Help Your Teenager Beat an Eating Disorder

1. Act immediately when you suspect an eating disorder

Don't hesitate or worry that you'll be seen as overreacting or interfering.

Early intervention is crucial. Eating disorders can quickly become life-threatening, so parents must act swiftly when they notice warning signs. These may include:

• Significant weight loss or failure to gain expected weight
• Intense fear of gaining weight or becoming fat
• Distorted body image
• Restrictive eating, binge eating, or purging behaviors
• Excessive exercise
• Withdrawal from social activities and family meals

Don't wait for your child to ask for help or for the problem to resolve on its own. Seek professional evaluation from a healthcare provider experienced in eating disorders as soon as possible.

2. Parents are crucial partners in treatment, not the cause

You are naturally anxious about your child's health and welfare, and this may make you unsure about what to do. A certain degree of anxiety is a good thing—it helps propel you to action—but too much anxiety can overwhelm and immobilize you.

Reject blame, embrace empowerment. Many outdated theories blamed parents for causing eating disorders, but current research shows no evidence to support this. Instead, eating disorders are complex illnesses with biological, psychological, and social factors. Parents are now recognized as essential allies in treatment, not obstacles to overcome.

Your role is critical in:

• Recognizing early warning signs
• Seeking appropriate treatment
• Supporting your child through recovery
• Implementing behavioral changes at home
• Advocating for your child's needs

Embrace your position as an expert on your child and a vital member of the treatment team. Your involvement significantly improves outcomes for adolescents with eating disorders.

3. Understand the cognitive distortions behind eating disorders

Eating disorders alter logical ways of thinking about food and body image. They distort what your son or daughter sees in the mirror. They implant in your child's mind irrational expectations about the consequences of eating and not eating, exercising and not exercising.

Recognize distorted thinking. Eating disorders warp your child's perception of food, weight, and their body. Common distortions include:

• All-or-nothing thinking about food and weight
• Overgeneralization of negative experiences
• Magnification of perceived flaws
• Minimization of health risks
• Emotional reasoning ("I feel fat, therefore I am fat")

Understanding these distortions helps you:

• Respond with empathy rather than frustration
• Avoid unproductive arguments about food and weight
• Recognize when the eating disorder, not your child, is speaking
• Support your child in challenging these harmful thought patterns

Remember that these distortions are symptoms of the illness, not willful defiance or lack of intelligence.

4. Choose evidence-based treatments tailored to your child

Although it's certainly not a bad thing to have some theoretical ideas about the cause of an illness, when these ideas remain untested but still become gospel for therapists—as has happened for eating disorders, particularly anorexia nervosa—treatments that aren't based on these ideas often remain unexplored as well.

Prioritize proven approaches. While many treatment options exist, not all have strong scientific support. Evidence-based treatments for adolescent eating disorders include:

• Family-Based Treatment (FBT) / Maudsley approach: Parents take charge of refeeding and normalizing eating behaviors
• Cognitive Behavioral Therapy (CBT): Addresses distorted thoughts and behaviors around food and body image
• Enhanced Cognitive Behavioral Therapy (CBT-E): An expanded version of CBT specifically for eating disorders
• Adolescent-Focused Therapy (AFT): Targets developmental and psychological issues underlying the eating disorder

Consider factors like:

• Your child's specific diagnosis and symptoms
• Age and developmental stage
• Presence of co-occurring mental health conditions
• Family dynamics and resources
• Severity of the illness and need for medical stabilization

Be wary of treatments that lack scientific support or focus solely on uncovering psychological causes while neglecting urgent behavioral changes.

5. Take charge of normalizing eating behaviors at home

To make changing disordered eating the priority sounds easy enough, but in practice families find this is harder than expected.

Actively manage meals and behaviors. In many evidence-based treatments, especially for younger adolescents, parents take a central role in normalizing eating behaviors. This may involve:

• Planning and preparing all meals and snacks
• Supervising eating to ensure adequate intake
• Preventing compensatory behaviors like purging or excessive exercise
• Temporarily limiting your child's food choices to reduce anxiety
• Gradually reintroducing feared foods

Strategies for success:

• Be consistent and persistent
• Stay calm and matter-of-fact during meals
• Avoid negotiations about food
• Use distractions during and after meals to reduce anxiety
• Praise efforts, not just outcomes

Remember that this level of involvement is temporary. As your child's symptoms improve, you'll gradually transition control back to them.

