"When I is replaced with WE, even ILLness becomes WELLness”
My first experience working with the eating disorder (ED) population was as a milieu therapist in an inpatient eating disorder unit. As milieu therapist I led groups, supported meals, and managed the unit throughout daily activities. Through spending 8 to 16 hours a day with patients over the course of weeks or months, trust began to develop and I was privileged to hear their stories. I began to view EDs as a coping tool, an escape, and as protection. They do not develop solely because someone wanted to look better in jeans or because they saw a skinny model on a magazine; they are complex biopsychosocial diseases and steps toward recovery are often tedious.
Through observation and listening I began to notice a pattern among the adults and children on the unit- the revolving door effect. Often, once patients entered their life outside the unit, symptoms reappeared and patients re-entered treatment. As a new treatment provider, I did not understand the complexity of this process. I knew these individuals had the skills, insight, and strength to take the necessary steps toward overcoming their illness. However, recovery is not a straightforward path. Studies estimate that 50-55% of adults recover within 6-8 years, and this is often marked by periods of relapse.1, 2
Therefore, something is different outside the treatment walls. On the inside, the program offered twenty-four hour structure, meal plans and support, as well as groups with the other patients on the unit. Outside the walls were relationships, stressful experiences, triggers, social pressures, gender imbalances, injustice, and pain. EDs cannot be viewed outside of relationships and the environment in which the person lives. What I experienced on the inpatient unit sparked a passion that lead to pursuing my PhD, with a focus on understanding and serving this population.
Currently I work in a private practice specializing in the wide spectrum of eating disorders. Whether I’m working with a 65 year old male with binge eating disorder, or a 13 year old female with anorexia, one treatment goal remains the same: help the client build a support network. While many programs are beginning to include family and support systems into adult ED treatment, research is needed to better understand the impact of including carers in their treatment.3 There is limited research on adolescent EDs and family treatment as well.4 However, of the eight randomized control trials that have included children and adolescents, seven include a family element. Those that were outpatient-based and had parental intervention were more effective than comparison treatments.4
With this in mind, I receive phone calls and emails from family members thinking someone they love has an eating disorder, yet they do not know how to talk about it. Family members often want to help but do not feel equipped to do so. Why are eating disorders still so hard to talk about? I believe stigma and lack of education around eating disorders continue to hold many people back from seeking the support they truly need. Eating disorders are not a choice, they occur in both males and females, and all forms of eating disorders are serious.5 There are some common myths around eating disorders, and in this powerful video, ED expert Cynthia Bulik powerfully tackles some of them. Medical and mental health professionals need to be equipped to dispel these false claims and facilitate supportive conversations for individuals and family members.
The following are 6 tips for encouraging positive family conversations about EDs.
1. Take an open stance to the conversation: Do not have an agenda or certain point you feel your loved one needs to understand by the end of the conversation, ask open ended questions. Be open to both their and your own reactions.
Example Questions: What is it like for you to have an eating disorder?, What has it been like for you to see me struggle with an eating disorder?,
How can I be a support? How can we continue to talk about the eating disorder?
2. Do not give advice:Speak from a place of concern. Many times we want to give advice out of love and trying to "fix” a situation. However, if the behavior was not helping the individual in some way, they would not be engaging in it. Advice such as "Just eat more” or "Try to exercise” can invalidate struggles and perpetuate symptomology.
Example Question: How can we work together to reach the treatment goals?,
3. Validate feelings:Eating disorders are complicated. Those who overeat or binge do not "lack will power” and those who restrict food intake or over exercise are not vain. When someone with an eating disorder does open up it is important they feel the environment is safe. Validation and support can go a long way. However often those with eating disorders have a difficult time expressing their needs or emotions. Simply acknowledging their challenges and efforts can both help them identify these needs and emotions and express an understanding for the difficult process.
4. Avoid demanding changes: Recovery is a long process. Avoid ultimatums (If you don’t change then I will…) and instead express support throughout the process.
5. Do not feel blamed for the illness: You are not to blame for your loved ones struggle. In the end the individual with the eating disorder needs to do the work. However you can learn ways of communicating and supporting their needs that can help in this process.
6. Do not push the conversation: If a loved one is resistant or denying the presences of a problem do not push this issue on your own. Encourage the individual to speak with the trusted physician or mental health provider. These conversations are difficult and can take time to open up to.
Whether working in family practice, pediatrics, or specialty settings you will most likely encounter someone with an eating disorder and a concerned family member or spouse. Relationships are complicated. Stressors, such as illness, often magnify worries and fears. Through sharing these tips you can help promote communication and a reduction of stigma around eating disorders. I hope these help you as providers feel confident and guided in facilitating/encouraging these conversations in your patients/clients.
1. Eckert, E. D., Halmi, K. A., Marchi, P., Grove, W., & Crosby, R.(1995). Ten-year follow-up of anorexia nervosa: Clinical course and outcome. Psychological Medicine, 25, 143-156.
2. Fichter, M. & Quadflieg, N. (2007). Long-term stability of eating disorder diagnoses. International Journal of Eating Disorders,40(S3), S61-S66
3. Le Grange, D., Lock, J., Loeb, K., & Nicholls, D. (2010). Academy for eating disorders position paper: The role of the family in eating disorders. International Journal of Eating Disorders, 43(1), 1-5.
4. Lock, J. (2011). Evaluation of family treatment models for eating disorders. Current Opinion in Psychiatry, 24(4), 274-279.
5. NEDA Toolkit for Educators. (n.d.). Retrieved April 28, 2015, from https://www.nationaleatingdisorders.org/sites/default/files/Toolkits/EducatorToolkit.pdf
|Brittney France, MA, MFTI currently lives and works in San Diego, CA. She has completed her classwork for her Ph.D. in Marriage and Family Therapy with a concentration in Families, Systems, and Health. She currently divides her time between writing her dissertation with a focus on families and eating disorders, working in a practice specializing in eating disorders, and teaching a class of masters students. She hopes her research will continue to bridge the gap between Medical Family Therapy and eating disorders research.|