Family Involvement in Treatment

Eating disorders are deeply personal, and it’s not uncommon for someone with an eating disorder to feel very alone. But in reality, one person’s eating disorder can impact the entire family, changing the way you relate to one another, and sometimes, even changing the way family members feel about themselves.

Families play a huge role in almost every stage of an eating disorder. They can help spot signs of disease, prompt the person to get treatment, administer some kinds of care, and more.

You will not do this work alone. A team of professionals should guide every step you take. And you may need your own mental health team to deal with the challenges of helping the person you love to recover.

Families can do a lot to help their loved ones recover from an eating disorder.

How Do Eating Disorders Develop?

No parent, spouse, or sibling wants a loved one to suffer. When eating disorders are diagnosed, it’s easy to redirect the shock and sadness inward. We take the blame for things that aren’t our fault.

Know that families can’t directly cause eating disorders. Instead, they tend to develop from an interplay of many factors.

Heredity

Eating disorders tend to run in families, and researchers think genes play a role.[1] If you’ve struggled with an eating disorder in the past, your child might have the same concerns.

You can’t change your genes, but remaining aware of their influence is wise.

Cultural Pressure

We live in a society that prioritizes thinness, and the problem worsens each year. For example, the average Victoria’s Secret model’s dress size dropped from 5.2 in 1998 to 3.7 in 2018.[2]

While you may not overtly praise a family member for weight loss or a small body size, the impact of even a small comment could be huge.

Peer Trauma

People who are bullied or ridiculed due to weight or size are prone to developing eating disorders.[3] People subject to sexual assault have higher risks too.

Signs of Eating Disorders Families Should Know

Sometimes, family members are the first to spot signs of an eating disorder. When they do, they can offer important help and advocacy that can help people get back on track.

These are a few signs to be aware of.[4]

Anorexia

People with anorexia experience significant weight loss. They may exhibit the following signs:

• Skipping meals
• Playing with food instead of eating it
• Discussing a meal’s calorie or fat content
• Exercising excessively
• Dry, thinning hair
• Wearing multiple, thick layers of clothes to stay warm

Bulimia

People with bulimia may be at a normal weight or even overweight. They may also cycle between being heavy and light. You may notice the following signs:

• Hiding food or storing it in their rooms to eat later
• Visiting the bathroom right after meals to binge
• Scars on their hands due to vomiting
• Discussing body weight and shape often
• Seeming preoccupied with dieting and weight loss

Binge Eating Disorder

People with this disorder share many of the same preoccupations as people with bulimia, but they don’t purge excess calories. They may show the following signs:

• Hiding or hoarding food
• Eating in private, including leftovers the family was planning to share later
• Only eating alone

Before Treatment: How Can Families Help?

You’ve discovered that someone in your family is showing signs of an eating disorder. What can you do next?

Eating disorders can be deadly. It’s best to speak up as soon as you spot the signs. Denial is a core part of many eating disorders, so the person you love may not admit to the problem right away.[5]

But you can ask the person to visit the doctor to discuss what you’ve seen. Be persistent, and ensure the person knows that you’re both serious and speaking out of love and concern.

A wise first step is to take the person to a physician, simply to ascertain the extent of the problem. If they have a full-blown eating disorder, it is time to seek professional individual counseling. It can also be wise to seek out separate counseling for parents and other children in the family.

There are three important points to keep in mind:

1. Eating disorders rarely resolve on their own.
2. If one child has an eating disorder, the entire family is impacted.
3. Parents should not blame themselves. The blame game accomplishes nothing.

If the person agrees to get treatment, meet with the treatment team as soon as you can. You’ll likely play a very important role in the recovery process, so the sooner you can meet your care partners, the better.

During Treatment: How Can Families Help?

Every eating disorder treatment plan is different, but many rely on the direct attention and support of the person’s family.

For example, in a family-based treatment program, parents will do the following:[6]

• Prepare all the meals based on the child’s diet plan
• Serve all of the meals in a family setting
• Supervise the child’s eating
• Offer support and encouragement throughout the entire meal

Parents meet with a clinician each week to learn how to make this process effective and helpful. But parents are in charge of the care at home.

