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The role of parents and loved ones can’t be overstated when it comes to recovery from an eating disorder like anorexia nervosa. When the family initially finds out that their loved one has been diagnosed with anorexia nervosa, there is a wide range of emotions to process.They may experience worry and fear that their child will suffer needlessly, and might have feelings of guilt or the thought that they might have done something to prevent it. These feelings are normal in a difficult situation like confronting an eating disorder. However, they may be able to refocus these emotions on helping their loved ones restore a fruitful relationship with food and eating.

It’s also normal to want the best possible anorexia nervosa treatment available and to want to learn how they can contribute to the recovery. As the family of an anorexia nervosa patient learns more about the disorder, their engagement in their loved one’s recovery becomes more prominent. Most eating disorder treatment programs include family involvement as a core segment of the treatment process and might include a variety of family therapy sessions during their time in treatment. Here, we’ll review what anorexia nervosa involves, what kind of treatments are available, and how the family of the person in treatment can promote and support their recovery

What Is Anorexia Nervosa?

Anorexia nervosa disorder is a very serious mental health condition wherein an individual restricts caloric intake. As defined in the DSM-V, anorexia nervosa involves:

  • Restriction of energy intake relative to requirements, leading to significantly low body weight in the context of their age, sex, developmental trajectory, and physical health (less than minimally normal/expected).
  • Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain.

People with anorexia nervosa usually have a distorted body image, called body dysmorphic  disorder, that causes them to perceive themselves as overweight or otherwise “flawed,” despite medical evidence to the contrary. Weight loss or the inability to maintain a medically appropriate weight is common with anorexia nervosa. There is a related disorder known as atypical anorexia nervosa in which the symptoms of food restriction take place, but the individual does not become severely underweight. Anorexia nervosa can cause a wide variety of health complications due to the lack of nutrition, including anemia, organ failure, thinning and loss of hair, premature osteoporosis, strokes, and many different gastrointestinal complications. Other mental health disorders like depression and anxiety are also quite common in people with anorexia nervosa.

While anorexia nervosa can affect people of all ages and genders, adolescence is the most common point of onset. In fact, anorexia nervosa statistics from NEDA (the National Eating Disorder Association) suggest that up to 10 million men and 20 million women will develop at least one eating disorder at some point in their lives. With these kinds of numbers, chances are strong that you know someone who has struggled with anorexia nervosa. With that in mind, you may ask yourself, “What is the best approach for families seeking anorexia nervosa treatment?”

A Few Facts About Anorexia Nervosa

  • Children can begin showing signs of anorexia nervosa as early as 5 years old
  • The average onset is 16 – 21 years old
  • Between 1 and 3 percent of teens in the US show symptoms of anorexia nervosa each year
  • While teen girls are diagnosed with anorexia nervosa most often, early adulthood (i.e. college years) is also a common time for the disorder to begin
  • Anorexia nervosa has the highest rate of death of any mental health disorder
  • Anorexia nervosa treatment normally includes a combination of therapy, group sessions, nutritional education, and meal planning, as well as family sessions and mindful movement classes

Why Do Adolescents With Anorexia Nervosa Need Family Involvement in Their Treatment?

Family therapy is useful in any mental health treatment setting, but it’s especially important for adolescents in recovery. Unlike adults, who have more autonomy and capability to make their own decisions, adolescents are more dependent on their family for everything from procuring insurance to going grocery shopping. It’s especially effective for adolescent treatment, as the family is even more present than it is with adults. Family involvement in eating disorder recovery begins during residential treatment and then continues after the individual returns home, although it may be part of an outpatient program as well. 

For an adult, the chances are their friends and partners are closer to them day-to-day than their immediate family (although spouses are of course considered family when it comes to eating disorder treatment). A child, including adolescents, on the other hand, is much more dependent on their parents, grandparents, and siblings not only for emotional support and support in recovery but also for routine daily needs. Even speaking in terms of legal issues surrounding treatment and medical consent, adolescents have an even greater need for family support during eating disorder recovery.

What Does Family Therapy Look Like in an Eating Disorder Treatment Setting?

When it comes time to enter an eating disorder treatment facility, it’s best to get educated about what to expect from family therapy and treatment in general.  A stay at an eating disorder treatment center can be intimidating; teens especially are at a fragile age of development and should be ready for what comes. Normally, there are three stages of family treatment, although they may change a bit depending on the program and the individual’s specific needs:

Stage 1

During the initial stages of treatment, parents are on the whole less involved than they will be later. The first few days at a residential anorexia nervosa treatment center fill focus on stabilizing the client medically (if necessary) and emotionally. During this time, the center’s staff will initiate intensive programsidentifying the causes of the disorder, helping to avoid calorie restriction and other disordered behaviors, and beginning a restructured eating and meal planning regime. While this stage is largely focused on clinical treatments, the parents can begin to learn more about the disorder and what steps they can take to prepare for their child’s return home.

Stage 2

After a few weeks of the initial stages of a residential treatment program, the most intense symptoms of anorexia nervosa should be under control and the disordered behaviors reduced if not eliminated, making way for a new set of coping skills for the teenager to employ at home and school. During this time, the parents and family might be invited to the treatment center to engage in family therapy sessions. They can begin to process any stresses caused by family relationships that might have contributed to the onset of the eating disorder and learn about ways to avoid triggering a relapse, such as avoiding value judgments based n weight or comments about eating too much, as examples. During this stage, there might also be sessions for the family without the client present, where they can learn about steps to take when the client graduates from residential treatment and returns home.

Stage 3

The last part of FBT should come when the client is ready to come home. Usually, this means that they have reached at least 95 percent of the ideal weight for their age, height and build, and are not showing any signs of continued disordered eating behaviors. At this time, the client is still vulnerable and at-risk for relapse. Most eating disorder treatment centers offer an outpatient step-down program and/or an aftercare program for recent graduates, which the family can take part in. With or without these programs, it’s essential at this point to re-instill a regular eating schedule and nutritious meal plans. The family should have received education on how to support their child’s recovery by this point, and they can use this training to establish regular meal plans and mindful exercise routines and to repair relationships. Appropriate parental boundaries should also be set to help the child regain full control over their relationship with food.

Adolescent Anorexia Nervosa Treatment Is Available and the Family Can Help

Interested in learning more about adolescent eating disorder treatment at an anorexia nervosa treatment center? Anorexia nervosa is a serious disorder, and it’s not something you should try to treat yourself. A quality center for eating disorders such as your nearest Clementine program will ensure that you’re involved in your child’s treatment – making for a long-lasting recovery.

A parent’s involvement in eating disorder treatment is paramount. You’ve always done everything you can to support your child – this time is no different. Reach out today and get started on the life-saving process of family-supported adolescent eating disorder recovery.

Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.