Here’s an overview of the help I’d like to offer you in this book and some suggestions on how to find your way around the information fast.
This is the whole of Chapter 1 of ‘Anorexia and other eating disorders – how to help your child eat well and be well’
The practical and emotional tools parents are asking for
- The practical and emotional tools parents are asking for
- What you will get from this book
- Is this book for you?
- Don’t just read this – get clinical support
- How to use this book
- With a little help from my friends
- Our story in less than two minutes
If your child has an eating disorder, you’re likely to have many questions you want answers to, as well as a whole lot of skills you dearly want to acquire.
Yet most of us parents don’t get the answers or the tools we need, even from the best professionals. We muddle through as best we can, and when we reach the light at the end of the tunnel, we say, ‘I wish that two years ago, I’d known what I know now.’
Take the big question: ‘How do we get our child to eat?’ It was always clear to my husband and me that we should feed our child rather than leave her to her own devices, but the how to do this remained a mystery to us. We scoured the books and the internet; we begged the professionals for tips, but it took a whole year before we got precise answers and some coaching on how to help our child eat. Then, practically overnight, we became infinitely more effective. I see a huge need for this type of help, as illustrated by the following email a parent sent me.
“Your practical refeeding scenarios saved us. Until then I knew what we needed to do but did not know how. And it worked for us. Having the words and dialogue to say was what I needed when a mother’s instinct flies out the window.”
In addition to practical questions, we need help with emotions: ours and our child’s. Eating disorders can turn a happy home into a war zone. If you’re like me, you’ll have panicked and shouted, threatened and cried, and you’re the last person your child is ready to trust. Meanwhile, you feel exhausted, incompetent and bruised.
When you get skilled at managing emotions and at communicating with compassion, it’s possible to support your child no matter what.
Children can achieve wonderful things when we treat them with compassion, when we withstand their outbursts and nurture trust and connection.
“I came across your draft whilst in the middle of an emotional meltdown, both mine and my daughter’s. With your advice, I turned the situation round. Deep breath and hand on heart. I am new to this but learning very fast, or trying to. Some of what you say has saved me from sinking into depths of despair.”
Our daughter made rapid progress once we’d got all our external and internal ducks in a row. It’s been a joy to see her thrive, and as a parent who’s also a writer, it gives me huge satisfaction to pass on resources to other parents.
“I immediately put some of your suggestions into practice with almost instantaneous results.”
In this book, I guide you through a vast collection of strategies, based not only on my experience and knowledge but also on what I’ve learned from parents and clinicians all over the globe.
It’s my heartfelt hope that among this wealth of expertise, you will find what you need to help your child recover and for your relationship with her to thrive.
What you will get from this book
My aim is to give you strategies for action as well as emotional support. If your child has an eating disorder, I’m assuming you’re not feeling at your best right now, so I want to take good care of you. I will not give you disaster stories. This is most certainly not a misery memoir. I will do everything I can to empower you. Not because I’m a nice person, you understand, but purely because the evidence is that results are best when parents are supported in caring for their ill child.
Many parents, at some stage, have questions and doubts about the method used to treat their child. I will help you recognise the treatment approaches that are validated by research and those that are based on outdated theories.
I will offer you tools you can use right away, and then I’ll build on those with more tools to help in the longer term. My intention is to support you through the entire journey to wellness.
I will address the practical questions that come up, again and again, in parent circles, such as:
- How do I get my child to eat foods she’s avoided for months? To eat anything?
- Will I push him over the edge if I stop him exercising?
- The specialist is aiming at another 3 kg. Won’t that make my daughter even more anxious?
- What should we do about school, about holidays?
Most parents also have a whole lot of questions relating to their child’s mental state and how to better connect with them. For example:
- What’s going on in her head?
- What should I say when he’s hysterical and wailing that he’s fat?
- How can I connect when she’s pushing me away?
- Rewards haven’t worked, and threats haven’t either. Is this the end of the road?
Finally, many of us sense that our power to support our children lies in the love we’ve had for them since the day they were born. We need emotional resources when we are sorely stretched:
- How can I stay calm when I want to scream?
- My ex hates conflict; my partner is undermining my efforts; my mother-in-law says I’m making our son worse. What can I do?
- I resent losing friends, activities, my job.
- Will my kid and I ever be close again? I miss her.
I’m offering to sit down with you over a cup of tea (tea is, of course, the answer to all of life’s stressors!) and guide you. I’ll give you general principles, lots of ideas for you to pick from, and lots of examples.
Is this book for you?
If you’re the parent of a child suffering from the restricting type of anorexia nervosa (i.e. she’s restricting her food intake), this book is definitely for you, because that’s where my experience lies. Note that a child in the early stages of anorexia might only meet all the diagnostic criteria for anorexia once the illness is entrenched. This book will help you to start treatment early, when it’s easiest and most effective.
