FAQs: how to help your son or daughter recover from anorexia and other eating disorders

I answer this in more detail here.

Briefly, eating disorders are classified in the DSM-5 diagnostic manual as anorexia nervosa, bulimia nervosa, binge eating disorder, rumination disorder, and pica. There is also 'other specified feeding or eating disorder (OSFED)', which covers a variety of conditions.

Many people get diagnosed with OSFED when they don't tick all the boxes for anorexia, bulimia or binge eating disorder — their eating disorder may be classified as 'atypical'. Don't be fooled by the word 'atypical': atypical anorexia is the most common form of anorexia, often equally or more serious, and it's just as urgent to get specialised treatment.

A very different type of eating disorder is 'avoidant/restrictive intake disorder (ARFID)', which includes a wide variety of difficulties around eating, often from a very young age.

Finally there is UFED, which stands for ‘Unspecified Feeding or Eating Disorder’, and is a useful classification when there is not enough information to make a more specific diagnosis.

One more term you may have heard of is EDNOS (eating disorder not otherwise specified). This is an old category (from an earlier version of the diagnostic manual, 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.

For a more detailed description of each of those conditions, see here. For more on how to get diagnosis and referral to a competent clinician, see Chapter 3 ('Your part in diagnosis') of my book, which you can read in here.

People can go back and forth between the different eating disorders at different times. If your child has lost a lot of weight and/or is underweight, restricting their food for major parts of the day but also, at times, having bouts of increased eating, the diagnosis might be "binge-purge anorexia".

I describe a few conditions that are similar to eating disorders and that can be just as serious here. They include diabulimia, orthorexia, drunkorexia, and muscle dysmorphia, also called bigorexia or reverse anorexia. Some of these, especially orthorexia, can be precursors to a diagnosable eating disorder like anorexia.

From my Bitesize audio collection: Hear more on how these are related to eating disorders :

With anorexia it's normal to have an obsession with 'healthy' eating, with exercise, and having a lean or toned body. So you don't need to look for an extra diagnosis if you observe those issues.

Parent education sometimes involves sitting 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, feel free to read the next bit. But if you already care about helping your child, I recommend you skip the next couple of 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.

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. So are those who lost a lot of weight, or children who have failed to gain weight with age ('weight suppression') as well as the speed of loss. All eating disorders also come with high risks from suicide or self-harm (more on that further down). Whatever your child's eating disorder, he or she need regular medical checks and specialised treatment.

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.

Only by passing on your genes, which were passed on to you by your parents. These would be genes associated with metabolism, and with some personality traits.

Genes do not, by themselves, make the illness happen, but they make it more likely if the environment interacts in such a way as to switch those gene functions on. An example of a high-risk environmental factor that is seen, so often, to trigger an eating disorder, is weight loss or being underweight. And the stressors around the Covid-19 pandemic have been associated by a rise in eating disorders by a factor of up to four.

Parents are precious resources in the treatment of eating disorders, and are welcomed by all the good therapists. See for instance this video by Adele Lafrance, of Emotion-Focused Family Therapy (EFFT): 'The Why of Parental and Caregiver Involvement in the Treatment of Mental Health Issues'.

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.

I have written in plenty of detail about causation: what is known, what has been disproved, what are the myths. I wrote a briefer account  in Chapter 5 of my book here. I also recommend video 'Do parents cause eating disorders? The experts speak' as well as podcasts (episodes 1 and 2) from Laura Collins Lyster-Mensch, so you hear it directly from the most enlightened professionals.

It does look like body image and disordered eating can be influenced by the environment. But there's a big distance between that and getting an eating disorder. More in Chapter 10 which includes suggestions on reducing the risk of your other children suffering from an eating disorder.

Partly. Genetics and environment affect each other. The genetic studies so far highlight the extent to which anorexia (more to come on other eating disorders) is a biopsychosocial illness:  similar genetic markers are found in OCD, depression, schizophrenia and anxiety, in attainment of academic degrees, the drive to exercise or move, some metabolic traits, and the tendency to low body-fat. As I say more on my page on causation.

There's tentative research on this, in particular for anorexia. As explained on 'Could targeting gut microbes help treat anorexia nervosa?' it's unclear if gut health is part of causation and/or part of the solution, for some people. If you are looking into the use of probiotics, prebiotics or synbiotics, note that these are unlikely to provide a total solution, so keep your focus on standard treatment as well.

If your child is displaying some really weird symptoms, you might have come across a syndrome called PANS (Pediatric Acute-onset Neuropsychiatric Syndrome), and a subset of it called PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) . I tell you more about these here.

But before you go down that route, which will require some specialist neurologist to investigate, I invite you to first read my post on bizarre yet normal eating disorder symptoms.

Join the club. Most of us can expect to have some weight bias and I list resources in 'How to overcome weight bias and fat phobia'. We are in a toxic environment which shames various body shapes and has made eating for health very complicated. When our own country's health agencies are preaching harmful messages to kids about calorie-counting and obesity, what can poor parents do?

You can buffer your child against some of our crazy environment by modelling a positive attitude to eating and body shape (early episodes of this podcast series may help you). This may protect your child, to some extent, against disordered eating. However, there are plenty of examples of families where there was a wise attitude to eating and body shape in the home, and the child still went on a diet and got caught in an eating disorder.

If you don't already have your family doctor or eating disorder specialists on board, read  Chapter 3: The parent's part in eating disorder diagnosis. I guide you to getting an urgent diagnosis, health checks and a referral to a specialist.

The essentials of treatment are in Chapter 4 of my book, which is entirely available here. Or for something even briefer, see the first two pages of my free helpsheets. Or hop onto one of my regular workshops. You can also learn what you need, in a simple and friendly way, with my searchable Bitesize audio collection.

