Welcome to the FAQs, the pressing questions parents ask when they desperately want to help their son or daughter recover from an eating disorder, in particular from anorexia. This page is a bit of encyclopedia. You’ll find quick answers, links to entire chapters in my book, and to blog posts from myself and others.
What is an eating disorder?
What are the different types of eating disorder?
Eating disorders are classified as anorexia nervosa, bulimia nervosa, binge eating disorder, rumination disorder, and pica. There is also avoidant/restrictive intake disorder (ARFID), for those who may be in great need of treatment but don’t tick all the boxes for anorexia, bulimia or binge eating disorder — in other words the large proportion of people whose eating disorder is referred to as ‘atypical’. There are two more categories designed to catch the remaining disorders which are serious but tick even fewer boxes: other specified feeding or eating disorder (OSFED), and unspecified feeding or eating disorder (UFED).
One more term you may have heard of is EDNOS (eating disorder not otherwise specified). This is an old category (from DSM-IV) which used to apply to a majority of eating-disorder sufferers as it covered everything that couldn’t be categorised as anorexia or bulimia.
Please understand that ARFID or OSFED are no less dangerous and distressing than, say, anorexia. These categories are experts’ best attempts to classify what they see in order to work out the treatments most likely to suit the person.
Chapter 3 (‘Your part in diagnosis’) in my book explains all this and you can read it here.
Can you have both anorexia and bulimia?
People can go back and forth between the different eating disorders at different times. If your child is underweight, restricting their food for major parts of the day but also having binges, he or she may actually have “binge-purge anorexia”.
How common are the various types of eating disorder?
So common that every school and doctor and sports club should know what to do about them. Yet there is a widespread myth that they are rare. I’ve gathered statistics for you here for prevalence. And not to scare you parents, but to get the attention of those who need to take action, I included some figures on mortality. All here.
The dangers of eating disorders
What is the minimum a parent needs to know about the dangers?
Some treatment providers require families to sit through slide after slide of dire warnings about the effects of an eating disorder. It’s supposed to motivate parents to engage with our child’s treatment. If you need that kind of motivation, read on. But if you already care about helping your child, I recommend you skip the next few questions and concentrate on what you need to do, and can do, right now, using an approach which wasn’t dreamed of when most of the statistics were collected.
Which of the eating disorders is the most dangerous?
All the eating disorders present immediate and long-term risks. It is easy to see the great danger an underweight person with anorexia is in, but people who binge or who purge are at high risk from malnutrition and electrolyte imbalance. All eating disorders also come with high risks from suicide or self-harm. Whatever your child’s eating disorder, he or she need regular medical checks and specialised treatment.
What are the statistics for suicide and eating disorders?
People with an eating disorder are several times more likely to commit suicide than those without an eating disorder, and I present statistics and charts here. Dear parents, if your child is suicidal, take it seriously. Otherwise, get on with compassionate treatment and leave these statistics to policy-makers.
What causes an eating disorder?”
Do parents cause eating disorders?
I regret some bits of how I brought up my child. Did I cause the eating disorder?
Are you just saying that to make me feel less guilty?
No. Researchers have looked for all the typical causes you might think of, and they haven’t found any links. Maybe you were dieting all the time and your child got anorexia? OK, so I didn’t diet and my child got anorexia. Maybe you regret being strict, working too much? I was quite laissez-faire and prioritised home life. And so it goes on.
More in Chapter 5: ‘A parent’s guide to the causes of anorexia’, which you can read in its entirety here. I also recommend this video (below) and these podcasts (episode 1, episode 2) from Laura Collins Lyster-Mensch, so you hear it directly from the most enlightened professionals.
It feels like my child’s therapist is undermining me
Some therapists have learned the theory of family therapy for eating disorders, but it is such a huge shift from previous psychological training they’ve grown up with, that blame leaks out in more or less subtle ways. This is why even specialised therapists need supervision from experts.
Even when we are not blamed for causing the illness, we can be judged as maintaining it. My experience of supporting parents is that it adds to their burden and weakens them, especially if the child is present while the disparaging comments are made. In my own family we were lucky, as right from the start, we parents were validated for all our efforts and the mistakes we inevitably made as we struggled to get our child to eat were written off as quite natural. If you are able to give feedback to your therapists, do so. They may also see a model of parent empowerment in this talk by FBT therapist Dr Rebecka Peebles:
Treatment for an eating disorder
Maybe my son/daughter doesn’t need treatment? The doctor’s advice is to wait
Early intervention is the best thing you can do for your child, even if — especially if — you’re not sure he or she is not so bad as to have a diagnosable eating disorder. Very few clinicians have the up-to-date knowledge required to gauge how urgent or serious this is. You need a referral to a specialist right away. I explain this in Chapter 4 (‘Treatment: the essentials) of my book. Read it here.
