ANOREXIA NERVOSA & RELATED EATING DISORDERS
Our family therapist said my child needs to gain weight, but should I be weighing her at home to track her progress?
While weight checks are necessary to track a patient’s progress toward weight restoration, it is often best if they are conducted by the treatment team, rather than at home. In fact, you may consider getting rid of the at-home scale for the time being.
Frequent weighing can be a source of stress and anxiety for an anorexia patient and can actually serve to increase food- and weight-related obsessions. Patients have been known to hide a scale and weigh themselves often, sometimes hourly—a habit that is clearly unproductive for recovery. If your child’s treatment team instructs you to conduct weight checks at home (once per week, at most), try having your child step onto the scale backward so that he or she is unable to read the number on the scale; that way you will be able to see how your child is progressing toward targeted treatment goals without sharing specifics.
Our daughter has been in recovery for 2 years now and is doing well. She wants to go away to college in the fall, but we’re not sure it is a good idea yet. What should we consider when making this decision?
You may wish to garner the assistance of your child’s treatment team for this important decision. Each member of the team will be able to offer valuable input as to your child’s level of readiness, dietary concerns, warning signs to consider, and potential emotional triggers to be aware of when your child is away from home. Eating disorders are more prevalent on college campuses than in the general population. In addition, the stress of leaving home and living in an unfamiliar environment, and the challenges of individuation are factors that can serve as triggers for an increase in eating disorder symptoms. Another important consideration is whether your child has developed the sufficient coping skills necessary for self-care. Usually, it is best for a person in recovery to wait to go to college until he or she has returned to a healthy weight, has demonstrated normal eating patterns, has a balanced approach to exercise and nutrition, and has acquired sufficient skills for managing daily stress. You may wish to ensure that your child does not take on too many courses or social commitments too soon and/or arrange a “Plan B” alternative schedule should the experience become overwhelming. You may also wish to provide reassurance that returning home is an option if your child decides he or she is not yet ready to live away at college.
Ideally, you should connect your child to the college student health center or a local treatment professional before he or she leaves for school. This is a much better alternative than waiting until a potential crisis arises before connecting to local resources. Additionally, telephone contact can be maintained between your child and his or her home-based treatment team while a relationship with local professionals is being established. Prior to leaving home, you may wish to role-play some scenarios with your child; for example, you may work through what to do if his or her roommate has an eating disorder, or what to do if he or she experiences some minor setbacks in progress. Finally, maintain open communication between you and your child while he or she is away. Keep in mind, however, that with certain exceptions, if your child is over the age of 18, unless he or she makes allowances for you to communicate with his or her local treatment team, the information shared between the team and your child will remain confidential.
What are some practical suggestions for families of loved ones dealing with anorexia nervosa?
Many families find it helpful to have a list of “do’s” and “don’ts.” I have included one here to which you can refer as needed. Things to do when a loved one has anorexia or another eating disorder:
• Understand all you can about this complex illness.
• Obtain adequate self-support to ensure you have the coping skills needed to care for your loved one. Know your own limitations.
• Expand your list of resources for information and support.
• Seek appropriate treatment.
• Listen to and heed any recommendations from healthcare professionals.
• Maintain contact and open lines of communication with all members of the family.
• Encourage positive self-esteem (not based on physical appearance) in your loved one. Support their unique personality, talents, and abilities.
• Sincerely praise any progress in recovery, but avoid basing comments on appearance or weight.
• Relate to your loved one as a person, rather than relating to their anorexia. Understand that the two are separate.
• Know that recovery can be a long, hard process and can take a significant amount of time and resources.
• Realize there are no quick and easy solutions to an eating disorder.
• Understand there may be times when your help may be rejected or when you cannot bring about change.
Remember that your loved one must choose to put in the effort and do the work associated with recovery. You cannot force a person to recover. You can, however, be a consistent source of love and support.
• Maintain clear relationship boundaries.
• Allow your loved one privacy. Resist the temptation to “spy” on his or her eating disorder behavior.
• Strengthen family relationships. It is okay to have enjoyable, fun times as a family, and it may indeed prove quite helpful to do so.
• Maintain an active, supportive social life for yourself. This can help reduce stress levels and offers a great way to “take a break” from the demands of caring for a loved one. It will also help you avoid drifting into isolation and exhaustion. Also allow and encourage supportive friendships in the life of your loved one.
• Set a healthy example. Have a positive, balanced approach to food. Enjoy and respect your own body.
Exercise in moderation.
• If your loved one is at an immediate risk of harm, seek emergency intervention.
Things not to do when a loved one has anorexia or another eating disorder:
• Do not threaten your loved one if he or she refuses help.
• Do not engage in a power struggle to make your loved one receive help.
• Do not attempt to control the progress of a loved one’s recovery.
• Do not assign blame. Do not criticize or judge your loved one for his or her illness.
• Do not act as “food police.”
• Do not make comments about weight or appearance-even your own.
• Do not try to diagnose or treat an eating disorder on your own, apart from the appropriate involvement of a healthcare professional.
• Do not ignore medical risk or complications.
• Do not keep your loved one from socially appropriate activities because of his or her eating disorder. This can lead to further isolation.
• Do not feel obligated to respond directly to weight related questions such as, “Am I fat?” Instead, remind your love one of your unconditional support and reinforce his or her inner attributes and positive qualities.
If you are unsure how to respond to a question, write it down and discuss it with the treatment team.
• Do not deny or ignore your own need for support. Do not ignore other family members’ needs for interaction and support. Do not allow a loved one’s anorexia to be a distraction or excuse for not attending to your own needs.
Sarah shares:
The best thing I could have hoped for was a positive role model, who for me, came in the form of my mother. Knowing that someone could eat in a healthy way and not lose control of them was a great comfort to me when I couldn’t do these things for myself. Even at the worst times, I wanted people to understand that the old, healthy Sarah was still deep down inside me and that I didn’t like being the way I was (even if my behavior suggested otherwise). I will always appreciate those people who talked to me like I was still a person, and spoke of my anorexia as a temporary illness that would pass even when it seemed like I would never get better.
Term:
Individuation – The developmental process of forming one’s individual personality.