Since you're here, these are the main steps I suggest for you now:

• Get a doctor to check on your child's health right now, especially if there's been weight loss, or vomiting, or over-exercising or excessive muscle-building. Specific tests are needed. See Chapter 3 for standards or jump to 'My child seems very sick. What medical checks are urgently needed?' on this page.
• If your child is currently eating extremely little, get them monitored for refeeding syndrome (more further down these FAQs) to be on the safe side. If they've lost weight but don't seem to be currently underweight, read this in case the doctor isn't aware of the risk from weight suppression.
• Insist on an urgent referral to a specialist. For instance, England has official standards that the treatment of youngsters must start within one week — that's how fast you should get expert guidance. For more info regarding your own country, see here.
• If it's up to you to find a specialist, see my page 'How to choose treatment'.
• You can't make your child's (suspected) eating disorder worse by paying attention to it (as long as you stay kind and supportive)
• Make it very clear to your child you are on their side and do not judge them. Do not indulge in your own why's and self-blame. Shit happens, people get ill… and the good thing about eating disorders is that with modern treatment, youngsters recover.
• A good sign that someone does have an eating disorder is that their parents are concerned — don't let yourself be labelled as "over-anxious" and don't accept "it's a phase" or "come back in two weeks".
• While you're waiting for specialist help, start supporting your child to eat 3 meals and 3 snacks a day, and to stop any purging. You're aiming for enough to regain any lost weight. Get the school to help you, or keep your child at home.
• If your child has lost weight and/or isn't eating enough and/or is compulsively exercising, put exercise on hold.
• Learn as fast as you can to do the above with kindness and persistence. Know that an eating disorder puts your child in a near-constant state of fear. Having to eat, gain weight, stop exercise, further increases their anxiety, so be their compassionate coach. Out of all my resources, your fastest learning at this initial stage is probably through my Bitesize audios.
• Avoid making any deals, any promises — there will no doubt be some changes to makes as you learn more.
• Choose or vet your specialists with care. Nowadays it's not OK to give a young person individual therapy before trying a family-based approach. More on this in Chapter 12, which is entirely on this website here or reaad my shorter guide on 'How to choose treatment'
• Take care of your own wellbeing. This is a shock for you. With good information and good support, you can stay well and give your child the active, practical love they need to fully recover.

Early intervention, or intervention at the 'prodromal' stage — before it ticks all the boxes for diagnosis — is the best thing you can do for your child. Parents tend to worry that they could make their child worse by 'making an issue of it' or 'labelling' them with an illness. They hope it's just 'a phase' that will pass better if everyone pretends everything's fine. To reassure you that none of this is true, and that you can intervene swiftly and simply, read 'Can FBT strategies be used for early eating disorder intervention and prevention?'.

Very few clinicians have the up-to-date knowledge required to gauge how urgent or serious your child's situation is. You need a referral to a specialist right away. See  Chapter 3 of my book for help with that family doctor visit. Then see Chapter 4 for the essentials of treatment here.

If you're in the UK, and struggling to get your child diagnosed or treated, see my England page for help.

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. In there I provide links to recommendations from professional organisations.

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.

I say more on treatment further down.

If there is a waiting list and you're not given any guidance, then be aware that early intervention really pays off. Before Covid, in the UK most child and adolescent services managed to comply with a standard requiring non-routine cases to be seen within one week. If you're being made to wait for many weeks or months, get started with what you can do. If meanwhile your child keeps losing weight, keep updating services so they can re-prioritise.

If you're in any doubt about your child's medical safety, take them to your accident / emergency unit or get an appointment today with your doctor.

"We took the initiative to take her to A&E as the referral was taking too long and the doctor had said another week and her brain will start to shut down.  

We said, “my daughter has an eating disorder and is in crisis.“

As soon as we mentioned crisis  we were whipped through and seen straight away. 

As soon as they saw her and did obs they reacted swiftly seeing the gravity of the situation and admitted her to the children’s ward."

There are particular medical checks to do, and you cannot assume that a clinician who hasn't specialised in eating disorders will know these.

For instance, an ordinary blood pressure measurement is not enough: 'orthostatic' blood pressure must be measured (comparing lying to sitting to standing). And on their own, a couple of 'normal' blood tests can be misleading:

"Blood parameters that fall within laboratory reference ranges are frequently seen in advanced uncomplicated malnutrition and should not be taken as cause for reassurance."

Medical Emergencies in Eating Disorders (MEED) guidance – UK

"It is important to note that individuals with EDs may present with normal laboratory findings, and a normal physical exam, despite a serious ED, because of the body’s ability to compensate in the face of malnutrition. Abnormal lab values, therefore, are cause for serious concern."

Eating Disorders Academy (AED) guidebook for nutrition treatment of eating disorders (2020) – USA and used worldwide

So a common recommendation is for you to bring to the clinician a printout of recommended medical checks.

In the UK, take with you 'Appendix 3: Medical emergencies in eating disorders risk checklist for clinicians'. This is on page 184 of 'Medical Emergencies in Eating Disorders (MEED)', produced by the Royal College of Psychiatrists. You could also print page 27 of Annexe 1: Summary sheets for assessing and managing patients with severe eating disorders. When you have more time, take a look at the whole document as it's full of excellent advice for you and your clinicians.

For the US, and recognised worldwide, use the Academy for Eating Disorders (AED) guide to Medical Care, pages 8 to 9 (2021). Also useful are pages 18 to 22 of the Eating Disorders Academy (AED) guidebook for nutrition treatment of eating disorders (2020). That entire guidebook is excellent.