The family doctor/GP says my teen is fine
This is a common problem and you can avoid it by preparing a list of symptoms that will leave the GP in no doubt that this is no ordinary fad or passing phase. I offer lots of help on this in Chapter 3 (‘The parent’s part in diagnosis’) which is on this site in its entirety.
The family doctor/GP is not giving us a referral
Early referral to a specialist eating disorder service is so important, and has so much scientific evidence behind it, that in England, a standard requires the health service to allow self-referrals to specialists eating disorder teams. Treatment for urgent cases must begin within one week of the parents’ or patients’ first phone call, and for everyone else the maximum is four weeks. Wherever you are in the world, kick up a fuss if you are made to wait, and use all the help you can from my Chapter 3 (‘The parent’s part in diagnosis’) . And while you shake up the system, also get yourself informed: as my book and this website shows, there is much important work you can do right now.
Is treatment for children and adolescents different from treatment for adults?
Yes, it’s very different. And that is a shame and I hope it will change. Adults tend to have treatment similar to what was done throughout the 20th century. There’s very little good research to motivate radical change. Adult treatment emphasises psychological approaches, getting the patient to be motivated to get well, to gain insight, and to work on their recovery on their own, with weekly outpatient appointments. There can be a lack of ambition in getting them to fully recover, possibly because a fair number of adult patients are chronic sufferers. Often treatment for anorexia stops before the person has reached a normal weight, and people are left to their own devices before they’re well enough to take care of themselves. Sometimes treatment stops because the adult is kicked out for lack of sufficient motivation.
If weekly outpatient appointments don’t work, in the US there are partial hospitalisation programs (PHP) and in some countries (including the UK) there are day treatment programs. People get help to eat several meals a day, but are often required to muster some willpower back home alone. Again, they may get kicked out if that fails. Some adults can be in limbo until they get ‘sufficiently’ ill to be admitted to an inpatient unit, where there is more robust help to get them to eat, stop exercising and purging, and gain weight. If they can’t eat and are very ill, the mental health act kicks in and they are tube-fed against their will.
With most adult treatments, if there is any ‘family therapy’, it looks at the interactions between family members, on the basis that dysfunctional relationships may have caused, or may be maintaining the illness. When I talk to parents in this situation, they generally feel blamed, disempowered and helpless, and it may become even harder for them to help their child eat at home.
The picture is a lot more positive with children and teens, thanks to research on a totally different concept of family therapy for anorexia. On this site, when I talk of ‘family therapy’, I refer to an evidence-based approach whereby parents are part of the team and are empowered to take charge of meals and of normalising behaviours. The standards of many countries make this approach either highly recommended or mandatory, as the first approach to try. The beauty of it is that this treatment does not require the child or teen to have motivation or insight, and it addresses the biological aspects of an illness that cannot be healed while the body and brain are malnourished. My book, and this website, are designed to help you support your child in this way.
There are good chances that family therapy for eating disorders, or some variant of it, could help people beyond their teen years. See my article ‘Young adults with anorexia: not too old for family therapy‘.
Some eating disorder services treat all ages, which means that adults benefit from the best treatment principles used for teens. One-second quote from the video interview below: “A colleague of mine said, it’s brilliant because they actually get better!”
Where can I get help on adult treatment?
At present my expertise is mostly on children and adolescents, though I do give individual support to a number of parents of university-age people. I recommend Tabitha Farrar’s website, podcasts and discussion groups for quality information and real positive action you and your son or daughter can take.
Is treatment for bulimia or binge eating disorder different from treatment for anorexia?
Yes and no. There is not a lot of research for bulimia, and even less for binge eating disorder. For young people with bulimia, the family therapy approach is just a little different from the one for anorexia, and it is a good bet. For binge eating disorder, we know even less. Personally I would adapt the family therapy approach. There is also some evidence to justify a specialisation of CBT for eating disorders. It is mostly for adults with any of the eating disorders, but can work with teens. More on this in Chapter 12 (‘Which treatments work?’) which you can read in its entirety here.
On the whole, if your child is purging or binge eating, the treatment involves regularising their food intake. So someone who binges needs help to eat the next meal at the regular time even though they really don’t want to eat. And everyone needs help to eat every few hours, hunger or no hunger, in order to prevent big hunger cues later, which lead to bingeing.
