In Charge? BE In Charge Of Eating Disorder Behaviors

"It's all about control."

Not really. In fact, eating disorders are better described as being controlled: by thoughts and compulsions that lose all relationship to reality. Eating disorders take control of the person and the family. But how does one take control away from the anorexia or bulimia or binge eating and get normal life back? First: figure out who is in charge.

Teamwork works

Teamwork is a key component of eating disorder recovery. Not only is it important for the patient to have people on his or her side against the illness, it is important that no one be pulling in the opposite direction.

I've learned that working as a team isn't as easy as it sounds. It requires everyone involved to have the same underlying ideas about what the illness is, who the patient is, what the support system is like, what the treatment should be, and exactly what roles everyone will play. I wish I believed that could happen naturally or by accident, but the truth is that it rarely does. It takes work, and it is hard.

I believe parents have to consider themselves and make sure they are an equal member of the team. Eating disorder treatment that concentrates on the patient in isolation is unlikely to be enough. But fair warning: not all eating treatment providers are used to doing this, and not all believe in it! Modern treatment of eating disorders needs to consider the whole picture to be successful, and if the family isn't involved in a positive way, they can do the opposite.

"When in charge, be in charge" is an excellent phrase but not always understood. It means that if you, as a parent, are responsible for food, medicines, monitoring, going to appointments, then you have to do so in a confident and assertive way. It has to be direct and it has to be supported by everyone else on the team. When we cede authority or responsibility to others, we need to do so willingly and with confidence as well - trying to control at a distance or without authority is painful and even counterproductive.

Having an eating disorder is frightening and confusing. Patients do better when the messages and boundaries are clear and consistent. It is so important that each member of the team - including parents - know exactly who is responsible for what and how information is shared.

For example, who is in charge of shopping, weighing, reporting on behaviors? And if new symptoms or compliance issues come up, who is responsible for communicating that to other members of the team?

The most important is knowing who is in charge of the team, however. Is it the doctor, the therapist, the parents, or the patient? Does the person who is in charge know they are, and are they taking care of everything, including communication with the others? I see so many cases where the therapist is considered in charge but isn't communicating with others on the team, including the parents. Many times, I see when the parent is in charge, but is too frightened to do what they need to do. Or times when the parents are in charge but disagree with each other.

In many cases, the person in charge is "ED" and that is rarely a good idea.

(next post I'll talk about when we're NOT in charge)