Treatment for an eating disorder is a long hard road. Part of the reason relapse rates are so high and full recovery so difficult is the enduring emotional struggle even after normalizing food and weight. It takes personal fortitude and outside support to help people in recovery not succumb to the iron will of an eating disorder. The crucial but often missing piece for families to understand is that the battle isn't over when someone looks normal again.
It's standard to educate families of people with eating disorders for the best chance for full recovery. Most treatment programs provide family groups in which the group members bring families for an education session. Primary therapists usually include the family in sessions from time to time for the same reason. Recommending books to families can help the patient feel better understood and expand what kind of support is available in the treatment. There are a few practical points all families need to best participate the process.
Everyone is aware of the eating disorder behaviors, restricting, binging and purging. Most families assume that ending these behaviors means full recovery. That false statement is especially worrisome when the patient goes to an inpatient treatment program. Upon admission, the relief for the family is significant, and the expectation is that the patient leaves the program fully cured. Unfortunately, that's never how it works. From the moment of admission, families need to understand that a program can jump start treatment, but that support will be even more necessary once the loved one comes home.
Learning how to eat back in the world has new challenges both in choosing and preparing food and in handling the stresses of life without returning to the eating disorder symptoms. In addition, it's very difficult to struggle to eat while trying to accept the changes to one's body. The underlying, internal critical thought process, the main psychological symptom of an eating disorder even after resuming normal eating, is much stronger after treatment. Consistent, loving support is the best antidote.
One inevitable mistake families make is to focus on the food. Patients avoid families most frequently because of feeling constantly watched at meals. The monitoring always comes from a caring place. After feeling so powerless, families wish that just ensuring enough food passes the patient's lips will be enough to lead to a cure. Instead, patients feel exposed and avoid families rather than submit to being constantly watched and criticized. The most effective way to handle meals is to provide food the person feels comfortable with, allow her to choose and eat as she wishes and simply ask if everything is fine. Giving her the freedom to act like an adult will be most encouraging while watching her at every meal only reinforces the eating disorder.
Families understandably want a clear treatment course with a definite prognosis and endpoint. The process of getting better from an eating disorder is a much more complex road. The exigencies of stabilizing the body and mind to relearn how to eat normally and how to function as an adult without the security of the eating disorder rules are cumbersome. The path to recovery involves many ups and downs and demands a resiliency to weather the tough spots and remember the light at the end of the tunnel. It's extremely difficult for the patient, battling daily in the trenches, to see any light at all. One of the most helpful things families can do is to reinforce the need for patience and to remember treatment is a long, arduous process. Believing in the family member even at the toughest of times reflects a level of confidence and love that endures and strengthens her resolve each day.
By focusing on the positive steps and remaining steadfast on the hard days, families express a sentiment that an eating disorder has surely eroded over the years: trust. The shame of being sick pushes patients to sneak and lie and leads families to question this person who had always been seen as trustworthy and reliable. The internal, critical thoughts of an eating disorder only get stronger when families decide they can no longer trust. I routinely suggest families learn to distinguish the hiding that comes with the shame of being sick from one's true character. Re-establishing trust can make the difference between a full recovery and a partial one. When families work hard not to criticize and blame but instead to forgive and love, the effect on the course of recovery is immeasurable.