6. Present a united front as parents against the eating disorder

To keep your anger from either overwhelming you or being vented on your child, it's important to recognize the signs that this may be happening. You may notice that your patience is short, that you're jittery, that your tone of voice is tinged with sarcasm, or that you're irritated by things that you usually would let pass.

Align your approach. Disagreements between parents about how to handle the eating disorder can create openings for the illness to persist. To prevent this:

• Communicate privately about concerns and strategies
• Agree on meal plans, behavioral expectations, and consequences
• Support each other's decisions in front of your child
• Present a consistent message about the importance of recovery
• Share the workload of meal preparation and supervision
• Seek support for your own emotional needs

If you're a single parent, enlist the help of other supportive adults to create a united team. Remember that you're fighting the eating disorder together, not each other or your child.

7. Stay empowered and informed when working with professionals

Clearly, the main argument of this book is that parents need to actively take charge of helping their children with eating disorders. We have stressed repeatedly that eating disorders distort thinking and behavior to such a degree that, as a parent, you are your child's best hope for making significant progress.

Be an active partner in treatment. While respecting professional expertise, don't be afraid to:

• Ask questions about diagnoses, treatment plans, and progress
• Request explanations of the reasoning behind recommendations
• Share your observations and concerns
• Advocate for your child's needs
• Seek second opinions if you have serious doubts

Red flags to watch for:

• Professionals who exclude you from treatment decisions
• Advice that contradicts established best practices
• Lack of focus on normalizing eating behaviors
• Blaming parents for the eating disorder
• Resistance to involving you in your child's care

Remember that you have valuable insights into your child's history, personality, and day-to-day functioning. Your active involvement improves treatment outcomes.

8. Separate the illness from your child to maintain compassion

For parents to be effective at helping their child through an eating disorder, and for the adolescent to know that his or her parents and the doctors aren't fighting him or her, it's very helpful to see the anorexia or bulimia as something that has overtaken the adolescent.

Externalize the eating disorder. This approach helps you:

• Maintain empathy for your child's struggles
• Avoid blaming or shaming your child for their behaviors
• Unite with your child against a common enemy (the eating disorder)
• Recognize when the eating disorder, not your child, is speaking
• Preserve your relationship through difficult times

Practical ways to externalize:

• Use language that separates the illness from your child (e.g., "the eating disorder is making you think that way" instead of "you're being irrational")
• Remind your child that you're fighting the illness together, not fighting each other
• Celebrate small victories over the eating disorder
• Acknowledge the strength it takes to resist eating disorder urges

This approach helps your child see that they are not defined by their illness and that recovery is possible.

9. Focus on changing behaviors rather than uncovering causes

Dwelling on cause in treatment keeps therapists and parents from dedicating their efforts to the problem at hand—keeping the starving teenager before them alive and restoring her to health.

Prioritize immediate action. While understanding the origins of an eating disorder can be helpful in the long term, it shouldn't delay urgent interventions to normalize eating and weight. Reasons to focus on behavior change first:

• Malnutrition perpetuates disordered thinking and behaviors
• Medical complications can be life-threatening
• Habits become more entrenched over time, making change harder
• Improved nutrition often alleviates psychological symptoms

Key behaviors to target:

• Normalizing food intake (quantity and variety)
• Achieving/maintaining a healthy weight
• Ceasing purging behaviors
• Reducing excessive exercise
• Challenging distorted thoughts about food and weight

Once eating behaviors are stabilized, there will be time to explore underlying psychological issues if needed.

10. Gradually transition control back to your child as they recover

As hard as it may be to imagine now, there will come a time when you will need to figure out how to begin backing off from being so involved in the day-to-day management of your child's eating disorder symptoms and behaviors.

Plan for independence. While parents often need to take charge initially, the ultimate goal is for your child to manage their own eating and health. Signs it may be time to start transitioning control:

• Consistent weight restoration or maintenance
• Regular, adequate eating without significant struggles
• Reduced eating disorder thoughts and behaviors
• Improved insight into the illness
• Increased motivation for recovery

Strategies for gradual transition:

• Allow your child to choose from a range of acceptable foods
• Reduce supervision of meals and snacks
• Encourage independent food preparation
• Support appropriate exercise under medical guidance
• Involve your child in treatment decisions

Work with your child's treatment team to determine the appropriate pace for this transition. Be prepared for setbacks and adjust as needed. The goal is to help your child develop the skills and confidence to maintain their recovery long-term.

Last updated: November 18, 2024