Figure 1 offers a model that illustrates the journeys that parents of daughters with eating disorders described navigating in their relationship with themselves, others, and the illness. We conceptualized the parents’ journey as beginning with the aspiration to fix the eating disorder, observing that over time and with experience of treatment, this aspiration evolved into a desire for an unrelenting connection with their daughter. While not every parent articulated the beginning and end point of their journey in precisely these terms, there was nonetheless a collective shift observed across the parent group. This transition involved a departure from solely focusing on resolving the eating disorder, to having the relational goal of cultivating and maintaining the best possible connection with their daughter.

Fig. 1

The journey of parents of adult children with eating disorders

This journey from practical to relational focus was neither straightforward nor linear, and was characterized by an emotional journey, with parents describing their terror, sadness and bewilderment as they adjusted to their daughter changing from someone who they believed they knew well, to someone they at times struggled to understand. Parents also described moving in and out of acceptance and letting go, as they grappled with their own emotions while learning to respond to their daughter’s evolving needs.

Three interconnected skills were fundamental to parents’ journey toward growth and a deeper connection with their daughter. Parents saw the importance of managing their reactions and expectations and recognized that while they were entirely understandable in light of their concerns for their daughter’s health, it could interfere with their ability to respond in a way that served. Learning their daughter’s and their own boundaries facilitated this process. Perhaps most importantly, aspiring for an unrelenting connection with their daughter was linked to the recognition that what she most desired was to feel seen and understood. Parents came to see that their daughter struggled with shame, self-criticism, and confusion over their eating disorder, and many of them described learning that receiving validation was key to supporting both their connection and their daughter’s recovery. This process of offering validation was new and thus for many parents required learning and practicing validation techniques.

Managing their reactions and transforming their relationship with their daughter through the practice of validation did not occur in isolation. Two supportive conditions served as a backdrop for this to take place: receiving support from professionals, friends and family, and practicing self-care. In the next section, each of these model components will be described. Please note that “P” refers to participant.

Aspiration: fixing the eating disorder

Nearly all parents noted that discovering their daughter had an illness elicited feelings of shock, bewilderment, and fear, and led to an intense drive to fix or get rid of the eating disorder. Parents’ commitment and love was captured by one parent simply stating “you know you’ll take a bullet for them. You’ll do it, and you do it, and you do it.” (P3). For those who were living in the same home as their daughter, the desire to fix the problem was often associated with a period of struggle and conflict around eating.

“There would be yelling matches. Finish your food. Finish what's in your plate. You're not going to move from here till you're done. Get out of the bathroom.” (P5).

Over time, there was disappointment and bewilderment as their efforts were neither positively received nor appreciated.

“We couldn't understand why she couldn't accept our love, couldn't accept our urging her to eat… just be a healthy person. It didn't take long for us to realize, okay, that's not working, and this is way beyond our control.” (P8).

Over time, parents’ yearning to fix was accompanied by a growing awareness that despite having the best of intentions and drive to help, this approach was not effective.

“I'm a fixer. I want to fix. I can fix anything and do anything. I can't fix it. I can't fix her. … I try to accept the situation. It is what it is… I need to fix this. I need to change this, but I can't.” (P4).

Foreshadowing an eventual shift in focus to relational goals, one parent noted: “I think she just wants to be seen, and I think she just wants to be heard. She really wants us to just listen to her. Stop trying to fix things.” (P18).

Conditions that supported parent journey

On the path to finding a more supportive and fulfilling way of relating to their daughter, parents identified conditions that set the stage for acquiring skills that ultimately better served their relationship with their daughter as well as her recovery. This container included receiving support and self-care.

Receiving support

Receiving support was key to decreasing parents’ distress, normalizing their experience, and helping them to feel less isolated. Support occurred in the context of therapy (family, individual, couples), as well as informally from friends, family or professionals.

For many parents, simply learning from a professional that it was acceptable to have conversations about challenging topics gave them permission to address some of the emotional challenges their daughter was grappling with that they had previously believed to be private or off limits.

“We learned, I think through the sessions with [family therapist], that we could—that we didn't die after having difficult conversations… That was new to me to have that kind of intimate talk about feelings and just listen and not try and solve a problem.” (P1).

