What's The Role Of Family And Friends In The Treatment Of Eating Disorders?

As treatment for eating disorders has moved past a focus on weight to a concern for psychological needs, more and more doctors are recommending family-based psychotherapy. Physicians favor family-based psychotherapy because it works. But there are more benefits to family-based psychotherapy for eating disorders than just its benefits for the individual who is living with the eating disorder. Eating disorders are by definition egocentric. They cause people who suffer them to withdraw from others to pursue a love or hate relationship with food. Psychotherapy not only helps people who live with eating disorders, but also their families and friends.

How eating disorders affect family and marital relationships

Parents have dreams and ambitions for their children. An eating disorder doesn’t have to mean that those dreams and ambitions are unattainable, but most of the time, the parents’ hopes are shattered. Parents may need their own psychotherapy when their children develop an eating disorder.

Brothers and sisters of people who have eating disorders may suffer a lack of attention. They may become understandably jealous of the attention given to their sibling who seems never to get well. They may be deprived of clothes, toys, travel, educational opportunities, or even their own medical care because family resources are going to their brother or sister who has the eating disorder. They may believe (and sometimes will be correct) that their sibling does things to remain the center of parental attention.

And eating disorders can have a devastating effect on marriages. Often one spouse is unaware of the other spouse’s eating disorder. This isn’t because that spouse is uncaring. It’s because the nature of eating disorders is to be secretive about them. Anorexia and, to an even greater extent, bulimia are shrouded in deception. When the truth is eventually found out, there is no way to explain the dishonesty.

The spouse of a person who has an eating disorder may insist on marital counseling. It is not unusual for the spouse with the eating disorder to insist everything is alright right up until hospitalization. No surprisingly, a study has found that when spouses are allowed to be and make an effort to be helpful, there is a greater likelihood of recovery from the eating disorder. When spouses are distant, the chances of recovery are lower.

Parents, siblings, and spouses benefit from psychological support along with their loved one who is dealing with the eat disorder. Also, as we will review a little later, the presence of family in therapy sessions makes a measurable difference in certain aspects of recovery from eating disorders. How does that work?

Who’s in the room during psychotherapy?

In theory, family-based psychotherapy for teenagers and young adults who have eating disorders could involve the parents, siblings, and patient all in the same session at the same time. In practice, it’s usually the patient and one or both of the parents. Inclusion of siblings, particularly younger siblings, is even more unusual.

Does family participation in therapy make a difference?

In one clinical program, intense cognitive behavioral therapy with “practice eating sessions”:

• Reduced the fear that weight gain would be immediate once normal eating habits resumed.
• Reduced the number of times per day participants looked in the mirror
• Greatly reduced fear of eating.
• Significantly reduced concern over weight and shape.

Similar data do not exist for the participation of siblings and spouses in therapy sessions, but the therapist’s judgment on this issue should be respected.

What role do friends play in recovering from eating disorders?

Younger people who have eating disorders respond well to expressions of support from their friends. Older teens, young adults, and older adults who have eating disorders tend to expect their friends to avoid telling them what to do. Keeping those facts in mind makes it easier for friends to be accepted in their efforts to support recovery from eating disorders.