As the child improves, parents gradually give back responsibility to the child. For example, a child may prepare a meal while the parents watch.[7]

Some treatment programs don’t require this level of commitment. For example, adults with bulimia may lean on their partners for emotional support between therapy sessions, but they always cook their own meals. Flexibility and adaptability are part of any treatment plan.

But families should expect that they’ll be deeply involved in helping the person they love to recover.

How Long Does Recovery Take?

Completing treatment is a beginning, not an end, to the long road to recovery.

For families, coming home is a time meant for joy, with possible plans for festivities and socializing. These are times meant for families to draw closer together and to reaffirm love and support — a time to catch up on what has been going on and share hopes for the future with one another.

To the individual dealing with an eating disorder or in the throes of recovery, these occasions can be overwhelming and threatening.

Few people with eating disorders are completely healed when done with treatment programs. Instead, they continue to work on their recovery, often for the rest of their lives. Through it all, families can offer kindness and support, which is vital to their loved one’s long-term recovery.

Open lines of communication are critical. Ensure that the person with the eating disorder can offer feedback if the family’s support isn’t helpful. And speak up if you feel the person isn’t taking recovery seriously and is backsliding.

The Importance of Self-Care

Families are so important to people struggling with eating disorders. For example, researchers say a parent’s involvement in a child’s eating disorder treatment helps the child get better. But parents often neglect their own well-being, and that can make a child’s recovery less likely.[8]

While someone you love is working through an eating disorder, you’ll have access to that person’s treatment team. You’ll get coaching, support, and a listening ear.

But you may benefit from connecting with your own therapy team. Perhaps working through your feelings about the eating disorder with a professional could be useful for you and your recovery.

Siblings may also need support. Researchers say siblings of people with eating disorders may experience a decrease in quality of life, and they may feel isolated.[9] A child may not have access to the eating disorder treatment team at all, so connecting them with therapy could be very helpful.

Remember that eating disorders can be devastating to the individual and highly destructive to the family. You did not cause this; therefore, you cannot fix this on your own. Get help so everyone involved can heal together.

References

1. Eating Disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/eating-disorders. December 2021. Accessed July 2022.
2. Unattainable Standards of Beauty: Temporal Trends of Victoria’s Secret Models from 1995 to 2018. Aesthetic Surgery Journal. https://academic.oup.com/asj/article/40/2/NP72/5611156?guestAccessKey=7e1bf87a-7a93-4612-99ec-2c23f1ff38f3&login=false. November 2019. Accessed July 2022.
3. Eating Disorders. National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Eating-Disorders. Accessed July 2022.
4. Signs and Symptoms. The Eating Disorder Foundation. https://eatingdisorderfoundation.org/learn-more/about-eating-disorders/signs-and-symptoms/. Accessed July 2022.
5. Pitfalls in Anorexia Nervosa Research: The Risk of Artifacts Linked to Denial of Illness and Methods of Preventing Them. Psychiatria Danubina. https://pubmed.ncbi.nlm.nih.gov/27658828/. September 2016. Accessed July 2022.
6. Family-Based Treatment for Eating Disorder. Child Mind Institute. https://childmind.org/article/family-based-treatment-for-eating-disorders/. Accessed July 2022.
7. Family-Based Treatment of Eating Disorders in Adolescents: Current Insights. Adolescent Health, Medicine, and Therapeutics. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5459462/. 2017. Accessed July 2022.
8. Parents of Children with Eating Disorders: Developing Theory-Based Health Communication Messages to Promote Caregiver Wellbeing. Journal of Health Communication. https://pubmed.ncbi.nlm.nih.gov/24380433/. December 2013. Accessed July 2022.
9. Siblings of Individuals with Eating Disorders: A Review of the Literature. Frontiers in Psychiatry. https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00604/full. June 2020. Accessed July 2022.

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