Accommodation Behaviors (& why they don’t work)

By Tracy Narins Welchoff, Ph.D

What are “Accommodation Behaviors”?
Accommodation behaviors involve participating in or supporting the Eating Disorder behaviors.
 
Examples of Family Accommodation

• Providing reassurance regarding the ED concern (“You look thin!”)
• Waiting for them to complete ED behaviors (i.e. staying out of the kitchen while they cook)
• Directly participating in compulsions (e.g., weighing food, reading nutrition labels)
• Providing items needed to do compulsions (e.g., purchasing special foods, buying a scale)
• Taking on individual’s household responsibilities that he/she cannot complete due to ED
• Modifying family routines because of the ED (i.e. eating at an inconvenient time)
• Supporting avoidance of feared situations such as restaurants or family parties

 
Accommodation behaviors interfere with learning new information:
Assisting a family member in avoiding anxiety (with the intention of being helpful to them) interferes with an opportunity to experience the anxiety, do nothing to “protect” themselves, and realize that the anxiety reduces on its own (this is called “habituation”). 
 
Family accommodation behaviors can cause stress in the relationship:
Over time, it is easy for family members to develop resentment and frustration at having to make accommodations (such as buying special foods, changing who is “allowed” in the kitchen during cooking and eating, etc.).  Using accommodations (which are often unreasonable) to “keep the peace” will backfire when the anxiety returns.  It can stress the entire family system that is working hard (without benefit) to provide relief (often with the family’s inconvenience). 
 
Family accommodation behavior can be motivated by the many reasons:
Accommodations are often motivated by guilt, anxiety, or difficulty tolerating the anxiety of the ED sufferer.  Though intended to be helpful, they rarely provide comfort or protection but rather support the continuation of ED behaviors.  It is understandable to want to accommodate because “at least they will eat”, but this actually reinforces the abnormal or symptomatic behaviors.  Although it may seem to help in the short run, it typically fails to reduce symptoms in the long run (and in fact can strengthen the symptoms). 
 
What does work?
What works is careful adherence to the Exposure Therapy protocol developed by the treatment team.  Supported by a wealth of research, Exposure Therapy is the treatment of choice for Eating Disorder (and many other anxiety-based) behaviors.  This involves gradual exposure to what is scary (i.e. eating a dessert, eating in front of other people), preventing the unhealthy response such as avoidance or purging), and teaching the individual that the feared outcome will not occur, or if it does, is really no big deal.   Although hard to watch a loved one experiencing anxiety, rest assured that this technique is highly effective.
 
“Feel the Fear and Do It Anyway.”