This is a section from Chapter 14 of ‘Anorexia and other eating disorders – how to help your child eat well and be well’
Also useful: you can hear me demonstrate examples of dialogue in Bitesize.
Has it become difficult to recognise your son or daughter? Do you struggle to help them as they flip between depression and aggression? Are you finding it hard to give unconditional love, and are you confused about rewards and punishment? In this chapter I offer you resources and examples to help you deal with common issues, communicate with compassion and build connection.
In this chapter I propose to address typical difficulties we parents experience with our children when they have an eating disorder. I’ll share what served me well with my daughter, what’s worked for others, and what professionals say.
If you skipped Chapter 13 this one should still make sense in most places, but you’ll get a better grasp of matters relating to communication if you first read Chapter 13.
As always, take what’s helpful, and discard the rest.
“My feeling, with my daughter, is that each time she goes through a mood swing or a difficult time, if we handle it calmly and compassionately and she gets through it just fine, she is learning from that. It means the next time something goes wrong, she is more likely to get through it a little more easily.”
Food is medicine, and love is life
My connection to my child feels like my most precious weapon against the eating disorder. Food and time are crucial to healing, but humans need their souls nourished too. A parent’s love is life-giving. With our love, we soothe our children’s nervous systems. While our children are drawn to eating-disorder behaviours to reduce their anxiety, we are modelling for them far more effective ways to deal with all kinds of emotions. I believe that because we matter enormously to our children, and because we support them, they’re able to take on major challenges in spite of their fears. We make things seem safer, calmer. Our love heals their battered self-esteem, counteracts their self-hate and guarantees that we will not abandon them.
I find this quote from a young person in recovery very moving, given the suffering brought on by the illness.
“What an amazing gift the eating disorder brought me and my family – the gift of communication, of love, of acceptance.”
Unconditional love and acceptance
Unconditional love and acceptance of your child is one of the most important tools in your toolkit, both for your own benefit and your kid’s. It’s natural for us, in our suffering, to have all kinds of judgemental thoughts, and it’s easy for these to leak out and spoil our work. I’m proposing to give you some of the principles that helped me, and also to be transparent about the mental twists and turns I underwent as I tried to be totally present to my daughter and offer her unconditional love.
‘Love her even when she’s down’
One afternoon, when my child was very ill, I arranged to meet a generous young woman who was recovering from anorexia. She gave me precious insights, and as we parted company I asked her, ‘What is the one most important thing I should concentrate on? One thing that will make the biggest difference to my child?’
She answered without hesitation. ‘Love her at all times. Even when she’s down. Even when she’s at her worst.’
I still get a lump in my throat when I think of this and everything it implies.
What is unconditional love and acceptance?
Unconditional love is loving our children irrespective of what they do or don’t do. Love, no matter what. It’s about them mattering to us. It’s making them know that they are wanted, special, significant, valued, appreciated, missed, and enjoyed.
I thrive on unconditional love, and I’m a grown-up. I want my child to be nourished by that too.
I believe that it is because of our love for our kids that family therapy has been shown to work (more on that in Chapter 12). I believe the treatment is about putting love into action. Even the best residential units can’t give that kind of love.
My child is more important than what she does. My relationship with her matters more than any of her achievements or behaviours. Or to put it another way, ‘I’m her mum!’
Here’s how I saw it when times were hard: it’s easy to show her my love when all is sweetness and light, but I believe she needs it most when her behaviour is out of order. These are times when she has no resources to hand and her only tools are abuse, defensiveness, lies. If she had better ways of getting what matters to her, she wouldn’t be getting in such a state. In fact, many times she’s done a great job of achieving her aims peacefully. Right now she is lost. I am the person she needs to turn to. I am her anchor, her rock. I will not add to her stress, uncertainties or self-loathing by criticising her. In fact, because of the state she’s in, she will be expecting me to judge her, so I will take extra care to show her my uncritical acceptance.
How about her behaviour? If she has my love, is she going to think it’s OK to behave without any consideration for me?
Connect before you Direct (I did a YouTube on that). I will address the behaviour later, if necessary. But first I will take care of our connection.
Parents can find it difficult to believe that love and acceptance work better than rewards, punishments and forceful displays of authority. They think the only alternative is to be permissive, and who wants to create a spoiled brat? Some have become masters of unconditional love and they are delighted by how well compassionate persistence works, but to them it’s an abnormal, temporary way of parenting which is only appropriate to eating disorder situations. I disagree. Nonviolent Communicationprinciples were developed with all human beings in mind. You don’t need to have an eating disorder to thrive on connection and mutual respect.
