Team Discussion of the Month: How Eating Disorders Affect the Family

By Jen Villaseñor

If you’re reading this, I’m guessing that you or someone you love is struggling with an eating disorder (ED).

If that is true, I’m sure you are acutely aware of how the eating disorder has impacted your home. Perhaps your family has been plagued with anxiety and ruminating thoughts over what cannot be directly controlled with regard to the ED. Or, maybe someone in the family responds to their own anxiety by avoiding discussions about the ED altogether. Maybe you’re a parent or a spouse who is so desperate to help your loved one reduce ED behaviors that you find yourself in a trap of catering to their food requests. This may look like preparing foods that your loved one is more likely to eat or refrain from purging, but that lack specific food groups such as fats or carbohydrates.

Some families go so far as to lock up or remove entire food groups from the home to help their loved ones prevent binges (catering to the eating disorder or locking up food is generally not recommended, by the way). We also can’t forget the fact that eating disorder treatment is expensive, from the cost of medical appointments, out-of-network eating disorder providers, and sometimes gaps in employment to attend treatment facilities with higher levels of care. 

If someone in your family is struggling with an eating disorder, you may also feel that you can’t say anything right to your loved one.

You may have witnessed the paradox that commenting on their appearance is not welcomed, but not complimenting their appearance can also be a trigger. You may want to shower them with love, support, and praise for making recovery-focused choices, but a well-intentioned, “I’m proud of you for eating that meal!” may lead to a dark spiral of eating disorder thoughts.  The collection of examples above represents sentiments that I’ve frequently encountered in my work with eating disorders as a Marriage and Family Therapist, although no single example applies to every person or family with an eating disorder. 

While you are undoubtedly becoming the expert on how the eating disorder is impacting your family, you may not be aware of some additional complexities. Here is what to look out for: 

ED recovery tends to shatter beliefs about which behaviors are and aren’t healthy. 

Yes, this can be related to exercise or nutritional choices. Your loved one’s therapist or Registered Dietitian may be providing recommendations that contradict everything you thought to be true about promoting mental, emotional, and physical well-being. However, if your loved one is working with a therapist, they are also likely targeting lifestyle choices, interpersonal patterns, and belief systems that contribute to disordered eating in a less obvious way. For example, your previously selfless spouse who has always jumped to help everyone in the family may need to challenge their urge to give to others, and instead focus more on their own self-care and setting interpersonal boundaries.

At first glance, this shift away from altruistic behavior might look like a back-slide in mental health to the rest of the family. Or, your bright and social 17-year-old teen’s flawless grades and engagement with extracurriculars may be less rooted in strong mental health, and more related to perfectionism. I often warn parents that we can’t and should not selectively challenge perfectionism. This means that with increased body acceptance and peace around food may come the need to reduce involvement in extracurriculars, to have more wiggle room with grades, and so on.  Recovery often means that the individual will be challenging and reworking some patterns that the family has come to view as fundamental parts of their loved one’s characteristics and personality. 

Your loved one’s eating disorder may be serving a useful function within the family system. 

This can be a hard concept to grasp and accept. Marriage and Family Therapists are trained to be curious about what might become destabilized in the family system when a loved one’s mental health improves. To be clear, there is rarely a single, concrete reason why someone develops an eating disorder, which means that family dynamics cannot be blamed as the entire ‘why behind.’  In fact, therapists generally take something called the Biopsychosocial Model (standing for biology, psychology, and social contributing factors) into account when completing assessments.  While the family is almost never solely to blame, family history and current family dynamics are one facet of the Biopsychosocial Model, and it is important to explore their interactions with the eating disorder. 

How can an eating disorder serve a useful function within the family, considering all the chaos that eating disorders tend to unleash upon the family?

First, we must consider that engaging in eating disorder behaviors can feel very soothing or relieving to the individual. This means that someone with an eating disorder may be able to diffuse otherwise intolerable stressors by engaging in their ED behaviors. Someone who can quietly diffuse intolerable stress is subsequently less likely to push back on the source of that stress. 

You can imagine a working parent who feels stressed, exhausted, and overwhelmed but is determined to be a present and emotionally regulated figure in their child’s life.  That parent may find themselves overeating, restricting,  purging, or over-exercising as a way to self-soothe instead of becoming snappy with their child. Recovery for that mother or father may involve reducing their hours at work (with a potential financial impact on the family) or not always being able to act like the superparent that their children have come to expect. 

We can also imagine a different situation in which a parent has unrealistically high standards for their child’s academic performance, perhaps because the parent’s own self-esteem is bolstered by their child’s successes. A child without an eating disorder may become frustrated or visibly overwhelmed by these pressures. A child with an eating disorder may become momentarily frustrated and overwhelmed, and then rapidly shut down those emotions through ED behaviors in order to ‘keep the peace’ within the family system. 

When the family is actively engaged in the treatment and recovery process, the whole family may experience personal growth. 

Being the support person to someone with an eating disorder often requires developing sensitivities to their triggers and recovery goals. If you find it particularly challenging to engage in supportive behaviors such as refraining from negative food or body talk, it is useful to consider why that is the case. Do you have your own internalized diet culture mentality or belief that only certain body types are healthy? If so, how does this impact your own sense of well-being? Also, if your loved one’s eating disorder is, at least in part, a response to certain family dynamics it may necessitate working with a Marriage and Family Therapist or having family members establish their own individual therapy to foster insight and change that supports the ED recovery process. 

Conclusion 

Eating disorders come with a wide variety of symptoms, co-occurring issues, and medical complications. It is important to note that this article does not and cannot reflect the full scope of how eating disorders affect individuals or the family. However, I hope that this article has sparked some curiosity about how eating disorders can impact the family system in ways you may not have previously considered. If you are part of a support system to a loved one with an eating disorder, I recommend seeking your own support due to the level of stress, confusion, overwhelm, or need for personal growth that the experience can bring.

Work with an Eating Disorder Therapist in Orange County, CA

You don’t have to struggle with eating disorders alone. Our team of caring therapists would be honored to support you and your family with the hardships of ED. You can start your therapy journey with Kindful Body by following these simple steps:

• Schedule a free 15-minute consultation with our client care coordinator or call (415) 323- 6755. 

• Connect with a caring therapist.

• Start understanding the impact of eating disorders on the family!

Other Services Offered By Kindful Body

At Kindful Body, we offer more services in addition to eating disorder treatment, both internal and external. We draw from Internal Family Systems (IFS), Mindful Self-Compassion, Brené Brown’s Shame Resilience Theory, Intuitive Eating, Health At Every Size®, and Body Trust in our body image therapy approach. We also offer trauma therapy and grief counseling. When you’re ready, we are here to help you with your eating disorder recovery. We also offer eating disorder treatment in Sacramento, San Jose, Oakland/Berkeley, Walnut Creek, San Mateo, Orange County, CA, or anywhere online in California. Learn more about us by checking out our blog and FAQs page!