Family-based treatment for the young adult patient

For most of us when we are 17, 18, 19 or slightly older, independence from our family of origin can’t come a moment too soon.  We are anxious to be independent, and highly allergic to ‘being told what to do’.  And usually—though young folks often do not credit this—our parents are equally anxious for us to do so.  Although many of us parents are very tearful at the ‘loss’ of our child to our home, we are also excited to see them stretch their wings and yes, excited to lead our own adult lives.

Enter an eating disorder that either strikes or cycles out of control at precisely this, the wrong, time.  

Anorexia nervosa is an illness, as I have repeatedly stated.  Further, it is a brain disorder, selectively and powerfully affecting judgment and as such needs the kind of family support to recover from that a young adult is likely to want to avoid.  Even the parents may want to avoid it.  Family-based treatment at this point, with the implications of resuming some degree of parental responsibility and involvement, feels like a “step backward” to all involved—and blows a hole in everyone’s plans.

Is it worth it?  Can it work?  I submit to you that it is often the only thing that works, and if you don’t believe it, ask people who have lived through it.  AN is not a life-style choice: it is not about “being healthy” “being athletic” “eating lean” or “being obsessed and driven to excel”, although in its early stages it may appear so.  No, eventually it will isolate the person who suffers from it in a private world of fear, obsession, food preoccupation and ill health.  And eventually it will make a successful college career impossible.  Untreated, it’s only a matter of time.

Why go there?

Well, the reason people ‘go there’ is because the onset (or exacerbation) is often initially subtle and, because it is striking at this important time in a young adult’s life, everyone just wants it to go away.  “If she/he gets into trouble, she’ll/he’ll see a college counselor or a nutritionist” they may tell themselves.  But remember the part about brain disorder?  The part about affecting judgment?  Even if it were effective to just “see a counselor or nutritionist”, this is unlikely to happen in a timely or intensive fashion.  And then comes the downward spiral that culminates in a shocking visit home at Thanksgiving or Christmas when one parent says to the other (or the only parent says to themselves): “Houston, we have a problem.”

If your college-aged child were hit by a car and unable to care for themselves for several months while they healed, you would not hesitate to step in and do whatever it took to care for them.  Even over their protest I imagine you would step in if they could not feed themselves because of their injuries.  I know I would.  Parents are our most powerful allies and advocates for as long as they live.  Do not discount the power of families.

Family-based treatment is as appropriate for the young adult patient as for the very young patient, it merely takes some modification to make it developmentally appropriate for the young adult’s life stage.

Anyone disagree?  Feel free to open the discussion here.