Last updated on June 15th, 2020
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
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, stay persistent, 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.”
This is a big book because I cover the great many questions parents encounter along the journey. I provide plenty of signposting so that you can get the answers you need in a hurry. 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 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?
Parents also have a whole lot of questions relating to their child’s mental state and how to have a better connection. 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, nor have threats. 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. they are restricting their food intake), this book is definitely for you, because that’s where my experience lies. Note that a child 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. This book is also for you if your child is anxiously following restrictive food rules. Some youngsters become malnourished from an obsessive drive to eat ‘clean’. For some (usually male), the mental and physical dangers come from a diet aimed at increasing muscle bulk and weight, and from insufficient body fat.
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, then she needed some support again age 15 to 18. The type of family-based treatment at the heart of this book is backed up by good evidence from research on 12 to 18-year olds. 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 whatever your gender, and the same goes for your child. I hope you will be comfortable with my varied use of ‘he’, ‘she’ and ‘they’.
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 Scotland, United Kingdom.
I hope this book will be helpful to clinicians, too, and that it will complement your work with families. At the very least you will 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 wellbeing 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. 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). Experts in these fields have kindly checked and commented on my writings. Note that 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.
Keep your radar switched on. The field is evolving and there may be new, promising interventions that are missing from this book if the version 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 wellbeing is monitored and keep your clinicians in the loop. Modern eating-disorders specialists encourage parents to exchange know-how, so you should find it possible to be open with them if I write anything that contradicts their views. 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 right now.
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 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).
- 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
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 parents and clinicians who’ve contributed are local, while others are all over the world, online.
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. 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.
My husband and I live in the UK and have one daughter. She was a happy, well-adjusted kid until shortly into her tenth year, when she spiralled into restricting anorexia. The trigger was a fall-out with friends. She decided to become thinner so they couldn’t ever again call her fat. Besides, restricting food and rest fitted well with her school’s health promotion messages. 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 the mental health ward of a children’s hospital. 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. During her home visits we couldn’t reliably feed her or make her feel secure. Much of the time, we were the enemy. So she remained a hospital patient, increasingly long spells at home and at her normal school.
The staff described her as ‘stuck’. By her ninth month she’d narrowed her range of food and was again losing small amounts of weight. By month eleven we thought we could do better at home. There were hopeful days, but soon she was missing out on snacks, then on entire meals. We were now using the outpatient mental health services, who provided vague family sessions and insisted on giving our little girl individual therapy. It was fruitless. Her weight kept dropping, her mood was low, and we feared she’d spend her adolescence in and out of hospital if we couldn’t find a better way to support her.
At last several things clicked into place. A specialist eating-disorders service came on board. They were receiving training from James Lock’s team in Stanford in a well-validated method called Family-Based Treatment (FBT). Our new therapist followed the principles of this method, though in our case she did not go through all the standard steps. In addition to the standard weekly family sessions, she and I had regular phone discussions, where we did most of the work of reviewing and moving forward. When she gave us meal coaching at home, we became competent… at last.
That on its own might not have been enough, though. At the same time I’d been absorbing everything I could about communication – Nonviolent Communication, specifically – and mindfulness, and I was taking care of my own wellbeing, which for several months had been at an all-time low.
Now, when we took control of meals, it worked and it worked fast. I believe this is because whatever the difficulty, we were coming from an assured, well-informed and compassionate place. Within months, our girl 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 twelve year old. Any signs of an eating disorder were few and far between. We remained discreetly vigilant – a little too discreetly, as it turned out, because she went downhill again age fifteen (just as I was finalising the first version of this book). It started with her secretly cutting down on school meals. With our experience it was relatively painless to keep her stable. Most of the time she was happy and enjoying a full life. But as her parents we could see that the mental symptoms were there, and they hung on – at a relatively low level – for the next three years. We sought the support of therapists, then decided we got better progress alone. By age 18 she was pretty well, and six months later we had no problem in letting her attend a local university and enjoy independent living. Improvements continued. She’s now 20 and for each of us, life is sweet. Usually I think she’s completely recovered. I’m also open to the possibility that she might be secretly backsliding. We’ve been duped before. We are ready to live with some level uncertainty, jump into action if and when necessary, and meanwhile, enjoy life.
During her main periods of illness, I let go of most of my work so as to have time for her. My husband went on working, though he had flexibility and was able to share the care at home several days a week. Since publishing this book, I have devoted my working hours to keeping myself up to date, publishing revisions, producing new resources on my website and on YouTube, and supporting parents by video-call.
Everybody’s story is
different. My child’s ups and downs will be different from your child’s. At the
same time, as I know through my daily contact with parents, this illness gives
us much in common. I hope the resources that helped me and others will also