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Chapter 7 in 'Anorexia and other eating disorders'
This page gives you some extracts of Chapter 7.
And in my Bitesize audios you can hear me explain and demonstrate those tips. I also offer short online workshops.
Chapter 7 book extracts
And now, prepare yourself. I’m going to invite you on a bungee jump. I hope you are suitably terrified!
Actually I have no intention of raising your stress levels and I’m going to take very good care of you. The aim of this thought experiment is to help you empathise with your child, so that when you’re in the middle of a meal the tools come to you instinctively and you don’t have to go and consult a book.
The great bungee-jump thought experiment
Your child’s resistance is driven by fear
One day I realised that just about every mealtime obstacle my daughter threw at us was driven by fear. This changed everything. Her behaviour might have looked like contempt, or stupidity, or rudeness, or defiance, but the eating-disorders specialist coaching us suggested that the underlying emotion was fear.
“Before, we knew she was having rages and tantrums, however, on the multi-family therapy week we have all learned together that it is fear and anxiety.”
[Jumping to another section of the chapter…]
Logic doesn’t work when you're trying to get your child to eat
I do hope my friend won’t try logic to get me to jump. I can’t think of anything more stressful than having a geek rabbiting on about Hooke’s law, while I’m staring down into the abyss. Is that Young’s modulus he’s talking about now? He is seriously getting on my nerves. All I can think is, ‘I cannot take that leap. It’s too hard.’ My friend says, ‘But the elastic cord will hold you. Remember when we did Newton’s laws in school?’ I don’t like the look of the rope. It looks frayed. Yes, I’m sure it’s frayed. And it looks too long. I’m going to crash headfirst into the riverbed. My friend is getting impatient. I play for time by starting an in-depth argument about the elastic’s tensile properties. My friend gets annoyed that I am so dense about the laws of physics, which gives me a good excuse to let off steam and scream at him. I am glad to note that while we argue, he’s not making me jump. I simply cannot jump.
When we are scared (and our children are scared at each meal), our brain cannot engage with intellect or aspirations. We are thrown in a state of fight, flight or freeze, which prioritises safety (see my short YouTube video on this subject.)
I still squirm when I recall that I once produced a colourful chart to show my daughter the humongous number of chocolate éclairs needed to gain just half a kilo. She looked at them and nodded wisely. Then she refused the next meal.
Parents quickly discover that rational talk at mealtimes doesn’t work. In Chapter 8 I’ll show you how to avoid discussing calories, quantities and metabolism. Logic may have been a good-enough tool in your toolbox for ordinary life, but with any situation where emotions run high, it’s as much use as an ashtray on a motorbike.
[End of extract from the chapter]
In this chapter on helping your child to eat:
- The great bungee-jump thought experiment
- Planning the challenge
- Logic doesn’t work
- Education: the dinner table is not a lecture hall
- Eating prompts work best
- Conversation topics: pick with care
- Distraction: a firm favourite
- Reassurance: surprisingly not reassuring
- * Pause for self-connection *
- Calming skills
- Trust me, I’m an expert
- Shock tactics: short-lived gains, high costs
- Shouting, intimidating, blaming: counterproductive
- Threats, punishment, and ‘consequences’: unnecessary
- Rewards and bribes: handle with care
- Incentives: a nudge in the right direction
- Visualisation: access to inner resources
- Praise: complex and risky
- ‘It’s your medicine’: worth a go
- Lost your temper? Repair and resume
- Teamwork: have a break, make a graceful exit
- Containment: stay close
- Humour: the best relaxant
- Feelings: a good start
- Empathy: listen and reflect with kindness
- Pause for self-connection *
- Selective hearing, body-swerving and translation skills
- Mirroring: model calm confidence
- Defusing fear: remove the fear of fear
- Notice indicators of progress
- Wait a few minutes
- How long should you persist?
- Focus on the current step in the present moment
- Let your kid save face and maintain some dignity
- All singing from the same hymn sheet
- Giving uncritical acceptance
- Putting it all together
Onwards
* How to get your child to eat: refeeding mealtime tips for a teen with an eating disorder A page with key tips*
* Next: chapter 8: See the tools in action: mealtime scenarios *
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Comments
My son is Autistic and has ADHD and is also Anorexic.
