Parenting and creating a safe and supportive home environment for all family members during eating disorder recovery

An eating disorder diagnosis affects every member of the family and the lifestyle of the family, just as it would with any grave illness. Although it is natural for parents to want to retain normalcy throughout recovery, families often find that during recovery it is necessary - and a relief - to make temporary changes in the home environment to support recovery. Some changes may be permanent. But one thing is clear: parenting the ill person and other siblings during the months of initial recovery is a true challenge.

Many of the tools parents need to employ during recovery do center around food:

• Deciding who will be accountable and in charge of food during recovery, and at what stages. Although it was once believed that patients of all ages should be in charge of food decisions during recovery, the recommended treatment for adolescents has evolved to one where parents and caregivers, or inpatient staff, take the lead during the early stages.The "Family-based" or "Maudsley" treatment puts parents in charge of what, when, and how much food until the patient is able to reliably take this responsibility back. Some families use the "Magic Plate" approach.
• Having regular family meals in which all members eat the same menu is often advised.
• During inpatient stabilization and residential care, parents learn skills and techniques for continuing the recovery process after release by attending family therapy, training sessions, and family week activities.
• Nutritionists and dieticians can be an excellent resource for parents in learning about dietary goals, the dynamics of the recovery process, and transitioning to normal eating.

Other issues involve skills around discipline, boundaries, and rules during recovery:

• The Off the CUFF book published by Duke University's Eating Disorder Program
• The Carer's Toolkit based on the Skills-Based program by Janet Treasure offers a view of caregiving styles and how to best support a loved one.
• Sample college transition contract
• Template of letter to future treatment providers if adult patient refuses support from family (anosognosia)

As in any caregiving situation, there is also a need to balance attention to other siblings, to the marriage, and responsibilities outside the home:

• Parents often decide to suspend any non-essential activities in the community
• Many families find that a leave of absense from work or staggered shifts are necessary to make sure a parent is home at all times for meals and monitoring
• Siblings need and deserve appropriate support and attention during recovery. (Family-Based Maudsley approach includes the entire family, including siblings, in the treatment)
• Finding peer support can be very helpful: local support groups
• Parents often use the analogy of "if my child had cancer" to assess priorities; an eating disorder is a life-threatening emergency and deserves the same urgency and attention
• Self-care, for parents and caregivers, is necessary to keep the necessary focus and stamina for long-term recovery. It is not a luxury but a necessity to get enough sleep, emotional support, practical help, and respite. UNC/Duke Caring is Caring website.
• Taking advantage of resources outside the eating disorder world which support caregiving, like the National Family Caregivers Association.