How To Support Your Eating Disordered Child
"My daughter won't talk to me - she's wasting away." "My son gets angry every time I bring up my concerns that he's eating more than his body needs." "I hear her vomiting every time she leaves the dinner table." "She says that she's fine, but I know that she's not."
Do these scenarios sound familiar? How can it be that one can suddenly go from being a happy-go-lucky child to an anxious, withdrawn and sad individual who seemingly is angered by everything you say? Perhaps the eating disorder started after a breakup of a relationship, bullying at school, transitioning to high school or even an innocent attempt to drop a few pounds? Sometimes it seems as though obsession with weight loss, binging, purging or hating one's body comes out of nowhere. It feels like a stranger has literally taken over your child's mind and is pushing them further and further away from you. Ironically, parental instincts that once worked like a charm, are no longer effective. The eating disordered individual is emotionally fragile, easily angered, guarded and even seems paranoid at times. So how do you help? What do you say? What if they don't want help? These are important questions. Eating disorders are not something to be taken lightly. If left untreated, eating disorders can be life threatening. In fact, eating disorders have the highest death rate of all psychiatric illnesses!
FIND A TREATMENT TEAM!
It's tempting to believe that if you watch them like a hawk, monitor their meals and/or exercise and follow them to the restroom, the unhealthy behaviors will stop. Unfortunately, your child's behavior is serving a meaningful purpose in their life that has yet to be discovered Yes, your child's behaviors are helping them to cope. The behaviors might create the illusion of control or success. The behaviors can even be addictive or reduce anxiety. If your child feels micro-managed, they likely will intensify the behaviors, become more secretive or try new strategies that they feel will improve their appearance, comfort them or allow them to continue their weight loss mission. It's important to be aware that your child is terrified of recovery, weight gain, of losing their "best friend" (the eating disorder) and of not being sick enough to receive professional help.
Often, my clients are not excited to see me the first time. It can take years before an individual can see the negative impact that the eating disorder has had on their life. Sometimes, this realization does not come in time and the battle comes to a tragic end due to no intervention. It's a blessing when one's child wants help, but this certainly is not the norm. I suggest that parents find an eating disorder specialist that they trust and tell their child that they love them and want them to meet with someone who can assist them with the stress that might be impacting their self-image and eating habits. If the child insists, they do not wish to have help, the parent can indicate that this is not an option, but the child can meet two professionals and select the one they feel most comfortable with. Of course, if the child absolutely refuses, the parent reserves the option to suggest that the child could go to an inpatient facility instead. The parent’s dialogue with their child should be presented in a calm, loving and caring manner. A good clinician usually can ease a clients' fears and create a rapport quickly. Getting your child to treatment is the hardest part. I find that so often, the client who was reportedly going to give me a "run for my money," leaves their initial appointment feeling appreciative, understood and agrees that treatment is not such a bad idea!!!!!
A team approach is critical. A dietitian, medical doctor, and possibly a psychiatrist, should all be introduced into the treatment as soon as possible. Your therapist can help you to slowly build the right team. By the way, groups can be a wonderful adjunct to therapy but should never be utilized instead of individualized treatment in the early phases of recovery.
FOCUS ON THEIR HEART VERSUS THEIR APPEARANCES
"She constantly asks me if I can see the bulge on her tummy." "He wants to know if his muscles look too small." "If I eat this, will it make me fat?" The list of questions and worries can be endless. Does it feel like no matter what you say, you upset them more? Perhaps you remind them that they look beautiful today. Their response: "You have to say that because you’re my mom". Perhaps you tell them they look "healthy" and "perfect". In their mind, you just called them "fat". Honestly, commenting on physical appearances can be a no-win situation. I encourage ALL parents to focus comments on your child's intrinsic value verses their looks. Even if your child does not suffer from an eating disorder, it is better to love oneself from the "inside out" versus the "outside in". Catch your child doing something kind and tell them you appreciate their loving heart. If they ask you questions about their appearances, let them decide for themselves. For example, you can say, "How do you feel in your dress?" View questions about their body as in indication that something else is troubling them. Usually one’s focus on their body has nothing to do with appearances but another struggle. You can say, "It sounds like you are being hard on yourself today, want to talk?"
BE A HEALTHY ROLE MODEL:
If you discuss your own weight or exercise program, they will follow suit. If you tell them that you wish you looked as great as they do, they might believe you are in competition with them and may be afraid to trust you. If you comment on the appearances of friends, family, or people in the media, they may fear that you will be critical about them as well.
Exercise in moderation doing things that you enjoy. Hiking, riding a bike and dancing all are ways to enjoy being in your body without the formality of a gym. Yes, these activities count as exercise!!!!! When the focus becomes the number of calories burned or to make up for the damage done the day before, we are stumbling into unhealthy territory. Adopt an attitude that all foods are acceptable in moderation. A piece of birthday cake to celebrate a new year is yummy and appropriate! Enjoy food! Eat three meals a day and at least two snacks. Your child notices when you miss meals or label foods as "taboo" or "bad".