[Jumping to another section of the chapter…]
How to be effective
You don’t have to walk on eggshells
We parents know what it’s like to walk on eggshells. Eating disorders often make our sons and daughters react violently and unpredictably. They accuse us of ‘saying the wrong things’ and then step up their restricting, bingeing or purging behaviours. So we pussyfoot around.
What if she doesn’t want to tidy her room or clean her hamster’s cage or stop hitting her sister? What if she storms off when Grandma’s expecting a birthday visit? It’s bad enough having a hard time around meals six times a day; what can we do about all the ordinary situations? Should we show her who’s boss and demand what we want? Or should we say yes to everything because she has already lost her autonomy around food and health?
In Chapter 13 I introduced you to the principles of making requests, and now I propose to go into a few more details that might be particularly helpful with your child.
Teenage rudeness or eating disorder?
Parents tie themselves in knots when they try to work out if a rude behaviour is driven by the eating disorder or whether their child is being a terrible teenager. Their understanding is that if a bad behaviour is ‘just teenage behaviour’, then their child is being deliberately obnoxious and needs to be given ‘consequences’ (punishment). Otherwise the parents will look like they are condoning the behaviour, they will become a doormat, and there will be no end to the rudeness. Whereas if they believe the behaviour comes from the eating disorder, parents appreciate how well a compassionate, non-blaming, non-punitive approach works. They also understand it’s unfair to punish their child for something which is not his fault.
Take the example of a teen screaming obscenities because he’s run out of clean school shirts. The parents freeze, uncertain how to respond. Is it an eating-disorder issue, because their son saw his weight yesterday and because breakfast will include a fear food? If so, they have the skills to say, ‘Use polite language! Now tell me, this is not like you. What’s up? What is it that makes this issue so serious for you?’
But if they think their son is being a pesky teen, they go for: ‘Don’t you dare speak to your mother like that! Your outing with your friends is cancelled!’
I propose that you let go of these distinctions and use your wonderful compassionate communication skills for everything. You know how well they work even in the toughest of mealtime situations. If they can get your child to eat, they can also get your child to empty the dishwasher and to find a pleasing alternative to the F-word.
We can’t tease apart all the factors that tipped our child’s nervous system into a state of threat. Having difficult meals, having constant eating-disorder thoughts, is tough. But so is dreading an essay, or having a teacher shame you for forgetting your homework. An eating disorder puts our children in a near-constant state of stress, and so do exams.
There’s an added difficulty when our children are depressed or suicidal. Punishments (like cancelling friends) are hardly going to lift their mood.
Yes, it’s counter-intuitive to be compassionate when you’re at the receiving end of appalling behaviour. It’s strange for parents to step out of a well-worn groove to create peace, not war. There’s an assumption that we can use our higher status to make our kids polite. All the same, when your child is being disrespectful, consider that they are not in choice. Human beings, when they are in choice, love harmony, connection, growth, happiness. Your child is connected to you, you are the person who gives them unconditional love, who can help them with homework and friendship issues, who gives them the stability they need to practice flying the nest. So when your teen screams at you, assume that his nervous system is in a state of threat. He’s in fight-flight-freeze. He is driven by forces just as real as those of an eating disorder He does not expect love and support, though he longs for it. This makes it extra important – and extra challenging – for you to create the very connection he so needs to be his own gorgeous, wonderful self again.
[Jumping to another section of the chapter…]
With de-escalation, you start off strong to match your child’s intensity, then you model a progressively quieter, kinder tone of voice. You’re juggling several things at once: giving yourself self-compassion, listening and responding to your child with compassion, making clear requests to stop aggressive behaviours, and bringing down the emotional temperature with your own body language and tone of voice. The sooner you can get yourself to a state where you’re grounded, the more likely your child will also become calmer.
De-escalation can take a while, during which your child may go from one accusation to another. It can start with ‘You’re a control freak! Everyone else can use Instagram’ then move on to, ‘You gave me too much pasta at lunch!’ and then, ‘You never listen to me!’ Usually, this is not a good time to justify yourself or to correct. Instead, look for responses that validate each of the emotions as they emerge (as explained in Chapter 13).
For instance, you could respond to the Instagram complaint with, ‘Sure, I can well imagine how you’d like more freedom, because we’re already in charge of your food, and because you have friends who are given that kind of freedom.’ A few minutes later, when you’re accused of never listening, you could say, ‘I’m really sorry, that’s terrible, I really want to listen and understand. Tell me more. And it will help if you speak in a lower tone of voice. Can you do that?’
This can be a feat of endurance for us parents. When you get lost, remember the simple template, ‘I’m sorry, and I love you’ as well as the power of silent empathy. This will save you from trying to fix problems in a hurry – usually badly. You may need to keep breathing and giving yourself compassion at every step, in order to stretch your patience a little further, just enough for the next rung on the ladder.
