The Challenge of Including Family Members in Collegiate Eating Disorder Treatment.

Attachment and connection are powerful antidotes for the isolation and self-consciousness associated with having an eating disorder in college. Collegiate recovery campuses recognize this, providing opportunities for students to spend time with peers and professionals. These connections provide skills and resources in addition to empathy, support and appreciation for the effort it takes to work on recovery while in school.

Coaches, roommates, teammates, significant others, peer and academic advisors and even specific faculty can enhance a student’s recovery journey when we educate and invite their participation in relationship-appropriate ways. Options include a group or team meeting with an opportunity to ask questions; bringing a romantic partner or best friend into a counseling session; helping the student with words to share his or her experience; and anything else that diminishes isolation and shame. Anyone whose relationship with the student impacts the outcome of treatment and recovery can be a part of the support system.

When a student lives at home with his or her family, involving those family members in the treatment process is crucial. Family members can assist by providing information during the assessment process, including medical history, family history and course of the illness. They should be included in education about the student’s condition and recommendations for supporting the medical and nutritional treatment plan.

The stigma and misunderstandings surrounding eating issues in our society have falsely portrayed eating disorders as a personal choice, bad habit or something to “shake off.” It is our responsibility as treating professionals to replace these misconceptions with accurate information, and to reach out to family members who are confused or uninformed. Otherwise efforts to help a student think and eat differently can be derailed when his or her behavior changes are questioned or criticized.

There is no “typical” family anymore, if in fact there ever was. Informing, educating and involving a student’s family members might mean reaching out to parents, grandparents, siblings, aunts and uncles, family friends who are considered members of the family, step-parents, foster parents, and others. Determining who plays a role in the student’s eating recovery takes thorough assessment, plus navigating confidentiality issues, complicated relationships and interpersonal drama. If a student gatekeepers us from contacting family members, it is our responsibility to convey our rationale and encourage the student to allow communication. This may require that we provide specifics of what and when we will be interacting with family members, or to only speak to them when the student is present. Conference calling and video chat allow us to include individuals in multiple locations in the same session.

The process of incorporating family members into eating disorder treatment is more difficult when key players are not interested in participating, have a volatile relationship with the student or are unwilling to accept that their loved one has an eating disorder. When one member of the family is struggling, everyone involved copes or fails to cope in different ways. Common defenses are rejecting the diagnosis, ostracizing the identified patient and retreating into dysfunctional behaviors. It can be easy to judge and believe that we would handle things differently. If we offer family members the benefit of the doubt, outward anger and alienation can reflect inner devastation and guilt. If at all possible, instead of excluding difficult or unwilling family members, our goal is to convey the importance of their participation without implying that they are at fault. If their reluctance to participate stems from a belief that they have contributed to the development of the eating disorder, education and counseling can help them work through feelings of guilt, grief and failure.

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