Tuesday, October 2, 2012

Involving families in eating disorder treatment

Brie asked that I address the topic of involving families in the treatment process, especially for adult patients. I think this is something we do that is maybe a bit more unique. But, I also am somewhat blown away by the number of providers who treat children and adolescents, with and without eating disorders, without including the family. I don't see how that make sense. Therapy is one hour out of a week that has, ummm, 168 hours, I think. I just don't see how therapy alone will be powerful enough to override an eating disorder that resides in the patient's mind each of those 168 hours.

When it comes to involving family in an adult's treatment, however, there reasonably can be some hesitation. After all, adults don't want to feel like they have been rewinded to childhood or adolescence, and have to answer to Mom and Dad; this is fair! But, again, this disorder is lodged in the mind of the patient ALL THE TIME. It damages the individual's brain, and thus his or her thought processes, and rational thought suffers as a result of damage to the frontal lobe. I often speak of the vortex that exists right at my office door. When patients sit on my couch, it makes sense to give up their ED, stop the behaviors, and choose health. But, they hit that vortex, and get slammed by the world, and suddenly, that motivation and desire can wane.

So, here's where family and friends come in. But, it is key that the adult patient drive the family/friend involvement. They need to be able to tell their family/friends what they can do to help, and give them permission to say the difficult things the ED does not want to hear. Many patients will choose this path because it is the intervention that comes immediately prior to hospitalization; so, for those who do not want to be hospitalized, a good number will choose this alternative.

And, really, I think what most of us probably want is our family/friends' support anyway. When you have an ED, you tend to lose the ability to communicate as well, so it is harder to ask for that help. I have seen many patients feel great relief from being able to address their ED with those they care about in a safe environment, where a therapist can help the family to understand that the disorder is not rational and that, often, their gut reactions are not what is most helpful to the patient. I can write more on that at a later time.

Now, selfishly, as a provider, I will say that it is also helpful to have family and friends involved to help avoid unintentional undermining of what we are trying to do. If you think of the patient as having this totally separate voice in their head, the voice of the ED, and then the providers are trying to challenge the disorder; well, we are not always EXACTLY correctly quoted by the time the patient makes it home. In addition, with families being on the front lines of the battle against the disorder, they sometimes are more likely to try to negotiate with the disorder, perhaps saying a lower weight is reasonable, or that the patient doesn't need as much support as the treatment team recommends. If the family/friends are involved in the treatment itself, it provides an avenue where they can ask why we do what we do, and hopefully then feel more able to support our recommendations.

In short, EDs are terrible disorders that cause so much damage. The more people who can help treat them, the better. Families used to be banned from treatment because psychology LOVED blaming parents. Now, I think we all need to recognize that blaming parents has no benefit, but involving them in helping, when they are willing, can have incredible power.


  1. I agree that family involvement helps because if my parents hadn't been apart of my treatment I think I would still be in my old ways. My mom has especially worked on her own anxiety and it made a huge difference.

  2. I would like you to talk about body image and why it's the hardest last hurdle !

  3. I will tackle the body image topic. In my opinion, one of the hardest things to effectively treat.