A subset of parents had the resources to seek out therapy of their own and reported a benefit from individual or couples’ work. Some identified personal challenges of their own that were critical to address in order to support their daughter, such as processing grief or an addiction. For many, attending workshops and meeting other family members with adult children who were further along in their recovery journey was key.

“Hearing people's stories… you're like, oh, my God. That's me. Oh, my God. Look at them. Where are they now? I can be there too. So very helpful.” (P5).

Finally, many parents identified important friends and family who they felt comfortable confiding in. Key experiences were feeling seen and accepted, receiving empathy and compassion, and having an opportunity to discuss their situation with individuals who were psychologically minded. For some, confiding in their spouse was immensely helpful and strengthened their relationship with one another, as well as their capacity to provide ongoing support to their daughter.

Self-care

The majority of parents emphasized the importance of tending to their own emotional and physical needs in order to support their evolving relationship with their daughter. In some cases, the motivation for self-care was inspired by a wish to model a healthy way of living for her. Many parents saw self-care as essential to relieving their daughter from the responsibility of caring for them. One mother noted that when she prioritized her well-being, her daughter felt more secure to lean on her for support.

“Her knowing I was getting help helped her as well because it was devastating for her thinking that I was suffering. ‘Mom, I'm so happy you're getting help because I feel better now that I know you're covered as well. I can come to you because I know you go to somebody.’” (P19).

For parents who struggled with mental health or addictions issues of their own, self-care and maintaining sobriety was key to their capacity for learning new skills to support their daughter.

Parent skill development

The container of receiving support and practicing self-care allowed parents to cultivate three key sets of skills: learning boundaries, managing reactions and expectations, and practicing validation.

Learning daughter’s and own boundaries

As parents became aware of their daughter’s changing needs, they increasingly realized that their well-intentioned gestures of love and support needed to adapt accordingly. One mother stated: “my husband and I both, we really just surrendered to the fact that there's—we really need to learn and to watch and to observe and to love and to care in a different way.” (P15).

This awareness was often fueled by recognition that trying to get their daughter to change in accordance with their wishes and with their timeline was counterproductive, ultimately leading to greater distance in the relationship.

“There was no pushing her to do anything… The boundaries are there. The walls come up. I can see the wall come up and hear the wall come up immediately. It's okay then. Okay, back off. Don't push. Don't push.” (P4).

Common themes that emerged were recognition that their daughters desired more space and privacy, less emotional reactivity, and less or no parental involvement in modifying their eating. One mother simply noted “the one thing she didn't want us—and she made it quite clear—was to poke at her to eat. That worked the other way.” (P19). Recognizing that both space and responsiveness to her daughter’s needs were fundamental, another mother summarized her goal as “to try to stay engaged with her without becoming too enmeshed and without disconnecting.” (P18).

Some parents noted the importance of also clarifying their own boundaries. Examples included one father speaking about not being treated kindly by his daughter or spouse, and a mother choosing to decrease the time she spent providing practical support to her daughter in order to support her own sobriety and mental health.

A second set of fundamental skills was navigating the emotional challenges that arose when parents’ expectations for their daughter diverged with the reality of her life. Parents described experiencing a roller coaster of emotions; anxiety and terror when their daughter’s health was compromised, sadness for her struggles, and grief for the losses that both she and they endured due to the eating disorder. Parents expressed dismay that many of their initial attempts to support their daughter went unappreciated or rejected. While some spoke of times they felt disliked, all described struggling with feelings of frustration and powerlessness as they realized the need to change the way they interacted with their daughter.

“Okay, if I say it this way—it was initially very hard and frustrating to figure that out. It was very frustrating. I used to question myself. I was like, why can't I just be myself with my child? Why do I have to think before I speak? What is this pretend relationship?” (P5).

As illustrated in the model, this emotional journey, characterized by an interplay between acceptance and letting go, was not linear. In some cases, parents heard their daughters asking for space and for parents to manage their expression of distress in her presence.

“… she said something to me like, ‘Yeah, well, look. I know you love me, Mom. But you don't have to love me too much.’ It was like, oh, God, I didn't know you could love too much…When I heard that, I thought, oh, okay. Well, this is going to be hard. I have to love but not love too much. I now think that that was a little bit of code maybe for maybe you were a little overprotective, Mom.” (P9).

