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collateral damage – parents and siblings of the anorexic child

written by Martin Knight-Willis

Anorexia is a complex illness with both biological and psychological elements and requires an integrated treatment involving both medical doctors and mental health professionals. Recently, while explaining to a friend the areas in which I work as a psychotherapist – anxiety, grief, depression, anger, relationship issues, trauma and stress – I realised that in my work with families of an anorexic child, all of these conditions may need to be addressed.

Whilst treatment of the starving child dramatically takes centre stage, it is the secondary impact on parents and families living with the illness which, if ignored, can cause collateral damage and hinder the process of recovery.

Most families live very busy lives in an effort to “get ahead”. Both parents are often working full time to sustain large mortgages and climb the professional ladder or achieve business success, whilst children are under pressure to achieve academically and at sport. When a child becomes overwhelmed by certain elements in his/her life and develops severe anorexia, it is often well entrenched and physically debilitating before the busy family notices and takes action.

Lack of knowledge and information about how to respond can result in high levels of anxiety, sadness and feelings of helplessness initially. As the child resists efforts to help, this can change to anger, depression and arguments over how to manage the eating disordered behaviour. And the stable structure of the family routine is shattered.

What Families Should Know

  • The earlier treatment is started the more favourable the outcome is likely to be
  • Your GP is the first point of call as it is a priority to manage the medical risks associated with starvation
  • Mild cases may respond well to psychotherapy or counselling available locally, however moderate to severe cases will require longterm specialist psychotherapy and medical management
  • Referral to a specialist service or a hospital if needed, will be arranged by the GP
  • Families should prepare for treatment to last from 18 months to four years and may need to re-organise family life to cope with this.
  • Most anorexia sufferers recover
  • Parents role in the recovery is crucial.

Family Survival

Winston Churchill is quoted as having said to the Admiralty that “the first duty of every battleship in War is to stay afloat.” This is also true of the family of the anorexic child and can be interpreted as vitally important that parents are mindful of the need to care for themselves and other children as the prolonged stress of supporting the unwell child progresses month after relentless month. The health professionals involved consider this a high priority and will encourage and assist.

Community Support

The Eating Disorders Association of NZ (edanz) is run by parents of eating disorder sufferers and can offer support and advice based on experience. Visit their website at or phone (09) 522 2679

Self Help

In addition to accepting the full range of resources available within the public health system and community, I also recommend to the families with whom I work, that they obtain and read a copy of a very good book first published in 2007. Skills-based learning for caring for a loved one with an eating disorder – The New Maudsley Method. This is a very readable self-help book written by experienced and very effective specialists at the Maudlsey Hospital in London.

It contains essential information and a wide range of skills to help parents and professionals manage the difficult behaviour and promote recovery from anorexia. It also contains vital information to help the carer stay mindful of their own health and to stay well. Its fourteen chapters cover such important and practical matters as managing difficult behaviours, managing undereating, understanding change, stress strain and developing resilience and the lived experience of an eating disorder.

I am continually impressed by the courage and commitment displayed by families struggling with anorexia, by the skills of their doctors managing under pressure the medical risks, and the recovery made possible by skilled psychological professionals.

Treasure, Smith and Crane. (2007). Skills-based learning for caring for a loved one with an eating disorder – The New Maudsley Method. Routledge: London.

Martin Knight-Willis is a retired counsellor and psychotherapist. He was formerly a member for the Auckland District Health Board specialist psychotherapy team for Eating Disorders.

Article posted 31 July 2008