A few weeks ago a reader asked a question that many parents and caregivers struggle with when it comes to eating disorders (and other illnesses):
What do you do when your adult child doesn’t want to seek treatment for their eating disorder anymore?
Specifically, here’s the comment:
Hi there, I am a mum of 22yo daughter who has after 6 1/2 yrs told us she is BN. We had our suspicions & have confronted her in the past but to no avail. She has lived away from us for the past 4 years but now living with us & we have been going to Eating Disorder Clinic seeing Specialists but now she has said that she doesn’t want to go as feels that all talk and not actually helping and that too expensive. How can I get her to keep going as hard at her age – very independent. She is talking to me off and on but obviously only when she is ready. Very moody, distant etc. Any assistance would be appreciated.
I turned to eating disorder experts Amy Pershing, Dr. Ashley Solomon and Dr. Sarah Ravin for insight. They raised excellent questions and offered valuable ideas, everything from talking to your child about what’s not working in treatment to seeking family therapy to working together on her (or his) eating.
While they responded directly to the reader, I wanted to share their wise words because they’re relevant for any parent or caregiver of an adult child with an eating disorder.
Here are their responses, in their own words:
Amy Pershing, ACSW, executive director of the Pershing Turner Center LLC, Annapolis, MD, and clinical director of The Center for Eating Disorders, Ann Arbor, MI.
- Recovery needs to be on each person’s terms, in their own time. The daughter is 22 years old, so she may need to be asserting that this is HER journey. Are the parents pushing too much? If so, hanging on to the ED becomes more likely as protection of Self.
- If I was the parent, I’d like to know more about what she doesn’t like about the treatment, and can she tell that to the therapist? Has she made progress with the treatment prior to this stall? Does she need something besides “talk” to help her get to what’s really going on? Maybe art or equine therapy?
- Are they doing family therapy? And/or would the daughter’s therapist be willing to meet with the parents (and would it be OK with the daughter?) to find out more about how to best help?
- “Moody and distant” and hesitant about treatment may mean she’s hit some tough material (perhaps some trauma?). She might be needing a breather for a bit. If she’s not in danger, it might be good to not push too much. It might also be about a co-occurring mood disorder or SUD (substance use disorder). Are there any signs of substance use or depression or bipolar behavior? All these things make people hesitant to be in treatment.
- It might be she’s ready to make a big change, and is backing up a bit, [which is] all part of the process of recovery. It might not be dangerous, but just a bit of “applying the brake” to slow down a little.
- It might be good to do things together that are not recovery focused as a family, so she is reminded that ED is not the only thing about her people care about.
- Finally, for the parents, just voice their concerns with her, ask how they can help, and let her know they’ll back off for a bit if she needs it.
Dr. Ashley Solomon, PsyD, a clinical psychologist who specializes in eating disorders and writes one of my favorite blogs, Nourishing the Soul.
First of all, let’s start with the fact that your daughter confided a long-held secret about her eating disorder to you. Eating disorders live and breathe in secrecy and shame, and the fact that she was able to share her struggle with you is extremely significant. In that moment, even if it doesn’t appear so now, she was reaching out for help, recognizing that she couldn’t do it on her own.
And the truth is that no one can. We don’t live in a vacuum and support is crucial for loosening the grip of a disorder. Shannon Cutts, an author and person who struggled with an eating disorder, says that “relationships replace eating disorders.”
I whole-heartedly believe that. It doesn’t imply that letting someone in is the cure – there really is no simple “cure” – but it’s the first and best step in long-term recovery.
The fact that your daughter’s motivation for treatment is waxing and waning is not unusual. Recovery from an eating disorder is rarely linear.
It’s more often fraught with ups and downs, challenges and successes, sometimes in equal measure. Individuals who pursue recovery often point to times along the path when they felt like giving up, walking away from their support team, and returning to old behaviors. This disease is insidious and strong.
That’s the tough news. The good news is that full, long-term recovery is possible, and even likely. How to handle a situation when someone you love is pulling away from treatment is very dependent on the individual case.
One thing I can suggest is to try to open up a conversation with your daughter to talk further about the reasons she is feeling uncomfortable. Not every treatment provider or center is the right fit for an individual. There are many approaches to treating eating disorders, in addition to many therapeutic styles.
Make sure that the center your daughter is utilizing is able to provide what she needs. Is a key element missing? Is she struggling with a certain therapist? Sometimes, these issues can be easily addressed by working with a treatment team.
Speaking of a team, often family therapy is helpful in having these discussions. If your daughter is open to participating in family therapy, it might provide a great opportunity for you to increase your understanding of her disorder and what she needs from you right now. It can also allow you to share your thoughts and concerns in a supported environment.
If your daughter isn’t interested in having your involved, it could be best to give her space. As a parent of an adult child, it can be hard to step back when you see her struggling. That doesn’t mean that you won’t continue to love her and show her encouragement. Keep letting her know that you are available to listen and to support her.
The reality is that eating disorder recovery is hard work. The fact that you are invested and concerned about your daughter gives your daughter at least one advantage in fighting this disorder.
Dr. Sarah Ravin, Ph.D, a clinical psychologist who specializes in eating disorders and has a private practice in Florida.
This is a common dilemma faced by parents of young adults with eating disorders. Once a patient has reached the age of majority (18 in the US), legal and ethical issues, along with social norms about independence and autonomy, often prevent parents from becoming involved in their child’s treatment.
It is extremely difficult to recover from an ED without strong support from loved ones. In my opinion, every person with an eating disorder, regardless of age, deserves to have their parents and/or other loved ones fully informed and actively involved in their treatment.
This generally requires the patient to provide specific written permission allowing their parent to participate in sessions and receive information about their care.
In the case described, it sounds as though the patient is receiving treatment that hasn’t been helpful. Her complaint about it being “all talk and not helpful” is common and probably true. All the talk in the world won’t help her if she continues to binge, purge, and restrict.
Perhaps in this case, given that the daughter doesn’t want more therapy and hasn’t benefitted from it, it would be more helpful for the mom and daughter to work together on their own to come up with a plan for getting the daughter’s eating under control.
For example, the mom could help the daughter structure her eating by providing 3 balanced meals and 3 healthy snacks each day, with a balance of protein, carbs, and fat to promote satiety and curb the urge to binge. The mom could spend time with the daughter after meals to distract her and help prevent purging.
I recommend the following resources for parents of young adults with eating disorders:
Skills-Based Learning for Caring for a Loved One with an Eating Disorder: The New Maudsley Method by Janet Treasure, Ph.D., Grainne Smith, and Anna Crane; Routledge, 2007.
FEAST: Families Empowered and Supporting Treatment of Eating Disorders: http://www.feast-ed.org/
Online forum for parents of eating disordered children: http://www.aroundthedinnertable.org/
Giveaway: My Recovery
Thanks so much to everyone who commented! These are the two winners of Julie Parker’s new book My Recovery: Inspiring Stories, Recovery Tips and Messages of Hope from Eating Disorder Survivors:
Emily, who left this comment: I’m an epidemiologist by trade, so I am constantly trying to figure out why/how I developed my E.D. What’s helping me right now is trying to focus not so much on the “why me?” and more on how I can move past this. I’m just trying to take it every day at the time and see myself as healthy in the future to remind myself that there is life after E.D.