Teens with Eating Disorders Benefit from Family Support

A discussion with James Lock, MD, PhD

Families can help their teenagers recover from eating disorders, according to recent research by James Lock, MD, PhD, professor of psychiatry and behavioral sciences at Stanford University School of Medicine. That finding changes years of thinking about how to address anorexia nervosa, bulimia nervosa and related diagnoses. Lock is psychiatric director of the Comprehensive Eating Disorders Program at Lucile Packard Children’s Hospital Stanford and author of the book Help Your Teenager Beat an Eating Disorder.

Q: When a teenager develops an eating disorder, the family is often taken by surprise. Which young people are most vulnerable, and what allows these diseases to sneak up on a patient and family?

Dr. Lock: Eating disorders can happen to anyone. Adolescents who focus on their weight and shape are at highest risk. Some activities where appearance or weight is important also increase the risk, such as modeling, gymnastics, ballet, wrestling and rowing. Families can miss the early signs of eating disorders because increased worries about appearance are common in adolescents, who often keep their thoughts to themselves.

Q: What are the warning signs of an eating disorder, and what should parents do if they see these signs in their child?

Dr. Lock: Warning signs include changes in eating patterns, skipping meals, increased driven exercise or discussion about weight, avoidance of desirable but calorically dense foods, refusing to eat with the family, vomiting, large amounts of food missing from the refrigerator and increased irritability and emotionality. If a parent sees these signs, it would be a good idea to make an appointment for an evaluation and consultation.

Q: Why is it important to break the cycle of abnormal thinking that accompanies eating disorders?

Dr. Lock: The brain requires a large amount of energy to function well. Not eating sufficiently for a long enough period changes the structural features of the brain and can lead to confusion, slowed thinking and emotional instability. When weight is restored, many of the structural changes appear to resolve.

It’s important to break the cycle of abnormal thinking associated with eating disorders because this continued pattern of thinking increases the risk for these disorders. Changing behaviors is an important first step in overcoming eating disorders. Changing thinking takes more time but is necessary to decrease risk of recurrence.

For decades, experts thought that parents should be excluded from treating their teenager’s eating disorder. Why has that thinking changed?

Dr. Lock: For most of the early 20th century, parents were erroneously blamed for mental illnesses in their offspring: So-called refrigerator mothers (those lacking warmth) caused autism, and over-controlling parents caused anorexia nervosa, experts claimed. These ideas about causation are without foundation.

Research at Stanford and elsewhere has shown that parents can play a big role in helping their teens recover from eating disorders. For example, we have demonstrated that a specific family-based therapy is twice as effective as individual psychotherapy for treating anorexia nervosa.

Q: When families are involved in their child’s eating-disorder treatment, what are they actually doing and how do they learn what to do?

Dr. Lock: Families should be involved in the care of their children with any illness, including eating disorders. The odd thing was leaving parents out in the first place. We suspect that family-based therapies help by enabling the patient to learn healthy eating patterns in the context of real life instead of in a hospital environment.

The Comprehensive Eating Disorders Program helps parents learn how to prevent eating-
disordered behaviors and promote normalized eating in a supportive and loving fashion. Because the behaviors and thinking associated with eating disorders are often not well understood by parents, our team of professionals helps parents by providing information, support and guidance in deciding how to best help their child.

Q: Are there situations in which family-based treatments are not appropriate?

Lock: When parents do not want to do family-based treatment, are too psychologically or medically compromised, or where there is evidence of abuse, family-based treatment is not the right choice. Cognitive behavioral treatment for bulimia nervosa and binge eating disorder is a helpful alternative. For anorexia nervosa, individual therapy can be helpful but is much slower and less likely to lead to recovery than a family-based approach.