If you’re dealing with the binge-purge type of anorexia, the tools I offer will be equally relevant, as there is so much in common between the two types.
All eating disorders have big areas of overlap, so if your child has bulimia nervosa, binge-eating disorder or any other type of eating disorder, many sections of this book will also be relevant to you. I do recommend, however, that you complement the material in this book with information from other sources, as there are differences in how each type of eating disorder is best treated.
I use the word ‘child’ a lot. The age group I have in mind is young children and adolescents. My own daughter was 10 when anorexia hit her. She is now 15, and what I write is just as applicable. The particular type of family-based treatment at the heart of this book is backed up by good research evidence gleaned through work with under-18s. But I know of parents who have successfully used the same approach with their adult child. The communication resources I offer are not age-specific, so I believe that even if your child is an adult, you will find help in this book.
I’m referring to you as ‘parents’, but I’d like to include all carers in this. Sometimes the main carer is a boyfriend or a sister, not much older than the sufferer. I’ve also borne in mind that my readers may be single parents, or may not be a united couple.
I also would like you to feel included whether you’re male or female, and the same goes for your child. I use both ‘he’ and ‘she’, and no I haven’t checked that it’s 50/50.
What about the country you live in? It doesn’t make any difference to the tools in this book (though of course it make a difference to the health care you have access to). I’m in the United Kingdom.
I hope this book will be helpful to clinicians, too, and that it will complement your work with families. Whether or not what I offer is in line with your methods, you will at least get an honest insight into quite a few parents’ needs, perhaps more than you do in your consulting room.
As for the emotional resources I offer, they’re valid for you, me and everyone. The principles of communication, self-compassion, mindfulness and resilience are based on age-old wisdom, they have been adapted and tested in modern therapies, and they apply to all human beings of all ages.
Don’t just read this – get clinical support
Now for some words of caution. I care more about your child’s well-being than about being right. I write as a mother. I was a scientist in my younger years, so I get twitchy when I come across bad science or unsupported claims. But I have no qualifications in medicine, in psychology, or in the approaches I draw on, such as Family-Based Treatment (FBT), mindfulness and Nonviolent Communication (NVC). I have taken advice from experts in these fields as I’ve worked on this book. But there are heated debates going on in the world of eating-disorders treatment. I’m offering you approaches that, where possible, have been scientifically tested and validated. But if I stopped there you’d be left with huge gaps. I’m filling those by suggesting strategies that worked for us and for other parents.
There may be better approaches I haven’t yet heard of. Keep your radar switched on. The field is evolving and there may be new, promising interventions that are missing from this book if the edition you’re reading is more than a couple of years old.
The tips I give might not all be suitable for your situation. Our children have many similarities, but the differences matter too. Pay attention to your instincts, ask around, read, speak to other parents.
Most importantly, make sure your child’s physical well-being is monitored and keep your clinicians in the loop. If some of what I write contradicts what your child’s therapist is advocating, discuss any worries you have. Eating-disorders specialists strongly endorse parents passing their knowledge on to others, so you should find it possible to be open.
I’d like this book to support how families work with experts, because collaboration and openness produces better outcomes for the children.
How to use this book
Take the best and leave the rest
Therapists respond to their clients’ needs in the present moment. I can’t do this for you, so it’s fine if you pick out the bits that are relevant to you and leave the rest for now.
I’m here to give you resources to change the things you have the power to change. Some things are outside our control. If you try out some of my suggestions and get nowhere, it doesn’t mean you’re doing anything wrong. What’s much more likely is that your situation is very different and some of the tools I offer are not for you.
When you find strategies that are helpful, don’t beat yourself up or despair when you don’t manage them all the time (notice I said ‘when’, not ‘if’). I found that my numerous ‘mistakes’, however much I regretted making them, were harmless in the long term. The things I did well were surely far more important. Be kind to yourself. We’re human and we can only do our best with the resources available to us. This illness pushes us to keep learning and to develop new skills and resilience.
Jump to the chapters you need most right now
- If you’d like to understand more about what this illness is like for your child and what can be done to help her, start at the beginning of the book.
- If you’re desperate for tips to get the next meal in, jump to the practical chapters (Chapters 6 to 9).
- If you’ve already accomplished a lot but have reached a plateau, see Chapters 9 and 10 for the next steps.
- Chapter 11 addresses issues around family, friends, work and money and is relevant at any stage.
- If you’re researching approaches to treatment or trying to work more effectively with therapists (either your child’s or your own), go to Chapter 12.
- If you’re in a hurry to communicate better with your child and help her feel supported, jump to Chapters 13 and 14. They deal with emotions and are just as much part of the treatment as the earlier, practical chapters.
