Arkansas
Association of
Family and Consumer
Sciences

Of all psychological disorders, eating disorders are among the most difficult and intractable to treat. The sufferer's motivation for improvement is key. Lack of motivation for recovery is commonly associated with seeing the eating disorder as somehow beneficial to quality of life. If a young person is clinging to the eating disorder and genuinely doesn't want to change she or he presents a challenge to treators and family alike. It is difficult, at best, to treat an adolescent or young adult who persists in not sharing goals for recovery with treators.

We live in an era of pro-eating disorder expression and acceptance among a large group of young people. Chesley, Klein, and Kreipe at the University of Rochester School of Medicine looked at pro-ana (pro-anorexia), pro-recovery, and professional websites associated with anorexia. Within this context they summarized information from 100 "pro-ana" websites. Results showed that pro-ana sites typically provided:(1) instruction for initiating and maintaining anorexia, (2) prescribed practices for rapid weight loss, (3) competitions for weight loss, (4) methods to avoid detection, and (5) motivational images and creeds to inspire commitment to weight loss. The average age of visitors to the 100 selected sites was 16.7 years and the highest number of counted visits to a site was 94, 869. These sites were often well-organized and comprehensive, even if their mission was, and is, to promote disordered eating. Given the popularity of these websites as well as the commonly accepted pursuit of the thin "ideal" it is not surprising that many young people present in treatment with determination NOT to be successfully treated.

Serpell and Treasure (2002) recently examined the pros as well as the cons of bulimia from the perspective of female bulimia sufferers (average age 29.5 years) themselves. Serpell et al (1999) did a similar examination with people with anorexia. All participants in these studies were patients in treatment. People with bulimia were more likely to present cons to being eating disordered than those with anorexia. Yet both groups, despite their voluntary presence in treatment, identified clear advantages to being eating disordered. Some common reasons cited to stay eating disordered included avoiding and managing emotions, getting pleasure out of eating while staying slim, and filling time and avoiding boredom.

One theme of treatment focused on enhancing motivation for recovery is helping sufferers see more cons and fewer pros to disordered eating. Christopher Fairburn (1995) who wrote Overcoming Binge Eating, asks the key question of binge eaters, "Do you want to stop binge eating?" The question could read, "Do you want to stop purging?" or "Do you want to stop your anorexic behavior?" Fairburn goes on to say to readers, "Only you can decide how pressing the need is for change." He suggests that sufferers look at both the advantages and disadvantages of change and recovery. Hopefully the advantages of recovery will outweigh advantages of remaining ill. Likewise, the disadvantages of staying ill will hopefully outweigh the disadvantages of recovery.

While being motivated to change and get better is only part of the battle, it is an important part. (Another key issue for recovery is having the skills to effect change, even if the desire to change is there.)

What can you, as a parent, do to increase your child's motivation to recover?

Here are seven tips:

• Motivate your child for NON-EATING DISORDER BEHAVIOR. For example, support activities and conversation that are not supportive of the eating disorder.
• AVOID ANY SUGGESTION that your child should or can "just snap out of it." Suggesting this undermines positive motivation for change because it is rarely, if ever, possible.
• Do your best to CONTAIN STRONG FEAR AND ANGER reactions against your child's symptomatic behavior. Your agenda and motivation for your child's recovery will most likely not match your child's. Colliding and mismatched motivations in the same household can lead to de-motivating confrontations.
• If you have an unmotivated child who is still dependent at home and you are having trouble getting her or him to treatment, YOU CAN REMIND YOUR CHILD that any reasonable, competent parent or health care professional would mandate treatment because of the health risks involved in an eating disorder.
• SHOW UNDERSTANDING for your child's frame of reference. Reflective listening helps.
• ACCEPT YOUR CHILD'S POSITION rather than arguing. This doesn't mean you agree, support or encourage your child's position, for example, about the pro's of being eating disordered. It just means you acknowledge your child's view.
• Young people with eating disorders can suffer from shame and feeling defective. They may feel they are not worth saving or are hopelessness and offering to help. For example, support for aggressive management of depression, if it is present, can help your child emerge from self-loathing and hopelessness.

Summary: Your child's motivation for change is a key factor in recovery. Your positive motivation for your child's recovery may not be matched by your child's. Families and treators alike are up against formidable odds because of pro-eating disorder influences in our culture and media. While parents can't supply positive motivation to recover they can support pro-recovery treatment efforts by providing an environment, which enhances positive motivation for change at home.