There are ethical, financial and practical grounds for including parents in treatment of younger program participants. The Toledo Center approach emphasizes family therapy as one of the cornerstones of treatment and is required for almost all program participants who are under the age of 18 or who are living at home. From a strictly practical point of view, parents or guardians are legally responsible for the patient’s well being.Moreover, parents have the potential to provide powerful directives in support of therapeutic goals. From a theoretical perspective, the interaction between the patient’s thinking, feeling, and behavior and family members is usually so salient that it compels family involvement. We are committed to providing family services for patients suffering from eating disorders.
Approaching Someone With an Eating Disorder
Parents often come to treatment with tremendous guilt stemming from the belief that they are somehow responsible for the development of the eating disorder. There is really little evidence to support this contention. There is tremendous variability in the psychological health experienced by families prior to the onset of the eating disorder; however, conflict is a virtual certainty once the eating disorder emerges. Parents should not feel guilt or feel responsible for the eating disorder. They need to understand that they can play a crucial role in process of recovery. After the initial phase of treatment, some families are encouraged to take an even more active role in the treatment process while others are encouraged to relax controls for a period in order to allow the development of appropriate independence. This is where the specific advice of a therapist is valuable. In any event, families should be assured that they can play a significant role in the process.
I. Start with the proper perspective
- It is important to remember that the tips offered below are suggestions rather than rules. Those suffering from an eating disorder can sometimes react poorly to any well-meaning attempt to assist by family members or friends. Eating disorders usually result in starvation symptoms (see information on starvation) and these can have serious emotional consequences including irritability, anger, depressed mood, and mood swings making patients very sensitive to others. Therefore, even when you follow the suggestions offered below, your efforts may not be positively received by the individual with an eating disorder.
- Seeing someone engage in destructive eating patterns is frightening, frustrating and hard to understand. It is common to experience anger, fear, confusion and guilt. Regardless of how much you want to help, it is important to keep in mind that, if the person is an adult, they must make the decision to get professional help. If you are distressed about the situation and do not know what to do, you can seek help from a professional who specialized in eating disorders. You may want to seek advice from a support group like the Eating Disorders Support Network that is a professionally facilitated support group that meets the first Thursday of every month at the Toledo Center in Sylvania, Ohio (see below).
II. General points
- Encourage the person to get professional help. Start with asking them to simply go to a professional who specialized in eating disorders only for an assessment, without making a commitment to treatment.
- If the person with an eating disorder is a minor, and you are the parent or guardian. You should insist that the get a professional opinion since you are the person responsible for ensuring their safety and welfare.
- Do not blame the person with an eating disorder. A person with an eating disorder is trying to solve a predicament or conflict with their symptoms in the best way that they know how. They need understanding, not blame.
- Do not comment on weight or appearance. People with eating disorders usually have heard comments about weight or appearance Friend many times before and your comment will either be ineffective, irritating or will lead to a battle.
- Do not try to force the person to eat. If the person is a minor, you can insist that they seek professional help if you are the parent or guardian. If the person is an adult, you really cannot force her or him to eat.
- If the person is in extreme danger of death because they are very underweight or they are bingeing and vomiting many times a day. In these cases, you may have to step in and take control by asking a doctor to force hospitalization. However, this rarely is a satisfactory long-term solution since it may further alienate the person with the eating disorder.
- Be patient. Recovery from an eating disorder takes time. However, recovery is possible with proper treatment (see section on recovery).
- Assure the person that they are not alone and that you love or really care about them and this is the reason for your concern.
III. How to approach a person with an eating disorder
- Prepare in advance for the points you wish to emphasize in the discussion. Select a time when neither one of you will be under any time pressures or interrupted by anything. Select a time when you are calm and alert.
- It is important to use good listening skills when dealing with such a sensitive topic. Remember to use the following general skills.
- Active listening – Let the other person know you have understood what they are saying by repeating what you heard so that it gives them the opportunity to clarify any potential misunderstandings.
- Empathy – Try to put yourself in that person’s shoes and understand what he/she is experiencing.
Some Specific Suggestions:
- Withholding judgment – Try to be open minded and empathic.
- Be specific and concrete throughout your discussion.
- Try to keep all verbal and non-verbal messages consistent.
- Avoid treating the person in a condescending manner. Do not use threats to intimidate the person, and do not blame the person.
- Be open and honest about your concerns and try to convey your message in a straightforward manner without displaying signs of anger. Let the person know how their symptoms have impacted you and use “I” statements when doing this (i.e. “I really care about you and it is scary to see the changes that have taken place over this last while. I want to be able to help you, but I don’t know exactly what to do anymore.”)
- Try to understand the other person’s viewpoint and let the person know how much you care and want to be able to support him/her. Many individuals who have eating disorders often struggle with their lives in silence and feel very isolated from others.
- Try to keep the discussion focused on current behaviors and identify specific ones, without criticizing the person’s value system. Provide descriptive examples of what you have observed.
- Refrain from making comments that are likely to induce feelings of guilt or shame (i.e. “Why are you doing this to yourself/us?” “Why don’t you just eat like everybody else does?” “Just get over this, you are just doing this for attention.”), as it may cause the person to become angry, withdrawn, and defensive.
- Assist the person in seeing beyond food and weight issues and let him/her know that you view him/her as a whole person. Try to separate the person from the eating disordered behaviors the person displays.
- Avoid making any comments about body weight.
- Do not force the person to eat or make/buy food for him/her.
- Provide the individual with educational material on eating disorders, referral information (for eating disorder specialists) and programs in the area. Allow the person to read these materials at a later time. Encourage the person to get an initial evaluation from a qualified professional, which only provides him/her with another opinion and does not involve any long-term commitment. If you feel comfortable, offer to attend the first therapy session with the person.
- Let him/her know that this discussion is a first step to getting help and that he/she is not alone.
- Show your belief and support in the person’s ability to recover; however, remember recovery is not perfect. Full recovery is possible with appropriate treatment, and it is a process that occurs over time.
- Remember the strength and power of an eating disorder and that you alone cannot force the person to change. Be honest about your own feelings of anger, sadness, frustration, confusion, and helplessness and consider getting help and support for yourself. Set limits for yourself.
- Do not become discouraged if the person denies having an eating disorder (which may occur, depending on what phase of the illness the person is experiencing). Provide them with the information and resources on where to receive help, and let him/her know you are available if he/she changes his/her mind.
- If the person is under the age of 18 (or if you feel his/her life is in imminent danger), you may want to consider involving a trusted adult (a parent, teacher, coach, psychologist, school counselor, etc.) because of the serious health risks associated with eating disorders.