The American Psychiatric Association Practice Guideline For The Treatment Of Patients With Eating Disorders (Fourth Edition, 2023) Also Medical Management of Restrictive Eating Disorders in Adolescents and Young Adults (2022) from The Society for Adolescent Health and Medicine (SAHM)

I list resources for England/UK and for the USA. Other countries: you can use similar methods, and note that USA standards are often recognised internationally. You can also look for a support group or charity in your country that can give you specific advice: I list some here.

While you are working on getting the professional care you very much need and are entitled to, do also get started with meals at home.

It's normal you should be rather overwhelmed, that you should have a huge learning curve, and that you fear making things worse with a son or daughter who is likely to put up resistance.

The resources I offer are relevant if your child is restricting. The exception is for ARFID (I explain how ARFID needs to be treated differently here).

I put together a short page of pointers in my free helpsheets.

My Bitesize audio collection has many short audios that cover the early stages as well as the later ones.

I also take you by the hand in more depth in Chapter 6 of my book: 'Practical steps to help your child beat the eating disorder'.

See also my page "How to get your child to eat: refeeding mealtime tips'

And check out my online workshops. I also offer coaching.

For children and young people, the first line of treatment for anorexia or 'atypical' anorexia is very clearly and firmly a family-based approach. That might mean 'Family-Based Treatment (FBT)' or a variant of it (in UK standards you'll the name FT-AN, which stands for 'Anorexia Nervosa-Focused Family Therapy'). More from me in 'Family therapy for eating disorders: what is FBT / Maudsley?'

Most English-speaking countries have national or professional bodies recommending this. The most recent review of the science was done in England by NICE, and I explain their recommendations here.

A family-based approach requires a lot of skilled work from parents, and my resources aim to help you with that.

First: nutrition, weight gain, interrupt harmful behaviours

The priority in a first phase is to restore your child's nutrition and regain lost weight. This will restore their physical health and give a chance for their brain to function better. As your child is terrified of eating, Phase 1 requires parents to take responsibility for making meals work. For almost everyone that means you decide on the food and sit down to coach and supervise every meal. You also interrupt over-exercise and any bingeing or purging.

Not an easy task, and I give lots of help in my book, my Bitesize audio collection, a workshop on essential mealtime skills and a workshop on communication.

Next: expand your child's flexibility, bring back 'normal' behaviours

At first you may find you have to prioritise some relatively easy foods: those that do the job of nutrition and weight gain, without sending your child running screaming out of the house. But as soon as you can you'll be choosing a wider range of food. By then your child might be collaborating a bit more, but there will be some super-hard foods they'd avoid if you weren't hands-on. The work of bringing back 'normal' is mostly done through 'exposure'. I cover it in Chapter 9, in many Bitesize audios, and in a workshop.

Next: the 'Phase 2' work to carefully get your child back to independence

Eventually, as your child gets well, you'll stop making decision and stop supervising. You'll be wanting to return age-appropriate autonomy to your child. But — and it's a big 'but' — before that there must be a phase during which parents continue to guide, to coach, to correct (in FBT this is called 'Phase 2'). Our children just can't be expected to have the courage, or the perspective, to eat as much as they need, until they've had plenty of practice, until they have overcome all kinds of fears, and until their appetite and fullness cues are back on track.

This phase is often rushed or completely missed out (e.g.  when kids are discharged from treatment too early). I cover it in depth in Chapter 10 of my book, in many Bitesize audios, and I do a workshop on it.

Finally: back to a full life

FBT devotes a few sessions to 'Phase 3', where attention is given to your child getting their life back on track. Their normal development as an adolescent was interrupted by the illness, so the therapist looks into what help may be needed to get back into a good life. At this stage some clinicians like to offer some additional psychotherapy, such as Cognitive Behavioural Therapy (CBT), if there are any remaining beliefs, anxiety, body image concerns etc.

Because you're human: our own skills and wellbeing

All this requires immense skills, patience, unconditional love from you, the parents. In my resources I aim to support you through all this in a practical and compassionate way. Chapter 15, many Bitesize audios, and an entire workshop, focus on your wellbeing.

If (and only if) a family-based approach is unacceptable, contraindicated or ineffective, should anorexia be treated with individual therapy instead. I explain more here in the context of standards in the UK. I also introduce you to the two main alternatives: CBT for eating disorders (one branch is called CBT-E), and AFT (Adolescent-Focused Therapy)

I speak with parents in the UK, treated within the NHS, who are told the only offering is CBT. A family-based approach is never even mentioned. This contravenes the NICE guidelines. To advocate for your child to get the gold-standard treatment, see my resources for the UK on my page here.

Anywhere in the world, if a therapist offers for your teen's anorexia is one-on-one therapy, and they want you to be hands-off, then I recommend you keep looking.

There is less research, and more uncertainty, about what treatment is best for bulimia. The UK's health service advisory body, NICE, recently reviewed all the evidence and concluded that for young people a family-based approach must be the first line of treatment for both anorexia and bulimia. There are small differences between the two. If that fails, a specialised form of CBT is next in line. I explain the NICE guidelines in more depth here.

For binge eating disorder, there really is very little research. The official recommendation coming out of NICE's most recent review is first of all 'guided self-help'. As a parent I would want to be part of that 'guiding', in a manner similar to that of family-based treatment. In particular I would want to support my child to eat regular meals. If guided self-help doesn't work, the next NICE recommendation is for a specialised form of CBT for eating disorders (often called CBT-E). These recommendations apply to any age (presumably because there is not enough research to be more specific). CBT for eating disorders has been developed and tested mostly for adults but it can work with motivated and self-aware teens, especially if parents are supporting. 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 or restricting, a big initial part of the treatment involves regularising food intake. This is to stop the vicious cycle of hunger and bingeing or restriction. You may need to help your child to eat every few hours, hunger or no hunger. Someone who binges needs help to eat the next meal at the regular time even though they really don't want to eat, and even though they might recently had had a binge.

