Systemic Webinar: Non-Violent Resistance and Eating Disorders

Recent research acknowledges that NVR may be a treatment alternative for families of youth with anorexia nervosa (AN) when accommodating-behaviour of parents is a core element in the symptoms, and NVR may also be considered as an add-on to care-as-usual, for example family-based treatment (FBT). However, I have found that NVR can be equally effective with bulimia nervosa (BN).

The treatment of eating disorders has been dominated by the Maudsley Approach which encompasses family-based treatment, where parents have responsibility for weight restoration in the case of AN. or eliminating binge/purge cycles in the case of BN. Parents are asked to make all eating-related decisions for their child until the eating disorder is no longer influencing the child’s thoughts. However, unlike the New Maudsley Collaborative Approach (NMCA) for adults with ED, FBT hasn’t the same emphasis on the interpersonal maintaining factors in AN or BN. Dysfunctional responses to the illness, such as intra-familial communication with high levels of expressed emotions (EE), have long been noted to be a key element in the maintenance of ED symptoms.

In this presentation, I will explore how the New Maudsley Collaborative Model (NMCA) for parents with adults with eating disorders which focuses on compassionate, empathic communication from those caring for a loved one with an eating disorder, and uses animal metaphors to explain unhelpful communication patterns, can be effectively combined with an NVR approach when working with adolescents with an eating disorder. NVR emphasises the importance of de-escalation strategies and maintaining self-control, and the negative impact of reciprocal and complementary cycles of escalation. Reducing such cycles of escalation can reduce parents’ feelings of helplessness in response to their child’s self-destructive behaviour. The concepts of old-authority vs new authority parenting will be discussed in terms of parents managing power appropriate and avoiding a dominance or power-over orientation which can fuel the escalatory cycles. The concept of shame will be explored as it relates to both managing parental power appropriately and also how shame fuels escalatory behaviours such as acting-out, loss of control and rage, leaving both parents and adolescents feeling humiliated and engendering feelings of helplessness.

Contrary to NVRs original view that that children were trying to gain control over others with their self-destructive behaviour, this presentation views the adolescent as trying to get control over their ‘bully’ eating disorder, rather than necessarily trying to get control over others, and considers that emotional dysregulation is in part linked to the impact of the eating disorder on the brain.