This blog post represents the author’s views and should not be interpreted as professional/medical advice or endorsed by NEDA.
What changed my thinking about the tendency to blame parents in eating disorder treatment?
I’ve been doing clinical work (assessment, diagnosis, and treatment) for nearly 20 years. Early in my career, I approached parents the way many clinicians are trained to, often viewing them cautiously, as potential contributors to the problem.
Remember the older theories that blamed mothers for schizophrenia? Assumptions like those cast a long shadow across mental health. Even today, subtle messages can still lead clinicians to suspect parents may be the source of—or at least adding to—the issues.
True confession: As a young clinician, I sometimes assumed weight stigma and body pressures must be present in households simply because we live in a Western diet culture. But something changed my perspective.
When Parents Came Together
In 2011, I began running a no-cost, ANAD Affiliate parent education and support group twice a month. At the time, there were relatively few places where parents of children, teens, or adults with eating disorders could receive education and support. It was well before COVID, so we met in person.
Month after month, mothers, fathers, and other family members showed up. They learned. They shared.
Some had intentionally created body-positive homes while raising their children. Some emphasized messages of intrinsic worth and empowerment in everyday life. Others had no eating or body image struggles themselves and worked hard to protect their children from cultural pressures, encourage media literacy, and support healthy development. Many of these parents had already done what prevention books recommend.
The parents repeatedly shared more vulnerability and continued to show up for each other. They texted support outside of meetings, bravely communicating what felt hard, scary, or challenging with each other. And the times that deeply awful things happened to them, their kids, or the families, they supported one another with humanity and resilience.
Watching all this challenged many of my assumptions and began to feel less like isolated experiences and more like something I was seeing repeatedly in clinical work.
The “On Button” Analogy
Over the years, I developed an analogy for what can sometimes kick off an eating disorder. Genetics, temperament, neurobiology, trauma, cultural pressure, and developmental timing can all interact in ways we are still working to fully understand. It’s as if a button lives somewhere inside a person, and no one knows for sure that it’s there. If enough things line up, or sometimes even one factor presses it on, the eating disorder begins.
Some parents had done everything seemingly “right.” Yet their child still developed an eating disorder. This realization changed how I thought about families.
When Parents Could Reach Someone Who Treatment Sometimes Could Not
Another pattern began to stand out.
Some young people could not be reached by treatment providers. They would start treatment and stop. Some refused treatment entirely. Yet when parents had information and support, they sometimes made headway where treatment alone had not. Watching that unfold changed how I began to think about parents—not as obstacles to treatment, but as potential allies in recovery.
As a therapist, I might meet with someone for a single therapy hour per week. A parent may be around their loved one the other 167 hours a week. Even when their child is away from home, that parent often still has far more access and influence than I ever will. So who realistically has more opportunity to influence daily life—or even healing?
Opening the Door to Parents
From that point forward, I began opening my doors more intentionally to parents and caregivers. Together, we worked to better understand their child’s eating disorder, develop different boundaries, and shift communication patterns. I also facilitated interventions when families asked for them—not the dramatic versions you see on television, but ones grounded in care, honesty, and love. Sometimes, what professionals could not evoke, the power of parents or family could. (Note: Interventions are complex and not appropriate in all situations.)
When Parents Are in Crisis
Over the years, I have also felt deeply for parents. Many are trying to understand a complex illness while carrying the terror that their child could die. Eating disorders have one of the highest mortality rates of any psychiatric illness.
Parents often find themselves trying to learn quickly and make major decisions while navigating medical, psychological, nutritional, and logistical uncertainty—often financial as well. Because these illnesses usually require multidisciplinary care, they can also be expensive to treat.
At the same time, the field itself evolves at an uneven pace: sometimes slowly, sometimes rapidly. Parents are often trying to keep up. They face constant questions: What do I do first? How do I know who is a specialist? What treatment approaches should we try first? What if my child doesn’t want to get better?
Over time, in my work with families, I began noticing the same pattern again and again: Parents were searching for clear guidance, yet much of the information available to them was scattered across treatment programs, clinical literature, and online communities—something organizations like NEDA have worked hard to improve.
Why Organizations Like NEDA Matter
This is why centralized information matters so much.