Together they’re a lethal combination and the regular AN treatment hasn’t been working – he’s been with the Eating Disorder Team for 18 months now.
Do you know any resources for this combination?
Today he’s told me he isn’t going to eat anything because he’s mad at me (he’s too ill for school but wants to go to his youth club and I’ve said no). This is a regular occurrence – he goes on hunger strike and tells me it’s to punish me when I’ve said No. He knows that because of his anorexia I can’t let him starve.
I genuinely feel like at this point I KNOW my child is going to die from this illness and I feel hopeless as his treatment isn’t working.
It’s really awful.
Dear Katy, I so get your despair. It's not at all OK to feel so very unsupported.
Katy, have a good look at my page on autism: https://anorexiafamily.com/autism-eating-disorder-tips/ You will see many have had similar difficulties and found ways to succeed all the same. Note also I give some links to helpful people (my expertise on autism is almost zero) and I know these people have made a huge difference to others. So there's help there, so you can hold the candle of hope for your son.
You are also welcome at my regular "Help your child to eat" workshops https://anorexiafamily.com/workshops-eating-disorder/.
Parents of autistic kids tell me that my mealtime tips are useful — some of it they use, some of it they adapt, some of it they ignore.
For instance I can perhaps help you find alternatives to that "No" word that drives such resistance.
Hugs
Eva
my daughter is struggling to eat.
Today she ate 2 tablespoons of oatmeal, some carrots . She is self aware she has eating disorder, and is scared. she is nauseous ever morning
should i seek psychiatric help for medications first? or should i take her to her pediatrician first?
So worriedYani, I am sorry, it is indeed a horribly worrying time for a parent. Your fears are useful as they are spurring you on to getting well informed and taking energetic action, so that your daughter will recover her wellbeing.
Yes, pediatrician first, and insist on an appointment today: get the reassurance about her physical state, and set in motion consultations with an eating disorder specialist.
Don't allow any "wait and see/it's a phase" from the pediatrician. Chapter 4 of my book is also on https://anorexiafamily.com/diagnosis-treatments-anorexia-parent/ and it makes important recommendations to make the most of that pediatrician visit, and avoid pitfalls…. because pediatricians are not expert on eating disorders and can inadvertently make some things harder for your girl.Psychiatric meds do not treat an eating disorder — your priority will be to manage to get your daughter to eat, and sometimes a psychiatrist — as part of the eating disorder treatment — may prescribe a drug to reduce the distress of that process.
All my resources are there to help you. You might start by reading "The essentials for parents" on https://anorexiafamily.com/treatment-anorexia-refeeding-therapy/ For rapid learning you might want to jump onto my workshop "Help your child to eat"
I wish you all a swift journey to wellness,
Love, Eva
My daughter is 11, she has been diagnosed with disordered eating in the context of anxiety. She is underweight, and we have been trying to help her eat and regain weight at home since mid January. We are stuck – while we have managed to stabilise her weight we have not managed an increase. Some weeks she may gain but then will lose this the next week. She is completely terrified about eating and drinking and will only accept a restricted amount of food and drink. With your helpful tips we manage to get her to eat but if she feels she has eaten too much at one meal she will refuse later in the day. She compulsively tries to throw food away, hide it, spit it out or regurgitate it. I am concerned by the lack of progress, at her age the longer she is stuck means she is technically losing weight as she is not growing. She has no insight into how unwell she is.
Our ED nurse says the plan is for us to persist with the ‘meal plan’ at home until she restores weight. I am scared of letting her go on at this weight for more time.Hello Bel
Very hard indeed, and to my knowledge it is right that you should raise concerns when there is effectively no weight gain since mid-January. To me it's a sign that you need some extra or different kind of help. Something needs to change. A paper from Le Grange et al proposes exactly that: Family-based treatment for adolescent anorexia nervosa: Outcomes of a stepped-care model
What you describe is so very typical of anorexia, and treatment does rely on successful renourishment.
One of the things that might be offered is that staff help you feed at home a few times — maybe enough to push through with the required meals even when she is terrified of gain. Another thing might be more coaching for you — observing and coaching you in your home environment as you support a meal. If your services don't do that then do check out my workshop "First Phase: help your child to eat".