Finally, you’ll see a sign that your child is connected to herself and to you: a sigh, a relaxation, a change in her tone of voice, or even tears. Now you can offer a hug, or a break, or move towards problem-solving, or give explanations.
Some time after this demanding exchange, you may well need to go find someone to give you some compassion for what you’ve been through. If you want to be in top form for your child’s sake and your own, this goes in the category of essentials, not luxuries.
Your child may need more support too, as they may feel ashamed of how they treated you. So consider having a conversation later on in the day to mend the relationship and to problem-solve how to avoid such fireworks in the future. More on this ‘mending’ process later.
[Jumping to another section of the chapter…]
'Am I fat? How to respond
Your child is genuinely suffering
In their anxious, eating-disordered state, our children can be genuinely terrified of being fat, and indeed of any weight increase. Meltdowns are common after a weighing, or when they dress in front of a mirror (some parents choose to cover them). Our children ask obsessively, ‘Am I fat? Will this make me fat?’ They howl, ‘I’ve gained too much weight! I’m so fat! I feel fat! You’re making me fat!’ And they demand numbers: ‘What’s the weight target? How many more kilos?’ They perceive dreadful sensations in their body. Their vision may be distorted too. They accuse us: ‘All you want is to make me fat!’ Our natural reaction can be impatience, irritation, defensiveness, because this is exhausting, repetitive stuff, and sometimes it’s scary how crazy it is. Let’s remind ourselves that our poor child is currently being tortured by a malfunctioning brain, and that this is not for ever. However we choose to respond to the ‘Am I fat?’ questions, let’s keep judgement out of it.
The best way for an individual to get relief from those ‘I’m fat’ meltdowns is, paradoxically, to regain lost weight and stick to regular meals. So keep feeding, whatever you do.
For now, when your child asks, ‘Will you make me fat?’ you probably want some tips, and I’ll give you a whole range to choose from. You are unlikely to ‘convince’ your child of anything, so your aim is to make the next meal work, and if at all possible, interrupt the loop of eating-disorder driven questions. This is what I’ll cover here.
An opportunity to change your child’s mindset
When any child – eating disorder or not – asks, ‘Am I fat?’ thousands of parents all round the world answer, ‘No, of course not’ or ‘No, you’re beautiful.’ If your child is well enough to engage in conversation – and that’s a big ‘if’ – then it’s far more helpful to model a body-neutral or body-positive stance.
While your child is quite ill and going through refeeding, you may appreciate the suggestions that follow.
‘It’s not useful to talk about it’
For weeks or months, most of our children are so anxious about their weight that any conversation increases their rigidity. Their mind is too terrified, chaotic, delusional. When a child is wailing that she can’t drink water because it will make her fat, body-acceptance is hardly the issue. Someone for whom an ‘extra’ grape is agony is unlikely to engage in reflection about body diversity. They may agree that their best friend is both large and wonderful and even popular, but right now all they can think of is that their own body feels unbearably awful: ‘It’s different for me. I have to be thin. Am I fat? How much more weight do I have to gain?’
Our focus, then, has to be on creating trust and a sense of safety.
That’s easier said than done. We try to find helpful words to calm our children but they distort our meaning. The same questions keep looping back, and distress levels keep rising. Meanwhile, we get more and more impatient at our impotence and they think we’re judging them (which we probably are). For these reasons the best replies are short and sweet. I recommend a brief statement of empathy, then a refusal to talk about the issue, then distraction:
‘I’m so sorry this is so painful to you; I so love you. It’s not useful for us to talk about it. Come, let’s wrap Dad’s present.’
Expect your child to cling on: ‘You’re not saying I’m not fat, so that means I really am fat! I’m fat! I’m horribly fat!’
Keep to your script, to your broken record. Bring out the wrapping paper: ‘Which one do you think Dad will like best?’
To your child, ‘We’re not talking about it’ can be invalidating. How infuriating, how terrifying, to not have their greatest concerns addressed! So say it with kindness and non-judgement, so that your child knows you are not dismissing him or her. You could be transparent about your strategy:
‘I’m sorry, darling. I’m guessing you’re tense about all this and you desperately want reassurance… and we know that talking about it doesn’t do that. Best to go for distraction. Would you teach me to fold a paper bird?’
Later, when the ‘I am fat’ questions keep recurring, you can give a shorter reply, ‘Remember, sweetheart, we’re not discussing that because it’s not helpful.’
And of course make it clear you’re not discussing food amounts or weight gain. Those are non-negotiable. […etc...]
[End of extracts from the chapter]
In this chapter:
- Food is medicine, and love is life
- Unconditional love and acceptance
- Judgemental thoughts: my story
- She loves you, even when she loves you not
- What to do with your child’s anger
- Is your child’s anger better out than in?
