Family conflict in eating disorders and recovery

By Diana Beaudet and Heather Thompson-Brenner, Ph.D., FAED

For some of us, an eating disorder emerges after family conflict, while for others it can be the cause of conflict – either way resolution can be challenging yet healing. But for many, reaching a place of resolution with their family or family member may be impossible – time, distance, or unfortunate circumstances become barriers.

My family played a key role in shaping my disordered behaviors throughout my thirty-year illness. And throughout my treatment, my family dynamic has come up repeatedly in working with my nutritionist and therapist, and in my journal writing.  Though I’m unable to resolve the conflict directly with my family, I’ve focused a lot of effort on sorting out my family dynamics – what went wrong, what can I learn, how can I move forward – working with my therapist.  This work has allowed me to unlock and move past some of my family-related eating disorder behaviors.

-Diana

This post is an illustration of how the patient (Diana) and therapist (Heather) relationship can confront family conflict and remove barriers to recovery.

Leaning on the eating disorder for validation

Like most, my eating disorder story is layered and complex. I’ve struggled with avoidant restrictive food intake disorder, anorexia nervosa, and excessive exercise either independently or together to varying degrees. “ED” has been both a comfort and my coping mechanism during times of family stress and complicated dynamics. While my family often expressed disappointment in me, ED made me feel strong and empowered – I believed the disorder made me somehow a better person.

The first time I talked to Diana on the phone, I was struck by the way that she communicated. Although her thoughts were impressive—detailed and complex—her words came out in a rush, with palpable uncertainty. It seemed as though she didn’t believe she’d be given the time to say everything she needed to say, and as though she didn’t believe she would be heard. Now that I know so much more about her life, I understand why she didn’t trust others to respect her; I understand why she believed her thinness and restriction were necessary to prove her worth and her strength.

Family rejection and estrangement

The struggles with my origin family ultimately led to complete estrangement from my sisters. A week after giving birth to my second daughter, my first daughter then five years old, my sister called to say she could no longer tolerate my family and she wanted to end our relationship. The majority of my remaining origin family followed her lead – with really only my Dad consistently there by my side. We tried to work through our issues, but with each effort things only got worse. I felt devastated, and my eating disorder flourished – the smaller I could be, the better. ED helped me to disappear, and was the only thing that made me feel worthy of love.

Diana’s story of her rejection by her family was shocking. It was such a sad and terrible event—it made sense that it made her further question her self-worth, and that her loneliness and sadness gave strength to her eating disorder. From the beginning of our conversations, though, amidst her shock, horror, and resignation, she would sometimes give voice to a different perspective—it was a righteously angry voice, one that could say, “Frankly, my dears, I’m better off without you.” This voice started small, but strong, and it grew along with her recovery.

During the initial stages of our estrangement, my sister and I exchanged letters, which were full of her hurt and accusations, and my explanations and apologies. I saved and poured over these letters for years after they were exchanged. When I finally began recovery, I gave the letters to Heather to read and hold on to.

I kept Diana’s letters in a folder on the surface of my desk for many months. It was a substantial folder, with many back-and-forths, angry scribbling in the margins, exclamation points and heated words. I could feel the emotion and the deep import of the messages that it held. Though Diana was getting better—and beginning to live a life more deeply connected to people outside her family–I thought these communications and the story they told would be important to revisit, at the right time, with thoughtfulness and respect.

Confronting family conflict through therapy

Recently, a sudden illness and death in our family brought us briefly together again. I was so grateful to be able to say goodbye to my much-loved brother-in-law, and for my sister’s willingness to let me and my family be a part of his calling hours, funeral and burial. This was a sad, painful and surreal time; and the flood of all that had happened in the past, and all of the feelings that went with it, came rushing back. I immediately wanted to revisit those letters to go over it all once again – always hoping for some sense of clarity in a messy, murky situation. When I mentioned this to Heather, she suggested we open the letters and read them together – one by one, line by line, with lots of stops along the way to tease out their contents.

The combination of Diana’s intense sadness over her loss, her near-total submission to her sister’s wishes in the context of her sister’s devastating loss, and her equally strong clarity regarding the unfairness of how she was being treated, all made it feel like the right time to dive back into her story. The folder had been waiting on the desk, and it felt right to open it.

