By Oona Hanson
“If I could get my child to eat, we wouldn’t be in this mess.”
Soon after my child received an anorexia diagnosis, I started to read compelling memoirs about families who had successfully achieved weight restoration at home. I couldn’t understand how they did it. It felt like reading science fiction.
As our child endured multiple treatment programs and various levels of care, I continued to learn as much as I could about the illness, its causes, and ways to support recovery. When we eventually found our way to Family-Based Treatment, I brought these additional resources to buttress our new approach.
There is no one-size-fits-all approach when it comes to eating disorders, of course. But if you’re struggling and could use a few more tools, perhaps some of our lessons will resonate with your family, too:
- Don’t panic if things seem worse after beginning treatment. Remember your child is not the eating disorder; rather, they are like the victim of a demon possession or alien “body snatcher.” The demonic creature will try to fight back when you challenge its hold on your loved one. Be prepared for angry, even frightening, responses from your child. Rather than being a sign of failure, these cruel and shocking outbursts are a common sign that treatment is working.
- Keep the long-term goal in mind. At every meal and snack, you have the opportunity to feed either your child or the eating disorder. This is really hard. Giving in to a request for something “safe” or allowing them to refuse food may ease their (and your) distress in the moment, but it’s usually fueling the disorder more than the recovery.
- Have a united front. If you have a spouse or co-parent, be in an alliance against the eating disorder, and ensure any other caregivers or treatment team members are on the same page. Clever and manipulative, eating disorders will find and exploit the tiniest chink in the armor. A firm, consistent, loving stance is key.
- Get support for yourself. Caring for an ill child can be grueling, physically and emotionally. Even if you can access private counseling, consider taking advantage of resources geared specifically for caregivers. Whenever possible, lean on friends, family, and your larger community.
- Explore Emotion-Focused Family Therapy (EFFT). I hate to give you another acronym to unpack, but you might be glad to add this one to your vocabulary. EFFT gives parents and other caregivers the tools to communicate with a loved one whose thoughts and emotions are controlled by their eating disorder. Validating the sufferer’s feelings does not mean you are agreeing with their irrational, self-destructive statements or colluding with their illness. Feeling heard and understood, however, helps the sick person face the daunting task before them. For weary caregivers, having some go-to “scripts” can be incredibly helpful during difficult meals.
- Use a contract. With guidance from a treatment professional and input from your child, develop a written recovery contract–and stick to it. Be sure your document contains clear expectations and lays out a realistic system of rewards and consequences.
- Don’t be afraid to go old-school. Even if your child is an older teen or young adult, you might find it useful to create a sticker chart to track progress toward small, incremental goals. Intrinsic motivation to recover tends to be very low in anorexia patients. External motivators can be incredibly helpful along the way. Having a physical chart can also alleviate some of the interpersonal tension between adult and child.
- Model an “all foods fit” approach. Everyone has different tastes and energy needs, but a child in recovery from an eating disorder cannot be fully supported if other members of the household are exhibiting dieting behaviors or other food restrictions that are not medically required. If necessary, get support for anyone else in the family who needs help healing their relationship with food.
- Remember that food is the medicine, in more ways than one. Refeeding can be physically and psychologically painful, but the only way out is through. It may be helpful to imagine a child with another medical condition that required excruciating physical therapy–or if you had to administer a foul-tasting but life-saving medicine with unpleasant side effects. If you knew the interventions were necessary to help your child go on to live a fuller life, you would acknowledge their pain and ease it as much as possible–but you wouldn’t stop the treatment.
- Learn about Health at Every Size ®. Weight stigma is everywhere, even in many eating disorder treatment settings. Examining and dismantling your family’s own unconscious bias against larger bodies can be a crucial step in fostering a healing environment for your loved one. Remember that you won’t really know an individual’s healthy weight range until they get there. And regardless of your child’s body type, living in a home free from fat phobia is health-promoting.
Every family’s needs are different, so I would never say I have the one true recipe for successful recovery. But I do know these approaches worked in our home–and helped us turn science fiction into a true story with a happy ending.
Your article today answered my biggest question and major concerns. Thank you so much for posting this today!!!
Hi, Deanna. I’m so glad it was helpful to you. Thank you for sharing your comment.
I wish you well.
Hi, I really enjoyed your article. FBT is so hard. We we’re one of the unfortunate families who’s daughter still struggled after weight restoration.She did FBT and gained weight but developed maladaptive coping skills such as increased marijuana use, worsening exercise compulsion and self harming behaviors. We had her weight restored to 10 lbs over pre anorexic weight very early on. I now wish that earlier on go her into more intensive therapy such including psychotherapy, DBT as well as group therapy. She is now in a residential center and getting so much support and thus far doing pretty well. She at 98% of her target weight goal and finally able to get more out of therapy and finally wants to get better which has been a massive shift.
