Eating disorders are notoriously difficult to treat, especially without family participation. According to the Alliance for Eating Disorders Awareness, genetic, psycho-developmental and sociocultural factors combine to create an eating disorder. Although no single person can cause an eating disorder in another, the family members of an affected individual can be instrumental in that person's recovery.
Anorexia and Bulimia
Anorexia nervosa features self-starvation and extreme weight loss as its major symptoms. Anorexia is diagnosed when a person is 85 percent of ideal body weight or less. Anorexics are terrified of becoming fat and see themselves as overweight even when they are clearly underweight.
Bulimia nervosa involves eating large amounts of food, far more than the average person would eat at one sitting, and purging afterwards by means of self-induced vomiting, diuretics or laxatives. It is possible to be at or above ideal body weight and still suffer from bulimia.
Enmeshment
The term "enmeshment" is used to refer to families with serious boundary problems, says Boulder, Colorado therapist Dr. Allan Schwarz. He explains that a healthy family has flexible boundaries that accommodate age-appropriate autonomy and privacy. In an enmeshed family, the eating-disordered child has difficulty separating her own identity from that of her family members, often her mother in particular. A mother who has her own food and weight issues may project them onto her daughter, who feels she must be perfect to win her mother's approval or compete with her in the quest for weight loss. Enmeshed parents may be either overprotective or neglectful. The child feels if she cannot control what is going on around her, she can at least control what goes into her mouth.
Additional Factors
Trauma such as abuse or parents' divorce can trigger eating-disordered behavior in a child with a genetic predisposition. A daily environment that places a high value on thinness and beauty can compound the problem, as can a competitive component of the child's life. For example, athletes and dancers who are told their weight affects their performance can be susceptible to eating disorders. The bodily changes inherent in puberty and their implications of sexuality may contribute to an eating disorder in a child who is not ready to grow up or uncomfortable with his sexual orientation.
Ways of Hiding Eating Disorders
It is often difficult for family members to spot an eating disorder until the child is very sick, especially if they choose not to see the signs. A person who is becoming too thin may wear several layers of baggy clothing to hide her body and keep herself warm. She may defer eating with the family, stating that she ate at school or a friend's house, or that she plans to eat later. Hiding food or chewing and spitting food into a napkin when forced to eat with the family are common behaviors. Bulimics may turn on the water in the bathroom or take showers after meals to hide the sound of purging. Being aware of your child's behavior before and after eating is crucial.
Family Therapy
Some treatment programs insist on family participation in eating disorders therapy. By attending therapy sessions, family members show their support for the disordered individual and learn how to grant more autonomy while still supporting recovery. They learn how to prepare appropriate meals, monitor physical progress, and spot early warning signs of returning to eating-disordered behavior. Family therapy is not meant to blame or chastise anyone, but rather to show the family how to work together to mend broken relationships.