I had thought, as a therapist, that I would see two sides of the story. I imagined that I would see the angry and rejecting personalities Diana had described among her family members, but I imagined that I would also see something of Diana’s contribution to the situation. I did see an interaction, but not in the way that I had imagined. I saw how Diana had twisted and accommodated to fit an impossible set of demands, and how she had shrunk into the eating disorder as a part of that effort at accommodation, and then how the angry and vulnerable people in her family had perceived that withdrawal and disappearance as a rejection. I saw how they lashed out, because they selfishly felt Diana’s efforts to disappear, in the context of her role as the pleaser and the server, was the ultimate betrayal.

I both eagerly anticipated and dreaded these sessions with Heather. We dug in and ultimately spent hours talking through it all. When I left our final review session, I did something I’d rarely done by choice over the past eight years – I bought myself lunch. And, I ate it. After years of not allowing myself to eat lunch – my powers of avoidance of this meal in particular were equal parts impressive, pathetic and alienating – I actually felt hungry and worthy of eating this food.

Reflection on perspectives

Diana – The patient

I hope, by sharing my story, to let others in similar situations know they are not alone, they are not unusual, and that they are understood. What happened with my family felt deeply shameful to me, so I initially hid my story from almost everyone for fear that I would be negatively judged. The thought would play out in my mind over and over again – that I was so worthless, my own family could toss me aside. Over time though, I’ve learned from many others that family estrangement is not unusual. More importantly, in working with Heather, I’ve learned that my self-worth is not defined by my family, my physical size, or my eating disorder – it is defined by me, and me alone.

Heather – The therapist

What happened to Diana in her family of origin situation was unfair, and cruel. The eating disorder, and the ways it drove her to isolate, likely contributed to her family’s conflict, but it was clear how the eating disorder had arisen within these impossible demands and harsh criticism. This was my sincere and heartfelt, spontaneous reaction to Diana’s private communications. I sincerely validated her small, strong, righteous voice, the one I had heard from the beginning of therapy, which became stronger over time, and became certain during our conversations over the open folder. Though the road to recovery is long and bumpy, our work together to let go of this major event felt to both of us like a crucial step on the healing path.

Psychotherapy can help with relationship issues in many ways. Some forms of therapy–or periods of time within a long-term therapy–focus directly on talking about the relationships that are at issue, and help to put them in a new perspective. Even if the people are distant—as in Diana’s case—or even have passed away, sorting through the feelings and beliefs about ourselves that we have taken from them can be very significant. Other forms of psychotherapy help to set actual goals about dealing with relationships differently, and making changes that can have positive results. Many people with eating disorders struggle with anxiety about social situations, and/or social isolation, and goal-oriented therapies (such as cognitive-behavioral therapy or interpersonal psychotherapy) can be very helpful. Another equally important factor is the therapy relationship itself. The relationship with a therapist can be a new and different model of interaction, a source of insight into how we see others, and the crucial, supportive basis for making change.

About Diana

Diana Beaudet is a senior marketing professional, mental health awareness advocate, and the proud mother of two daughters. At age 40, Diana learned that her increasing health concerns were due to an underlying, decades-long, eating disorder. She immersed herself in recovery and quickly found her way towards advocacy, participating in the first World Eating Disorders Action Day in 2016, a global movement to create greater awareness of eating disorders. Through this movement and its incredible community, Diana met her friend and mentor, June Alexander. Diana has collaborated with June to create and manage www.thediaryhealer.com to help others find a safe, supportive and healing environment to stay actively and creatively engaged in recovery.

About Heather

Heather Thompson-Brenner is a clinical psychologist in private practice in Cambridge, Massachusetts. She founded the Eating Disorders Program at the Center for Anxiety and Related Disorders at Boston University, and directed the program for more than 10 years. Heather is a former member of the research faculty in the Department of Psychology at Boston University, where she is now Associate Adjunct Professor. Her research and publications focus on the influences of patient personality traits, clinician emotions and attitudes, and patient race/ethnicity on eating disorder treatment, as well as the implementation of empirically supported treatments for eating disorders in clinical practice. Heather serves on the editorial boards of Psychotherapy and the International Journal of Eating Disorders. She is a Fellow of the Academy of Eating Disorders and is a recipient of a Patient-Oriented Career Development Award from the National Institute of Mental Health.