Anorexia and bulimia kill and maim close to 20 percent of their victims, 87 percent of whom are children under the age of 20; the most lethal of all the mental health disorders, it is a little known fact that the afflicted also include men and women alike in their 30’s, 40’s and 50’s. In their roles as husbands, wives, parents, and highly successful business professionals, the latter are coming forward in increasing numbers to reveal these previously well-kept secrets, breaking silences that have lasted for decades. The ever-expanding community of patients, their loved ones, and their professional care-takers continue to seek better ways to comprehend and conquer these pervasive and life-altering, though elusive, diseases.

Be they revealed or undisclosed, diagnosed or undiagnosed, eating disorders insinuate themselves into the very fabric of life and human relationships. As the cornerstone of human connections, these diseases function as the interface between patient and significant others, as the third point in what becomes relational “triangles” between children and parents, husbands and wives, therapists and patients. Taking up residence within a person’s core, eating disorders dominate the inner life, robbing their host of the most precious of all relationships…that being the individual’s relationship with his or her own Self. Displacing and replacing the core personality, anorexia and bulimia wrest control over life functions, holding the patient hostage, depriving him or her of the emotional resiliency required to solve life problems, cope with adversity, engage in confidence-building life opportunities, and make healthy lifestyle choices. Children who fail to recover in their youth are destined to carry their disorder with them into their adult years, further decreasing their odds of ever finding and developing healthy, gratifying, and ultimately, healing personal relationships.

For the past three decades, clinicians and researchers in the eating disorder field have sought to find solutions to these problems and to optimize treatment practices and recovery outcomes. Despite their committed efforts, cure remains tantalizingly out of reach for far too many sufferers; cognitive behavioral techniques which have been shown to be the treatment modality of choice for bulimia nervosa fall short of achieving consistent, timely and sustained outcomes in all too many cases, typically rendering recovery an extended, expensive and at times frustrating and unattainable process. It has been my experience as a psychotherapist dealing almost exclusively with eating disorders for the past 35 years that effective recovery remains elusive in most instances where the patient is treated separate and apart from the context of family relationships. The key to effective, timely and sustained life saving recovery, even for the more intractable cases, lies in fostering the authentic and proactive human connections that will ultimately reclaim the lost or exiled Self.

Eating disorders are relational diseases. They show up within the context of daily living, side by side with family and loved ones, at kitchen tables and in family bathrooms, (and all too rarely in the doctor’s office) Recovery, too, takes place day to day in the course of life. Patients average 45 minutes per week face-to-face with health professionals, and spend “24/7” living out their lives alongside loved ones. It is for family members to pick up the gauntlet of opportunity for involvement in their child’s or spouse’s cure and to optimize it. Though not responsible for causing these diseases, parents, partners and siblings enjoy the potential to become primary forces in healing and/or preventing them. With eating disorders, the stakes are high; if not part of the solution, family members risk becoming part of the problem. Family members who provide reality-based, proactive and loving human connections through an authentic, courageous and creative use of themselves provide invaluable role-modeling for the patient in recovery who seeks to learn to do the same.

Eating disorders occur when, in the company of genetic susceptibility, life stressors outweigh a person’s developmental capacity to cope, when the achievement of developmental and emotional tasks has somehow been insufficient to prepare the individual to assume responsibility for effective problem-solving and self-care. Through creating, restoring, and augmenting primary relationships with loved ones and health professionals, the task at hand is to fill in the emotional voids that separate the afflicted individual from mature functioning. Healthy human connections, both personal and professional, become the primary source of the essential life lessons that need to be taught, and to be learned. They provide the context through which eating disorders heal.

Spirituality, a force essential to the healing of mind, body and soul, is also derived through healthy connectivity and nourishing relationships…with self, with others, with nature or a Higher Being. It is the capacity to achieve soulfulness or connectivity that gives ordinary life depth and value, which elevates a person to the most profound receptivity and acceptance of life and self. Psychotherapy, through the relationships it offers and ameliorates, is a care-taker of the troubled soul. It is through therapeutic change that the individual reorganizes and reshapes life and self, feeding the soul even as it enables the patient to re-feed his or her body.

The therapy relationship ideally becomes the archetype for healthful, quality relationships elsewhere in the patient’s life both within and outside of the treatment system. Acting as advocate, coach and mentor for the patient and his or her wider relationship system, through a creative and courageous use of the Self, the psychotherapist provides powerful role-modeling for families of eating disordered patients, enabling them to behave similarly in the interest of promoting their loved one’s healing. Achieving successful outcomes with eating disordered individuals is frequently dependent upon the professionals’ commitment to “growing” the quality of familial connections, to encouraging parents and partners to become proactive supporters of their loved one and of recovery.

An internationally renowned expert in the treatment of eating disorders, Abigail H. Natenshon, MA, LCSW, GCFP is a psychotherapist who has treated children, adults, couples, families and groups for the past 34 years. The author of When Your Child Has An Eating Disorder: A Step-by-Step Workbook for Parents and Other Caregivers (Jossey Bass Publishers, 1999), and the e-book Doing What Works: The Professionals’ Guide to the Treatment of Eating Disorders, Abigail is the founder and director of Eating Disorder Specialists of Illinois: a Clinic without Walls. She hosts three informative web sites, www.empoweredparents.com, www.empoweredkidZ.com, a wholesome alternative to the pro-anorexic web sites, and www.treatingeatingdisorders.com designed specifically for health professionals and educators. She has appeared on national television as an eating disorder expert on The Oprah Winfrey Show, The John Walsh Show, Starting Over (NBC) as well as on MSNBC and National Public Radio. Abigail is also a Guild Certified Feldenkrais Practitioner based on the work of Dr. Moshe Feldenkrais. She has become a leader in using this neurophysiologic approach to augment more traditional approaches to treating patients with eating disorders and body image disturbances. She speaks widely to parent and professional audiences and maintains a private practice in Highland Park, Illinois where she resides with her husband.