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Understanding the complex nature of eating disorders and fostering open family communication to increase connection with a child lost to an eating disorder illness is essential in supporting the recovery process. As a clinician, I have interacted with numerous clients, emphasizing the importance of including families in the treatment of young people who, through various means, restrict their food intake to the point of inducing malnutrition and both mental and physical distress.
The involvement of families in eating disorder treatment is crucial for several reasons. Firstly, during a phase when children’s executive functioning is underdeveloped and influenced by neurological changes due to illness, proximity to healthy adult role models becomes paramount. Secondly, parents often find themselves in the most advantageous position to disrupt eating disorder behaviors. Lastly, when children face challenges related to their food habits and body relationships, the bond between parents and daughters is often strained and requires repair.
I’ve had the opportunity to collaborate with many mothers, fathers, and their children, encouraging all family members to attend treatment with the ill young person for optimal outcomes. However, studies indicate a notable discrepancy in fathers’ participation in family psychotherapy sessions compared to mothers’, despite recommendations for both parents to engage. This trend has been associated with adverse effects on the outcomes of eating disorder treatment.
While it’s crucial for fathers to be involved, their reduced presence or absence is understandable. Social expectations dictate that mothers are to be ever-present and accessible to their children, while fathers are often more removed and relegated to supporting mothers. Further, the strain of caregiver responsibilities can overwhelm families, and fathers may find themselves preoccupied with increased duties resulting from their child’s illness. They might shoulder additional family responsibilities due to reallocating parental time and resources toward the affected child. Regardless of the reasons for the father’s presence or absence, the therapeutic journey must commence, and the family must navigate the challenges of eating disorder treatment together. This sometimes leads to mothers and daughters shouldering a disproportionate share of the therapeutic process.
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Maybe it is ingrained sexism and assigned gender roles that give once-breastfeeding mothers a priority seat in therapy with their teenage daughters. The same-sex bond between mothers and daughters undoubtedly contributes to mothers’ special place in treatment. Shared societal pressures on women and girls to derive their self-worth from body size and shape create a common understanding, further influencing the mother-daughter connection in therapeutic contexts.
Despite modern culture promoting more involved fatherhood, research on labor division between heterosexual parents indicates that mothers continue to occupy the primary parent role. That is not to imply that fathers are absent or not in a shared primary role in many families. Even in a secondary role, fathers often prepare meals. When that is true, fathers are especially important to family-based eating disorder treatments. The significance of parents preparing and serving balanced meals is often emphasized in treatment because normalizing eating is pivotal to treatment success.
I encourage both mothers and fathers to actively participate and remain committed to their children’s eating disorder treatment for optimal outcomes.
