The Importance of Family Therapy in Eating Disorder Care

Eating disorders can affect anyone and cause a lot of distress. Eating disorders involve one or more of the following: restriction, extreme picky eating, binge-eating, purging, excessive exercise, misuse of laxatives/diet pills/diuretics. Eating disorder symptoms also typically include body image distress and distortion.

Let’s take a quick look at the general characteristics of different eating disorders. Importantly, these descriptions are not inclusive of all symptoms.

Binge eating disorder is characterized by frequent and recurrent binge-eating episodes (eating a large amount of food in a relatively short period of time) in conjunction with feeling out of control, feeling shame/guilt, and/or eating when not hungry. There is a strong desire to lose weight and/or change body shape. This disorder is accompanied by body image distress.

Bulimia nervosa involves frequent and recurrent episodes of binge-eating and purging compensation mechanisms such as self-induced vomiting. There is a strong desire to lose weight and/or change body shape. This disorder is accompanied by body image distress.

Anorexia nervosa involves restriction of caloric intake by skipping meals/snacks, fasting, or eliminating categories of food or beverages. There is a strong desire to lose weight and/or change body shape. This disorder is accompanied by body image distress.

Avoidant-restrictive food intake disorder is the restriction of food due to aversion in taste, texture, look of food, fear of choking, and/or fear of gagging/vomiting. No desire to lose weight and/or change body shape exists with this disorder.

Other specified and unspecified eating disorder categories serve the purpose of identifying that there are distressing and impairing symptoms of an eating disorder that someone is experiencing that do not fit the full criteria for the above listed diagnoses.

Why is getting treatment important?

Eating disorders are never a choice. Research also supports this framework by identifying genes linked to eating disorders. This means that recovery isn’t as simple as stopping the eating disorder behaviors. Professional, expert help is often needed for recovery to be a possibility. An eating disorder team often includes an eating disorder therapist, family therapist, eating disorder dietitian, primary care physician, and psychiatrist. These providers work together to assist with making sustainable behavior changes, challenging eating disorder thoughts and beliefs, safely restoring physical health, developing insight, holding hope, and coping with overwhelming emotions.

How does the eating disorder impact the individual?

Eating disorder development is gradual and often offers solutions that become the problem. These solutions are important to pay attention to because there must be some underlying need that the solution is for. A lot of people with eating disorders are carrying around unfinished business and hurt that needs to be tended to. This is difficult to achieve while in the tortuous cycle of eating disorder behaviors and thoughts. It is also common for co-occurring mental health issues to be a part of the picture. Common co-occurring conditions include anxiety, depression, OCD, and trauma/PTSD.

How do eating disorders impact the family system?

Eating disorders impact that family system in several ways.  First, many eating disorders thrive in certain environments. Importantly, eating disorders do not appear in a vacuum, it is important to explore individual, family and other systemic factors that contribute to the eating disorder.  For example, eating disorders thrive in family environments where high expectations and high pressure exist.

Second, eating disorders disrupt a family’s everyday life.  As a family therapist I see this when families have to send their children to a higher level of care, or they need to alter their typical every day routine to help support recovery.

Third, eating disorders can lead to emotional distress, miscommunication and ruptures in the family system.  Family therapy can help to mitigate the impacts and heal from them.

Why is family therapy important in eating disorder treatment?

Families are often the first to notice changes. Importantly, families are the first line defense for getting support for their loved one.

Family therapy is a vital part of eating disorder treatment.  Family therapy creates the opportunity to directly address the eating disorder’s impact on the family system and identify paths forward.

Family therapy in the context of eating disorder treatment can include:

• • Psychoeducation on eating disorders

  • Communication exercises

  • Working through conflict related to the eating disorder

  • Creating a safe place to give and receive feedback

  • Enactments (this is when a challenging dynamic comes up during session and allows the opportunity to address it directly in session)

  • Meal Support guidance and support

  • Managing expectations

  • Assessing appropriate treatment level

  • ED specific family treatment models such as FBT

Three key takeaways for the family:

1. First, eating disorders don’t emerge in a vacuum.  It is important to explore shifts and changes both as an individual and a family that will help foster healing and recovery from an eating disorder.

2. Second, eating disorder recovery is hard work and family therapy can help you to better understand and work through challenges that evolve from an eating disorder.

3. Third, building and maintaining trust can be difficult in the recovery process. Family therapy can be a great place to explore ways in which trust has been damaged as well as setting reasonable goals for taking baby steps in rebuilding trust.