What to Know When a Partner/Spouse Enters Eating Disorder Treatment

There are substantial resources for parents of children with eating disorders. At times, it can seem that there are fewer resources addressing spouses/partners of those in treatment. Of course, there are key differences in the nature of these relationships, including unique experiences faced by each type of caregiver. 

Some of the unique differences between caring for a child vs. caring for a partner/spouse with an eating disorder include:

• Different power structures — The power structure in a relationship with a partner is one of equals rather than hierarchical as it would be with a child. Decisions about treatment are typically made together instead of for the individual in treatment. Therefore, individuals often have to possess a willingness to come to treatment, rather than having it decided for them as might happen with children and adolescents. 
• Complicating factors —There are more factors to take into account when a partners/spouse enters treatment, such as childcare and work responsibilities, from which the partner in treatment may need to be removed for a time in order to focus on therapy. Therefore, the significant other may have to assume more responsibility for running the household and attending to finances without the same level of participation or engagement from their partner.
• Reduced emotional support — Significant others may receive less emotional support than they are accustomed to for a period of time while their partner is in treatment. This is common, expected, temporary, and necessary as the individual works to heal themselves and make progress in recovery.

So, keeping all of these unique factors in mind, how might a spouse navigate some of the common questions that arise during the course of their partner’s eating disorder treatment? Here are a few of the frequently asked questions that we hear from caregivers:

A family vacation is approaching. Should we go without the partner, or should we postpone or cancel the trip?

Mental health professionals and medical doctors most often recommend that treatment is not interrupted for a vacation, especially when someone is involved in a higher level of care. Anyone requiring Residential or Partial Hospitalization (PHP) levels of care should focus on their treatment like they would a full-time job. Vacations involve travel, organization, lack of routine, and unfamiliarity which can bring unnecessary and unhelpful stress while a person is in treatment and focused on cultivating and sustaining behavioral and emotional changes. Once someone has stepped down to individual outpatient treatment it is less clear when they are ready to try a vacation. If you’re still unsure, try the following:

• Talk with the treatment team about meal planning, coping ahead with stressors, planning for challenges, and anything that can be done to set the individual up for success. 
• Consider taking a shorter vacation that is closer to home and requires less movement. Anything that decreases the stress of the trip from the onset is useful. 
• Instead of an overseas vacation (long travel time, disrupted circadian rhythms, disrupted eating schedule, possibly unfamiliar food, plenty of unknowns, lots of walking, etc.) try a beach vacation somewhere nearby where there is less need for mobility and plenty of opportunities for rest and relaxation.

Can I tell my partner that they look pretty/nice/sexy?

Typically, therapists recommend focusing away from commenting on physical appearance in general. Part of the eating disorder recovery process is helping the individual feel valued for more than their physical container. Significant others can help with this by de-emphasizing body-related comments and focusing instead on things you like and admire about the other person such as their sense of humor, kindness to animals, activism, etc. Plus, individuals with eating disorders struggle to hear body comments accurately:

• “You look nice” can easily translate to “you have gained weight.”
• “You look healthy” is a definite no-no; individuals hear “you have gained too much weight.” 

Consider asking your partner directly what they want to hear or don’t want to hear and be open to their feedback. 

My partner is uncomfortable with his/her body and seems less interested in sex.What should I expect out of our sexual relationship? 

Sex, like any other aspect of your relationship,shouldn’t be avoided but should be discussed openly. Less may be possible for your partner right now, but a total avoidance is typically not advised. Be more sensitive if the individual is working through a history of sexual trauma and becomes triggered or has flashbacks during intimate moments. Know what helps your partner stay grounded and be present in the moment. Respect their limits and their “no’s.” Again, try to maintain patience and know that this will not last forever. The more you can talk openly and sensitively about your partner’s concerns, the better. 

Do I have to give up certain foods even though I’m not the one who is sick? Should there be certain foods in the home? How much do you try to accommodate the household to the eating disorder?

Ideally, we work with clients to make sure that no foods are off-limits and there are no good or bad foods. At no time should food be locked up or hidden from the individual, as this increases shame and reinforces their sense of powerlessness and feeling out of control. Instead, talk with the patient’s dietitian and decide which foods might be best reincorporated slowly into the home in a planful and expected way. Don’t bring home a bag of chips and leave it out on the counter. This is not likely to feel supportive to your partner. You don’t need to limit your own food choices but choose to consume foods that might be particularly difficult for your partner at your office or when you are out socially, knowing that, again, this won’t last forever. 

My partner wants to leave treatment against the provider’s recommendations. What should I do?

Spouses should hold the line with treatment providers and help the individual stays for as long as they are able. Because treatment is difficult and can be lengthy, it is not uncommon for patients to want to leave prematurely and against the recommendation of their treatment team. The more fully an individual is recovered from their eating disorder while in treatment, the less work they will have to do on their own outside of a supported environment, so in most cases it is appropriate to hold the line and reinforce the teams’ recommendation for a certain length of stay or specific treatment goals. For instance, I once had a patient that wanted to leave treatment when she was still underweight and purging about once a week. She felt that this was an improvement and all the progress she was able to make at the time. Because her husband was stressed at home watching the kids, he agreed that she could come home, but returning to household duties while still underweight and purging set up this individual to require treatment again fairly soon after discharge. With recovery a good motto to keep in mind is, “don’t be penny wise and dollar foolish.” Spending the money and resources now to move someone more fully into recovery may prevent additional and more costly treatment later down the road.

This is just the beginning of the questions and concerns that significant others face in trying to support their loved ones. On-going support is necessary to give the caregiver the proper tools to function effectively in this difficult role. Consider utilizing additional available supports, such as:

• Eating Recovery Center’s Eating Disorder Family Connection Facebook page for parents and loved ones
• Visit the online Family Resource Center, sponsored by Eating Recovery Center/ Insight Behavioral Health for more resources to help you and your family during this challenging time
• Eating Recovery Center’s Family Days Program and other Events are a chance for families to learn from the experts at ERC about eating disorder treatment and recovery 
• The National Eating Disorder Association’s Parent Toolkit — this is an amazing resource and it isn’t just for parents 
• The Academy for Eating Disorder’s Patient-Carer Special Interest Group
• Surviving an Eating Disorder: Strategies for Family and Friends by Michele Siegel and Judith Brisman
• Talking to Eating Disorders: Simple Ways to Support Someone with Bulimia, Binge Eating, or Body Image Issues by Jeanne Albronda Heaton and Claudia J. Strauss