Hi, Lynne. Thanks for your comment and for sharing your experience. I’m sorry your daughter has struggled and suffered so much. I hope this new treatment approach continues to bring her the support and skills she needs.
My favorite quote from your article is “At every meal and snack, you have the opportunity to feed either your child or the eating disorder.” This is a great way to phrase what we need to think about at all times. I have always tried to keep the long term goal of full recovery in my mind, especially when having to make tough decisions. Whatever is really hard at the moment will most likely make things easier in the long run. Thank you for your article.
Hi, Lisa. Thanks for sharing that. Those tough meals are so hard to get through–both for the parent and the child. I wish you continued strength and resilience.
“The only way out is through.” Wow, I had to write this one down, such a powerful statement. I’m keeping this one for a day when my daughter doesn’t think she can do it! Thanks for this one!
Thanks, Jodie. That phrase was one of my mantras–I’m glad to know it resonated with you as well. There can be so many times when parents want to take a break or are tempted to give up. In our case, I kept thinking of the children’s book “Going on a Bear Hunt” with the repeated line (at each obstacle): “We can’t go over it, we can’t go under it, we’ve got to go THROUGH it.” Thanks again.
Thank you for this. My daughter was diagnosed just today and your article echoes the firm sentiments of the psychologist. Our first challenge is to externalise the eating disorder rather than laying blame to our daughter being difficult.
Thanks for sharing that, Heidi. I’m sorry that your family has to go through this. I’m glad you’ve found FEAST, and I hope you get the support you need along the way. Wishing you well.
I’ve been trying to find a support group for parents in the UK as it’s quite a lonely club to be in – daughter only recently diagnosed with anorexia but it does have her right in her grips. This group was recommended to me last night. I don’t understand all of the acronyms / abbreviations yet but ‘food is medicine’ is really helpful & reading this article & some of the blogs is reassuring me that whilst it’s so hard there are recovery stories which is great to see. As it does seem like a long road ahead at minute … one day at a time x
Alice, thanks for sharing that. This is so hard. I’m glad you’ve found FEAST. Yes, the “alphabet soup” can be overwhelming. I hope you find the support you need.
I’m in the UK too and searching online for a support group, I’m interested to know,did you find a group, other than this forum? My daughter is awaiting treatment, having been hospitalised due to low heart rate. Now 3 weeks on after a two night stay, my husband and I are left to try and help her with no support other than GP weighing and EcG etc weekly.
I have just recently discovered the following (after 5 years), and it has been really helpful:
BEAT: They have a an online support group for parents in the UK: https://www.beateatingdisorders.org.uk/
EDA (Eating Disorders Anonymous): I attended one of the open meetings at EDA and the women were really helpful and gave a lot of guidance: https://eatingdisordersanonymous.org/phone-zoom-meetings/
ABA (Anorexia Bulimia Anonymous) : https://aba12steps.org/about/
Good luck xx
I understand all this when I read it but actually doing it is so hard. Getting my daughter to eat is so frustrating. All other normal life stops. How long does it take before they start to eat without the anger, back chat, tantrums? It’s been 3 weeks of a meal plan and we are still no further forward than 1000 calories a day
Me, too. Same boat 3 weeks in. Will it get better?
Hang in there, Jane.
It’s really, really hard. But it’s not forever. Don’t give up. And remember things often seem worse before they get better (as the ED tries to lash out when it’s really being threatened).
I have been trying to refeed my daughter now for almost 8 weeks. The first 7 we barely got to 1000/day. She has agreed now to shoot for 1500/day. We are not quite there yet, but there has been progress. Has your daughter gotten better since this post? I certainly hope that you are caring for yourself. This is the pits!
It is really, really hard. I send you a lot of compassion, Sophie.
Do you have the book “When Your Teen Has an Eating Disorder” by Dr. Muhlheim? It’s short and has lots of practical strategies for mealtimes.
Thank you for this. We are one month in and we are slowly learning the disease is the thing that’s fighting us, not our daughter. It’s so hard. I am grateful to all of you for simply being parents who share our same reality. It’s lonely and one of the hardest things I’m finding is that there is no quick measurement of success. It feels like a constant 2 steps forward and 3 back.
Oh, Erin. It’s is so, so tough. You’re probably having more “successes” than you realize. Get whatever support you need to keep battling–it does often seem to get worse before it gets better, and the whole process is never a straight line. We’re all rooting for you.
Thank you for your post. Is there a timeline for this? Our progress has been so slow…our daughter is really trying hard…you can see it on her face when she tries to eat. This disorder has such a grip on her though. We are just now beginning to stabilize her weight. How long before we can see some weight gain? It has been 8 weeks of FBT…but I suppose years of creating the disorder. Did you ever use a Mass Gainer to supplement the meals?