A few years back, the Academy for Eating Disorders published a list of nine facts about such ailments. While, of course, plenty of work has been done in the interim, and many discoveries have been made, it is interesting to look back on this document created by 19 authors from three institutions of higher learning, two of them European and one American.
The very first fact mentioned is that many people who suffer from eating disorders may appear healthy, as in “no big deal,” while they are nevertheless quite sick. The problems exist in three different areas: the body, the mind, and the person’s interactions with society in general. To break it down even further, the somatic risks show up in “multiple organ systems including the cardiovascular, gastrointestinal, musculoskeletal, dermatologic, endocrine, hematological, and neurological,” while psychological/psychiatric difficulties present further potential for malfunction.
To complicate matters even more, the affected person’s appearance is not always a clue to the underlying problem. Someone who engages in restrictive eating might look emaciated; on the other hand, their physique might be quite hefty. Neither bulimia nor binge eating can be deduced from an individual’s looks, either. It is important to not make assumptions without evidence.
Another fact is that the majority of people troubled by eating disorders cope on their own, or simply give up, and never even seek treatment. They might keep the problem a secret for years, fooling family members, friends, medical personnel, and even themselves.
Old assumptions die hard
Premise #2 is, no one should leap to the conclusion that family malfunction is the cause. Fault does not always lie with the parents, and, in fact, a child’s eating disorder, especially if it becomes life-threatening, can bring a lot of stress into the family dynamic. Caregivers may be in for a rough ride, especially when the troubled person is anorexic. Parents might suffer “higher levels of distress than individuals caring for patients with psychoses.”
On the other hand, once the “identified patient” is under treatment, attention must also be paid to educating the caregiver/s in self-care, to prevent further erosion of the overall situation. This sounds distressing, but it is very positive news because, in contrast, the historical fact mentioned in a recent post, a “parentectomy” is no longer considered the first, best course of treatment for anorexia.
Start with the positive
In fact, family-based treatment has proven to be very effective, particularly in cases of anorexia. The first step is to help the older members recognize the knowledge and skills they already possess as a strong basis on which to build. When the affected person is an adult, a couple-based intervention can be successful, and might begin with teaching the well partner how to overcome the fear of making the situation worse with inappropriate actions or words.
Up to that point in the history of understanding such illnesses, family-based success had mostly been achieved in cases of anorexia. The study’s authors urged much more research into how BN (bulimia nervosa) and BED (binge eating disorder) could be affected. Still, no matter how good the intentions and how ambitious the family-based treatment may be, the functioning of the family as a whole, in addition to the well-being of individual members, cannot help but be affected.
In particular, there may be an unavoidable financial burden. For teenagers, dealing with these matters as either the identified patient or as a relative can add extra stress to the already multitudinous problems of adolescence. For adults, the more obvious areas of difficulty are intimate relations and reproductive health, as well as adaptation to the theory and practice of new parenting skills.
This should go without saying…
In the realm of family, it ought to be very obvious that prevention is much preferable to intervention. To raise healthy children is such a difficult undertaking, parents ought to have access to comprehensive training — early and often. If for any reason such education is not provided by official entities, perhaps this is a signal that groups of other types need to step up and take responsibility for offering solid advice and practices under which children can flourish.
Your responses and feedback are welcome!
Source: “The Science Behind the Academy for Eating Disorders’ Nine Truths About Eating Disorders,” NIH.gov, October 2017
Source: “Identified Patient Psychology: Unraveling Family Dynamics and Treatment,” NeuroLaunch.com, 09/15/24
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