Last Friday, I gave a presentation at my state professional organization’s fall conference entitled, “Illicit Lovers and Unwanted Guests: Treating Eating Disorders in Individuals, Couples and Families.” My organization, the North Carolina Association for Marriage and Family Therapy, comprises Marriage and Family Therapists who address all sorts of different problems that bring people to therapy, including, but not limited to, issues that cause problems in relationships.
The field of Marriage and Family Therapy sees people as creatures of relationship, and is based on the following notions:
- We develop our individual senses of identity in the context of relationships
- Families operate as a system of interdependent parts
- The problems that bring people to therapy often play a role in sustaining the balance in a relational system (i.e., a couple or familial relationship)
I named my presentation “Illicit Lovers and Unwanted Guests,” because I wanted to illustrate the dynamics that are often present when a family member or partner is a disordered eater. Psychotherapists unfamiliar with eating disorders who are working with couples and families might miss important aspects of the situations they are addressing. Disordered eaters are usually secretive about their relationships with food, exercise and/or their bodies, and eating disorders often fly under the radar, mistaken for normal concerns about weight, or even for healthy eating and exercise habits.
In a couple’s relationship, if one partner has an eating disorder, he or she has a relationship with that disorder that influences his/her relationship with their partner, much as does an extra-relational affair. Her thoughts are preoccupied with concerns about weight, shape and calories. She will go to great lengths to hide vomiting, saying when leaving a restaurant that she has to stop to pick something up on the way home and will catch up with her partner later, or mask undereating by saying that she had a big, late lunch at work and isn’t very hungry for dinner, or will wait until her partner has gone to bed so she can binge in private.
I’ve often seen disordered eaters find themselves in relationships with partners who abuse alcohol or drugs or gambling. Others find codependent partners who get a sense of worth and value from taking care of them. Improving the relationship involves increasing both partners’ connection to their own emotions in order to increase intimacy by verbalizing those emotions to their partner. A hidden eating disorder can throw a monkey wrench into this process without the therapist’s understanding. A thorough assessment for addictions and compulsions, including disordered eating, is a must. A skilled therapist can help both partners understand and appreciate the protective intent of the eating disorder—to enable the partner to participate in the relationship without the inherent anxiety—while strengthening the relationship by allying the partners against the eating disorder, e.g., “I’m not going to let you out of my sight after dinner. I love you, so I’m not going to let the eating disorder take over and have you throw up.”
When it comes to families, the eating disorder can often lurk like an unwanted guest, wreaking havoc at mealtimes (“You can’t leave the table until you’ve eaten more!”) and during shared family time (“Are you eating again? We just had dinner an hour ago!”). It’s important that a therapist working with a family in which a child or adolescent has an eating disorder help parents take a stand for their child against the eating disorder. Part of this means helping family members understand that the eating disordered behaviors are not something the child is doing willfully, rather, he/she is in the grips of a powerful compulsion. Family members can learn how to provide a wellspring of loving support for a disordered eater while refusing to tolerate the behaviors.
At the same time, the therapist should engage the parents in examining their own attitudes about food, weight, body image, expression of emotions, and achievement. Parents must recognize that an adolescent with an eating disorder is probably an emotionally sensitive soul who needs more attention paid to her emotions, thoughts, wants, needs, hopes and dreams, and less to appearance, achievement, ability and accomplishment. Validation of a child’s inner world versus what is visible to the naked eye is a potent factor in defusing the power of the eating disorder and strengthening the child’s sense of worth, as well as the parent-child bond. Eventually, the climate in the family will shift so that it is no longer a hospitable environment for an eating disorder to dwell in. The family dynamics developed over time to include the eating disorder, and must change so that there is no longer room for this unwanted guest.
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