Voiceless in Recovery: My Experience in Family-Based Treatment for Anorexia
My journey into the complex world of body image and disordered eating habits started innocently in elementary school. As a curious fifth-grader, I fixated on child models my age, like Kristina Pimenova, unknowingly beginning a comparison game that would haunt me for the next few decades of my life. This comparison game caught up to me during my middle school pacer-test weigh-ins. Amongst my friends, I constantly felt like the “bigger” one, a stark contrast to the idealized images I held in my mind. This was the start of my body dysmorphic disorder.
It was not until my sophomore year of high school that my relationship with food and my body became fixated on numbers. Whether it was the amount of steps I walked, the amount of calories consumed, or the number on the scale: all I cared about was the number. As a ballerina, the pursuit of perfection was ingrained in my identity. Yet beneath this facade of discipline, I faced a constant battle with that voice in my head. The whispers of what I can and cannot eat; food restrictions and calorie limits grew louder, slowly taking over my entire life.
In January 2024, my high school referred me to several eating disorder clinics after concerns were brought up about my eating. Soon after, my parents took me to an evaluation at the Mount Sinai Center of Excellence in Eating and Weight Disorders. There, the psychologist diagnosed me with Anorexia Nervosa. She told me and my parents that the recovery plan would be Family-Based Treatment (FBT). She stressed that, despite the name, this was not family therapy. Unfortunately, it was.
She outlined that the first stage was weight restoration and refeeding, the second was giving me my autonomy back and maintaining my weight, and then they would treat my generalized anxiety disorder. We left that meeting with no knowledge of how my meal plan would work. She gave us no information about how meals should be observed, or the caloric density of them. We left with just a diagnosis and nothing else. No resources, no information.
Because of issues with insurance and debating about going to a different clinic, my parents decided to wait 6 weeks before taking me back there. During those 6 weeks, we were left under the guidance of no one, and out of desperation, my parents would force-feed me double the normal portion size for dinner. Every night I braced myself for a plate overflowing with all kinds of foods, and every night I knew I would have to clear my plate for the sake of my parents’ happiness.
I was in agonizing pain, physically and mentally, trying to navigate how many times I could lie to my parents that I ate out with a friend, or quickly shove an item of food down my sleeve; and how I would possibly deal with forced recovery on my own. I was so eager to go back to the clinic so I could at least have someone to talk to. Instead, I was quickly overwhelmed with nutritional rehabilitation plans and daunting target weights.
Upon returning to the clinic, we met with a different psychologist. At this meeting, she defined how refeeding would work: 3 observed meals and 3 snacks. I would have to gain 1–2 pounds a week or my parents were allowed to take away school, ballet, and anything that made me happy. My doctor had quite literally given my parents permission to strip me of everything I loved if I did not eat.
Every meal was observed and every meal was miserable. Every time I tried to tell my parents and my psychologist that this was too much food, or I felt sick and nauseated, it was always deemed as my “eating disorder speaking.” Any genuine fears, concerns, and boundaries were chalked up to my “anorexia voice.”
My doctor proclaimed that my eating disorder controlled me and therefore I was not in the right mind to speak on my behalf. They wanted me to gain far beyond the highest weight I had ever been with absolutely no mental support. No one on my treatment team was actually going to listen to me, even if I brought up my worries.
FBT assesses success and recovery on weight gain alone. It failed to address the psychological distress I had gone through before and during my eating disorder. In my case, anorexia was like a shield for me. My eating disorder was the one coping mechanism I had for the trauma I went through and that one coping mechanism was ripped away from me.
Because of this, I found myself lost in dissociative states more often than not, grasping for any way to get me out of the reality I was living. Throughout the entire process of FBT, I felt lost. I felt hurt. I felt like the people meant to help me recover and support me were being deceitful and malicious. I had found my parents on FEAST Forums, reading about ways to add an extra thousand calories to meals without it going noticed.
During my time with FBT, my anxiety became worse; I became paranoid about everyone and everything. Food was on my mind 24/7, and the second I even thought about how large my serving for dinner would be an instant wave of panic would wash over me. I could not breathe at mealtimes, I had panic attacks that lasted half an hour after eating, and I felt like people were constantly plotting and talking about me behind my back.
