Article Contributed by: Tracey Lee Cornella-Carlson, MD, CEDS, DFAACAP of Rogers Memorial Hospital
From the first day a patient enters an eating disorder program at Rogers Memorial Hospital, the family is a critical component of therapy.
Families are vital to the recovery process because they will be the patient’s support when they leave the hospital. We educate them along with the patient to help them understand eating disorders and why they occur. By learning some key skills, they can help their loved one make a successful return home.
I want to stress that there is no one definition of “family.” It is simply someone who can and will support the patient during and after treatment, and it may be a boyfriend, girlfriend, parent, grandparent or spouse.
Preparation Helps Patient and Families
Reintegration into the home drastically changes the family dynamic, and that’s why so much effort goes into preparing everyone involved in that milestone.
If you know what to expect, it’s easier to deal with any obstacles, and treatment includes coping skills to handle situations that may trigger a binge, purging, over exercising or other behavior.
That’s why we regularly organize “practice” family meals at Rogers. Today’s families frequently eat at different times due to schedules, but for patients, it’s important to have a more structured setting.
Not only does it give families time to reconnect and socialize, it allows loved ones to see how and what the patient is eating without being regarded as the “food police.”
Family Weekends & Holidays
Even families from out of state will travel to Rogers Memorial for our “Family Programming Weekends.” During that time, families have the opportunity to eat with their loved ones on campus or even go out on a pass to a restaurant once patients are farther along in treatment.
To cope with large celebrations that traditionally center on food, we stage a Thanksgiving meal to teach appropriate portion sizes and how to avoid overindulging, avoiding food or other negative eating behaviors. We also encourage patients to focus on the social aspect of the holiday rather food.
Changing the Home Environment
Another step in preparing to leave treatment is to ask patients if there is something in their home environment they need to change in order be successful. Sometimes it’s a physical change, like rearranging their room to signify a new start, or it can be simplifying hectic schedules.
Kids who have been pressured to get straight A’s may need to join extracurricular activities to create more balance in their lives, while parents may need to modify their expectations to decrease a child’s stress.
Fixating on Body Image
Adolescents in general can be very fixated on body image, harshly comparing themselves to one another or to celebrities.
That’s dangerous for those recovering from eating disorders because the illness can lead them to take that self-criticism to the extreme, and it can restart the cycle.
Not Comparing Yourself to Others
We teach patients not to get caught up in comparing themselves to anyone else. Each body’s needs are different, and some need less fuel than others. It’s also important to acknowledge the role genetics play in body type.
I explain it to kids this way: “It’s like taking medicine. People can’t share prescription medications, because everyone’s body chemistry is different, and your nutritional needs are just as individualized.”
Reintroduce Activities Slowly
To help deal with peer pressure and stress, I recommend parents slowly allow children to resume activities and gradually give them more freedom. Rather than having them visit a friend’s house, ask the friend to visit your home. If things go well, over time, your child can progress to going to the friend’s house or to the mall for an hour or two.
It’s similar to driving – teens need much more supervision when they are learning to drive. Once they demonstrate that they can react to unexpected situations, you can trust them to drive without an adult. But you also can reserve the right to limit distractions while they drive, such as not permitting them to use a phone in the car.
Formal treatment continues after the patient returns to their home community with a team consisting of a psychiatrist, primary care physician, therapist and dietitian. Patients see the team weekly, except the psychiatrist, whom they’ll see every three to four weeks.
Acknowledging Their Accomplishments
When patients “graduate” from Rogers, I ask what they’re going to do to celebrate and to acknowledge their accomplishment. It doesn’t need to be a big party, but something they’ve looked forward to, like visit an amusement park. Typically, no one is completely cured when they walk out the door, but every mini graduation deserves some celebration.
I tell them, “Think of the progress you’ve made and take time to be proud of yourself – you’ve spent a lot of time developing coping skills, challenging your incorrect thoughts and, though those thoughts may not be completely gone, focus your energy on more important things like friends and family.”
Relapse Is Not Failure
It is the nature of this illness that patients sometimes need more than one treatment, because there are many stressors that can cause an unexpected relapse. For instance, going away to college, experiencing a romantic breakup or a death in the family can challenge even the most centered person.
I tell patients if they return: “You came back for a tune-up, just a reminder of all the skills you learned before. Do not consider this a failure–consider it a refresher.”
Ultimately, our goal at Rogers is to see our patients return to a fully functioning life, face issues head-on instead of avoiding them as they had in past and to put their eating disorder behind them. In short, we want life to replace the eating disorder.
About Rogers Memorial Hospital:
Rogers Memorial Hospital is a leader in comprehensive and effective behavioral health care treatment for children, teens and adults.
About the Author:
Tracey Cornella-Carlson, MD, CEDS, DFAACAP, is the medical director of the child and adolescent eating disorder programs at Rogers Memorial Hospital. A board-certified child, adolescent and adult psychiatrist, she received her medical degree from the Chicago Medical School in 1992.
At Rush Presbyterian St. Luke’s Medical Center in Chicago, Dr. Cornella-Carlson completed a three-year general psychiatry residency and a two-year fellowship in child and adolescent psychiatry, during which she was chief fellow. She has done research on co-morbidity in boys with attention deficit/hyperactivity disorder, and specializes in eating disorders.
Dr. Cornella-Carlson is a distinguished fellow of the American Academy of Child and Adolescent Psychiatry and a certified eating disorder specialist through the International Association of Eating Disorder Professionals (iaedp).
She was elected as the certification chairperson for the iaedp Heartland Chapter. Dr. Cornella-Carlson is a member of the Academy for Eating Disorders and serves as a co-chair for the Child and Adolescent Special Interest Group.