Family Involvement: The Role of Family in Eating Disorders

Eating disorders are deeply personal conditions, and it’s not uncommon for someone struggling with one of these mental health issues to feel completely alone. But in reality, everyone’s life touches others, and no one ever truly goes through anything alone or without outside consequences.

For someone who maintains family relationships, an eating disorder can impact the entire family unit, both through the way each member personally feels about the situation and through the way the group functions as a whole.

Indeed, family members can play a part in almost every stage of these conditions. Critically, family members are frequently the ones who help identify signs of a loved one’s eating disorder, prompt someone to get treatment, and administer some kinds of care at home. 

Recognizing Signs of Eating Disorders

In many cases, the family’s role in eating disorders is helping someone address the reality of their condition.

Other family members are often the first ones to spot a person’s eating disorder behaviors. And the closeness of their relationship may make them well-positioned to speak up about their concerns.

Yet many of these conditions can manifest as less obvious or well-known symptoms, so it’s important to understand all the various ways an eating disorder can present.

Anorexia Nervosa

People with anorexia nervosa (AN) are driven by a fixation on the concepts of food, eating, and body image and a fear of gaining weight.

They frequently restrict their food intake to extreme degrees, which often leads to significant weight loss. Though, some atypical forms of AN incorporate behaviors like self-induced vomiting or over-exercising to achieve weight control.

Other potential signs of anorexia nervosa include:¹

• Skipping meals or self-isolating
• Playing with food instead of eating it
• Fixating on nutritional facts like calories or fat content 
• Wearing multiple, thick layers of clothes to stay warm 

Someone with intense or chronic symptoms of anorexia nervosa may also have thin, brittle hair and nails, yellowing skin, or oral health difficulties.

Bulimia Nervosa

People with bulimia nervosa (BN) are also generally obsessed with thoughts of food, eating, and body image. However, they frequently use other methods to control their weight, including self-induced vomiting, laxative abuse, and fasting.

This disorder is also marked by frequent binging episodes, during which someone will often eat a lot of food very quickly.

Other signs of this condition include:¹

• Hiding food or storing it in their room to eat later 
• Visiting the bathroom right after meals
• Scars on their hands, also called Russell’s Sign, which frequently indicates self-induced vomiting 
• A preoccupation with weight loss, dieting, or body image

Due to their use of both binging and purging, people with BN may present at a normal weight or possibly overweight. They may also cycle between heavier and lighter weights.

Binge Eating Disorder

Binge eating disorder (BED) is similar to bulimia nervosa, except people with this condition don’t use purging behaviors after a binge.

It can be difficult to tell if someone is struggling with BED, as they frequently partake in binging behavior when they’re by themselves. But some signs of the condition include:¹

• Hiding or hoarding food 
• Eating in private
• Only eating alone 
• Frequently dieting

As with nearly all eating disorders, binge eating disorder is also marked by a fixation on the topics of food and eating in general and is usually driven by chronically low self-esteem.

Before Treatment: How Can Families Help?

Aside from spotting someone’s potentially disordered eating behaviors, family members can offer other forms of help before a person enrolls in a treatment program.

Talking to Loved Ones

One of the biggest contributions they can make is talking to someone about their condition.

These conversations are never easy and often operate as emotional minefields. However, taking the time to compassionately, yet reasonably, bring up concerns and genuinely listen to what the person has to say can make a big difference in changing their thinking about seeking help.

If they seem amenable, this can be a great opportunity to suggest treatment options or other steps that can help them start on the path toward eating disorder recovery.

Offering Emotional Support

Perhaps the most important role family members can play at this time is offering continuing love and support for someone. It can be challenging for someone to change deeply ingrained behaviors, no matter how destructive they are. And someone may have trouble even seeing or admitting their behavior is a problem.

Watching this unfold as a concerned outsider can be frustrating and devastating. However, continuing to show the person love can go a long way toward eventually getting them help.

During Treatment: How Can Families Help?

Every eating disorder treatment plan is different, but even when someone leaves to live at a treatment facility full-time, they’ll still have to learn to incorporate their new coping strategies and behaviors into their family life when they get back.

Some types of therapy, such as family therapy, take this eventuality into consideration from the start, working to involve family members in someone’s treatment throughout the process.

Other forms of treatment are more individually based, but it’s still important for family members to show support, care, and love for someone during this difficult time.

Understanding eating disorders better by researching the conditions can also help family members develop empathy and express greater patience throughout the recovery process.

Family-Based Treatment for Eating Disorders

Family-based therapy is designed to include family members directly in the healing process. These methods are modeled on the idea that eating disorders impact each member of the family individually and the family unit as a whole.

During family therapy, members meet separately or as a group with the same therapist. These sessions can help the group flesh out family dynamics that may be contributing to difficulties within the household and allow them all to learn more about eating disorders and how to create a caring environment for recovery.

Family-based therapy is especially recommended to help with adolescent eating disorders, as young people frequently still live with their families and are heavily reliant on their parents.

How Family-Based Therapy Works

Family-based therapy sessions are administered with the understanding of five major tenants:²

• That the therapist takes no view on the cause of the disorder
• That the therapist is viewed as an expert consultant on eating disorders, while the parents are viewed as experts on their child and family
• That parents are empowered to bring about the recovery of their child
• That the eating disorder is viewed as a separate entity from the child struggling with it
• That recommended treatments are action-oriented and meant to reduce eating disorder symptoms and behaviors

Once these ideas are understood, they can help bring discussions to a place of greater honesty and openness while helping to keep everyone focused on the task at hand.

Empowering Parents

An equally important aspect of family-based therapy is helping parents become the leading driver in their child’s recovery. This is accomplished by encouraging parents to:³

• Prepare all meals based on the child’s diet plan 
• Serve all meals in a family setting (family meals)
• 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. However, parents are in charge of the care at home. 

As the child improves, parents gradually give the child more autonomy. For example, a child may prepare a meal for themself while a parent watches.³

After Treatment: How Can Families Help?

Few people with eating disorders are completely recovered when done with treatment programs. Instead, they continue to work on their treatment and goals, often for the rest of their lives.

This path is often difficult, especially at first. But 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 and must work both ways to be effective. The family member with the eating disorder must be able to express how they’re feeling, as well as other members of the family.

This can be especially important when it comes to the potential for relapse or backsliding. If a family member notices the reoccurrence of some disordered thinking or eating behaviors, it can be pivotal for them to raise their concerns.

The Importance of Self-Care

While caring for someone with an eating disorder and supporting their recovery journey is crucial, it’s equally important for family members to take care of themselves.

Research has shown that a parental role in treatment does indeed help improve treatment outcomes, but the same parent’s neglect of their own well-being can actually work to impede recovery.⁴Siblings of those with eating disorders may likewise need additional support. Research has shown that these individuals may experience a decrease in quality of life or feel isolated as a result of the focus and stress involved in helping their siblings.⁵

Therapy Options

Those in these difficult positions may find help in support groups designed for family members of people with eating disorders. Frequented by those going through similar situations, these groups can create a sense of community and help family members, who have done so much supporting, feel more supported and cared for themselves.

Individual therapy sessions are another good option for family members. These can offer an open forum for them to discuss the ways their family member’s disorder has impacted their life and teach them new skills and coping mechanisms that can help them manage their emotions.

Just as someone’s eating disorder impacts the whole family, so too does the entire family need to work on healing. However, working together can help everyone involved move past this experience and find a happier future.

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Published December 4, 2024