I’ve been told I have to be involved in my child’s treatment. Is that true?
Yes. The the key is nutrition with loving family support. Chapter 4, which you can read here (‘Treatment: the essentials) gives an outline of what’s involved. I explain treatments (the good and the bad) in detail in Chapter 12 of my book, which you can read in its entirety here.
How long does treatment take and what are our chances of success?
It depends. All explained in Chapter 4 of my book, in this section here. The immediate message, if you are currently living a nightmare, is that if you use family therapy for eating disorders without too much delay, you will soon be breathing a huge sigh of relief.
Will my child end up in hospital?
There is still a role for day treatment or inpatient treatment for very ill children and teens, but with family therapy for eating disorders becoming more common, and early intervention, teams in the UK and in Scotland report that the need for admissions has dramatically reduced.
What is hospital treatment like?
Traditionally, people have been admitted to inpatient eating disorder units for long periods of time. Some discharge when the patient’s weight is restored, some much earlier. The key question is to take care of the transition to home: you need to know how to support your child once he or she has left the unit. A good unit will let you practice so that you’re all comfortable and skilled.
Things are changing as clinicians appreciate the power of treatment at home within the family. Children and teens may go for a few days in medical/paediatric unit for medical stabilisation (blood tests, nutritional supplements or tube feeding) with frequent involvement from the outpatient specialists and the parents. The parents get to do a lot of the feeding. This means everyone is ready to support the child when it’s safe to take him or her home.
For some, long hospitalisations are necessary because the illness is severe and complex. Chapter 12 talks about inpatient treatment here.
My child isn’t progressing as fast as others. Who’s to blame?
- Your child isn’t getting the best treatment available, or the treatment isn’t delivered by skilled, experienced clinicians. Check out my resources and work it out.
- The treatment your child is getting is not suited to his/her particular needs (for example, family treatment doesn’t work for everyone). Discuss it with his or her team.
- Eating disorders affect different people with different levels of severity, they are tough illnesses and treatment is still in its infancy. Perhaps you are all doing the best that can be done with our current knowledge, and your child would be more ill otherwise. Keep going. And if therapist is blaming you or your child for lack of progress, find another. [A good article on this by Julie O’Toole: ‘Why can’t everyone get a good result?‘]
my child isn’t making use of what he/she learned in therapy
Your child is failing in spite of individual therapy, and you feel like beating him or her up for not trying harder. Telling someone ‘Stop shouting and do your bloody CBT!’ isn’t going to work. Here’s a piece about giving your child a break. Also, please bear in mind that individual therapy is not the first choice for under-18s with anorexia, as explained in Chapter 12.
Is my college/university-age child too old for family therapy?
Plenty of parents report that family-based treatment for their college-age child works. This article of mine in Mirror-Mirror describes how the creators of FBT are teating it out on 17-25s. My experience of supporting parents with a son or daughter in that age group is that everyone very much benefits from the parents taking an active role. Traditionally, treatment providers have overestimated how much someone with anorexia can recover alone, and have only paid lip-service to family involvement.
England’s new eating-disorder treatment standard: a model for the rest of the world?
Very, very exciting improvements have been underway in England. Here is an idiot’s guide to the ‘Access and Waiting Time standard for children and young people with an eating disorder‘. Policy-shapers worldwide take note: we all need something as good as this, and we need it to include adult treatment too.
What does good treatment for an eating disorder look like?
Watch this video interview I made of two inspiring clinicians in Norfolk who are delivering the kind of service that’s needed everywhere. I hope that you have access to something at least as good and if so, hurray for your clinicians!
There’s talk of ‘underlying issues’ and of my child getting ‘insight’ into causes
This is normal for psychotherapists who don’t specialise in eating disorders, and that’s why your child needs a specialist. With specialisation, therapists learn about the biological and genetic factors, and they train in evidence-based treatments. Even then, it takes a while for therapists to really ‘get’ the family-based approach. I discuss this in “Eating disorders: understand where psychotherapists are coming from” here.
The therapist says it’s inappropriate for parents to take charge of an adolescent
In “Eating disorders: understand where psychotherapists are coming from” (here) I talk about autonomy and what is appropriate when.
What psychotherapy approaches might help my child… or myself?
Navigate your way through the alphabet of therapies that may be on offer, and some you may want to actively seek out. They include Positive psychology, NVC, ACT, CBT, DBT, Psychodynamic therapies, EMDR (for Post-Traumatic Stress Disorder PTSD) and Cognitive Remediation CRT. I outline them here.
What’s the best treatment for post-traumatic stress disorder (PTSD)?