Over time, as parents developed better understanding of their daughters’ needs and found new ways of relating, they described being able to interact in a way that the daughter trusted was responsive to her needs and not experienced as overpowering or taking over. This shift was described as accompanied by a sense of relief for both parents and daughters.

Learning and practicing validation

Parents’ proficiency at respecting boundaries and managing their reactions and expectations set the stage for developing validation skills.

Many parents described this process as akin to learning a new way of relating to their daughter. As noted earlier, several underscored that it was only after learning that their previous support efforts were not helping that they became open to learning validation skills. Several highlighted that the manner in which they communicated was often more important than what was said.

“Sometimes without realising we are—for us, we're just making a comment or asking a question. But it can be a very accusatory kind of a tone. That is something that I worked on.” (P5).

It is noteworthy that parents in this research had access to a family therapist, and many referenced coaching sessions, in which they had opportunities to prepare and practice prior to having joint sessions with their daughter.

“She [family therapist] would say, ‘She's going to delve into her past. What we need from you in this one is just to listen. If there's a pause, I might look to you and ask you to echo it back. All you can do is echo it back and nod.’ We would do that. We would meet with her [family therapist] later. She would say, ‘Oh, you guys are amazing.’" (P1).

Several parents emphasized the importance of receiving support to not correct their daughter when their perception of events differed, focusing instead on listening and recognizing their daughter’s feelings.

“[Family therapist] helped in hearing some of what maybe her concerns were or whatever. Some of it I felt we were there just to support her, to listen to her, to listen to what she was—what she was saying and what she needed to say to us. In some cases, to hear what she said—again, everybody has a different view of the same picture. Some we felt were not what the situation was in reality. Not being able to counteract that.” (P4).

Most parents indicated that learning validation skills was challenging, requiring effort and regular reminders. Some commented that it was not something that they had learned or experienced in their own families. In several cases, one parent learned the skills more easily than the other and attempted to coach their spouse. One mother summarized her understanding of the benefits of validation as follows:

“Validation helps, really helps because it's—instantly she was like, oh. I am a person. I have feelings. It's being recognised. I'm not just a little loser who's—they're always judging me that I don't do this, I don't do that. I have emotions that are being recognised.” (P5).

Aspiration: unrelenting connection with daughter

Navigating emotional, practical and financial ups and downs associated with the eating disorder, while learning and adjusting to their daughters’ evolving needs led most parents to the realization that the best way they could support her was through nurturing and sustaining their emotional connection. This realization did not occur in a linear fashion or as a result of a single insight. Rather, it was characterized by a process of accepting that they were not ultimately in control of the eating disorder, and letting go of the notion that certain actions would automatically lead to change or improvement. One mother stated simply "wherever she's going, whatever path she's taking, I want to know who she is." (P15). Parents spoke of coming to a place where they could bear witness to their daughter’s journey with respect, understanding and care, without taking away her determination or autonomy. In the earlier stages, for some, this involved taking time to prepare themselves and their spouses prior to getting together, in order to remain aligned with their aspirations.

“I have been on the opposite side when that wall goes up. I don't want that… That always was my fear. Sometimes with [spouse] it's like, you know what? She's coming over. I don't want any discussion. I'm the boss. I don't want any discussion about anything other than just being present there for the visit.” (P4).

The greatest relief and joy for parents often came when their efforts resulted in positive outcomes, and they felt connected to their daughter following interactions in which there was open sharing about issues of meaning.

Response to the interviewer

An unexpected observation was made by the interviewer that is worthy of mention. While care was taken to avoid asking leading questions or show preference for a particular type of response, the interviewer nevertheless offered validating feedback to parents’ depictions of the challenges they faced, their efforts at supporting their daughter, and their emotional experiences throughout their journey. Participants appeared to be both relieved and eager for this validating feedback, and for some, it appeared to unlock a floodgate of sharing. Some spoke at length of their frustrations with treatment providers, their efforts to help, and about their own experiences. Others noted that this was the first time they were given an opportunity to be open about their own vulnerability and acknowledge their own needs. Finally, some said that the interview served as a reminder for them to continue having open conversations with their daughter.