The Plight of the Powerless Family: An Adult Child with a Chronic Eating Disorder

Families frequently reach an impasse when struggling to help an adult child with an eating disorder. Seeking treatment for a child is easier simply because the law is on the family's side. There is no barrier to stop a parent from ordering a child to get help.

However, an adult can make personal decisions and maintains that legal right even when sick. The parents' only recourse is to involve the court, a desperate and usually ineffective and destructive act for the family in this situation.

Unlike other psychiatric disorders, forced treatment does not restore the thought process that enables recovery. Physical wellness helps by mitigating starvation, but that is not enough to lead to full recovery. Even the sickest patient will struggle with the eating disorder thoughts once fully nourished. 

Parents will frequently contact me under these circumstances asking for guidance. Typically, these families have tried to help their daughter for many years, seen little progress and have gradually lost hope.

Lost in years of illness, often never nourished and well for more than a few months at any time, the child only knows the physical and psychological state of being very sick with the eating disorder. As a clinician, I can see that any path towards recovery is a long one, but that does not mean all hope is lost. 

The choices a family faces in these moments are not easy. The key point to remember is that any steps forward must include both physical and psychological healing--eating and compassion--in order to have any possible chance of success.

Eating without compassion or compassion without nourishment seem to almost always falter. Steps towards recovery even for the chronically ill must take into account all aspects of the disease to lead to real progress. 

The advice I give is general because each person and family is different, but I always emphasize the message that any positive step must include both parts of recovery to be of any value. The family must remember how much their child is suffering at the hand of a vicious illness. Blame and hopelessness reinforce the power of the disease. Compassion and care leave open the door towards healing. 

Families often end up stuck in a few similar situations without any sense of how to proceed. What ties these family struggles together is the powerlessness of the family to help the child take a step towards getting better. 

Sometimes the child ends up minimally functional and totally dependent but refuses any further treatment despite an incredibly limited life. Here the eating disorder has had a devastating effect on the child's life but has also built in the kind of powerlessness and fear that overwhelms any attempts for change. 

Some adult children with eating disorders can have a somewhat functional life, with financial support, but have cut off all personal and emotional ties. Many parents in these circumstances pull away and largely give up but may still, in moments of urgency, try to help in more dramatic ways. 

Some children end up with a highly functional professional life and an increasingly limited personal one. The severity of illness is often hidden from most people under the surface of work success. The family tends to be much more aware of the problem but has no recourse to help. 

The extremes of response tend to be the most common ideas a family with chronically ill adult children consider. These include completely giving up or creating an intervention to force treatment upon the adult child, including the threat of legal action.

The next post will address why these approaches won't work and how a family can take steps to help an adult child with an eating disorder.


The Aloneness of an Eating Disorder

People suffering with eating disorders frequently talk about being alone. This experience is different from loneliness and also from the way most people experience being alone. It is best explained as isolation from the world by the symptoms of the illness. 

The issue is not related to being with other people. Often those with eating disorders feel more alone in a group of people than when they are physically alone because the illness makes them feel so different from others. The underlying concern is about feeling connected with others. The illness reinforces a need for independence but really interferes with any real connections in life. 

The thoughts and symptoms of an eating disorder effectively isolate the sufferer in many ways. The inability to eat regular meals makes socializing, which almost always involves food, a very difficult experience. The domination of one's thoughts by food and anything related to food leads to difficulty sustaining relationships because interaction with others necessitates the ability to engage on many topics and emotions, not just food.

The shame and fear connected with the eating disorder means that the openness and vulnerability of a friendship appears impossible. Last, the eating disorder symptoms lead the person to crave time alone when they feel calmer and safe, even though that time is dominated by the thoughts and symptoms of the illness itself.

For the person struggling with an eating disorder, the aloneness is painful but feels necessary in the circumstances of life. Pulling out of that place of being alone, no matter how strong the desire, seems impossible. The exposure and fear that would come with personal connection grow to such a degree that most people build an emotional and psychological wall to keep others out. It also keeps them locked inside the prison of the illness but there does not seem to be an alternative. Confronting that helplessness is challenging. 

A large part of recovery is to learn how relationships work in the world. There is such a focus on independence as a measure of success in our society, and that often misguided explanation of personal growth only fuels an eating disorder. 

The maturity of an adult certainly invites a measure of independence and resilience yet also necessitates important, trusting relationships in which people rely on one another. Learning how to trust others is a critical part of recovery. The difficult step is to recognize that independence using the eating disorder to cope is not maturity at all. It is an intellectual justification of the illness. It is largely denial of the severity of the symptoms and disability.

Dependence on others is not a sign of weakness but instead a part of being an adult. It is the way people cope with the challenges of life. And it is one of the most important parts of the escape from the prison of an eating disorder.