If your child has anorexia and you believe a trauma has triggered it, treating the trauma will probably not shift the anorexia: you will still need to do refeeding work. Still, if your child is receptive (or if you yourself are suffering from PTSD), check out my explanations on three treatment approaches for PTSD that stand out, either because they’re in health standards or because there’s a lot of research behind them. They are: Trauma-focused cognitive behavioural therapy (TF-CBT), Eye movement desensitisation and reprocessing (EMDR) and Emotional Freedom Technique (EFT, or ‘Tapping’).
Is recovery from an eating disorder possible? What does ‘remission’ mean?
Therapists, families and especially researchers tend to mean different things by ‘recovery’. It’s an emotional word for carers and sufferers. Some therapists work towards full recovery as a realistic goal, while others believe the patient will always need to manage some level of risk. Whichever way you look at it, there is hope for your child — lots of it, as I discuss here.
How do I help my child?
What do parents need to do about meals?
If your child has anorexia (or another eating disorder that drives them to restrict their eating), then the best treatment requires you, the parent, to find a way to get your child to eat. And to eat enough for weight recovery. And at some stage parents also help their child manage foods that have become fear foods. Usually that means that parents take charge of meals for as long as their son or daughter cannot safely and reliably take care of their nutrition.
Is there a danger in suddenly refeeding someone with anorexia?
Yes. It’s called refeeding syndrome, it can be fatal, and it’s caused by sudden drops in the levels of some electrolytes. There are no external signs of it, so you need blood tests to monitor it. . As I explain in Chapter 6, it is rare, and the risk is mainly if your child has eaten little or nothing for a long time. Traditionally, hospitals have refed very slowly because of the risk of refeeding syndrome, but more recent studies indicate that the risk is lower than previously thought.
How much should I feed my child?
If you’ve been told the risk of refeeding syndrome is not an issue in your case, if your child has lost weight you’re aiming at a gain of 0.5 kg to 1 kg a week. Or more. Do not tip-toe around weight gain: your child needs nutrition. Studies show that fast gains in the first few weeks predict better outcomes. So go for it.
How on earth am I supposed to get my child to eat?
It seems impossible. Hey, if it was easy, it wouldn’t be anorexia. But there are many ways of making it much more possible than you think. It’s a big reason why I wrote my book — I wish for you to be successful fast. You will find many tips and examples in Chapters 7 (‘How do you get your child to eat in spite of the eating disorder?), 8 (See the tools in action: mealtime scenarios) and 9 (‘How to free your child of fears: exposure therapy’).
Just give me a few tips: I need to feed my child right now!
I’m desperate. Give me just one thing that will help my child to eat!
I produced a very popular video ‘Help your child eat with trust, not logic: the bungee jump’ For some parents, using that one principle made all the difference.
Getting your child with an eating disorder to eat (HERE)
It’s not working. What can I do?
If you’ve not read chapters 7 to 9 of my book, then do that.
Ask your clinical team to give you coaching.
I offer coaching by video call.
Ask your clinicial team to send you help at home – some places have home feeding teams.
If your child cannot eat enough to regain weight, then it may be necessary to use a day unit (PHP/partial hospital plan) or an inpatient unit to kick-start a change, and/or to tube feed and monitor their health.
Care for the carer – how can parents survive?
I am sick of people telling me I should take care of myself
Take a break from reading and listen to this podcast, where I discuss ‘The surprising truth about care for parents and partners’. I hope it will make you feel understood, and will give you a boost too. Listen online or download the audio.
Are there any guided meditations to help me be at my best?
Funny you should ask. Yes! My book gives you the why and the how of compassion. I’ve produced recordings of guided meditations to help you actually experience the power that lies with a compassionate state. They will help you shift your state towards more wellbeing. [More…]
Help! I can’t sleep from all the anxiety
One of my guided meditations fades away at the end, after giving you soothing sleep messages. There are also many YouTube resources: search for “sleep hypnosis”.
I think I have post-traumatic stress disorder (PTSD)
On the internet, some parents report suffering from PTSD once their child starts to be well. Many report that therapy has fixed it. See my summary of three treatment approaches for PTSD. Please know that there is also such a thing as post-traumatic growth, and you emerge from this tough adventure wiser, kinder and with a greater appreciation of the good things in life. Rather than leave it to chance, learn very specific ways to take care of your mental health, in Chapter 15 of my book (‘How to build up your own resilience and well-being’).
How can a parent become more calm, confident and compassionate?
Why be calm and compassionate? Isn’t it better to be firm?
