Approaching FBT sensitively
From the perspective of an individual with Anorexia Nervosa
The most sinister thing about an eating disorder is that it manipulates and turns its victims against the people who care about them most – their family. I distinctly remember throwing a piece of steak at my brother after he sat with me for 2 hours at the dinner table, begging me to eat with him. When you are the victim of abuse, any person who tries to make you see that abuse for what it is, becomes an enemy. Even your big brother.
Think of an eating disorder as an abusive relationship you are helping your loved person out of. By thinking about eating disorders in this way, you may find that the way you approach your loved one’s eating disorder changes. Instead of being confrontational, potentially increasing the abuse of their own mind, try to be aware, gentle, and non-judgmental, intervening when necessary. Inpatient treatment is important to consider if family therapy is not enough to keep your loved one mentally and medically stable.
The importance of Family Involvement
The importance of family involvement in eating disorder recovery, nonetheless, cannot be underestimated. Anorexia Nervosa, Bulimia, and Binge Eating Disorder, in particular, all thrive on secrecy. The role of family members in recovery is to help tear down this wall of secrecy, freeing loved ones from the confines of their eating disorder mindset.
One of the first and perhaps most important pieces of advice I can give to any family involved in eating disorder treatment is to remember that when your child or sibling is in the throes of their eating disorder, they cannot see what you see. Thus, comments on appearance should be avoided entirely. Body dysmorphia, a condition most individuals with ED experience concurrently, distorts how they see themselves. For example, when you tell your relative that they are too thin, they will most likely become defensive and retaliate. More worryingly, eating disorders thrive on this validation. A more effective way of tackling the difficult first conversation with a family member who appears to be struggling with an eating disorder might sound like “Are you okay? I notice that you’re becoming tired more easily and haven’t been sitting with us for dinner as often. Want to talk about it?” If your child or sibling refuses to talk, it may be time to find a therapist or psychologist who can work alongside your family.
The second tip I have to give – one that my parents grappled with and eventually understood – is that sometimes listening and being aware is the most you can do. I understand how frustrating and painful it is to watch that car crash and not be able to do anything about it, but here’s the thing – the only person who can make someone recover is the person in recovery! If they have no desire to, no amount of pleading or attacking will work. However, there are ways you can prepare for the crash so that when it happens, the end result is not forced inpatient treatment or hospitalisation
Listen and Watch
By offering to listen when your loved one appears distressed, observing changes in how often and how much they eat (without commenting), and maintaining routines like dinner every night and breakfast together in the morning, you are supporting them through a struggle they are either not ready to talk about, or have not even come to terms with yet.
It took my Year 12 English teacher asking me bluntly “Are you eating enough? You’re looking too thin” to realise that I was not doing well. Your loved one may be just as unaware as I was. Remember this before labelling them or immediately signing them up for treatment. This may only increase the lengths they go to in keeping their eating disorder tendencies a secret.
Be patient
Finally, it is really important to be patient. If you are just starting FBT therapy, I would like to stress that it will sometimes take hours per night for weeks on end before any sort of breakthrough occurs. Although I took it for granted at the time, I am incredibly grateful that my brother, as well as my parents, sat patiently with me for hours until I felt brave enough to take just one bite of food. Having them sitting there was a tangible reminder of why I wanted to recover, and a barrier to the eating disorder’s attempts to separate me from my family. What’s more, there is a level of trust you have in your parents or siblings that simply isn’t there when nurses at an eating disorder clinic monitor meal-times. This is one of the key benefits of family-based therapy. From personal experience, it was a more comfortable, and significantly less frightening, environment for recovery to take place in.
Not ‘one size fits all’
Family-based therapy is very much an effective intervention, but it is not one-size-fits-all. It took a combination of FBT and inpatient treatment for me to finally recover from Anorexia Nervosa. Whether it takes FBT, CBT, inpatient treatment or other interventions, family will always be a critical pillar of support in eating disorder recovery.
Natalie Semaan