At some point during my treatment, I realized I had lost the energy and will to fight with my doctor and my parents. I felt like I was cornered, and as a result, decided to give recovery a shot as a way to protect myself from the trauma FBT ingrained into my life. This is ultimately not what real recovery looks like. I did not do it to save my own life, or because I truly wanted to, rather because of how terrified, scared, and ashamed I felt in FBT. Despite gaining some weight initially, the absence of mental health support led to a relapse within a month.
No one, especially a child, can possibly recover without psychological support. I hated myself for wanting to recover, I hated the way I looked and I hated the fact that I felt like I had given up on myself and let my psychologist take away a part of my identity.
I wish I had someone to talk to when I decided to recover; I wish I had someone to talk me through all the difficult thoughts and feelings I felt. If I had someone there to support me, I do think I could have made a full recovery. Sadly, this would not be possible in FBT because FBT claims that “less is more” and the work of parents in contributing to weight gain can be undermined by an individual therapist.
FBT did and has done absolutely nothing for me other than break my family apart and traumatize me. My psychologist would repeat the mantra “food is your medicine,” like a broken record. Essentially promising me that once I gained weight and once I started eating properly my anxiety, depression, intrusive thoughts and any psychological suffering I had gone through would magically be fixed. FBT is a lazy way to treat anorexia; it is a scapegoat for doctors to get out of addressing the core reasons why it developed in the first place.
I truly wish I received mental health support for my mental illness. Anorexia is a mental illness, not a physical one. Simply eating and gaining weight will not cure the deep-rooted disordered thoughts and behaviors I have been fostering all my life. Being stuck in a mind that is sicker than ever, but a healthy body is hell on earth, and it is inhumane to force someone with a debilitating fear of weight gain, to gain weight and leave them with no mental health resources.
My Zoom calls with my psychologist consisted of a hyperfixation of numbers. Everything was about my intake, my weight, my BMI, and my growth chart. And when I did bring up the fact that the intrusive thoughts about food were still there she hardly acknowledged it and dismissed it as if that’s totally normal.
At my very last FBT appointment, she never asked me about the food thoughts. During every single appointment, we discussed my weight gain, what I was eating, and what we should fix in my meal plan. My psychologist never asked me once how I was feeling and if I was okay.
The sick and dehumanizing “one size fits all” policy that FBT so proudly advocates puts everyone who suffers from an eating disorder into a box. One form of treatment may work for one individual, but that does not mean we can generalize every single person with anorexia and guarantee them that FBT will work for them.
FBT demonizes the child with the eating disorder and brutalizes anorexics into stopping behaviors. Anorexia is not something that can simply be turned on and off; the lack of empathy in treating those with eating disorders is deeply frustrating and upsetting. I had never felt so unsafe and insecure than when I was going through refeeding.
If I refused to eat something because I was overly full, strings of relentless threats and warnings were thrown at me by both my doctors and my parents. I could not finish my enormous plate of food for dinner? Sorry, you cannot go to school. I am full and I do not want my morning snack? You cannot go to ballet today. If I did not eat, everything I loved was taken away from me. No one listened to me. My voice was non-existent even in my own recovery. I felt not a single ounce of empathy or compassion from my psychologist.
A patient is supposed to develop a positive rapport with their doctor, and even after months of working with her, I never felt supported and I never felt like she wanted me to be healthy. I felt so disconnected from my psychologist because I truly do not believe she ever suffered from an eating disorder. Anorexia specialists should know what it feels like to struggle with anorexia. They should have first-hand experience of the torture and entrapment eating disorders place on the individual. Because my psychologist never had this experience, she lacked so much compassion toward me.
In the end, my recovery was never actually about me. It was about how my parents felt I was doing. I felt sick whenever my psychologist would tell me how much she adored my parents and how fun they were to “do therapy” with. My psychologist spent the majority of my Zoom calls just talking to them.
Mealtimes became a chore and a punishment for me. Even when I entered Stage 2 of FBT, I had no independence. My autonomy was supposed to be given back to me yet every meal and every decision I made was scrutinized and analyzed by my parents and my psychologist.