Or maybe there is a day clinic/PHP close enough to you, that would help move things past this current block. Basically, get your ED services to review as a team with you, and problem-solve.
I send you all my wishes. Eva
Sam
My brother (12) hardly eat anything, works out (extreme cardio -track, running, tag, etc) around 5 hours everyday. My family does meals together normally, but when we eat now he barely touches his food (usually just enough to not get questioned), leaves halfway (shower, “not hungry yet”, hw, etc) and doesn’t eat when he gets back. He hardly eats enough as it is, and with all the exercise paired with him always having a fast metabolism, I’m really worried. He’s always been thin and had little to no body fat, but now his ribs are see-able. I’ve told my parents and suggested things we could do to help meals be a more inviting space but they either listen and don’t do anything or just don’t do anything. My parents also applaud him on eating “healthy” and “knowing when to stop/eating the right amount”. I’ve told them that their language could be harmful and have negative effects but they still do it. What can I do to get him to eat more? Is there a way I can bring up food with out upsetting him? I’m 14 and his older sibling (we are really close) if that is helpful. Thanks for a informative article too.Hi Sam, you are a smart and caring sibling. I wonder what is stopping your parents from taking action when you so clearly see the need for your little brother to get help. My first thought is that you direct your parents to my resources. Perhaps they are scared of doing more harm than good, and information can make us all powerful. You can also direct them to the FEAST website http://feast-ed.org/ (where you, as the brother, may get regular support from other members, including people in your country who may better help you use any healthcare 'system' available) and you can also direct your parents to any eating disorder charities in your country.
An eating disorder is such a serious illness that I doubt there is much you can do yourself to get your brother to eat what he needs, bring the exercise down to the required level, and to not upset him. It's very skilled work and it usually requires family members to be consistent, on-message. The loving, authoritative confidence of parents is usually crucial too.
All this to say why your most effective action may be to direct your parents to good resources.
If that fails you could work to get your brother to your local doctor, and if your parents don't do it, write down a list of symptoms/behaviours.
In the most extreme scenario where parents don't act for their child's health, a country's medical and social services may take over, so you might feel supported in that way, though I hope it doesn't get to that.
Sending you all my love and good wishes, Eva
My daughter is 14 and just returned home from her first hospital admission where she was very compliant. Now that shes home she basically refuses to eat. Every second day she will eat something (that she wants, sometimes I can get her to eat my choice), but it is such a small amount. And if I ask her to eat or present her with food she flatly refuses. It has to be under her terms. She gets very angry when I question her, or try to change the situation. I am trying so hard to remain calm and persistent – but she is so strong willed and just refuses. How do I get her to even come to the table?
Hello Jen, these are hard times for you, for her. Sometimes a short hospital admission gets our children eating again, especially when the parents are involved in meals in the hospital, which helps the transition back home. I'm sorry that for you things continue to be so difficult. Keep raising the alarm so that she is safe. Some kids are hit harder than others by this illness. Some go through several rounds of hospital until they can be helped back home.
I'm not sure how much you've already seen of my resources.
This page is an excerpt of Ch 7 of my book. There's a lot more help in that chapter, and there are several more chapters on meals, including a fly-on-the-wall chapter covering the situation where you can't even get your child to the table. There's also my Bitesize audio collection, where you can get quick answers to so many of these questions and hear me modelling things you can say. Another suggestion is that you attend one of my workshops "Get started and help your child to eat" as we can then go through every step of your scenario, or if you're Zoom-shy you can watch other parents with similar questions.
I hope this gives you some pointers to your important question and send you all my good wishes for this to be turned around very soon.
Love, Eva
My daughter is 20 and has just been diagnosed with anorexia…. I am at a loss as to what to do. She only eats once a day and very little at that. I don’t know how to encourage her to get the help she desperately needs.
Hi my daughter hasn't eaten in 5 months she is being tube fed, she is 14 and 34kg was when she was admitted to treatment she is now 48 kg nearly to her healthy BMI, I cant get her to put anything to her mouth have you got any advise for me thanks.