- If you need some emotional support before you do anything else, go straight to Chapters 13 and 15. They give you tools for first aid and help with developing long-term resilience.
Videos and other resources that complement this book
On this website, you will find more resources that I have created to support you. Do sign up to receive updates.
With a little help from my friends
This book goes beyond my story and my views. I have gathered contributions from other parents, children in recovery, and I have had help from experts. I want to thank each and everyone one of them – and also to point out that anything less than wonderful in this book is mine, not theirs. Some of the people who’ve contributed are people in my locality, whom I’ve befriended through eating-disorders networks. Others I met online after I posted drafts of this manuscript on my website. I also share with you the wealth of knowledge and experience contained on www.feast-ed.org, an excellent website for parents, and its forum, Around the Dinner Table.
If you come across a quote without a name or without a link to endnotes, it’s a contribution from a parent who wishes to protect their child’s privacy. Some parents were happy for me to use their forum username. Apart from the researchers I quote, everybody’s name is false.
This is not my daughter’s memoir, or mine. I very much want to respect her privacy and dignity, and to credit the immense courage it took for her to withstand this illness and recover her smile.
Our story in less than two minutes
Since what I write is informed by personal experience, I’ll give you a brief overview of our story.
I live in the UK, with my husband and daughter. She was a happy, well-adjusted kid until shortly after her tenth birthday, when she spiralled into restricting anorexia. The trigger was a fall-out with friends. She decided to become thinner so they couldn’t ever call her fat, a standard insult in the playground. Looking back, we recognise that since the age of eight or so, she’d occasionally been checking her (perfectly fine) body in the mirror and asking if she was fat.
Our frantic attempts to help her eat and drink were to no avail, and less than six months after she first denied herself a sweet, she was admitted to hospital (an under-12s’ mental health unit experienced in treating eating disorders). Her food intake and her health quickly returned to normal, and for that we are very grateful. But her mind remained in the grip of the eating disorder. In spite of the efforts of the staff to involve us in her care, we couldn’t reliably feed her or make her feel secure during her frequent home visits. We were, much of the time, the enemy. So she remained a hospital patient and got a mix of one-to-one talking therapy sessions, meal-planning sessions, group work, family therapy, schooling, as well as lots of fun with the nurses and the other kids. As she got better she also had increasingly long spells at home and at her normal school.
She was described by staff as stuck, and by her ninth month she’d narrowed her range of food and was again losing small amounts of weight. We were keen to get her back home, and she was discharged in the eleventh month. There were hopeful days, but soon she was missing out on snacks, then on entire meals. We’d come under the care of the outpatient mental health services, where therapists gave us weekly family sessions (a space to talk, review and plan), and gave my daughter individual psychotherapy. It was fruitless. Her weight kept dropping, her mood was low, and we feared she’d spend her adolescence in and out of hospital unless we found a better way to support her.
At last several things clicked into place. A specialist eating-disorders service came on board. They were receiving ongoing training from the US in a well-validated treatment method called Family-Based Treatment (FBT). Our therapist followed the principles of this method, though in our case she did not go through all the standard steps. She gave us weekly family sessions and she and I also had regular phone sessions. My husband and I began to understand what we should be doing, why, and how. When she visited our home for a few meals and coached us, we at last began to behave like the competent parents that all along, clinicians had assured us we were.
That on its own might not have been enough, though. At the same time I’d been absorbing everything I could about communication and mindfulness, and I was taking care of my own well-being, which for several months had been at an all-time low.
Just as we’d done before our daughter’s hospitalisation, we took control of her meals. But this time everything was different. It worked and it worked fast. I believe this is because whatever the level of challenge, we were coming from an assured, well-informed and compassionate place. Within months, she recovered her joy in life and her closeness to us.
Two years after diagnosis, everything was back to normal – as long as she could lean on us to tell her what to eat. With time, that became less and less necessary. Every now and again she had a few minutes’ crisis over her body shape, but she was mostly a happy, carefree adolescent. Any signs of an eating disorder were few and far between. We remained discreetly vigilant.
Then, when she was 15, just as this book was being finalised, we dealt with a relapse. Some unknown factor had driven her to cut down on school meals a couple of months earlier. Her weight loss was minor but some of the mental symptoms were back. We immediately put in place the measures described in this book and although there is still a little work to do, she is smiling again.
Everybody’s story is different, but, as I see through my contact with other parents every day, this illness gives us much in common. I hope the resources that helped me and others will also help you.
 I was delighted to hear from this mother how well they’re doing now.
 Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T), is an international organisation of and for parents and caregivers to help loved ones recover from eating disorders by providing information and mutual support, promoting evidence-based treatment and advocating for research and education to reduce the suffering associated with eating disorders. Within it is Around the Dinner Table, an online community of parents of eating-disorder patients around the world. Highly recommended.