While there are similarities with the treatment of anorexia (and so some of my resources will help you) there are also important differences. Jump over to my section on ARFID here.

Sadly, as soon as someone turns 18, they may lose access to a family-based approach. Their clinicians may believe they must now 'take responsibility' and be autonomous. If that fails, a hospital will do what you could have done so much earlier, before things become more difficult.

On this page I compile information for you if you're the parent of an adult — or young adult — with anorexia or another eating disorder. Some of the strengths of adolescent treatment are translatable at any age. I list useful sites and blogs from adults, some of which show how a family-based approach can be adapted to adults.

In case you've heard of FBT-TAY, a variant of family-based treatment for 'transition-age youth', I report on it here.

On my page 'How to choose treatment for your child' I explain what a treatment team consists of, the qualifications you're looking for, and questions to ask to satisfy yourself that a clinician is up to date.

Ideally everyone will have access to a fantastic expert treatment team. Family-based treatment (FBT) is designed to be led by clinicians — it was never supposed to be something parents do alone. Nowadays geography is less of an obstacle, thanks to video calls (telemedicine). So if you've had a great recommendation for a therapist in another country, and if you can afford it, that's much better than going alone.

If you're not under the care of experts, make sure a GP/pediatrician is following your child's medical health, especially in the early days.

If you're on a waiting list for treatment (say, more than a couple of weeks), check with the clinician, but here's my suggestion. Get started with the first phase: getting nourishment and weight back up, preventing over-exercise and purging… Lots of help on this in my resources. I've seen many parents get their child to a stable and happy state by the time they got their first appointment. The therapists can take up the work from this point.

While you're on a waiting list, keep informing the clinicians of any downturns so they re-prioritise you. And of course you have Accident and Emergency services if needed.

If you have decided that your clinicians are doing more harm than good — this happens — and can't find or afford other clinicians (even remotely by video) then it may reassure you to know that many parents have indeed got their child to recovery by going solo. They use the principles of FBT — minus the inputs a good therapist would make. Make sure your child is followed by the GP/pediatrician. Get super-informed (that's what my resources are all about). Some parents groups can be a great source of information and support: I list some here. But as I explain on that page, be extremely cautious around any dogmatic, one-size-fits-all, 'how to do FBT' advice.

Yes — and that's even though by now your child may be pushing you away. The the key to recovery, in a first phase, is nutrition with loving family support. Chapter 4, which you can read here ('Treatment: the essentials) gives an outline of what's involved. There's a very brief summary on one of my free helpsheets to help you get set up for success, and loads in my Bitesize audio collection.

I explain treatments (the good and the bad) in detail in Chapter 12 of my book, which you can read in its entirety here.

Whether your child is autistic or not, they're likely to show signs that are typical of autism, as a result of starvation. As we learn to support autistic people through their times of high stress, we learn skills that are useful to everybody.

Be alert: it may be that around one third of people experiencing an eating disorder (any eating disorder) may be autistic or present with high levels of autistic traits.

The expertise on how eating disorder treatment must be adapted for autistic people is growing. Do jump to my page on autism as it's full of examples from parents and of links to good sources. One of these good sources is PEACE Pathway, a resources set up by clinicians with experts by experience — in particular this page about making meals easier.

The family-based approach has been validated on 12-to-18 year olds, so don't let anyone tell you your teen is too old for what is generally the most effective treatment. Even adults need hands-on help with meals.

This is not a time to prioritise autonomy and independence. Parents sometimes believe their child is unusually independent and determined, and that this means a family-based approach is impossible. I can assure you that most of our youngsters have those qualities, and they still very much need us to get well.

Plenty of parents report that family-based treatment for their college-age child works. More on my page here. 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.

If your child is due to leave home soon, you'll need to plan if and how this can work, and prepare carefully. Tips for this in Chapter 10 of my book and in my Bitesize audio collection.

You will help your child one meal at a time, even one bite at a time. Your confidence and your kindness will make it possible. The beauty of a family-based treatment approach is that your child can recover without every having decided they want to.

Hear more on this, and other 'taking charge' questions, in Bitesize:

The evidence is that we can achieve faster results when parents make meals work even when their child has no insight or motivation. Older treatments, and many adult treatments, rely on the person's buy-in, so a lot of sessions go into motivation. If meanwhile they deteriorate too much, they are hospitalised. In hospital they will be fed — so we're back to making meals work even without insight or motivation!

If you you're getting carer-training around motivation, readiness for change and motivational interviewing, this may well be a communication method called 'The New Maudsley Method'. I explain here the crucial differences with a family-based approach recommended for children and teens.

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.

Children and teens may go for a few days in medical/paediatric ward in the local hospital 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.

Ideally, all of your child's treatment can be done at home. At the start, though, the downward pull of the illness can be stronger than you can counteract. Sometimes that's just how the illness has hit your child. Sometimes the parents can succeed once they've had better instructions from clinicians, better information, and some coaching to get their child to eat. Then things get easier and the risk of decline, leading to hospital, passes.

In the UK, when early intervention with family-based treatment took off, professionals observed that the need for admissions has dramatically reduced.

You may be able to avoid having your child away from home if your treatment providers offer a short-term meal service. Skilled people help you with a few meals, at home or in their unit, just to get things kick-started. In the UK, some NHS teams do this, so ask! You might also find a team that does this privately, in person or by video call: I report on one such team in 'Professionals who help people with an eating disorder to eat at home'.

Treatment at home, led by parents, only works if it works! If your child doesn't manage full nutrition and progress towards weight recovery at home, then insist on a review with your professionals. A good therapist will want to review your needs if there's no progress (little or no weight gain) after 4 weeks or so, as described in this paper on 'stepped care'.

