Social relationships play a hugely important role in the development, maintenance, and recovery from eating disorders. Young people’s connections with others around them – particularly their friends and families – often contribute to the development of disordered eating behaviours during pre-teen or teenage years.
After the onset of anorexia nervosa, eating disorder symptoms typically put additional strain on relationships. This can lead to a vicious cycle of worsening symptoms and increasing tensions or isolation.
However, just as difficulties in relationships can contribute to disordered eating behaviours, supportive interpersonal relationships are crucial to recovery. Warm and caring bonds with others help young people build a positive sense of self and value their many strengths and attributes rather than focusing on shape and weight.
Families usually constitute young people’s closest relationships and support systems. That’s why family therapy is so important in the treatment of anorexia nervosa. Working with young people and their families, family therapy sessions support families in overcoming unhelpful behaviours that may reinforce eating disorder symptoms, replacing them with positive systems of relationships that nurture lasting change.
Interpersonal Difficulties in Anorexia Nervosa
Young people with anorexia usually experience difficulties in forming secure, supportive relationships with other people. Traits like anxiety, sensitivity to rejection, and comparing oneself with others are risk factors for eating disorders. Young people who are isolated or withdrawn socially may place increasing focus on their body shape and weight, with few relationships and social interactions to prevent these thoughts from dominating their lives.
This means that people with anorexia often already experience interpersonal difficulties with both friends and family members. But these problems often get worse as their illness progresses. Research suggests that starvation and malnutrition can cause problems with social thinking, such as difficulties expressing emotions nonverbally, emotional suppression, and increased comparisons with others. These traits can cause further isolation and social exclusion.
Responses to Anorexia Within the Family
When a young person is ill with anorexia, family members may experience a range of emotions. They may feel scared, frustrated, angry, guilty, sad, and helpless. But they usually also experience deep love and care for their young person and want them to get better.
However, even when families have the best intentions, unhelpful dynamics can develop within the family. Sometimes the reactions of family members to a young person’s illness can unintentionally reinforce disordered eating behaviours and make family relationships more difficult. This can increase a young person’s isolation and withdrawal.
Families often have limited information about their young person’s illness and may be confused by their behaviours. Sometimes, a young person’s refusal to eat can lead to frustration and emotional reactions from family members. They may become critical, hostile, over-protective, or controlling.
Family members may also start accommodating or enabling anorexia behaviours to avoid confronting the reality of the illness. They might organise family routines and habits around disordered eating behaviours or ignore or cover up some of the harm caused.
Often, family members respond in different ways. This can cause tensions and divisions throughout the family system. Some family members may put a lot of energy into a young person’s recovery, while others become more disengaged. These divisions can add to interpersonal tensions and make it harder for families to provide warm, caring support to a young person.
Why Is Family Therapy So Important?
Families are usually deeply motivated to support their young person, but they often don’t know what to do. Many of the harmful consequences of eating disorders on family relationships – which, in turn, may help sustain eating disorder symptoms – can be overcome with therapy and skills training for family members. Family interventions help families nurture positive relationships with young people with anorexia and provide effective support in their recovery journey.
How Can Family Relationships Support Recovery From Anorexia?
Positive family relationships can help young people with anorexia develop a more holistic, vibrant sense of self that places value on a range of strengths and attributes rather than focusing on body shape and weight. Family members should approach young people with warmth and be ready to listen, affirming and encouraging healthy behaviours when they arise (rather than disordered eating attitudes or behaviours).
Families can learn the basic skills of motivational listening and speaking, affirming speech that focuses on change and recovery and helping young people develop a positive image of themselves.
What Does Family Therapy for Anorexia Nervosa Involve?
Family therapy for anorexia nervosa often involves several distinct elements. This might include:
Psychoeducation
Family therapy usually includes psychoeducation about anorexia nervosa and what causes anorexia behaviours and symptoms. Family members may learn to understand a young person’s social behaviours, such as a lack of facial expressions or emotional suppression. This can help them to respond with empathy and appreciate that people with eating disorders have much more concern for others than it might first seem.
Emotional Response Training
During family therapy, parents, carers, and other family members may learn how to moderate and shape their own emotional reactions to create calm, compassionate, and collaborative relationships. They may develop skills to avoid hostile, controlling, or over-protective reactions that can make eating disorder symptoms worse.
While it’s inevitable that mistakes will happen, therapy can help families understand small setbacks as opportunities for learning, growth, and transformation.
Skills for Support and Change
Family members may also learn how to support a young person to achieve positive change in their recovery. In this context, family members can continue to reinforce the skills that a young person learns in therapy throughout their daily lives. This might include:
- Motivational interviewing – helping young people build a positive sense of self that’s committed to recovery
- Exposure to fear – supporting young people to gradually overcome fears and anxieties that harm their well-being
Creating New Memories and Experiences
Residential family therapy or intensive outpatient programs can offer families a change of environment where they can incorporate new practices and perspectives. By creating memories and experiences, families can find new ways to connect and communicate, building stronger and more supportive relationships.
Families may also learn and grow through creative approaches, such as family art therapy.
The Wave Clinic: Specialist Recovery Programs for Transformative Change
The Wave Clinic offers specialist recovery programs for young people with eating disorders and other mental health concerns. We provide a family-centred, trauma-focused approach that emphasises the way that past experiences and social systems affect the way a young person thinks and acts. By understanding the broader context of eating disorders, we facilitate meaningful and lasting change.
We include families from the very start of our treatment programs, building personal, collaborative relationships with family members. We invite families to our centre to join us for a week of residential family therapy. We also offer intensive outpatient family therapy with accommodation.
If you’re interested in finding out more about our programs, get in touch today. We’re here to support you.
