1. Remember, things are going to be different.
There is a new “part” of self or aspect of self that has ‘hijacked’ the old true self that you have always known. This new part is often very terrorizing, sending extreme anxiety and fear that certain foods or amounts of food will make them fat. For this reason, the teen cannot “just eat”. It helps to think of a phobia, let’s say of spiders, and the family saying to the phobic individual…just put your hand in a bunch of spiders! Your teen has a temporary phobia of certain types or amounts of food. Compassion is the first essential ingredient. Patience is next.
2. Identify how what is happening makes YOU feel.
It is helpful to use “I” statements instead of “You” statements. So, rather than say commenting on her behaviors, you could express concern it the following ways: “I’m feeling concerned that you are getting thin” or “I care about our relationship and I felt I needed to say something about my concern in order to save it.”
3. After compassion, limit setting.
Parents often are asked to help in any number of ways. It is best to have the treatment team meet with you and your child to negotiate for home support as every case is different. You may be asked to take away exercise or sit with your teen through a meal to ensure all of it is eaten. You may be asked to estimate calorie levels of a portioned food or insist on a supplement shake. Doing so in a calm, secure manner with as few words as possible is important. Often one parent tends to be very verbal, going on and on about why a food needs to be eaten, how hard it is for them as parents or making threats such as going to the hospital. Lots of words make your child more anxious! Just say, “I know this is hard. This is how it is going to be right now”. Then use distraction.
If they have to go to the doctor and get a shot, we don’t go on and on about why they need the shot and how it will be given. We generally change the subject, keep them distracted and keep the subject condensed. Your teen will often need distraction through playing a game (cards at a prolonged meal), watching a movie, when appropriate going for a walk or doing your nails together right after a meal or when they are feeling too full or if they are trying not to purge.
5. Stop talking about food so much
Never talk about diets, weight loss, share the fat or carbohydrate content of foods, your own diet, other people’s weight or ANY thing about you or anyone that has anything to do with valuing thinness or fitness. Don’t use words like ‘good’ or ‘bad’ to describe foods. It is critical that body image, anyone’s, NOT be discussed. (i.e. “Did you see how good aunt Karen looks now?) Keep your own diet values to yourself such as ‘only organic is good’ or ‘we don’t eat saturated fats’ or ‘we follow a healthy diet’. Most eating disorders start out as a good thing gone too far with a child that cut out junk foods or carbs or fats or sugar and then became overwhelmed with nutrition fears.
Keep in mind that the word ‘healthy’ for many eating disordered individuals is NO LONGER HEALTHY. In an attempt to get the ‘right body’, kids are now trying to ‘eat healthy’ and they are getting emotional illnesses (from other underlying stressors as well).
Be a role model! Let your child see you eating high calorie foods and desserts and enjoying them without any guilt to model eventual normal eating. Enjoying food without guilt is a key element in normal eating.
6. Provide quality attention.
Now that you are not nagging about food and weight, or really talking about it at all…find ways to connect to your teen. The best ways are non-verbal approaches. Teens often can’t stand being asked questions like, “How was school?” Instead…just read or listen to music somewhere near them, in the common living space. Or, if they are not too angry…ask if you can hang out in their room and bring a magazine in, or something neutral you can do while they are doing their own activities. Maybe they are on the computer and you are adding up figures from your check book. Eventually, they will often start talking about something. STAY POSITIVE. DO NOT LECTURE THEM. Seem interested in their music, even if you can’t stand it. Say nothing about their messy room. If they start talking RESIST GIVING ANY ADVICE or you will lose them. Just reflect back what you are hearing them say, with a comment like, “That is interesting” or “I never thought about it that way.”
Also, build in down time for your family and your teen or child. As kids, teens even adults need to learn how to “BE” instead of just “DO”. Hanging around talking, playing music, making a craft casually, sipping tea and musing out a window, lying in a lounge chair are all excellent models of “being”.
7. Consider getting rid of full length mirrors and definitely all scales.
Sometimes we assign the family to cover up some mirrors with butcher paper with graffiti assignments.
8. Avoid pleading or demanding change.
No bribes or rewards. These are simply a diversion from developing an internal means of controlling her behaviors.
9. If there are two parents in the house, do your best to present a united front.
Do any arguing about managing your child away from him/her. It makes kids anxious (and their eating disorder worse) if they see that they are getting one parent to side with them. Some kids actually push to see if they can split the couple (this can be an unconscious testing). Stay united.
10. Use your treatment team.
Call to schedule extra help with parenting as needed. Leave specific questions on our voicemails. Try to follow the treatment team’s advice, even though it is difficult and your child might complain. Meet with us to let us know how things are going.
Know that eating disorders are symptoms that carry many messages, asking for change.
In the end most families agree that much was learned from the experience, especially when each parent is open to learning more about themselves and open to change. As painful as they are, eating disorders can be an important transformer for all members of the family.
Written by Francie White, MS, RD, Co-Founder of Central Coast Treatment Center; edited by Ai Pono Hawaii Staff Contributor