They might decide your child needs a higher level of care for a while. If they start organising a place, you may get the confidence to be more persistent with regular, nutritious meals: it's easier to take the necessary risks when you know you have a safety net.

Before going for a higher level of care, clinicians might then offer you coaching, or some classes, or some at-home meal support. Ask if they don't offer. If they're really not set up to provide any of this, I hope my own resources get you over that hump.

There is guidance from professional organisations with criteria for a higher level of care. For instance:

• In the UK: 'Medical Emergencies in Eating Disorders (MEED)', produced by the Royal College of Psychiatrists.
• For the US, and recognised worldwide, use the Academy for Eating Disorders (AED) guide to Medical Care and the Eating Disorders Academy (AED) guidebook for nutrition treatment of eating disorders (2020).
• The American Psychiatric Association Practice Guideline For The Treatment Of Patients With Eating Disorders (Fourth Edition, 2023) Also Medical Management of Restrictive Eating Disorders in Adolescents and Young Adults (2022) from The Society for Adolescent Health and Medicine (SAHM)

Your child might be admitted to inpatient eating disorder unit / residential unit for several months. 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. See for instance: 'Can hospital equip you for family-based treatment? A parent's inspirational account'

For some, long residential care is necessary because the illness is severe and complex and things are just not safe at home. Chapter 12 talks about inpatient treatment here.

There's some fantastic, compassionate and skilful guidance on nasogastric tube feeding — voluntary or under restraint — on my page 'NG Tube feeding: parents' questions', written by people who have researched it.

For some kids, teens and adults, psychotropic medication has a place within eating disorder treatment. It can make the anxiety of eating a bit less. For a round-up of the evidence for various types of eating disorder, see the AED 'Guidebook for Nutrition Treatment of eating disorders' (page 27 onwards). Learn more in YouTube 'Does Medication Work in the Treatment of Eating Disorders?' with Dr Molly M. Perlman.

The drug most frequently used early in treatment of anorexia is an anti-psychotic — usually Olanzapine (it doesn't mean your child has psychosis and hears voices). Dr Julie O'Toole talks about it on her blog here and also on the F.E.A.S.T site here. Why that rather than anti-anxiety or anti-depressants meds? My understanding is they don't work so well on a very underweight body.

This is all the domain of a psychiatrist, so if your child is super-anxious, self-harming, suicidal, has a massive exercise compulsion or just can't eat, ask for a consultation to assess whether some psychiatric medicine would help. Medication has side effects, so be empowered to discuss pros and cons with a psychiatrist specialised in eating disorders, and to ask for regular reviews.

Check with your team if they'd approve of a small dose of an over-the-counter (non-prescription) antihistamine before a meal (the kind of thing you'd use for hay fever): the one usually given is promethazine, and it seems to provide a bit of calm.

I also must share the experience of one young person who stopped her massive resistance to tube-feeding once the team gave her 'rescue remedy' 15 minutes before each feed. Some parents also swear by various mineral supplements or probiotics.

If your child is failing to gain weight, check these possible reasons:

• If someone isn't watching all meals carefully, your child may be unable to tell you the truth, and not eating as required. In the early days, meals in school usually need to be supervised.
• Your child may be secretly exercising or purging.
• Your child needs more food and less movement. In hospital it's common to increase by 300-500 calories every 3-4 days until there's regular weight gain (see the Academy for Eating Disorders 'purple' guidebook for nutrition treatment).

For a general lack of progress / your child is 'stuck'

• Your child isn't getting the best treatment available, or the treatment isn't delivered by skilled, experienced clinicians. For instance it's all talk (about motivation, about insight) and no action.
• The treatment your child is getting is not suited to his/her particular needs (for example, family treatment doesn't work for everyone). Discuss other treatments (info in Chapter 12) 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?']
• Perhaps co-occuring conditions ('comorbid') need addressed sooner rather than later, for instance OCD (obsessive-compulsive disorder) or particular needs related to autism or to an earlier trauma. Perhaps your child needs more targeted help (drugs and/or psychotherapy) with depression or anxiety, or with volatile emotions as in borderline personality disorder (BPD). Perhaps there is a biological component that is maintaining the illness.
• Perhaps there's a flawed expectation that your child should be well just because they've reached a certain weight. Be aware that weight targets are often set too low. If you reckon your child's weight is now correct, jump to the next question.

I am so sorry — it is heartbreaking. The usual reason is that the young person was discharged before the treatment was finished. And even before that, the parents got disempowered, told to back off, when there was still a lot of coaching and monitoring to do.

People are not recovered from an eating disorder just because they got weight-recovered. Weight-recovery is necessary but not sufficient. There's also exposure work to do to normalise behaviours (Chapter 9 of my book, and my Bitesize audio collection, and my workshop). Then there's careful work on coaching for independence (Chapter 10 of my book, and my Bitesize audio collection, and my workshop).

See Chapter 12 of my book, 'Which treatments work?'

A great clinician is a joy to have and I wish you that. They are experts in their field, they update themselves, they have regular supervision. They are compassionate, they never judge you or undermine you. They model great communication and respect for you and your child. They're easy to talk with when you hesitate about a course of action. And they are focused on complete recovery.

There's a lot of negativity on parent forums, and I'm conscious that the next items on this page focus on the bad things too. So I want to assure you there are many fantastic clinicians out there. And yes, that very much includes the UK's NHS.

The asssumption with a family-based approach is that every session includes parents and child. Siblings as well if they're willing to attend. This is the 'conjoint' FBT model.

There is a variant though, called 'Separated' or 'Parent-focused treatment', with equally good results. The FBT therapist meets only with the parents. A nurse may do medical checks on the young person, but that's pretty much all.