Dear Amy, that must be so painful for you, to see her so dependent on tube feeding. I'm guessing you're in the UK, so one thing you can do is ask for your team (including the experts in the Community eating disorder service and maybe the Trust's children's commissioner, to review the situation with you. I followed a girl who could only survive by forced NG feeding for a couple of years. Eventually the children's commissioner arranged for a change of hospital, and slowly she started eating there. She's now totally recovered and having a great life. So a change of some kind may be useful. Or just to amplify the efforts to present her with the smallest, easiest things to have by mouth. Also, about the BMI issue, this video of mine may prompt you to check/ask questions: "Growth charts and goal weights made simple: eating disorder recovery" https://youtu.be/2yVa7jlUsMY
I wish you all progress very soon, Eva
What if I can’t get my daughter to even take one bite?
Dear Sara, that's a painful question which I know well. First, even with the best of skills, some of our children just cannot eat with us, and need a spell in a higher level of care. If she won't take even one bite, that sounds urgent. Even if she's eating a little, but isn't eating enough and you can't shift that, you can't allow this to go on for too long. If she's already had a spell in hospital, this time get more help on the transition back home, so as to stop the revolving door. More in my book, starting around page 255. Also there's an account from a mother here describing a hospital that really did take care of the transition.
I do give lots more tips to help get that first bite started, and then to keep going. Lots in my book and in Bitesize, and also a summary in my free helpsheets. I really feel for you and wish you some progress very soon.
Eva
What are your thoughts on this? My son repeatedly asks me to confirm how thin he is and wants me to confirm his bones and veins are showing before he will eat. Am I doing him harm confirming these facts? He refuses to eat without this confirmation. (He is back at the refeeding stage having lost 5kgs). I think getting him to eat is the priority but I’m not sure if I’m causing him future harm confirming these thoughts.Dear Becky, see https://anorexiafamily.com/fat-question/ where I give various options, pros and cons. I have a section on "Am I fat?" in my book and this link is me checking a revision I want to make to it for a number of reasons. When I first wrote my book, I thought that yes, eating and weight gain is the priority, so if confirming he's thin gets the next meal in, then great. At the same time you are right to consider the future, so see if my revision is helpful, and I'll be glad for your feedback.
Wishing you successes for today!
Eva
My daughter has just been diagnosed with the same problem and yes this is the norm for us 🙁
Dear Rebecca, I hope your daughter's diagnosis means she is now getting good treatment. Wishing you lots of good things as soon as possible.
EvaI hope you reply my adult daughter age 46 is not eating g. She is melting away e every day.p
Times I get her to eat something I pay the price with I instant relentless anger throwing things and just basic rage. I have had her in hospital 4 or 5 times and each tie they send her home it eds up the same. I don't know what to do. Since she is an adult I am tied up to get her help. I am a few days short of 70 and don't want my daughter to die sleepless in will County
Dear Sleep less
I am so sorry and so very sad that you, as a mother, have been living with this horror for so long, and that your daughter is still suffering so much age 46.
I don't have any great answer to offer you — partly because I don't have any particular expertise on adults. What I do know I have put on https://anorexiafamily.com/faq-help-anorexia-eating-disorder#Treatment-for-adults-or-young-adults and follow the links I offer.
Apart from that you could you could look at my resources to learn what parents find effective with teens, and adapt as wisely as you can for your adult daughter, whether it's about commmunication skills to get her into treatment, and/or to get her to commit to hands-on support from you.
Sending my love, Eva
Hello
Our daughter (13) was diagnosed in July with AN. We managed to keep her in school and have got her up to her healthy weight. She’s dipping in weight at the moment because she has been given control back and is struggling.
My question is this: she has daily meltdowns, they end in hitting, screaming, throwing things, it’s like she’s been ‘possessed’! Camhs tell us this is normal for an anorexic and can go on for months/ years. Is this anyone else’s experience? Reading other people’s accounts, I think I should be happy she is eating ( but not enough) has not been admitted to hospital and has been continuing with school. She also refuses to go out with friends – is this usual too? She’s too anxious.
Many thanks.
Hello Kirsty, well done for having got her weight back up. I'll do my best to give you pointers, though please remember I don't know the details of your situation!
