Family Members of the Eating Disordered Patient

For Family Members And Those Who Treat Them

Individuals with eating disorders directly or indirectly affect those with whom they live or who love and care about them. Family patterns of socializing, preparing food, going out to restaurants, and just plain talking to each other are all disrupted by an eating disorder. Everything from finances to vacations seems jeopardized, and the person with the eating disorder is often resented for an illness she cannot control.

A family member with an eating disorder is most likely not the only member of the family with problems. It is common to find problems with mood or behavior control in other family members, and the level of functioning and boundary setting among parents and siblings should be evaluated. In many families there is a history of excessive reliance on external achievement as an indicator of self-worth, which ultimately or repeatedly fails. Fluctuations between overinvolvement and abandonment may have been occurring for some time, leaving family members feeling lost, isolated, insecure, or rebellious, and without a sense of self.

Parents, who have their own issues both from the past and in the present, are often frustrated, fighting between themselves, and unhappy. Overinvolvement with the eating disordered child is often a first reaction in trying to gain control of an out-of-control situation. Futile attempts at control are exerted at a time when understanding and supportive direction would be more helpful.

In a marriage where one partner has an eating disorder, the spouse's concerns are often overshadowed by anger and feelings of helplessness. Spouses often report a decrease of intimacy in their relationships, sometimes describing their loved ones as preferring or choosing the eating disorder over them.

Individuals with eating disorders need help in communicating to their family members and loved ones. Family members and loved ones need help as they experience a variety of emotions, from denial and anger to panic or despair. In the book, Eating Disorders: Nutrition Therapy in the Recovery Process, by Dan and Kim Reiff, six stages that parents, spouses, and siblings go through are delineated.

STAGES OF GROWTH EXPERIENCED BY FAMILY MEMBERS AFTER BECOMING AWARE THAT A PERSON THEY LOVE HAS AN EATING DISORDER

Stage 1: Denial

Stage 2: Fear, ignorance, and panic

• Why can't she stop?

• What kind of treatment should he have?

• The measure of recovery is behavior change, isn't it?

• How do I respond to her behaviors?

Stage 3: Increasing realization of the psychological basis for the eating disorder

• HealthyPlace.com Articles/Conference Transcripts Childhood Obesity: Managing Your Child's Food Environment Childhood Depression and Bad Parental Habits

  Family members question their roles in the development of the eating disorder.

• There is increased understanding that the process of recovery takes time and that there is no quick fix.

• Parents/spouses are increasingly involved in therapy.

• Appropriate responses to the food- and weight-related behavior are learned.

Stage 4: Impatience/despair

• HealthyPlace.com Audio The Psychology of Getting Better Our guest, Susan, was sexually abused over 30 years ago. She's been diagnosed with major depression, PTSD, OCD and panic disorder and was hospitalized at least twice. Susan's spent the last 10 years in therapy trying to deal with what happened. Over that period of time, she's changed meds, changed doctors, tried to journal, tried meditation, tried keeping busy. At 45, she still can't deal with the sadness. She, like many who suffer from various psychological disorders, wants to know -- what's it take to get better? Listen with Real Player.

  Progress seems too slow.

• The focus shifts from trying to change or control the person with the eating disorder to working on oneself.

• Parents/spouses need support.

• Anger/detachment is felt.

• Parents/spouses let go.

Stage 5: Hope

• Signs of progress are noticed in the person with the eating disorder and oneself.

• It becomes possible to develop a healthier relationship with the person with the eating disorder.

Stage 6: Acceptance/peace

To help family and friends understand, accept, and work through all the problems a loved one with an eating disorder presents, successful treatment of eating disorders often mandates therapeutic involvement with the patient's significant others and/or family, even when the patient is no longer living at home or a dependent.

Family therapy (this term will be used to include therapy with significant others) involves the creation of a powerful therapeutic system consisting of the family members plus the therapist. Family therapy emphasizes responsibility, relationships, conflict resolution, individuation (each person's developing an individual identity), and behavior change among all family members. The therapist assumes an active and highly responsive role within this system, altering the family rules and patterns in a significant way. If the therapist appreciates the vulnerability, pain, and sense of caring within the family, he can provide initial support for all family members. Supportive, guided therapy can relieve some of the tension created by tenuous and previously disappointing family relationships.

One goal in family therapy involves helping the family learn to do what the therapist has been trained to do for the patient (i.e., empathize, understand, guide without controlling, step in when necessary, foster self-esteem, and facilitate independence). If the therapist can help the family and significant others to provide for the patient what a healing therapeutic relationship provides, the length of therapy may be reduced.

In doing family work, the patient's age and developmental status are important in outlining the course of treatment as well as highlighting the responsibility of family members. The younger the patient is, both chronologically and developmentally, the more responsibility and control the parents will have. On the other hand, patients who are developmentally more advanced require parental involvement that is more collaborative and supportive and less controlling.

SUMMARY OF IMPORTANT TASKS FOR SUCCESSFUL FAMILY THERAPY

The multidimensional task of the therapist in family therapy is extensive. The therapist must work on correcting any dysfunction occurring in the various relationships, for this may be where the underlying causal issues have partly developed or at least are sustained. Family members, spouses, and significant others need to be educated about eating disorders and, particularly, the patient's unique manifestation of symptoms. All loved ones need help in learning how to respond appropriately to various situations they will encounter. Any serious conflicts between family members, which contribute highly to the development or perpetuation of eating disorder behaviors, must be addressed.

For example, one parent may be stricter than the other and have different values, which may develop into serious confrontations over the raising of the children. Parents may need to learn how to solve conflicts between themselves and nurture each other, which will then enable them to better nurture their child. Faulty organizational structure in the family, such as too much intrusiveness on the part of the parents, too much rigidity, or fused boundary issues, must be pointed out and corrected. Expectations of family members and how they communicate and get their needs met may be underhanded and/or destructive. Individual members of the family may have problems that need to be resolved separately, such as depression or alcoholism, and the family therapist should facilitate this happening. The task of family therapy is so complex and at times overwhelming that therapists often shy away from it, preferring to work solely with individual patients. This can be a grave mistake. Whenever possible, family members and/or significant others should be a part of overall treatment.

The following is an excerpt from a session where an extremely upset father was complaining about the fact that the family had to be in therapy. He felt that there were no family problems except that his daughter, Carla, was sick. Allowing this kind of thinking is detrimental. In fact, for teens and younger patients, statistics show that family therapy is necessary for recovery.

Father: Why should I listen to this? She is the one with this disgusting sickness. She's the one screwed up in the head. She's the one who is wrong here.

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Therapist: It is not a matter of right or wrong, or of blame. It is not just something wrong with Carla's personality. Carla is suffering from an illness that affects you and the rest of the family. Furthermore, there may be certain things in her development that got in the way of her being able to express her feelings or cope with stressful situations. Parents can't be blamed for creating eating disordered children, but how a family deals with feelings or anger or disappointment can have an effect on how someone turns to an eating disorder.

Yelling and punishing Carla have not worked to help resolve her problem, and in fact things have been getting worse. I need you all here if Carla is to get better, and if all of you are to get along better. When you try to force Carla to eat, she just finds a way to throw up afterward—so what you're doing isn't working. Also, everyone is angry and frustrated. For example, you disagree on things like curfew, dating, clothing, and even going to church. If you want Carla to get better and not just follow your rules, I need to help you find compromises.

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By Carolyn Costin, MA, M.Ed., MFCC - Medical Reference from "The Eating Disorders Sourcebook"

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