I appreciated having a mixture of both approaches. I problem-solved efficiently with time alone with the therapist. I could bring up matters without fear of the effect on our child. But it was also helpful to be all together and have the therapist validate us, and model great ways of interacting with our child. More from FBT therapist Sarah Ravin on this here.

In the clinical world there can be two camps. Those who like treatment manuals say that is the only way to provide evidence-based treatment. If you deviate, you're stepping outside known science. You may be deluding yourself about your level of knowledge and your success levels.

They may also point out that the FBT manual contains general principles rather than very detailed instructions. Note also that parents are seen as experts on their child, so even when you follow the FBT manual, you are shaping decisions based on what parents report.

Those who like 'evidence-based practice' try to combine recommendations from manuals with their own experience and with the patient's individual situation. They don't believe in 'one size fits all'. They may also point out that there are not 'dismantling' studies to check if a particular instruction in a manual is truly useful. My example is the FBT manual's focus on showing the young person their weight right from the start. There are no studies to check out the experiences of some families, where it's better when weighing is blind until the child is mentally better.

My view is that if a clinician isn't very experienced, I'd like them to stick to the manual, because they don't know what they don't know. But I'd also want them to have the humility to make some adaptations depending on the expertise of the parents. Conversely, if the clinician is very experienced, then I'm very happy for them to deviate from manuals and individualise to my child.

In my resources I offer a wide range of tips and I tell you where they deviate from the FBT manual.

For an evidence-based alternative to a family-based approach, check out Chapter 12 of my book, 'Which treatments work?' Also in the UK, the NICE guidelines.

Once your child is in individual therapy, your role is affected. Think about what you will do if your child is eating an apple a day but presenting a great facade to the therapist. What will your involvement be? How will you communicate? A good therapist will discuss all this with you.

I discuss this in Chapter 12.

Briefly, a family-based approach — especially the FBT model — proceeds without your child getting any individual therapy (though there's increasing flexibility on this). Your child gets well through the work of nutrition, weight-restoration, exposure, time and so on. Sometimes though, a family therapist will recommend psychotherapy as an adjunct (in FBT that's usually at the end of the treatment) when your child is in a better state to engage.

For therapies that might be a useful adjunct, see my page 'Psychotherapy approaches: which might help?'. Methods include Positive psychology, NVC, ACT, CBT, DBT, Psychodynamic therapies, EMDR (for Post-Traumatic Stress Disorder PTSD) and Cognitive Remediation CRT.

Your child is failing in spite of individual therapy, and you feel like beating them 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. And over-18s need lots of support too: self-help only goes so far.

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 page on three treatment approaches for PTSD. These are methods 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)
• Emotional Freedom Technique (EFT, or 'Tapping')

Quite right. I don't understand how parents are expected to deliver this difficult treatment without individual support for themselves. I give guidance on all kinds of therapy methods  in 'Psychotherapy approaches: which might help?' If you feel you have PTSD, see further down.

And here's a gift from me that might be just your cup of tea: some guided meditations to help you find your calm, your self-compassion and your compassion for your child. Some parents report these really helped.

If your child has anorexia (or another eating disorder that drives them to restrict their eating at times), then the best treatment requires you, the parent, to find a way to get your child to eat. Regularly (3 meals and 2 or 3 snacks a day). And enough for weight recovery (0.5 to 1 kg gain per week).

Later (and asap) 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.

My Bitesize audios and my book have lots more on meals and how to get your child to eat. I also offer online group workshops. See also this page 'How to get your child to eat: refeeding mealtime tips'

Yes, though nowadays experts say this has been overblown. 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, just 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 (and first-hand experiences from experienced therapists) indicate that the risk is far lower than previously thought. Much more common is the damage done by under-feeding.

There is guidance for your doctor on assessing for refeeding syndrome in section 8 of the Academy for Eating Disorders (AED) Guidebook for Nutrition Treatment of eating disorders (2020).

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 unless your clinicians tell you otherwise, go for it.

If the risk of refeeding syndrome is now over, there is no good reason to go slow with weight gain. If you go very slow, you have the disadvantages of what some call 'underfeeding syndrome', where your child deteriorates or stays stagnant.

In adult treatment, traditionally, there was a fear that rapid gain would scare patients away. This has leaked into the thinking of some of those treating youngsters, for no good reason. Your child will be scared of eating and of weight gain anyway. You will support them through their fear.

There's lots in my book and in Bitesize about this.

Briefly: you should quickly get to the stage you can feed your child 3 meals and 3 snacks a day, in quantities that will give any weight gain required, fast.

Some therapists will give you a meal plan. Some parents like this, as long as it's flexible enough to reflect the family's normal food preferences. An FBT therapist may not give you a meal plan because they want to empower you: they tell you you know how to feed your child. And you can also get high calorie meal ideas here.

You can give normal food — just in bigger quantities. It's helpful to make the food 'dense': lots of calories in a smaller volume. That usually means using rich ingredients like fats. Make sure the two other macronutrients are there: proteins and carbohydrates.

If your child needs to gain weight, that's your priority, so it's OK to stick to the foods they are just about comfortable with. But if your child is only eating vegetables and quinoa, you will have no choice but to serve richer food right from the start.

Once you're reasonably confident you can feed your child for weight gain, consider introducing some 'fear foods'. It's up to you how soon you do this, but it has to be done eventually ('exposure' techniques are in chapter 9 of my book and in my Bitesize audio collection). You can't have recovery from an eating disorder if you continue avoiding the foods you used to love, or the foods that are part of normal life.'

If your child became vegetarian or vegan as part of their descent into an eating disorder, the normal rule is that you should re-introduce the dairy or meat that they've been avoiding. The idea is to help your child your child let go of anxiety-driven or perfectionist rules. You can share their sadness over the suffering of animals: the point is that once they are truly recovered, they can make choices from a place of wisdom, not a place of restriction.