So far you've succeeded in weight restoration. That's only part of the treatment. If she is having meltdowns and her weight is dipping, it sounds to me like you are still in the first phase of treatment, where parents need to be in charge of food and of eating-disorder-related behaviours. The meltdowns may be because she is still scared of eating, or very hungry (if her weight has dropped she will be hungry and anorexic thinking will be heightened), so it sounds to me like she continues to need the kind of support you gave her since July.
"She has been given control back" sounds like it could be too much, too soon.
When she's more able to eat what she needs without a fight, you will enter phase 2 of the treatment, which is indeed about giving her control back BUT only at the rate she can benefit from it. You will be doing experiments in giving her small amounts of autonomy around food, one at a time, and adjusting depending on how each experiment is working. All this is in my book, so I hope you will get a lot more from that.
I would say that for most young people, the meltdowns die down as their fear of food reduces. So it could go on for a few more weeks or months, but reducing in frequency and intensity, and no way should it go on for years – that would imply she is not responding to treatment! So it sounds to me like you need to re-focus on supporting her to eat, keep an eye on that weight (is the weight target generous enough?) and do the work of taking her through fear foods (that's in my book too).
Do check that she has a regular input of plentiful food throughout the day, especially if she is not supervised in school. If she is skipping a decent lunch you can expect meltdowns, and it would also hold back her recovery.
Anxiety is common and yes, anxiety and anorexia both mess up social life. This may all disappear as her weight and eating stabilise and she can better engage with life. If the anxiety persists even after she's eating easily, then CAMHS would probably offer her individual treatment for anxiety. But don't rush into that – best to concentrate on the eating disorder for now. So… keep up the good work …you can certainly be happy and proud you got her this far. I hope this helps you in the next steps. Feel free to show this to CAMHS – if they disagree with details, it's best out in the open!Thank you for your reply. She is at the end of phase 1 and it is Camhs that have overseen her gaining back control, but it probably has been too much too soon. You’ve put it back into perspective for us. Thank you.
Tia, I am so with you about how horrible eating disorders are, and the need for people to feel supported and understood. I imagine that this is something you dearly long for for yourself, and I am sending you warm wishes.
I dearly hope that my book shows how our children can receive so much loving support and understanding and a whole range of possible strategies to help parents find a way to help their child regain weight, so as to get the best chance of recovery. The strategy you are suggesting will be useful for many people much later on in treatment, when they are increasingly able to take care of themselves and to practice doing so.
On the other hand it can often be unhelpful in the acute stages, when the person is unable to eat enough for weight gain when they have a lot of choice. Parents often find that when they give choices, their son or daughter is anxiously trying to reduce their intake and the trend tends to be downwards. When parents take charge, their child also goes through anxiety, but after a while the anxiety is reduced because there's less internal conflict – plus, at least we know the person is on the path to freedom thanks to the better nutrition and weight gain.
Parents who use my book or videos tell me they really get how scary and horrible it is for their child. If you read my book, I hope you will warm to it and see how much care and love we parents put into giving our children their life back.
As you write that you have an eating disorder yourself, I wish you lots of good things, and in particular, lots of understanding and support.
As somebody with an eating disorder I can just encourage all parents don't force your children too eat food or try food
Try asking them too help you cook or they can choose what's for dinner. Make them feel supported and undeestand not forced and pushed
Eating disorders are horrible!
Am so glad i stumbled over this site. My daughter was addmitted to hospital with eating problem we felt so alone. We have no idea how to help but reading the comments has made me feel a bit better will try to download uour book.
Kirsty, I'm hoping you are now on more stable ground, less alone, better informed and supported.
My daughter (13 years old) is in the early stages of the refeeding.
She said that the last two weeks were the worst of her life..
Sometimes she simply close her mouth and stop eating saying that she cant eat.
What is the best approach to this situation?
Thanks
Jorge, you're at the most horrible stage, and it's so hard for all of you.
My best ideas and suggestions are in the book, so I'm wondering what more to suggest for your particular situation.Something that is positive is you say she stops eating.