You can be calm, compassionate and firm. I call it compassionate persistence. What you want to avoid is blaming, judging and criticising your child. Research shows that when there’s a lot of that, outcomes are poorer. But please understand that all parents occasionally lose their temper and say the wrong things — it’s such a difficult illness — and no lasting harm is done. In a loving atmosphere, our children are actually quite resilient.
What has self-compassion got to do with parents?
Self-compassion is a great tool to transform tough emotions. It is the route to your internal power, your intelligence, and your ability to be kind to your child. It tells your brain you are safe and brings you out of fight-flight-freeze. Once you’ve got the hang of it you can help your child do the same.
How do I do self-compassion?
Chapter 13 (‘Powerful tools for wellbeing and compassionate connection’) in my book gives the how-to of compassion and self-compassion, along with examples. And there’s more in Chapter 15, to help you cope in real tough situations.
I hear that mindfulness could help me. what is it?
Mindfulness means paying attention to what’s going on around you and within you, in the present moment, with an attitude of kindness and allowing. It gives you a break from the brain’s tendency to interpret, to judge, to criticise and to add layers of anxious thought about the past or the future. If you learn how to do self-compassion you’ll be doing mindfulness. I’ve collected more resources on mindfulness for you here. And Chapters 13, 14 and 15 of my book are all based on mindfulness.
I hear that I should ‘let go’ and ‘accept’. How can that help my child?
Mindfulness teachers and stress gurus often talk of acceptance and letting go. This can easily be misinterpreted as resignation, giving up, or giving in, and that’s no good at all when your child needs you. Yet the concept of ‘acceptance’ is really useful when used with skill. I guide you through this in Chapter 15, ‘How to build up your own resilience and wellbeing’
Can you make mindfulness and self-compassion real simple?I’m in a hurry
OK! Using ‘O for Observe’ and ‘K for Kindness’. ‘OK’ is the simplest way of quickly steering yourself out of distress and judgement, into a place of compassion and strength. All described in the article ‘Two steps to being OK when your child has an eating disorder‘ by yours truly.
What can I do with all the Guilt and self-blame going round my head?
If you’re finding it hard to disentangle yourself from blame and shame, if you’re stuck in an internal conflict, if you’re tortured by thoughts of what you could have done better, you need some skilled compassionate listening. Logic is unlikely to help. For now, you might like the self-compassion and acceptance exercise in this example: “Self-compassion and how to mediate arguments in your brain”
How can I communicate better with my child?
Eating disorders make emotions run high. What can parents do after the fireworks?
Your child has screamed, kicked, run away, and you need to work out what to do when things have got calmer. Chapter 14 of my book will help you (“Love no matter what: how to support your child with compassionate communication”). I also offer you this example of post-fireworks dialogue.
What can I say when I discover my child has been binning food in school?
In Chapter 14 of my book I give you principles and examples of empathy and dialogue. Here is one more example you might relate to. The child has secretly been binning food in school and the parent is trying to connect, understand and find solutions. Read it here.
How can I ease my child into normal life?
can I get the school to help my child stay or return to classes?
Your child might benefit from going (back) to school, but some support measures need to be in place. Otherwise your child might go without morning snack or lunch, and that will stall or reverse recovery. Chapter 10 (‘The road to full recovery’) will help you work out what’s right for you. And here’s a checklist to remind you of issues to discuss with the school.
Is my child safe to go on a school trip?
If you’re in two minds about it, then your child probably needs the support of teachers, who need to be properly briefed. Here’s a flowchart to use as a starting point for your discussion with the teachers who will be on the trip.
Do I need your book?
Where can I get your book?
Amazon, bookshops, ebook stores… anywhere worldwide. As a paperback or ebook. Links are here.
What’s in your book?
Practical tips and emotional support for parents. It is mostly aimed at parents of children and teens, but I have had parents of adults and young adults tell me they got lots of useful help form it.
The table of contents is here.
Is your book reliable?
Yes, I work hard at keeping it up to date with the science, and also use the experience of many parents as well as mine. The book has been checked by experts and many professionals recommend it. See their reviews here.
There are so many books on eating disorders. Why yours?
Mine is the only book that gives you the ‘how’ of supporting your child along family-based treatment lines. And it is the only book that holds your hand through all the wider questions families face, like what to do about school, friends, relapse prevention.
Other books give you the ‘why’, the theory. And then there are many books that are the memoirs of parents or sufferers. I take care of my readers’ emotions: my book is sympathetic and upbeat – the furthest you can get from a misery memoir.
Where can I find a list of all your posts?
It’s all here