LOOK FOR THE SHADES OF GRAY:
"I'm fat". "I'm stupid". "No one will ever fall in love with me." Sound familiar? Eating disordered individuals tend to subscribe to "all or nothing" thinking. Help your child to find the "shades of gray" For Example, "You are an appropriate weight for your height". "We all make mistakes - you are learning." "You have had love before and are capable of finding it again - We do not know what the future holds.” If you are not sure how to respond but you can recognize that they are talking in extremes, point out "that sounds like all or nothing thinking." You can them challenge them to find the exceptions to what they have just said. For instance: "If you were truly overweight, do you think that your peers and your doctors would all be telling you that they are concerned you are too thin?"
ROUTINE, ROUTINE, ROUTINE:
During recovery, structure in your child's daily routine is extremely important! Let's face it: when life feels "in control", we feel better. Routine helps the eating disordered individual to feel more in control. Having meals at predictable times, knowing plans and being in a familiar environment can all make your child feel safer and more relaxed. Even fun activities like going on vacation, trying a new restaurant or going on an all-day outing can leave your child feeling vulnerable and overwhelmed or simply sabotage their goals. Imagine what it must be like for someone to go to a hotel and eat all their meals at a restaurant when they are terrified to eat anything that has not been prepared at home by oneself. Or imagine how a binge eater might feel spending a day at a theme park that has mostly buffets and fast foods that they are terrified of being around. Of course, the long-term goal is to be able to be intuitive about one’s food intake and to experience new adventures. Doing this too soon can result in emotional upset for everyone involved. Discuss upcoming plans, schedule changes (summer vacation versus school) and travel with your treatment team so that these things can be discussed and prepared for in advance.
UNCONDITIONAL POSITIVE REGARD:
Your child's self-esteem is fragile right now. They question their value and their worth. There is nothing more powerful than showing them that you love them because they are your precious child. It is so critical that guilt, punishments or bribes are not utilized to promote recovery. Eating disorders are an illness, not a choice. One did not choose to develop an eating disorder, but they can choose to get well. Say things such as "I love you and I want to help you to love yourself." It's imperative that we avoid saying things such as "If you love your family, you will stop this behavior." Similarly, it's important not to offer gifts for recovery or weight gain. If we tell them that we will purchase them a new car when they get to their goal weight, what happens when their weight fluctuates? Of course, statements such as "How could you waste all of that food?" only reinforces a sense of shame and disgust with oneself. The more they feel our love combined with our commitment to keeping them safe, the easier it will be for them to slowly learn to love and accept themselves.
Some days we will feel like we are getting our happy-go-lucky child back, the next day they will spiral downward into a pit of angst and despair! Gently explore what triggers their eating disorder. You can say things such as "You seem more preoccupied with your weight today. What is happening in your life that might be causing you to feel more stressed?" Remember, eating disorders are a coping mechanism. Try not to focus on your child's weight with them. Don't assume that someone or something is to blame for the eating disorder. Eating disorders are not caused by parents, the media or vanity. Eating disorders can show up after starting a simple diet. As stated previously, eating disorders are an illness. Certainly, many things can trigger the onset of the eating disorder but, realistically, the eating disorder was likely going to show up regardless of the stress in one's life. If you can assist your child in recognizing that they restrict, binge, purge, etc. when they are stressed about school, having social struggles, upset with their boss, or other matters that are occurring in their life, then they can be encouraged to address these situations directly. Caution: Don't tell your child what you believe is stressing them out that led to them being triggered. Ask them questions so that they can discover the trigger themselves. If they don't want to talk, honor their request and remind them that you are there for them should they change their mind. Sometimes just spending time with them watching a movie, walking the dog or hanging out will help them to decompress and move away from their eating disordered thoughts or behaviors.
Encourage healthy coping! Journaling, drawing, knitting and prayer are just a few examples of healthy behaviors that can provide an outlet for emotional distress and provide a sense of accomplishment or feeling of being more in control. Unfortunately, suggestions to exercise, read a magazine, work in a clothing store or search the web, can all intensify the eating disorder. For example, if we say, "Go to the gym, you will feel better," your loved one might hear this as an indirect message that they need to lose weight. Never assume that exercise will restore an anorexic's "lost hunger". I have had a few clients suggest that their anorexic child exercise for this purpose. It is not safe or appropriate to suggest that someone underweight go to the gym to cope or to work up an appetite. Reading a magazine might trigger one to become more agitated as they see diet suggestions and emaciated models. I have had one to many clients tearfully tell me that their size was mistakenly overestimated by a customer who wanted to purchase a gift for a friend or family member in the store in which they worked. The goal is to focus on activities that have nothing to do with food, exercise, fashion, appearances or weight!!!!!!!
RECOVERY IS FOR REAL:
Yes, I do see clients recovering from eating disorders every day!!!!! Having been blessed to do this work for over 20 years, I've had the opportunity to see clients grow up and have beautiful lives loving themselves, getting married, excelling in careers and creating families. Family support and love is a gift you can give your child. With a good team and a commitment to treatment, miraculous changes and growth can occur.
By: Michelle Gross, MA, LMFT: Eating Disorder Specialist in Westlake Village, CA