So I'm guessing that means you managed to get her at the table, you've made it OK for her to sit down, and she has managed to eat something before stopping. Apart from the stopping, these are real successes. Notice what you've done that might have supported her to do all that, and keep doing it. Seriously. In the early days there were times I couldn't get my own daughter to even begin a meal.It's great she's telling you she "can't eat", as she is probably telling you 100% her truth. I mean, it's more direct than "I don't need to eat" or "This will make me fat" (which can be expected too). You can tell her you believe her. That you really hear that to her, eating seems totally impossible, and at the same time you know that eating is safe and is exactly what she needs, and you are there to help her, one bite at a time. That way she feels heard and understood and it helps build trust so she can accept your support, meal after meal.
What may help you, as you support her, is to ask her to have one more bite than she thinks she can manage. I know from your email to me that she is under clinical supervision, so at least she is safe, which means you can try and not panic when she doesn't manage enough food right now. You can only do what is possible, and you are busy learning as fast as you can. I am guessing that although you want her to eat 100% as soon as possible, it may take this one-bite-at-a-time process for a few meals before she really manages to eat quite a bit more and you can breathe more easily.
She's also telling you these last 2 weeks are the worst of her life. Whether she's screaming it at you or crying (you don't say), hear how she relies on you to be helped, to be understood. Pretend you're an expert already (you will be soon) and tell her this illness is treatable, that you know what to do, and that you will support her all the way through.
I hope this gets you going for now and send you all my best wishes.
Eva
Sounds like you have hope as well as resources to help you shift things. I dearly hope that by now you've experienced some kind of success, even if it's just a tiny step in your daughter's ability to take a bite of something else, or in your ability to be by her side, no matter what. I would love to know and send you warm wishes.
Thank you.
My daughter is only eating oranges and aiming for a weight of 32kilos. Your word have given me some hope to work thru this
Hi Eva,
you referred me to your site on ARDT forum
This is EXCELLENT advice, so wise and well worded
Thank you again
SnP
I hope it makes your tough job a little easier, SnP. And thank you for giving me that feedback.
Eva
OK, Anonymous, you were asking about what can be done if a child doesn't stay at the table.
There's a detailed example entitled
'Lunch: a re-feeding scenario'
in chapter 8 of the book
I so hope it's helpful, and as always, I truly value your comments.
Lia, that's most encouraging feedback, thank you. I like to know the humour is OK even though eating disorders aren't funny, and that the bungee jump analogy will help concepts stick in a parent's mind.
I love your use of humour and I think the analogue with the bungy jump is very powerful. This makes it easy for parents to remember waht to do and what not to do during a stressful time. Thank you Eva
You sound like you're up for taking an active role at home, and you'd like to know that's a realistic plan and that you could make it work? What I can tell you is that many other parents have done this, so it's definitely not cloud cuckoo land. It doesn't matter whether your daughter thinks it will work or not: either way she's bound to put up resistance because that's the nature of the illness. But it's a pleasant start that she'd like to come home (we didn't have that luxury). Ideally you'd want to be ready, well supported, and continue to have some kind of medical set up, as this will see you through the ups and downs. Note this article by Harriet Brown on following an FBT approach with a non-FBT team: http://maudsleyparents.org/workingwithanonmaudsleyteam.html
On the other hand, is there a chance that her residential unit could work for her if, I don't know, communication was improved, something was changed? Either way you'll still have work to do when she's discharged – we certainly did – so it's useful that you're getting yourself psyched up and ready.
What would you think of asking the same question on the Around the Dinner Table forum? http://www.aroundthedinnertable.org/
Then you could give more detail, and you'd receive support from not just me but lots of other wonderful parents. I'll go on and look out for you there in case you decide to do that.
Thanks for asking about how to get your daughter to stay at the table when she gets up to leave. That was a tough one for us too, and I ought to add this to the book. Rather than answer any old how, I'd like to write it up properly and add it to this website. That might take me a few days. Would that be OK for you?
Meanwhile, thanks for getting in touch, and for giving me the feedback that what I write makes sense – that's really encouraging – and I'm crossing my fingers for you at this possible time of transition.
Our daughter is in a residential programme at the moment but is continuing to lose weight and we are seriously wondering if they are doing anything that we couldn't do at home. We have talked about her coming home but she has said that although she wants to come home she knows it won't work. Are we living in cloud cuckoo land thinking we can manage this? Also any advice on how you get them to stay sitting at the table when they just get up and leave? I'd love to hear your thoughts – everything you said made a lot of sense!
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