Recipes for Hope and Change

Tools and Information for Family Members Who have Loved Ones Struggling with Eating Disorders

Michael Levine, PhD
Laura Hill, PhD,
David Dagg, PCC, LICDC
Heather Guthrie, PhD, LPCC

Philosophy and Purpose

This site is designed by staff and consultants working for The Center for Balanced Living in Columbus, OH. Our philosophy is that, while eating disorders and concomitant conditions such as depression and substance abuse are very serious and very disruptive illnesses, (1) people can and do recover; (2) the process of recovery is typically long, complicated, and bumpy; and (3) family members play a critically important role in the recovery process.

We also believe that the search for causes and for something to blame is, while understandable in the face of disorders that challenge everyone’s sense of control, not productive. We choose instead to embrace and embody the philosophy that

Although no one in the family is to blame for an eating disorder, everyone in the family has a responsibility to work together to do what he or she can to facilitate the loved one’s recovery and to do so without sacrificing his or her own health, well-being, and self-respect.

The purpose of Recipes for Hope and Change is to provide family members with information, support, and other tools. Working together and with knowledgeable, experienced professionals, family members can create and sustain a strong, meaningful sense of hope and work toward positive changes for their loved one, for themselves and for their family.


10 Fundamental Principles and Assumptions of the SHAIRE Model

 1. Eating Disorders are serious, complex conditions that often take on a life of their  own - in fact, to such an extent that it may be very helpful for loved ones to think of the person (e.g., “my daughter”, “my son” or “my spouse”) and their eating disorder as separate entities (e.g., a “monster on her/his shoulder”)

 2. Eating Disorders are caused by complex combinations of biological, psychological, and sociocultural factors. This means that recovery needs to address, at the very least, the following aspects of the particular disorder that affects your loved one:

medical and physical health

genetic and neurobiological factors

psychological factors (e.g., fears, attitudes, goals, self-concept)

nutritional status

behavioral knowledge and competencies

interpersonal and coping skills

relationship to cultural pressures that promote negative body image and disordered eating

 3. No one or no thing is “the cause” of an eating disorder, so blaming one’s self or others is, while understandable, ultimately counterproductive

 4. Eating disorders are frightening, confusing, and, at times, maddening. Thus, an array of strong emotions are normal and expectable. However, one of the important things family members can learn in order to help their loved one is how to express their negative and positive emotions more effectively, constructively, and humanely.

5. No one is to blame – but all family members have a responsibility to aid in the  person’s recovery to the best of their ability. In fact, parents and other family  members are one of the major keys to recovery.

 6. Many people do recover from eating disorders, but it takes time, determination, and, in most instances, coordinated intervention from family members and professionals.

 7. Expect - and try not to take personally - the gamut of human emotions and foibles from the person with an eating disorder, and at times from yourself: anger, confusion, ambivalence, dependence, willful independence, anxiety, clarity, progress, backsliding, embarrassment, pride, etc. Your loved one is human and the  disorder is a monster. Thus, as you and your loved one work to overcome the monster, there will be struggle, emotional distress and outbursts, and the ups and downs of any long-term battle that is marked by fear and courage.

 8. Ambivalence, fueled by fear, anxiety and uncertainty, is the rule for people suffering from eating disorders; they do not want to suffer, they do not want to make the family’s life a “living hell,” they do not want to die, AND they are afraid AND they are confused AND they may be having trouble thinking straight.

 9. It is important for families to work with each other and professionals to establish a united front to move beyond anger, helplessness, and blame - and toward

an atmosphere of compassion, consistency, security, and constructive action

learning to respond dialectically and with validation

non-negotiables for the health and well-being of the family as a unit and as individuals making health more attractive and feasible than illness

10. Self-care for all family members is of the utmost importance - the key is giving  of yourself, not giving up yourself or on yourself. You can't share and build  upon what you don't have.


1Herrin, M., & Matsumoto, N. (2007). The parent’s guide to eating disorders: Supporting self-esteem, healthy eating, & positive body image at home (2nd ed.). Carlsbad, CA: Gürze.

2Treasure, J. (1997). Anorexia nervosa: A survival guide for families, friends and sufferers.East Sussex, UK: Psychology Press.

3Andersen, A. E. (1985). Practical comprehensive treatment of anorexia nervosa and bulimia. Baltimore: Johns Hopkins University.

4Health Education Center, & Eating Disorders Institute. (1999). “How did this happen?” A practical guide to understanding disorders—for teachers, parents and coaches. Minneapolis, MN: Institute for Research and Education, HealthSystem Minnesota.

5Natenshon, A. H. (1999). When your child has an eating disorder: A step-by-step workbook for parents and other caregivers.San Francisco: Jossey-Bass.

6National Eating Disorders Association [NEDA]website =

What Do Families Need?

The Center for Balanced Living has for many years conducted free support groups for family and friends of people suffering from eating disorders. The Center offers a program for family members and adults who have loved ones with eating disorders titled: Fed Up? Get FED. These are daylong conferences that provide family members with the most current toolbox of support, research based information and “how to” tools for family members with loved ones who have eating disorders. In addition, therapists at The Center have extensive experience working with individual clients and their families in the treatment of eating disorders and related conditions (e.g., depression, obsessive-compulsive disorder). In the course of this work, family and friends have time and again, in surveys and during support group meetings, told us that at different times, in the process of their loved one’s illness and recovery, they—as family and friends--need varying degrees and combinations of these:

Support  |  Hope  |  Acceptance  |  Information  |  Respect  |  Empathy

There is nothing magical and extraordinary about these needs—other than how important they are, how powerful they are, and how difficult it can be to identify and sustain them. Thus, we have organized the recipes for hope and change through the first letters of these needs into the easy-to-remember acronym SHAIRE.

We share this SHAIRE model in our work, with each other, and with our clients in treatment. Consequently, we are confident in sharing it with the families and friends of loved ones suffering from an eating disorder.