- Is your own anger better out than in?
- It’s not about you (even when she’s mad at you)
- Punishment, sanctions, consequences and ultimatums
- Rewards and incentives can backfire
- How to be effective
- Dealing with aggression
- ‘Am I fat?’ How to respond
- Hysterics, panic attacks and extreme anguish
- Comfort and reassurance: what works and what doesn’t
- Nurturing your child's wellbeing
- Personality traits that help and hinder
- The power of your relationship
- Sick, mad, bad? What model are you using?
- Mending, apologising, and regrets
- Influencers and reading materials for your child: take care
* Next chapter: How to build up your own resilience and wellbeing *
* Empathic and effective dialogue with your child: example after food is binned in school *
8 Replies to “Love, no matter what: how to support your child with compassionate communication as you treat the eating disorder”
This article was so helpful, except that I am so filled with despair about all of the ways I’ve messed up, and about some horrible things I’ve said to my child when my emotions have gotten ramped up and I’m frustrated and angry at the eating disorder. I wish I could go back in time and start over, but of course I can’t. It feels like the eating disorder is always two (or more) steps ahead of us. We’ll be able to get our child to eat for a time, and then things change and the old strategies no longer work. I thought we would be loving and strong and smart enough to beat the eating disorder and save our child, but hope is slipping away fast despite our efforts and a care team that has been extremely dedicated.
Dear ScaredMom, I hear your despair and the dip in hope. Please know that our children are very resilient to our many mistakes. We all regret things we said or did, when we didn't know any better, or when we were out of bandwidth. I'm glad you have a dedicated care team, and though you are allowed times of grief and discouragement, know also that hope is always there. It may be the journey was longer than you anticipated, but either way, between you, the great team, the life force in your girl and time, there is always a better future ahead.
Sending all my love and good wishes,
Seriously I love your positive attitude, it doesn’t help me though as I resent what he’s done and every single meal battle I feel less love for him. This has destroyed our family, his sister now has OCD as a result and I would do anything to be able to walk away. Our lives are dictated by him, I feel that he’s selfish as he expects everything to be done his way. I hear your cries of love during a food battle but what about reality?
I’m not allowing this to be his new normal. 6 months on and he’s at his target weight due to my persistence but we’re no closer to him becoming completely independent in caring for his dietary needs in the mean time, his sister hasn’t been allowed to sit at the table with him, due to lockdown and no parental support his sister now has OCD, he’s spent 6 weeks in hospital, his 83 year old grandfather has to collect him from school and force him to eat to allow me and my husband to work and I’ve considered suicide, all along with feeling tremendous guilt that this is how I feel about my son. My husband get really angry when I vent to him but who else can I vent to? I absolutely hate anorexia and I’m not prepared to soften that as it isn’t welcome in anyone’s life.
Oh my darling, you have been under tremendous strain with this so-difficult illness, and what sounds to me like woefully insufficient support. Please know you are in good company with ALL the feelings you express. Until we get the knowledge and support we need, this is how we parents struggle.
Darling, there is a lot more in my book than what you found on this page. A lot of emotional help, a lot of practical help. Or follow the links for sources of learning from others. There is a world of knowledge out there which may truly help you, even if all it does is help you to find real good professional support for your son and your daughter. Consider also the charities (e.g. Samaritans) that are there for you in your own despair and exhaustion.
All my love, Eva
My 17 year old daughter is 5years into recovery but recently she seems to have relapsed into saying, "I'm too fat" " Have I got bigger" "I'm not hungry, so I don't need to eat or I'll get bigger" and hurting herself by pulling at her tummy.
I have gone back to my Bible, your book Eva, as i seem to have forgotten how to respond to her without making things worse.
Just wondering if people have experience of whether to respond differently so far into recovery or do I go back to basics ? She is far more resilient than she was, and is good at doing the right thing for her health and going against her ED voice BUT the questions to me are relentless. I am the constant voice of reassurance, but is thst the right thing to do?
After a rollercoaster 5 years ans seeing good progress I'm feeling helpless all over again.
I have gone back to reading Chapter 14 but I would be grateful for any advice on whether I should be reassuring her she is not fat when she asks( when she needs to restore weight still )
Hi Lucy, I think there's lots of 'It depends' on this one, and so it's taken me several pages in Chapter 14 and several Bitesize Audios to tackle it. See https://anorexiafamily.com/fat-question-reply/ I wonder if your book version is pre 2020 (see the copyright page)? The 2020-onwards version should have it. Let me know if yours is an older version and I'll send you the latest ebook. I hope this helps. Love, Eva
Thank you for this wise and life changing information.