Organizations like NEDA help bring together resources that families once struggled to find. NEDA provides an online document to help you vet your clinical providers: Questions to Ask Treatment Providers. For nonclinical providers (e.g, coaches and peer mentors), the same questions may apply with moderate revisions—since nonclinical providers often support treatment under the guidance of a clinical team. As you review the questions, maybe substitute the words like “treatment” and “psychotherapeutic” with “support.” For both clinical and nonclinical providers’ screenings, trust your “spidey sense” and ask questions.
NEDA also created the NEDA Parent Toolkit, which provides practical information that can help parents better understand eating disorders and treatment options. Resources like these can help families begin navigating the system and the healing process with greater clarity and confidence.
Access to trustworthy information can make an enormous difference during an already frightening time.
Treatment Is Expanding Beyond Traditional Settings
Around the same time, my thinking about parents was evolving, Family-Based Treatment was gaining traction, and various levels of care began happening at home. The treatment landscape was changing in other ways as well, and in some higher levels of care, it became harder to attain deeply individualized treatment. Additionally, the COVID-19 pandemic brought about an increase in at-home, online care.
As a result, many clinicians and families began moving beyond traditional models. Home-based care (e.g., true FBT, FBT-informed approaches, and clinical teams that actively included parents as treatment partners, among other variations) could replicate aspects of higher levels of care, depending on acuity, safety, and medical stability.
Residential and outpatient programs typically have large staffs compared to a household that may have one or two parents. So at-home care requires a lot from them. Yet with guidance from strong clinicians and teams, many parents began taking on expanded roles in supporting daily recovery work at home. In some cases, families also brought in additional support to help bridge the time between clinical sessions and give parents a breather.
The Role of Coaching
Coaching is one form of additional support that became more visible during this period—recovery coaching and parent coaching. In addition to the clinical team, some individuals benefit from additional encouragement, structure, and support. A well-trained, skilled recovery coach might help provide that additional support. Parent coaches also offer education and support to caregivers learning how to navigate these complex disorders.
An Important Distinction
Through all of this, my perspective continued—and still continues—to evolve.
I now see that parents—when given support, information, and guidance—can become some of the strongest allies in treatment. At the same time, an important distinction remains. Clinical providers (such as doctors, dietitians, and therapists) offer treatment grounded in research, training, and supervised experience. In most cases, they are licensed and regulated by the state, which creates oversight and accountability.
Nonclinical supports, including parents and coaches, can also play powerful roles. In my view, those roles are strongest and safest when guided by or collaborating with clinical teams, particularly when medical or psychological risk is present.
What I Learned
Parents are often under-resourced, deeply committed, and capable of remarkable impact. As treatment models continue to evolve, supporting and educating caregivers will likely remain a meaningful yet underused avenue for potentially improving outcomes.
If you are a parent navigating an eating disorder in your family, it can feel overwhelming and frightening. You may worry that you are doing something wrong or fear you might make things worse. “On eggshells” is a phrase many parents have said. Still, over time, I have seen that parents who are willing to learn, seek support, and speak their truth with love can become important allies in recovery. With information, guidance, and persistence, families can help create the conditions where healing becomes more possible.
Note: It’s also important to maintain hope for people whose parents cannot show up in the ways recovery sometimes requires. I have also seen individuals heal from eating disorders even without parental support. Still, despite the path feeling uncertain, parents often matter far more than they realize.
A Question for Parents
If you’re asking, “What can I do to be more helpful?” Consider a support group. Many are free and virtual for convenience. It can be a starting point for learning more and expanding your support network. NEDA can point you to caregiver-specific groups. You are not alone, even though you may feel like you are.
NOTE: These are themes I explore further in my recent work focused on helping families navigate eating disorder treatment. In this article, the terms “parent” and “caregiver” can be used interchangeably. This article is for informational purposes and does not provide therapy or professional advice or establish a therapeutic relationship.
Resources
Think you or your child may have an eating disorder? Take or share our confidential screening test
Looking for eating disorders treatment? Find providers in your area or online.
Are finances preventing you from seeking support? Learn about free and low cost support options
Alli Spotts-De Lazzer, LMFT, LPCC, CEDS-C, IEDS, is an eating disorders specialist with nearly two decades of clinical experience, the lead author of My Child Has an Eating Disorder: An Essential Guide for Parents of Kids, Teens, and Adults, a Psychology Today columnist, and Medscape contributor. For more information about Alli: www.LiveYourFullStory.com
