Patients with eating disorders often have significant ambivalence about participating in treatment.  Current clinical guidelines recommend that family members or other supports be routinely included  when working with adults with eating disorders  in order to both support caregivers in their role, and provide assistance regarding current relational issues that may affect treatment (e.g., Wilksch, 2023). Given ambivalence related to recovery, the level of involvement from the parents and caregivers may differ. The main focus is engagement in some way, shape, or form. It can be a significant challenge when parents or supports are not involved, especially for young adults. As clinicians, if an adult patient leaves treatment, we have no recourse if we haven’t established contact with parents/supports. 

No matter how old your child is, they are still your child and the same person you were caring for when they were young. You wouldn’t step back and take a back-seat approach if this was another type of illness (e.g. cancer, heart disease, etc.) There are several ways that parents can be involved if their child is over the age of 18 years old, including providing collateral information to providers, engaging in family therapy, creating a safety net, such as an agreed upon plan of support and increased involvement in the event that they are not moving forward, etc. A safety net could include things like meal planning and grocery shopping, plating, being physically present to monitor meal plan compliance and provide accountability before, during, and after a meal, providing financial aid, etc. Other examples of ways parents of adult patients can be involved include monitoring physical progress such as weight restoration goals, and providing emotional support.  

Although it’s not always possible, it is recommended that your loved one sign a release of information  (ROI) at the start of treatment. If your loved one signs an ROI, this gives the provider permission to  provide information and converse with whomever the patient designates. Patients are allowed to put as many limits on ROIs as they wish, which may include permission to only provide specific information, their presence during conversations, etc. There may be circumstances in which your loved one does not consent to your involvement in their treatment. If this is the case, you still have the right to provide relevant information to the treatment team, however, they will legally not be able to converse with you in return.  

It is helpful for the treatment team to receive collateral from a patient’s family members and/or support system to best support them in the treatment process. Oftentimes, parents and caregivers have a different perspective of the patient’s eating disorder history. Given that patients with eating disorders often have significant ambivalence about recovery, initiating and developing structure is key. Anorexia nervosa (AN) is an ego syntonic disorder, meaning it limits a patient’s insight into the harm that their behaviors cause, as well as serving as a “dissonance with the patient’s values” (Gregertsen et al., 2017). Patients with AN typically value their disorder and lack the ability to create their own structure. Although bulimia nervosa (BN) is typically ego-dystonic to an individual, meaning the behaviors such as bingeing and purging, 

conflict with the patient’s values and sense of self, those with BN still require structure and support to maintain recovery (Miller, 2023). 

If your loved one is open to family therapy, go for it! It can be easy to say, “We’ve tried family therapy before and it didn’t work.” However, it’s recommended to try again. Family therapy with adult patients  is often different from that with a child or adolescent in that it’s not uncommon for the individual and  family therapist to be the same provider. It’s also important to note that we’re not doing “traditional” family therapy. In family therapy for adult patients with eating disorders, how they can be best supported throughout the process of treatment and recovery are the main focus. While we  want to break systemic interactions and cycles that reinforce the eating disorder, we’re not focusing on the system as a whole. Additionally, there is less communication between systems as patients have more of a say in how much or how little their supports are involved. We are also focusing on creating a balance of  independence and interdependence. 

There are ways to be involved both emotionally and informationally/technically when supporting an adult in eating disorder treatment (Knatz et al., 2015). Emotional support can look like being present, being aware of emotions, and providing validation and encouragement. Some examples include: 

• Providing validation, empathy, and encouragement 
• Being present and engaging in active listening 
• Remain curious and ask questions rather than making assumptions 
• Taking a non-judgmental stance in regards to treatment, the eating disorder, and progress in  recovery 
• Treating your loved one like the expert on their own eating disorder and recovery 
• Allow independence (when appropriate) 
• Thinking of the eating disorder as separate from the person 

Informational/technical support is having awareness of recovery goals and guidelines, and providing accountability. Some examples include: 

• Being aware of recovery guidelines and progress (when your loved one allows)
  • Upholding an agreed upon recovery structure 
• Providing accountability and contingencies (e.g. rewards & consequences) 
• Helping with building and upholding behavioral contracts/agreements 
• Establish warning signs/symptoms and be aware of when you need to step in
  • Provide practical support (e.g. money, groceries, rides, stable housing while in treatment) 

It can be helpful to discuss in advance with your loved one an agreed upon plan of support and increased involvement in the event that they are not progressing as expected/appropriately. 

In short, yes, however, a few adaptations can be made to better serve the adult population given that the level of parental control prescribed in traditional FBT is likely not realistic for adult patients (Knatz et  al., 2015). Studies have indicated that Family-Based Treatment for Young Adults (FBTY) has been successful in regards to weight restoration, improvements in eating related obsessions and compulsions, and global functioning (Chen et al., 2016). A continuum of phases 1-3 can be utilized and adapted based on the adult’s capability and level of independence, however, you’re likely going to be focusing on phases 2 and 3 including allowing the patient gradual control over their eating, as well as addressing developmental issues and independence (Lock & Le Grange, 2010).  

Additional evidenced based treatments that include supports that can be used with adult patients with eating disorders include Temperament Based Treatment with Supports (TBT-S; Stedal et al., 2023) and Dialectical Behavior Therapy for Families/Couples (DBT; Fruzzetti, 2007), to name a couple. In general, parents can be included in any form of eating disorder treatment.

Parental/support involvement will vary from patient to patient. Variability in involvement considers the level of parental/support involvement that the patient allows, as well as the level of ability to participate in  recovery that the patient displays. It is important to keep in mind that the goal of eating disorder recovery is not only  weight restoration and reduction in eating disorder behaviors, but also emotional maturity and the patient’s overall ability to engage appropriately and effectively on their own. Often, we see patients who present with a desire for much independence, and other times, we see patients who present with desires to remain  emotionally, financially and physically dependent on their caregivers. The goal is to find balance  between independence and interdependence. Ideally, we’re helping patients to learn to apply and utilize skills effectively on their own, while their treatment team and caregivers stand by to provide additional assistance and support should the patient require it. 

It is common for adult children to not live at home, or even nearby to their parents/supports while in treatment. This may be due to being away at school and/or traveling to receive treatment. It is still recommended that some familial/support involvement occur. Involvement in your loved one’s care from afar may look like family sessions via telehealth, regular check-ins with your loved one’s treatment  team, attending support and informational groups, regular phone calls with your loved one, and ensuring technical support and accountability is taken care of.