Every choice I made on a food-related basis was questioned and considered a “disordered,” or “restrictive,” behavior. I grew up in an extremely healthy household and I have been accustomed to making healthy decisions. I have never liked chicken, and I would never choose to eat a fried chicken sandwich from a menu full of options. Yet, when I say this or ask to order something else, my mom lectures and ridicules me about restrictions and having anorexic behaviors.
These “anorexic behaviors” that my doctor and my parents talk about are behaviors I have had since birth. I have always been a perfectionist, I have always been sensitive and I have always made healthier decisions in terms of food. Now that they know about my eating disorder, everything is the “anorexia speaking.” At what point is it me speaking? At what point do I get my voice back?
The biggest thing FBT neglects is the family dynamic. FBT heavily depends on the relationship between the patient and the parents as a way to re-feed their child. My father is an addict and an alcoholic with mental health issues and narcissism. My mother and father have an extremely dysfunctional relationship and I live in a toxic household because of it. I would have never stood a chance to make a full recovery living in this house.
Part of the reason I developed anorexia was to shield myself from the trauma I have because of my dad. Yet FBT permits him to take control of my life and my nutrition. My parents do not comfort me and never have, they are not emotionally responsive and have never learned to deal with their own emotions toward one another. My psychologist never asked about their dynamic and that is the reason I would have never been able to recover with them in my life.
I hope no other adolescent has to suffer through what I did, and I just hope that the future of FBT is more thorough regarding family life. There should be a way for eating disorder specialists to screen families before starting FBT. Some parents have mental health issues, substance abuse issues, can’t communicate with one another, or do not have a good relationship with their child outside the eating disorder and are sometimes straight-up abusive. Adding FBT into this is a recipe for disaster.
FBT is fundamentally a rushed process. There should be separate interviews with the parents, the patient, and any other family member to assess if the family has what it takes to complete FBT. Parents should take a mandatory course on distress, tolerance and emotional regulation skills to help their child deal with emotions and manage their own. In an ideal family fit for FBT, the parents should have a strong relationship with their child so that they not only play a role in weight gain but also support their child mentally.
You cannot want recovery on behalf of someone else; support needs to be on the terms of the sick individual, not how the family wants to support them. My psychologist had them convinced I was too sick to make my own decisions and influenced my parents to hurt me time and time again all for the sake of “defeating” the eating disorder. They refused to believe they could have possibly been the reason behind my eating disorder, and everything I have gone through was blamed on the eating disorder.
People with anorexia deserve better access to mental health care. Rather than hurting and bullying the individual with the illness, there should be a nuanced approach. FBT ultimately made my disordered habits worse. I have become more sneaky; I hide everything from my parents, and I have developed rituals that are now more detrimental to my health than just anorexia, all of which I would have never done to this extent before FBT.
FBT was the largest step backward for me. I was never taught how to flexibly eat meals, nor was I taught intuitive eating, or planning proper meals. I gained no long-term skills, and in the end, all I gained from this experience was more trauma and an even more broken family life.
The mental health system in America is deeply flawed. FBT touted as a gold standard for treating eating disorders, proved to entirely disregard the complexities of the illness. I found myself in a constant cycle of refeeding protocols and arbitrary weight goals. My story, however, is not unique. It reflects the millions of adolescents who have tried to navigate the world of eating disorder recovery, just to come out more wounded and damaged than before.
I implore parents who are thinking of putting their child through FBT to do as much research as possible. To read personal narratives and experiences of those who have gone through it, and to thoroughly think about what they are committing themselves to. If you do not have what it takes emotionally, physically, and mentally to help your child through FBT then you need to find another way. I understand that parents want what is best for their child, but if in your case you are not entirely certain that FBT is right for you, do not put you and your child through that.
FBT is incredibly isolating. Struggling with an eating disorder is lonely in itself, but having to go through recovery with no support or understanding from anyone is worse. The only thing FBT gave me was a name for what I was suffering through.
I ultimately came out worse than I did before FBT, and the only way I have salvaged my relationship with my parents is by avoiding talking about my eating disorder in any capacity anymore.
The trauma I have endured because of FBT has made me reluctant to open up about my anorexia, but also ready to discover a different form of treatment and therapy. Everyone deserves to have their voice heard in their own treatment, and no one deserves to feel silenced by the people meant to support them.
