The Core of Family Support in Eating Disorder Recovery

Normalizing eating, health and weight are the easiest part of an eating disorder for families to understand. Even though the concept of not eating regularly perplexes most people who have never had an eating disorder, the prospect of needing to regulate nutrition as a part of getting well makes sense.

However, the crux of an eating disorder is psychological and not behavioral. Although the behaviors are compulsive and destructive, the eating disorder thoughts and rules are the engine that make these illnesses so powerful.

Therapy focuses on the emotional reasons underlying the disordered thought processes, but families do not need to understand the full scope of the internal working of an eating disorder. They only need enough information to provide true support.

It’s still very complicated for families to understand that an eating disorder can co-opt a person’s mind. In all other aspects of life, a person with an eating disorder typically thinks clearly and rationally and functions like anyone else. In relation to food and weight, other thoughts and rules dominate and insist on eating disordered behaviors and actions.

Families find this concept almost impossible to understand and also terrifying to accept. No one would want to believe someone cannot think clearly about food, a basic necessity to live. Acceptance means fully believing this family member has a psychiatric disorder they cannot control. Perhaps the stigma of mental illness has lessened in recent years, yet within families it still often remains present.

The purpose of family sessions with a therapist first and foremost needs to be to reinforce the psychological nature of the illness. Fighting the eating disordered thoughts is crucial to recovery and takes a lot of hard work. If families question the validity of disordered thoughts as a symptom of the illness, then they also undermine therapy.

Families don’t need to fully understand what eating disorder thoughts are exactly or how they function. They need to know the family member does not willfully choose to engage in eating disorder behavior. The thoughts are part of an illness and the person needs help and support to get well.