When an eating disorder finds its way into your family it can often feel like you have woken up in a parallel universe, and you may find your normal family rituals, rules, culture feel changed.

Focusing on healthy boundaries can help us navigate this frightening time.

What are boundaries?

Boundaries are the limits we set for ourselves and our family members.

Healthy boundaries means being true to ourselves and our family values.

Unhealthy boundaries are often observed in someone with an eating disorder where rigid rules are put in place to protect the ED and to keep people wanting to help at a distance.

Why are healthy boundaries important?

Boundaries keep us safe.
Boundaries prioritise our needs – what we will and will not accept
Boundaries create trust and security for our young person
Boundaries give you a strong sense of what is important

How do we create boundaries?

You already have the skills to create boundaries for safety. Remember when your small child was riding their first little bike and they hurtled along loving the feeling of speed and how fast their little legs would go on the pedals and as they gathered speed down the footpath you would say a firm STOP to ensure they would not go close to the road? Of course they did not want this boundary but it was necessary for safety.

So the message here is that even though a boundary may feel punitive to the person receiving it – it is our job to keep them safe (even though our confidence may have been eroded)

What are the steps for boundary setting:

1) Make a plan. This ensures you won’t operate in crisis as an eating disorder loves to create chaos. A plan ensures you are being proactive rather than reactive. This plan will look different for every family. Decide what you will and will not tolerate (example: swearing, removing bedroom door, phone access, behavior towards siblings, violence). Your plan needs to include consequences for each behavior (for example – because you spoke to your sister like that we will not go to the movies as planned, food to be added to plate if meal not consumed in allotted time frame etc.).

2)  Parental agreement is critical.  An eating disorder gains strength with parental/carer disunity as it allows negotiation and uncertainty of consequences. It is therefore important that parents/carers are on the same sentence of the same page of the same book!

3)  When formulating your plan it can be helpful to ask yourself “what would we do if the eating disorder was not in charge?”

4) Consequences: You must be willing to follow through. It is very scary for a young person with an eating disorder to think Mum and Dad cannot handle their behavior. It is great modelling for your young person to see you enforce consequences for boundaries that are crossed. Often young people with eating disorders have porous boundaries with their decision making relying heavily on the opinion of others so it is good for their ongoing self esteem in recovery to see that firm boundaries are okay.

Note – Discussing consequences during a meal is not recommended as your young person’s “healthy self” is usually off-line whilst dealing with the stress of the meal.

5) Review your plan regularly. When something goes wrong it is great feedback, not failure. Eating disorders are shape shifters and as such you will need to adapt your plan as required. Be aware of the difference between changing your plan to accommodate the eating disorder’s wishes as opposed to what is required for recovery so that it does not appear to your frightened young person that you don’t know what you are doing (As stated previously, remember to ask yourself “what would I be doing if the eating disorder was not in charge right now”).

6) What makes a plan successful?

• Reliability
• Consistency
• Delivery
• Flexibility to adjust when things aren’t working
• Secure consistent boundaries that are set by caregivers and NOT NEGOTIATED by the child create predictability which in turn reduces anxiety.
• Boundaries need to be delivered with love, understanding and kindness. For example – “we can see how tired you are so we will sleep with you for the next 30 days to ensure that you aren’t compelled to exercise at night.”
• Be firm and loving – your plan will ensure you don’t act out of emotion.

What are some ideas for your plan?

• Supervision for meals at school
• Things we can say if the snack/meal is hard
• Consequences of meal or snack refusal
• Our “time out” plan when one of us isn’t coping
• If X is self harming or exercising excessively or secretly we will…
• Distractions pre-meal and post meal

Barriers to boundary setting

Many families report fear of destroying the relationship is their main block to setting firm boundaries. Especially when their child seems so unhappy already.

However the good news is!

• Evidence shows the relationship is worse if a young person remains chronically ill
• Evidence shows parental involvement strengthens rather than harms the relationship
• Don’t expect positive return of relationship until your young person is some distance from the illness.

Final thoughts:

• Take charge and set expectations – get the ED out of the drivers seat
• Follow through
• Be consistent
• Remember that boundaries make your child feel more secure even though they will not always like them

It is frightening for a young person with an eating disorder to think they can make the rules as it allows their ED to constantly berate them to negotiate with