhouse, H. Anorexia nervosa, bulimia and alcoholism: Association of eating disorder and alcohol. Journal of Psychiatric Research 19(2/3):377–380, 1985.



Published Date: February 6, 2013
Last reviewed: By Jacquelyn Ekern, MS, LPC on February 5, 2013
Page last updated: February 6, 2013
Published on, Information for Eating Disorders Treatment Help