If your child was vegetarian or vegan a very long time before the eating disorder started (because who knows when they really started to restrict), and if you totally trust that your child became vegetarian or vegan for ethical reasons rather than from an anxious drive to 'eat healthy', then it might be fine refeeding them with these dietary choices.

But first, are you confident that if you do so, you will be able to re-nourish your child fast, both for weight and nutritional balance? Most (but not all) parents I speak to feel far too limited with vegan foods and don't know how to bring in enough calories. Personally I wouldn't know how to do it with veganism, whereas in my family we've almost always been vegetarian. If you think that refeeding along veggie/vegan rules will be slow, then consider that 'food is medicine' — we take medicine we don't particularly like, if it's going to help us recover.

There's a lot more help on this page which two expert dieticians wrote for me: 'Is it OK for my child to be vegan during eating disorder treatment?'

The problem with hiding is that if your child finds the hidden ingredients, that can bring an extra obstacle to an already difficult job.

But it's also not OK to only feed the ingredients they're comfortable with — they could stay stuck with their eating disorder forever.

Also, if you engage in long discussions about how many grams of butter it's acceptable to put onto the potatoes, that's eating-disorder talk — not therapeutic.

So I recommend this and you can check that your clinician approves:

Provide the food that you know your child needs. If you're frying an egg, go ahead and use oil. When your child anxiously or angrily asks if you used oil, you can say, "Darling, I can see how you would think it's helpful to know what's in the food. And at the same time, we know it makes things harder. So for a while, we're not going to discuss ingredients. Trust us to serve you what you need. I've heard of a great new series on Netflix, by the way, would you find it for us?"

With old-style treatments, patients were involved in all the food choices. Meal plans would be negotiated with clinicians a week at a time. Sometimes calories were counted, food weighed. Parents were told to stay away while their child cooked and ate in their bedroom.

This makes recovery very slow, or non-existent. Our children are too scared of food, and of weight gain, to make wise choices. Given too much choice, some eat less and less. Some eat just about enough to avoid hospital.

This is why a family-based approach normally works better: parents are mobilised to support their child to eat what's needed. Most often that means parents take charge of meals: they decide what to serve and they support and supervise so the food gets eaten.

Some parents call it 'Magic Plate': the plate appears in front of their child as if by magic, containing what the child needs to eat. The young person is not involved in shopping, and stays out of the kitchen. Negotiations are kept to a minimum — though the parents may listen out carefully for hints ("I imagine I will never eat ice-cream again" means, "Please make me eat ice-cream soon").

You'll only be making decisions for your child and supervising their meals for a while. There will be a different kind of work to weave in to get your child to complete recovery.

While the huge majority of youngsters only start progressing when the parents decide on the food and serve the right portion, there are exceptions. If you are seeing that your child can choose their food wisely (proteins, fats, carbs — enough for weight gain) then you are lucky. A collaborative approach is more pleasant for all, so if it's working, go for it!

But make sure it really is working. If your child is choosing insufficient meals, you will need to intervene.

It seems impossible. Hey, if it was easy, it wouldn't be anorexia, or bulimia or binge-eating disorder in its restrictive phases. But there are many ways of making it much more possible than you think. You can hear me explain and demonstrate tips in my Bitesize audios, and I share every useful tool in my book. Also, check out my online workshops.

You will find many tips and examples in Chapters 7 ('How do you get your child to eat (the bungee-jump analogy), Chapter 8 ('See the tools in action: mealtime scenarios') and Chapter 9 ('How to free your child of fears: exposure therapy'). More below…

• Read my tips on 'How can I get my child to eat'
• There's also a free helpsheet which you can download here.
• And I explain 'Seven Tips for Getting a Person with an Eating Disorder to Eat' in a podcast with Tabitha Farrar.

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.

I am not a fan of simple, one size-fits-all rules that some parents share, like 'Life Stops Until You Eat' or '100 percent nutrition, 100 percent of the time'. It depends on your child's mental state, on whether you're about to do harm by finally losing your temper, on what you have learned works with your child, on your aims (weight gain? fear food?).

If you have a meal to serve right now, think 'compassionate persistence'.

If you have 7mn, read more on my post here: 'How long should I persist with a meal?'

If you have 20mn, watch my video, which talks you through your options.

• If you've not read chapters 7 to 9 of my book, then do that.
• Reading may not be your thing and it's probably useful for you to hear this stuff too: that's what my Bitesize audios are designed to do.
• Ask your clinical team to give you coaching. Many teams don't do it, presumably because they themselves don't have that particular expertise. A few think it's better for parents to work it all out by themselves — I think that's a very weird (and ineffective) theory of empowerment, so keep asking.
• I offer online workshops.
• Ask your clinical 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/residential unit to kick-start a change, and/or to tube feed and monitor their health.

It depends on the priorities at this stage of treatment. And check with your clinicians as opinions do vary a bit.

Does your child need to gain weight? Then rapid weight gain is your priority and will give you both the biggest bang for your buck. Rather than risk failed meals, serve up easy foods, as long as these provide the required calories and cover the basic food groups: fat, protein and carbohydrates. I remember that when our daughter was very underweight, we did fine sticking to quiches almost every night.

If your child fears all fats, or all carbohydrates, anything high-calorie, then you have no choice: you will have to introduce some of these now to make any progress.

Once you can feed reasonably confidently for weight gain, start bringing in variety. If you do it as soon as you feel is manageable, there is less risk that your child's rigidity will increase — too often, we see our children making more and more foods a big 'No'. On the other hand, you can leave some of the hardest foods for later, when your child is generally better, less anxious and more flexible.

If your child doesn't need weight gain, it's still likely that they have issues around rigidity around certain foods, eating in company, eating regularly. They can't beat the eating disorder without help around this.

