A common question that parents ask is: "How much should I be involved in my child's recovery from an eating disorder?" I am sorry to say that there is controversy over the answer to this question. Some professionals believe that the child needs independence from the parent in order to learn how to cope with and recover from the disease on her own. This stance would limit the involvement of parents in monitoring the disease and/or progress in recovery and places the responsibility for making increasingly healthy choices on the adolescent. But it is important to understand why this position is promoted. First of all, overly controlling or authoritarian parenting generally serves to inhibit the healthy development of any adolescent, particularly given that their developmental task for this age is to separate from parents, not to remain closely attached. Thus, even in the absence of any psychological issue, there is often tension in the parent-child relationship because the developmental needs of an adolescent fly in the face of the type of control that parents of younger children are able to exert to successfully win compliance. In contrast, these tactics will be met with resistance by an adolescent.
Much to parents' dismay, as children enter puberty, that docile, easy-to-get-along-with child may suddenly develop a mind of her own and no longer accepts parents' opinion at face value or dismisses the idea that theirs is the most important opinion to consider, favoring peers instead. As painful as this displacement may be for parents, it is part of normal development and should not be treated as rebellion or betrayal. In addition, giving adolescents needed latitude to properly accomplish the developmental task of separation (toward the goal of independence) becomes a crucial part of the dance of successful parenting. This means that adolescents must have the freedom to make some personal choices and to deal with the resulting mistakes as part of their preparation for independence.
For adolescents with eating disorders, overly controlling behavior or an authoritarian style of parenting can be contributing factors for the development of an eating disorder because the adolescent is attempting to retake control over some aspect of her being; in this case, to literally control what goes in and out of her body. In these situations, yes, the parent would need to step back and release the child from the choke-hold of demands that invade her person, space and emotional needs for independence in order to allow alternative forms of coping to be embraced by the adolescent that will help to pull her back onto a more normal developmental path. Another form of developmental derailment occurs when the child becomes afraid of growing up. This can occur because parents have overly controlled her life to the point that she feels incompetent to make her own decisions and choices or because the parent has enabled unhealthy dependence through enmeshment (i.e., over involvement rather than over controlling).
In contrast, for parents who are more balanced and authoritative in their approach to child-rearing and have been allowing the adolescent an appropriate amount of freedom to develop independence and make increasingly mature decisions, may need to step forward instead of stepping back in the event of an eating disorder diagnosis. If a child is being adequately supported in the parent-child relationship and the developmental drive for separation and independence has been respected, then the adolescent's development of an eating disorder signals a failure to thrive and mature in an otherwise healthy environment, which argues for more parental support rather than less.
One way that I explain this balance to parents and adolescents is to say that an adolescent's increasing need for independence and freedom in making personal decisions is to be respected so long as the adolescent is staying within expected bounds of behavior and healthy development. This is not to say that they will not make mistakes, because it is part of growing up. But when an adolescent stumbles sufficiently as to cause serious harm to self, to others or to parents - this freedom has been forfeited for a season until recovery is obvious. For example, once drug use has been established, then the sanctity of an adolescent's room or personal belongings is forfeited such that a parent has the responsibility to ensure that illegal substances are not brought into the home or are not found on the adolescent's person or in her belongings. For an eating disorder, this means that the parents have the responsibility to ensure that the adolescent is consuming sufficient nutrition and to actively interfere with food restriction, bingeing, purging, medication manipulation, laxative use or over-exercising until such a time as the adolescent begins to demonstrate voluntary compliance and her thoughts, emotions and body indicate signs of recovery. Once a recovery path has been established and the adolescent demonstrates consistent compliance, parents can then correspondingly back up on their level of involvement to allow the adolescent to continue developing healthy coping skills on her own, which is to be responsible for learning and practicing new coping skills and continuing to reduce the offending eating disorder behaviors.
In reality, the exact nature of parental involvement, and the balance between respecting the development task of separation and individuation at this age versus protecting your child will vary according to the circumstances of each individual family. However, it is important to keep the big picture in mind. Recovery from the eating disorder and preventing your child from continuing the downward spiral is certainly the primary goal in the initial stages of recovery and more rather than less parental involvement may be required. However, ultimately it is only the adolescent who can truly beat the disease through personal knowledge and acceptance of the disorder, skill development and long-term lifestyle changes. Thus, the balance of power and responsibility for recovery must at some point transfer to the adolescent and away from the parents.
If you are struggling with the notion of whether you are to blame for your child's eating disorder, please see the Ezine article: "Eating Disorders in Teens: Are Parents to Blame?" for an enlightening discussion on this topic.
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