DENTON, Texas (WOMENSENEWS)– A family talks quietly on the stairs as the sun begins to rise. They have talked all night in what began as an argument. Their 16-year-old daughter struggles with an eating disorder.
Last night, she was finally ready to talk, and they listened all night long. In the months following the evening spent on the stairs, the daughter recovered.
I am a Ph.D. trained licensed professional counselor and I have specialized in the treatment of eating disorders for 30 years, with the last 15 of those as the director of an outpatient treatment program for eating disorders.
Working with families is my favorite part of the recovery process because I get the honor of helping everyone heal. Eating disorders are the most deadly mental illness and, according to the National Eating Disorders Association, they claim the lives of up to 20 percent of the 30 million women and men in the United States who struggle with them.
During the past three decades, I have participated in a growing understanding of how best to treat eating disorders. Families used to not see the warning signs, and now they generally seek care sooner. In many cases, I see patients as soon as the eating disorder starts, or even before it has had a chance to develop, when recovery is easier to achieve.
Eating disorders are complicated, with equally complicated causes. They are biopsychosocial, meaning they have a biological cause with a genetic predisposition for an eating disorder, a psychological cause such as depression or an anxiety disorder and a social cause because our culture promotes thinness in some very unhealthy ways.
At some point, these factors reach a tipping point and an eating disorder develops, often when a woman reaches puberty. Women become much more concerned about their bodies at the beginning of puberty, and they may develop body dysmorphic disorder, which can be a precursor to an eating disorder.
Once an eating disorder becomes fully developed, the behaviors and thinking can be difficult to reverse, so early recognition and treatment increases the odds of recovery.
Families are in a unique position to address the eating disorder. Although teenagers may be initially resistant to treatment, they can respond, unless deeper psychological issues, such as bipolar disorder, exist. From my experience, families are savvier than they were 30 years ago, and they spot eating disorders sooner.
How Families Help
Reaching out to an eating disorders specialist is a good way to start. A therapist can help coach the family through the recovery process. A dietitian will also be needed to develop a nutritional plan. Eating disorder recovery is done by a team consisting of a therapist, a dietitian and a physician. If you find a qualified eating disorder specialist, they can make recommendations for other team members.
For a long time, people believed the only approach to eating disorders was residential treatment, and that may not be necessary if the eating disorder is caught early. Residential treatment is expensive and it is rarely covered well by insurance. An additional downside of residential treatment is that it exposes patients to others whose passion for their own eating disorder teaches them new ways to practice.
The Maudsley Family Therapy approach, which was developed in England, has become popular in this country, although it is controversial. Parents like it because, in addition to avoiding an expensive hospitalization away from home, it allows them to be a part of the solution as it requires them to sit with their daughters and make sure they eat three meals and three snacks a day. The only candidates for Maudsley are girls under the age of 18 with anorexia. Patients with bulimia or binge eating disorder need other approaches.
Critics of the Maudsley approach say that taking control over food from adolescents may irritate the underlying issues that led to the eating disorders. Maudsley doesn’t teach adolescents how to eat intuitively, just that they must eat. The approach also blurs the boundaries in families that may already struggle with them.
The only right approach to recovery is the one that works for the patient and their family. Adolescents are emerging adults, and they should have some input into what approach is chosen. When parents choose the treatment approach, the adolescent doesn’t always buy into the process.
Once a treatment provider is selected, they can recommend reading materials that will support their approach. Getting treatment providers who are not accustomed to working together or reading books that are not recommended by the provider can be counterproductive, as approaches to eating disorders vary.
Talk About Mistakes
Mistakes are a part of the recovery process. Families who establish a norm that allows their daughter to identify and discuss things that trigger her will be equipping her to recover, although it may be difficult to admit mistakes. From my experience, families who listen open the door to recovery. Talking about mistakes within the family enables the patient to talk about other problems that led to the development of the eating disorder, and it develops trust and shows unconditional love.
Although disordered eating is the main symptom of eating disorders, this mental illness is not about food, and this is probably the hardest concept for families to grasp. Recovery begins when family members learn to see disordered eating as a symptom that can be addressed.
An eating disorder is an affective disturbance, and the person with the eating disorder is attempting to express feelings they don’t understand or to control a situation that feels out of control by eating too little or too much. Once underlying causes that started the eating disorder are addressed, food doesn’t have to be the problem.
When girls start treatment, they often express anger at their families and at their treatment team. Families can find this difficult to handle, especially from a daughter who was always cooperative and sweet. Listening to the anger, and being willing to help allows the patient to get better. Parents who are courageous enough to acknowledge things they can change show a child who may be perfectionistic that they are human and that mistakes are allowed.
Parents don’t cause eating disorders, but they can be a big part of the recovery process. People can and do recover from them. The patient at the beginning of this article did recover completely, and she went on to do great things because she realized she had better things to do than to struggle with an eating disorder.