I was in treatment for an eating disorder and remember having zero insight into what caused my eating disorder. I had no clue how my family dynamics may have contributed to my behaviors or cognitions. I had no idea how my Dad’s anger and frequent travel or my Mom’s depression and disordered eating affected me. I remember the other clients dreading family therapy and I questioned what was so hard about it. I didn’t have any understanding that my family could be a part of the problem. I couldn’t imagine anything being involved in the development of my eating disorder other than my low self-esteem and a desire to be thin. As I soon learned, the reality is that eating disorders are much more complex than self-esteem or a society placing importance on a specific physique. Our environments, experiences and culture all influence the development of eating disorders and must be addressed in order to successfully heal from them.
My parents had known each other since they were 11 years old and decided to announce their divorce post my leaving residential treatment. Coincidence? Probably not. In no way am I blaming my parents for my eating disorder or my recovery on their divorce, but I do believe that the environment in which I grew up played a role in the development of the disorder. The family therapy we went through helped my parents gain insight into their own work, which allowed them to see how their marriage wasn’t what it once was. Eating disorders can be red flags that something in the family system isn’t working. That was certainly the case for my family. My illness served as the official announcement that we needed help as a family and it was the catalyst for family therapy and my parents own individual therapeutic work.
I remember my Dad struggling with guilt in a family session pleading, “I gave you everything – vacations, cars, clothes, everything you ever wanted and now I am to blame!” It’s not about blame, but is about how certain environments can hide or nurture the eating disorder. My parents had given me every opportunity a parent could dream of giving. But, I came to learn I am very sensitive and pick up on everyone’s emotions and feel things quite deeply. I internalized my parents’ problems as my own. I worried about my Mom’s mental health and internalized my Dad’s anger to be about me, and my eating disorder was the perfect escape. I remember telling my Dad things that happened may not have affected others the way they affected me, but with my temperament my parents’ unhappiness became my own. The development of the disorder requires the perfect storm of temperament, biology, personal psychology, environment, and events that occur in our lives. Those realizations were probably the most important part of my treatment; they allowed me to let go of the guilt and recognize I wasn’t broken beyond repair … that everyone in my family had a role to play and that we could all work as a team together to heal. No one person causes an eating disorder, but the perfect storm of events must occur to create one.
These stereotypical nuclear family anecdotes are most likely not helpful for older adults with eating disorders, but more than likely the seeds of the eating disorder were there much before adulthood. Striving for perfection, comparison in the family, feelings of not being good enough, and family secrets can certainly impact the way we grow and become adults. Adults with eating disorders often find themselves in family dynamics that contribute to or hide the disorder, as well. High achieving couples, emotional avoidance, physical or emotional distance, and traditional gender roles can certainly impact the development or maintenance of the eating disorder. Often adults in recovery are able to change their cognitions and extinguish their behaviors but the same environments where the disorder thrived is certainly not likely to promote change and wellness.
It is important and highly recommended that family therapy be a part of treatment for adolescents, but family therapy is imperative for any person in recovery. If someone is being asked to change everything about the way they think and behave in their daily life, how are they going to sustain these changes if everything around them is exactly the same? It is possible, but the odds are certainly against them. Secrecy, shame and certain family dynamics that maintain the secrecy and shame are breeding grounds for eating disorders and it’s critical for recovery to move beyond them. I encourage all people with eating disorders to have family therapy to help each member of the family learn their role in order to help themselves and the client heal.
Eating disorders are an opportunity for all family members (whoever they might be – significant others, close friends, extended family, etc.) to reflect on their role in any dynamics that may have contributed to the development of the eating disorder. Taking the time to do this provides the space for each participant to consider the shifts needed to support healthy changes. I believe family therapy is the most effective way to establish these healthy changes for the entire family system.