A resource for professionals and carers of people with eating disorders

Accomodation_and_enabling.jpg Eating disorders have a social context that draws others into the illness. The symptoms of an eating disorder very soon play a central role in family life; normality disappears, social life disappears, future plans are put on hold and interactions around food increasingly dominate all family relationships. Understanding how families reorganize their lives around a problem, however, is far more important from a treatment point of view than knowing how that problem developed, Eisler (2005).

When living in the midst of an eating disorder, families frequently become bullied into what they eat, how they eat, where they eat or when they eat. It is only natural that they frequently respond in a manner that accommodates the symptoms in a bid to keep the peace.

Our intervention is based on a cognitive interpersonal maintenance model which proposes that interpersonal factors (overprotectiveness, hostility, criticism, accommodation and enabling) can develop within families and maintain the illness (Schmidt & Treasure, 2006; Treasure & Schmidt, 2013). Inadvertently, these may hinder recovery. These are modifiable behaviours, however, and it is thought that carers may benefit from skills training in aspects of eating disorder management, similar to those used by professionals in specialized inpatient services (Rhind, et al., 2014).

Consequently, skills include the use of motivational interviewing as a means of providing calm and compassionate meal support, engaging intrinsic motivation to change. Carers are also taught the application of behavior change principles and about the cognitive and emotional styles associated with eating disorder behavior. Skills and techniques include:

  • Strengthening carers beliefs in their abilities to make change possible
  • Giving carers the opportunity to express concerns about the illness
  • Discussing the basic principles of behaviour change
  • Teaching communication skills (ability to express & process emotions)
  • Promoting respect, satisfaction and a unified approach within the family
  • Learning the skills of problem solving
  • Maximizing carer skills (warmth with limits and boundaries)
  • Highlighting those factors which may be aggravating the problem