Friday, February 20, 2009

Anorexia and Couples

It always surprises me when clinicians and researchers suddenly decide that serious illness also affects the well partner and that the couple unit is an important healing resource. Here is a story about anorexia and couples.


The eating disorder anorexia nervosa has a profound effect not only on the person with the disorder, but also on their close relationships. Spouses or partners of people with anorexia typically have not been included in treatment. This leaves partners in the dark about what is happening and robs the person with anorexia nervosa of one of their greatest potential allies in recovery - the support of a loved one.

Now the University of North Carolina at Chapel Hill School of Medicine's Eating Disorders Program is seeking adults with anorexia to participate in a 20-week comprehensive treatment course that includes couples therapy. Developed by the UNC School of Medicine Eating Disorders Program and funded by the National Institute of Mental Health, Uniting Couples (in the treatment of) Anorexia Nervosa, or UCAN, is the first and only NIH-funded trial of treatment for anorexia that emphasizes couple therapy.

Anorexia is stereotypically thought of as a disease of adolescent girls, but at any given time about half of the patients receiving treatment in the UNC Eating Disorders Program are adults, said Cynthia M. Bulik, Ph.D., director of the program and co-director of the trial. Partners of adults with the disorder want desperately to help but have no idea how and are often afraid of saying the wrong thing. "Anorexia nervosa is a complex disorder even for professionals to treat, so it's completely understandable that partners are unclear about their role and how best to help," said Bulik.

"In the past, families were often excluded from the treatment of adolescents. It's only within the last five to 10 years that we have realized we need to incorporate the family as a major part of treatment for adolescents," Bulik noted. "The same principles hold for adults.

The partner can be a powerful force in the recovery process if we teach the couple how to address the eating disorder together as a team."

Margie Hodgin and her husband Tom, of Greensboro, N.C., enrolled in the trial and completed the couples therapy. "The communication skills and problem solving we learned were great, because one of our biggest problems was that he didn't understand what was going on, and I didn't understand why he didn't understand," Hodgin said.

Hodgin developed anorexia at age 40, during what she said was a chaotic time in her life. She lost some weight because of a stomach illness and liked what she saw, then started dieting to keep the pounds off. When she got below her goal weight "It was on from there," she said. She lost about 40 pounds, more than was healthy.

A Florida residential treatment program helped her a lot, Hodgin said, but her husband felt out of the loop. "He always felt like I wasn't telling him everything, or that I wasn't getting better fast enough,"

She says. "Couples therapy has just given us both a voice and an ability to become better partners and to know how we can help each other. It has taken away the secrecy of everything."


One Sick Mother said...

It always make me laugh when researchers suddenly have these sudden "epiphanies" of what normal people call common sense and call them breakthroughs.

therapydoc said...

Actually, we've been using families to treat eating disorders for thirty years. It's been pretty obvious even to people with psychodynamic, as opposed to pure family systems orientations, that something usually has to change in relationships to make it easier for individuals to change.

Margie said...

true enough. However, the UCAN study at the University of North Carolina Chapel Hill is very precise in the issues targeted. It's not traditional couples' therapy, per se. It's manual driven and limited time-wise so acute problems inherent in eating disorders are addressed in a very proactive, spelled out kind of way. I'm a nurse and sometimes the best advice you can give a caregiver or partner in life during a health crisis is instructions on something they can DO. Simple as that. In the case of dealing with a spouse with an ED, the helplessness is huge and having a forum specifically geared toward basic honesty and trust and the tools to acquire these things is what, I think, is crucial to recovery and also what UCAN strives to do.

May not be anything new in theory, but it's specificity in addressing the ED issues builds the basis for therapy AFTER UCAN. Now my husband and I can move on to the deeper "usual" issues addressed in conventional marital therapy now that we don't resent each other and have been what the study sets out to do: UNITED.

hope this clarifies the "epiphany" issue.