For children and young adolescents with eating disorders, families play an important support role in eating disorder treatment. Families make up the primary therapeutic team for a long time, especially for patients who have a lot of growth, development, and maturing to do in recovery.
In this article, Dr. Tanner shares her expertise on families and eating disorder treatment and recovery. “Families are part of the cure,” she says. “It’s really important that we incorporate families into understanding the illness and the impact of the illness and provide them with the skills needed to help the child get well from the illness.”
Family Dynamics and Eating Disorder Development
When concerned families come to Dr. Tanner, she immediately acknowledges how difficult it can be to know when and how to ask for help. “I always assume that the families who come to me want the best for their child,” she said. “They might not always know the best way to help. They might worry that some of the things they’ve done in the past weren’t helpful, but I always reassure them that coming in and wanting to get help is really important.”
Dr. Tanner says many of the behaviors that kids engage in are normalized, such as dieting, calorie counting, and excessive exercise behaviors, which can make it difficult for parents to identify a larger problem. “A lot of times these behaviors are hidden and parents are not aware of what’s going on until it’s farther down the road,” she says. “I think it’s really important to acknowledge that it’s not the parents being complicit with the illness or doing something to make the illness develop. Instead, the illness develops and at some point, the parents become aware of it.”
For a long time, there’s been a lot of shame and stigma around mental health and eating disorders — which is why Dr. Tanner focuses on supporting the entire family throughout the recovery process. “We know that parents don’t cause this illness and that kids don’t ask to have this illness,” she said. “I focus on positioning treatment as the whole family working together to help the patient get better from the illness.”
Genetics and Family-Based Treatment
One of the approaches Veritas applies in its treatment programs is Family-Based Treatment, which focuses on the unique and comprehensive knowledge that parents have of their child since day one. “They know how they used to eat, what they used to like to eat, and how their family eats,” Dr. Tanner says. “The idea is returning them to those behaviors and empowering parents to be able to coach them through that.”
For chosen families who may not have the genetic and family history knowledge, Dr. Tanner aims to embrace the unknown. “For a lot of our families where there is a family history of mental illness or a family history of eating disorders, sometimes those families are more familiar and comfortable with the process, but sometimes it can be scarier for them,” she says. “I think it’s important to not make any assumptions about where the family sits with approaching this illness, whether they’ve had prior experience with it or not.”
At Veritas, children and adolescents are given and taught skills for eating disorder recovery, while parents are simultaneously empowered to better understand the illness. “It’s essential that parents also have these skills to move their children forward on their recovery journey as they transition to receive less support from us and our treatment teams,” Dr. Tanner says.
COVID-19 and Mental Health in Young People
The COVID-19 pandemic has worsened the severity, acuity, and frequency of mental health concerns in young people and has made accessing care for eating disorders more difficult. Supporting families through treatment has looked different at Veritas as well during the pandemic. “Passes and excursions for outings that we’ve done in the past that really help our patients in treatment have been limited with COVID-19,” Dr. Tanner says. “While we’re using the same methods and therapy approaches, it’s limited right now, and I do think it places more responsibility on the families at home.”
What Family Involvement in Recovery Looks Like at Veritas Collaborative
A core element of treatment at Veritas, family meals have remained constant throughout the pandemic. “These help the family and the patient learn to eat again together,” Dr. Tanner says. “But going through the process with a staff of support is a very different environment and experience offsite.” To help families with that transition, Veritas offers family dining rooms. Practicing cooking a meal at home is a unique part of Veritas’ programming. “Families sign up and prepare meals in these rooms and then sit down and eat the meal with their patient in care,” she says. “This allows them to go through the entire meal process together with the support of nearby staff and get an idea of the support they’re going to need at home.”
Advice for Families Supporting a Loved One with an Eating Disorder
For family members who wish to support a loved one with an eating disorder, Dr. Tanner has a few tips to consider:
- Keep lines of communication open: Early detection and intervention are important factors in full recovery.
- Use “I” statements: Focus on behavioral changes that are not related to eating or weight, which can be easier for your loved one to see and accept.
- Be prepared for a negative response: Everyone responds differently and that’s okay.
- Express your concern: Share behaviors and changes that you have observed, explaining why you are concerned.
- Avoid overly simplistic solutions: By oversimplifying the solution to eating disorders, you are not validating your loved one’s struggle, which can cause them to feel defensive, frustrated, alone, and misunderstood.
- Stay calm, caring, consistent, and nonjudgmental: Remind your loved one that there is no shame in admitting that they are struggling with an eating disorder (or any other mental health problem) and that asking or accepting help is a brave decision.
While ultimately empowering, the recovery process can be scary and exhausting. “It’s a very long process and there’s not a quick solution,” Dr. Tanner says. “It’s important to support the patient and their entire family throughout recovery. It’s a gift to walk this journey with those families.” If you or a family member is interested in learning more about eating disorder recovery, explore Veritas’ Child & Adolescent Treatment Program.
Dr. Anna B. Tanner is Vice President of the Department of Child and Adolescent Medicine at Accanto Health. She is a board-certified Pediatrician who has specialized in the care of complicated adolescent patients, in particular patients with eating disorders, for over 20 years. Dr. Tanner completed medical school and residency at Vanderbilt University and then remained there to serve on the Pediatrics faculty in the Division of Young Adult and Adolescent Medicine. Dr. Tanner has been very involved in advocacy and education efforts and serves on national and international committees for eating disorders education. She speaks frequently across the United States on the Medical Complications of Eating Disorders, especially as they affect children and young adolescents. For more information about Veritas Collaborative, please visit veritascollaborative.com.