Last updated on December 27th, 2023
Our children remain stuck in an eating disorder while they fear certain foods or situations. Practical tips for parents to extinguish fears and restore flexibility.
This is a section from Chapter 9 of 'Anorexia and other eating disorders ā how to help your child eat well and be well'
- For some more 'live' help, I also provide a workshop in which I cover exposure to fearful foods or situations
- And there are audios on exposure work and fear foods in my Bitesize audio collection. For instance in the clip below I suggest ways to talk with your child about exposure work:
You can also get an entire free helpsheet on extinguishing fears with exposure.
Extinguishing fears, returning to flexibility
Our children are bound by rules and rituals. While these are frustrating for us, they have a function for our child: they provide short-term protection from surges in anxiety or disgust. It makes sense that a human being clings to momentary safety, even though overall this makes life fearful, rigid, rule-bound, and small. In this chapter Iāll propose ways for us, as parents, to help our children become free so that they can enjoy a rich, expansive life.
In this chapter Iāll use the word ācoachingā when describing what parents do at home, and often works very well.
And when I talk of āexposure therapyā Iāll be referring to methods, based on ongoing research in eating disorders.
[Jumping to another section of the chapterā¦]
The safety behaviours our children cling to
In this chapter weāre talking about āsafety behavioursā, such as counting calories, chewing slowly, doing star jumps after a meal and other compulsions. Weāll include in āavoidant behavioursā: avoiding ice cream, avoiding resting, avoiding eating in public. And any reactions driven by disgust. These behaviours are all self-reinforcing. āThe bad things I fear didnāt happen when I followed my rules, so that means my rules work. Without the rules, the bad things would certainly happen.ā Our children may recognise that their rules are not logical, and that overall safety behaviours make life harder. But until they experience that the rules are not needed, usually nothing changes.
Thatās where exposure comes in: doing the fearful thing (e.g. eating ice cream, not counting calories) and preventing the person from compensating with a magic rule. (If youāve heard of Exposure and Response Therapy (ERP), āresponse preventionā is about preventing use of safety rules.)
When is a good time to challenge a safety behaviour?
If your underweight child is terrified of everything except apple and kale, you have no choice: you must serve high calorie foods, and you must serve those feared carbs and fats. Itās a life-saving intervention. Console yourself with the thought that your child would have resisted a useless low-fat yoghurt just as fiercely as they fought your creamy pasta.
The start of treatment also presents an opportunity to set the parameters: no purging, no sport, parents in charge of meals, and so on. This way many safety behaviours are nipped in the bud before they get entrenched. And at the same time, we canāt achieve complete normality from week one. Itās already so hard for our children to just eat. Theyāre malnourished, confused, self-hating, in a state of massive anxiety, and they may not cope with exposure to every single fear. So itās likely youāll be leaving some tasks till later, and that youāll tackle them gradually. Think of the two ways you might peel off a Band-Aid:
āWhen we were aiming for weight gain, we ripped. When we were working through the list of fear foods, we tugged.ā
Once our childās brain is better nourished, thereās a decent chance theyāll be less fearful, more flexible, braver. Some of the work towards normality may even happen all by itself:
āI do remember worrying about the fact that my daughter became very stuck on the same diet plan and we never introduced any fear foods. I neednāt have worried because actually she went from the very restricted diet plan to eating everything literally overnight.ā
So do as much as is feasible at the start, and remember to work on the rest later. Butā¦ you can probably shake things up and work on bringing back the old ānormalā earlier than you think.
One situation where exposure work is urgent (along with the work towards independence ā see Chapter 10) is if your child intends to leave home soon. Theyāll need time to consolidate before theyāre safe to go.
Weight gain isnāt enough
Careful! Thereās a misconception that with weight gain, all fearful thoughts and rigid behaviours disappear. If your child gets discharged too early, purely because theyāve reached a target weight, please know you can keep them progressing through exposure work and coaching.
[Jumping to another section of the chapterā¦]
Should you collaborate with your child?
With exposure therapy, a patient is never āforcedā. Everything is a collaboration ā even the agreement that the therapist may bring in some surprises. In treatment for ARFID collaboration is the norm, and some parents of autistic youngsters say that getting buy-in is the only way to be both safe and effective.
With parent coaching, ideally we would collaborate with our child. And happily, some youngsters are willing to shed at least some of their safety behaviours. My daughter realised that she couldnāt possibly have the Christmas she wanted with the wider family, if she couldnāt sit for one hour in the car. She was (reasonably) motivated to find the courage to practice sitting during short car journeys.
On the other hand, in the inpatient unit, she had 11 months of being consulted on her meal plan, and her range just shrunk.
To bring back flexibility in spite of our childrenās resistance, we parents often have to make the decisions. This means we canāt yet give our child independence (Chapter 10).
We took our daughter through many fear foods in spite of her protests, and it worked well and fast. Her mental state improved tremendously. I put it down to her being generally less frightened, to enjoyment and a sense of freedom and empowerment. If we had waiting for her willingness to eat a cookie or eat in a cafĆ©, I suspect sheād have stayed ill a very long time.
Occasionally a parent tells me that their child, who for a long time could absolutely not collaborate, is now motivated to take on all kinds of challenges. Oh joy! So why not let them take the lead. Be alert, though. Donāt let them have blind spots (āI donāt need unhealthy food!ā) and donāt let them go so slowly that theyāre standing still.
[End of extract from the chapter]
In this chapter:
- Extinguishing fears, returning to flexibility
- The safety behaviours our children cling to
- When is a good time to challenge a safety behaviour?
- Weight gain isnāt enough
- Dealing with fears: parents and professionals
- List those fears
- Pick an item from the list
- Should you collaborate with your child?
- āWhy are you torturing me with ice cream?ā
- Should your child feel the fear or be soothed?
- What does your child actually fear?
- The fears associated with eating out
- Example: from packaged food at home to eating anything anywhere
- Gradual steps, or dive in?
- Ideas to make the steps gradual
- Repeat and vary
- A flowchart to guide your exposure work
- When your child doesnāt manage
- Moving through the exposure list
- Forewarn or surprise?
- Your persistence
- Success breeds success
- When can exhausted parents take a break?
Where to next?
* Next:Ā Chapter 10: The work towards full recovery and independence *
* How to get your child to cope with calories on menus (and get free of the eating disorder) *
* If your child has ARFID, there are specific approaches. See 'The main eating disorders: binge eating, bulimia, anorexia, ARFID and OSFED' *
* If your child is autistic, you may be inspired by these experiences parents have shared with me: 'Autism and eating disorders: individualising treatment for your autistic child or teen' *
HI again Eva
will you be putting a page number reference after your comment of 'I talked about the Magic Plate system earlier? This is totally addictive reading, now have a numb bum and need to dance:)
Eva, this is the best description of exposure therapy for eating I have read. We've been at this for a while, and I still learned so much from your experience. I feel recharged!
Recharged!! Oh wow, Iris, this so validates everything I'm wanting to do. Thank you for letting me know.
I'm sorry you've been at this for a while and send my wishes for you to reach the end of the tunnel very soon.