Your child has an eating disorder, and perhaps they’ve come to ask for your help. Or maybe not. Out of shame, fear, or a distorted belief that there is no problem, many people with eating disorders do not talk about their symptoms, much less ask for help. Whether your child is a young adolescent, well into adulthood, or somewhere in between, their eating disorder is a serious matter carrying both medical and psychological consequences. The need to identify and address the problem, and then find help for it, must often be shouldered by the people they are closest to or those that feel closest to them—their parents.
While every child is different and each parent-child relationship is unique, there are a few guidelines which can be helpful to everyone. Regardless of age, gender, or factors that precipitated the disordered eating, parents might consider the following advice to help a child:
1. Don’t blame yourself.
Over the past decades, studies have suggested multiple factors contributing to development of an eating disorder. These include genetics, temperament, an inclination towards depression and anxiety disorders, and environmental factors. While parents and families may have some effect on body image, eating or exercise patterns, these do not necessarily precipitate the development of an eating disorder.
When a mother, who’d had anorexia as a teenager, discovers that her own adolescent daughter now has the same symptoms, she is apt to blame herself and wonder how her own behaviors and comments, carefully chosen as they were, could have caused her daughter’s illness. But the blame more likely lies in their common genetics rather than their common behaviors. Plenty of children and adolescents worry about their weight and shape, often sparked by their parents’ concerns, but only a small percentage develop bulimia nervosa, and an even smaller fraction develop anorexia nervosa.
Carrying so much guilt about their contribution to their child’s eating disorder may hobble parents in their ability to help. Perhaps a better way to channel the guilt is to allow that you can only blame yourself if, once the illness is apparent, you don’t do something about it. But what can you do?
2. Take responsibility, call it as you see it, and be an ally with your child.
There is a simplistic myth, now de-bunked, that eating disorders develop in children because of a need for control. While this may be a precipitant for some kids, it is not a sufficient explanation for many. The ironic truth is that once a child has anorexia nervosa he/she has little control over anything else in their life besides their eating, and with bulimia nervosa or binge eating disorder even that feels out of control. Parents used to be advised to step back and let their child be more autonomous, believing that then their eating disorder will improve. To the contrary, parental involvement, when appropriate and therapeutic, can promote recovery and continued health.
An intrinsic part of anorexia nervosa is a denial of the illness itself. However, even when a child is denying that anything is wrong, a clear, steady message from a parent can make all the difference: “I will not stand by and do nothing, while you are suffering.” Remember, you are allying with your child against his/her illness. Many recovered patients report that they were relieved that their parents saw beyond their denial, confronted them, and insisted on treatment. In the long run, they were truly grateful for the help from their parents that they had once vehemently refused.
3. Act quickly.
Eating disorders do not typically resolve themselves. Parents may dawdle in talking with their child or seeking professional help because they want to avoid the conflict and disruption. However, early intervention, especially with adolescents, often leads to a better long-term prognosis. This makes sense when you consider the gradual onset of symptoms characteristic of eating disorders, and the eventual inflexibility of thoughts and behaviors that occurs over time.
4. Find effective help.
The promotion of scientifically proven treatments over the last decade has brought about promising therapies for the treatment of eating disorders. Family-based therapy, cognitive-behavioral therapy, and anti-depressant medications have all been demonstrated to be effective, and clinicians are increasingly more adept in using these. Researchers are also continuing to develop novel psychotherapies and to learn more about medication use in children and adolescents. Depending on the severity of your child’s illness, you may need to make decisions about the appropriate level or intensity of care (for example, inpatient versus outpatient treatment), and the use of a treatment team which could include a psychotherapist, physician, psychiatrist, and nutritionist.
How can you tell if the treatment is effective? Watch for a reduction in your child’s symptoms: for example, steady weight gain in anorexia nervosa, reduced frequency of binge eating and/or purging in bulimia, improved flexibility in food choices and more normal exercise patterns.
To be the best help to a child through recovery, it’s essential for parents to take care of themselves. Help is available in a variety of forms including supportive psychotherapy and self-help resources (including books on what to do if your adolescent has an eating disorder, family-based therapy principles, and basic features of cognitive-behavioral therapy).
It’s important to remember that just curing the symptoms does not necessarily signal the end of the need for treatment. Recovery is a gradual process, and relapse may be lurking in the shadows. Certain features of these conditions, like poor body image and low self-esteem, can take longer to improve. Your child needs to know your support and concern will continue long after the eating disorder appears resolved.