"An eating disorder causes acute, painful, and prolonged stress in the family."

"In general, I think there has never been a real awareness of what an eating disorder entails, and although there has been greater sensitivity towards mental health and eating disorders in recent times, we are still far from where we should be. Perhaps there is a tendency to think of it as a minor disorder within the spectrum of mental disorders, when in reality it has the highest mortality rate , and the daily life of the affected person and their family is very painful and difficult."

It also happens that we socially share one of the risk factors for developing an eating disorder, which is this desire for thinness, an excessively thin ideal of beauty . This leads us to normalize certain behaviors without being aware of the risks they pose, such as a minor making changes to their diet with the main goal of losing weight for aesthetic reasons: the bikini body challenge, detox diets, intermittent fasting…

"Eating disorders have a multi-causal origin, but it is undeniable that psychosocial risk factors have a very important weight and, specifically, the aesthetic pressure that exists today to have a thin body, especially in the case of women, has a very clear influence on the development and maintenance of these disorders.

The message we receive regarding body image and thinness is actually a very perverse double entendre: you have to be thin to succeed in life , to be considered valuable, but behind this message lies the implicit and very harmful idea that if you're not thin, it's because you're not trying hard enough. The combination of these two messages contributes to the high number of eating disorders. Yes, we can say that we live in a social environment where the pressure to be thin, especially for women, "creates eating disorders."

How do young people feel about their bodies?

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"What we do know is that exposure to social media at younger ages contributes to the development of these disorders because it amplifies all the pressure to be thin. This pressure to conform to beauty standards is omnipresent and affects us all to a greater or lesser degree, but adults, in general, by virtue of being adults, cognitively mature, and having accumulated life experience, have resources to defend themselves against this pressure that minors lack. And the younger they are, naturally, the fewer resources they have. Sometimes we get into the debate about whether or not to allow cell phones, but perhaps the discussion should focus on how to address this situation . What is undeniable is that social media is having a negative impact on the mental health of adolescents and, in the case of eating disorders, it contributes to hindering the development of a positive body image for both boys and girls. It is urgent to find measures to protect them from this situation that is causing them so much harm."

The aesthetic pressure that exists today to have a thin body, especially in the case of women, has a very clear influence on the development and maintenance of an eating disorder.

"What lies behind it is a very emotional underlying disorder, a significant difficulty in managing emotions, in tolerating frustration, a substantial lack of self-esteem, and many fears . Sometimes, all this self-imposed pressure, responsibility, and perfectionism that we observe stems from a desire to be very accommodating to others , with the goal of pleasing them and thus trying to build a little self-esteem, but in reality, it's one of the worst strategies for doing so. That's why treatments are longer than individuals or families expect, because addressing all aspects related to eating can be relatively simple, but then there's a whole psychological aspect that needs to be worked on, and that requires time, patience, and a lot of effort."

Now we know our daughter has an eating disorder. What do we do?

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"It's like a bomb going off in the middle of the living room, exactly like that. Eating disorders have a very insidious and perverse development because the first warning signs can go unnoticed. You might observe that your teenage daughter, instead of taking a sausage sandwich for breakfast at school, starts taking apples or carrots, and you think, 'That's probably for the best, because it's healthier.' Or you see that she's spending more time on her phone or that she's more withdrawn, but well, you think, 'She's a teenager.' It's very understandable that families don't identify the first warning signs until, suddenly, the disorder reveals itself in a very obvious way, and you start to see the food restriction, the refusal to eat, the completely altered, irritable mood... Families often express that they don't recognize their own daughter."

When it explodes, it's like a puzzle suddenly falling into place, and, understandably, the family reacts with immense fear and uncertainty because they don't know what they're facing, whether there's treatment available, who to turn to, or what steps to take. From this point, a whole process begins in which it's essential that the family receives accurate and sufficient information about eating disorders and has guidelines and strategies so they can manage it at home in the healthiest way possible and contribute to improving the prognosis for the affected person.

When an eating disorder enters a home, it's like a bomb going off in the living room. It's quite understandable that families don't recognize the early warning signs until, suddenly, the disorder manifests itself in a very obvious way.

It's important to understand that when a family has a child with an eating disorder, they are under acute stress because it's a serious disorder that significantly disrupts family functioning and dynamics, requiring a long and winding process with ups and downs. The family will have to learn to tolerate this uncertainty, these periods of improvement and decline, and will need emotional support to manage their own suffering and preserve family well-being. Furthermore, we often see that the majority of the burden falls on the mother, which takes a significant personal toll on her, ultimately reducing her work, leisure, and social life. We can end up with a child with an eating disorder and a mother or father experiencing depressive or anxious symptoms, for example.

"The association was founded in 1992 in Barcelona, when family-based therapy was not yet a concept, and there wasn't the understanding we have now of how crucial the family is in the entire recovery process for the affected person. For families, it's essential to have information to understand eating disorders and to anticipate certain situations and feel prepared to act, but it's also important for them to have a space to share their anguish and manage their suffering."

In our activities aimed at families, we not only have a psychologist specializing in eating disorders, but we also have the figure of the expert parent , a person who has lived through the experience and has received training to be able to support others who are going through this situation. This type of psychosocial support is parallel to and complements the clinical care provided by mental health teams.

The importance of the family in addressing eating disorders

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"We assist any individual or organization that, for whatever reason, needs help or simply needs information about eating disorders. When an adult with an eating disorder approaches us for consultation, what we try to do is nurture that emerging awareness, reinforce it, empower them, and help them take control and confront the disorder by starting specialized treatment. We offer them a helping hand to begin treatment , we give them the push they need, but we don't offer treatment because we believe that's not our role, but rather that of the mental health teams, with whom we must coordinate to combine our efforts."

We must help our sons and daughters to be critical of the messages they receive so that they can build, as far as possible, a healthy body image.

"We always emphasize promoting what we call protective factors , which are those that reduce the likelihood of developing an eating disorder, but are not an absolute guarantee. However, it's worthwhile to reinforce these protective factors because if an eating disorder does occur in the home, they will then be factors that indicate a good prognosis. The main messages we could give at a preventative level are:

• If possible, have at least one meal together as a family . If we can have more than one, even better, but at least one. Everyone sitting at the table, with the same or similar food, sharing a relaxed and pleasant space for connection and conversation, and without screens during that time, including television.
• We must foster a critical perspective at home regarding the pressure to be thin. We should help our children to be critical of these messages so they can, as much as possible, develop a healthy body image. And, in this sense, we must set a good example by not subjecting ourselves to restrictive diets for aesthetic purposes, for example.
• "Promote at home a parenting style based on positive discipline , based on good treatment, that focuses on the bond, on attachment, and that promotes guidelines such as having meals together as a family."