On a recent trip with her 15-year-old, Savanna, Carolyn Straight knew the teen needed a snack. She popped into a gas station and deliberated over a pack of Pop-Tarts – an item that was once forbidden, but is now seen as necessary fuel for her daughter’s recovering body.
Straight brought the sugary treat out and watched Savanna’s face light up.
“There’s a lot more stuff that we eat now that we didn’t eat before, because I need her not to feel like food is a control,” Straight said. “That’s something we learned.”
Less than a year ago, Savanna might have regurgitated the snack. She was vomiting regularly after meals, a symptom of her bulimia nervosa. Now in recovery, she credits her mom, and the rest of her family, for helping her to stop stressing about food.
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“I don’t worry about it – I eat because I’m hungry,” she said. “I don’t think I would have made as much progress as I did without my family, because of how much I rely on them.”
Keeping parents involved is the focus of a new family-in-residence program at the Eating Recovery Center of California, the Sacramento eating disorder treatment facility where the Straights sought help last spring. The new program, launched this month, offers a more intensive version of the partial hospitalization program that Savanna participated in, building on its family-based elements.
For decades, parents were seen as the cause of adolescent eating disorders and excluded from their child’s treatment. Studies have shown that parental pressure regarding food, body image, academics and other issues can contribute to the development of eating disorders, as teens may rebel by refusing to eat.
But trying to blame someone for a child’s eating disorder is not the point, said Jennifer Lombardi, a marriage and family therapist and executive director of the center. The top priority is getting the child to a healthy place where he or she can eat normally. Research from the past few years has shown that tying parents and siblings into treatment can help with that in a big way.
“This is the next generation in terms of the services we provide here,” she said. “(Previously), you’d see the total separation of the patient and the family members, and it’d really vilify families, which is not productive. I can put your child in a bubble and get them medically stable, but if I don’t educate you on the red flags and what to say, you’re setting your loved one up for relapse.”
Eating disorders, which include anorexia, bulimia, binge eating and others, have the highest mortality rate of any mental illness, according to the National Association of Anorexia Nervosa and Associated Disorders. Anorexia is the third most common chronic illness among adolescents. Health experts have been promoting education the past few days as part of National Eating Disorders Awareness Week.
Family-based treatment, also named the Maudsley approach for the London hospital that conceived it, is increasingly becoming the preferred treatment for eating disorders, said Dr. James Lock, a Stanford University professor who helped pioneer the approach in the United States.
Rather than sending the adolescent to a hospital for recovery, Maudsley-style programs encourage families to live together in their home or in a housing facility near the treatment center if they live too far to travel. This allows parents and siblings to attend therapy, nutritional education, meal preparation and other programs with the patient. The approach works in three phases: weight restoration, returning control over eating to the adolescent and establishing healthy adolescent identity.
The benefit is that teens don’t have to be completely removed from school and friends, which can be “extraordinarily destructive to development” at that age, Lock said. Beyond that, teaching teens recovery skills in a familiar setting increases the odds that they’ll stick.
“When you need to make a change in your behaviors, you need to make them in an environment where you’re going to be practicing them,” he said. “If I learn to eat in a hospital with a nursing staff and can do perfectly well, that doesn’t mean I’m going to be able to do it when I leave.”
The Eating Recovery Center of California does not offer an inpatient treatment option. Its newest and most intensive family-in-residence program is offered to patients age 12 to 17 struggling with anorexia nervosa. Adolescents visit the facility for 8 to 11 hours per day – with families visiting for supervised meals – seven days per week.
In other programs at the center, meals are prepared by the center’s nutritional staff in an on-site kitchen. In the new program, parents are encouraged to bring meals and snacks for the child from home. This allows staff to work with patients and parents on serving size, nutritional value and preparation. It also helps patients relearn to eat using foods they enjoyed before their eating disorder took hold.
Mealtime at the center might involve staff watching parents as they try to persuade a reluctant child to eat. One of the biggest issues for parents, Lombardi said, is that they often blame themselves for the child’s disorder and don’t feel empowered to help them.
“You get stuck in a kind of purgatory,” Lombardi said. “You don’t want to say the wrong thing and make it worse, but you don’t know how to say the right thing. Parents can get overwhelmed with the pushback and the tears and the fighting. We sort of cut through all of that.”
Soft-spoken parents may require coaching on how to be more stern, while extra-vocal parents may need to learn to pull back. The main goal is to make parents understand the “food as medicine” concept – the teen needs to get the medicine, or he or she will only get worse. Lombardi compares the situation to saving a child who has forgotten how to swim.
“That feels counterintuitive – the child is 14, 15 years old and should be able to feed themselves for the most part,” she said. “But anorexia has come into their child’s life, and essentially forbidden them to eat. The goal for the parent is to take the reins and not allow your child to die.”
Carolyn Straight said that one of the biggest takeaways from the program she was involved in was learning the extent of Savanna’s illness. When she noticed Savanna purging in their El Dorado County home last year, she used a firm tone and told her to just stop. Three words from Savanna convinced the mother to seek help: “Mommy, I can’t.”
After that, Straight learned to communicate with and understand her daughter in a way she never had before, she said. Savanna, a free-spirited and artistic teen, was feeling smothered and held down by her parents. Now, Straight and her husband give Savanna options and let her choose, rather than telling her what to do.
“I use what I’ve learned here to be able to parent her even outside her recovery,” Straight said. “Just regular, everyday teenage stuff. It’s like a life skill that everybody should learn.”
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