If you think your child might be autistic (more from me on autism here), or has ARFID (more from me here), and they've always had trouble with certain types of food, then get more advice. Most likely, you will be advised to help them return to the foods they used to be OK with. Any work on expanding their range needs to be done with great care (if at all).

Chapter 9 and many Bitesize audios are devoted to this topic. And I regularly do a workshop on this.

Sadly the only method that consistently works to get rid of a fear, is to do the fearful thing. The brain goes, 'Oh, that wasn't so bad' and after some repetitions, it gets retrained, desensitised, 'rewired', so it doesn't send our poor children down the fear route. More consciously, your children realise that they can fear something and when they still do it, the anxiety isn't as bad as they thought.

You can learn to do exposure work in a consistent, planned manner, so that every effort really pays off and your child doesn't keep losing ground.

Lots of help in Chapter 9 of my book: 'How to free your child of fears: exposure therapy'. If you prefer listening, there's plenty in my Bitesize audio collection. For more interaction, come to my workshop.

There's also my short helpsheet on doing exposure therapy.

Use the same principles as for fear foods. Until your child has freedom around everything that used to be natural to them, they need your help to practice 'normal'. Lots of help from me in Chapter 9 and many Bitesize audios. I also regularly do a workshop on this topic.

Again, the same principles as for fear foods. I have a Bitesize audio specifically on progressive steps to manage restaurants and examples in Chapter 9. And this page: 'How to get your child to cope with calories on menus.'

The way I see it, you're working to free your child of rules, so that at all times they can be in choice. An eating disorder, like any stressful situation, brings a rigid mindset. We aim to bring back flexibility — a relaxed attitude.

Your child says they don't need to eat sweets or french fries? You can validate that this is true and at the same time the aim is that when they're in a setting where sweets or french fries are being offered, they can easily have some, without stress. They say they don't need cheese? Then let's see if they go back to enjoying cheeses, or at the very least, feeling indifferent about them.

My book and Bitesize audios have lots of tips on communication, to help you with all this.

Often our children say they're only exercising to be fit and healthy and better at their sport. You will know if things are not right.

Exercise is, for many, very much part of the eating disorder. Your child can't sit still, they're exercising in their bedroom, they keep increasing their hours at their sport, and they are unable to provide the food and rest that their body needs. All this is very 'normal' with an eating disorder and your child needs help with it

Check with your clinicians. Parents are usually tasked with stopping or reducing exercise at first, often for medical reasons or to prioritise weight recovery. Some young people have revealed that they were relieved when they were made to rest, as they were so very tired.

The drive to move is, in some youngsters, so strong that parents can hardly stop it. Do consult your professionals, so you know what to prioritise. Medication helps some youngsters, so insist on seeing a psychiatrist because anything to do with antipsychotics, antidepressants or anxiolytics is their domain. Some parents report that a strong, clear exercise veto from a clinician made all the difference.

If you're on a waiting list and getting no professional input, I suggest you play it safe (for medical and mental reasons): stop all sports, ask your child to stay in the living room if they are secretly exercising in their bedroom. It may be fine to accompany your child on short, slow strolls so they get some fresh air and gentle movement.

Much later on, treat exercise a bit like you do fear foods: gradually expose to whatever form of exercise seems to be an issue, monitor, explore your child's attitudes. Your aim is for your child to recover (or discover) the pleasure of movement, free of compulsion, rules and self-hate.

If your child was engaged in a high-level of sport, they may or may not return to it eventually. It's not clear what makes it OK for some and not for others. Take it slow and gradual, and don't make any promises.

I guide you in more detail on my page 'Exercise compulsion – what can we learn from others?' as well as in Chapter 10 of my book, and in my Bitesize audio collection.

The eating disorder will stay if your child is allowed to stay underweight. A healthy/recovery weight corresponds to whatever your child needs for physical, mental and emotional stability. It cannot just be weight gained through musculature — the body needs fat too. Your child's fear of weight will only pass by them going through the painful process of being exposed to that fear, and discovering it's OK. More on Weight Restoration: Why and How Much Weight Gain?

Thinness or muscularity are held up as ideals in our society, so to get your head around it, you may enjoy my page 'How to overcome weight bias and fat phobia'

There are pros and cons to your child being told a target, and there are skilful ways of doing it. More on Weight Restoration: Why and How Much Weight Gain?

It sounds like a 'one-size-fits-all' target, which is insufficient for roughly half the population. More on: Is your child’s target weight a gift to the eating disorder? If you want to bring to your clinicians quotes from experts, I've gathered many here.

It's infinitely better than using BMI/weight-for-height. But it will only give you part of the picture, and could still be vastly inaccurate because growth charts don't show the variability in a particular child's growth patterns, including the inevitable growth spurts.

See Weight Restoration: Why and How Much Weight Gain?

'Overweight', by definition, means over a threshold BMI. The problem is people also think that 'overweight' means 'fat', 'unhealthy', 'must lose weight'. Very often, that is not the case. BMI is just a very crude way of classifying big populations. More on What do BMI and Weight-For-Height mean? The general rule is that youngsters should not lose weight. Get yourself some specialist advice.

A child or teen who loses a lot of weight presents high medical risks — especially if their loss was rapid. Their mental state can also be severely eating-disordered. This is 'weight suppression'. When your child's weight ends up in a 'normal' range after a lot of weight loss, they may get a diagnosis of 'atypical anorexia nervosa'. Sadly, the risks are often missed by generalists who generally see a 'normal' BMI as a sign of health. If your child has the mental and behavioural symptoms of anorexia, consider them to have anorexia (even though it's called 'atypical'). Get your child checked out as thoroughly as if they were skeletal. They will need to regain all or most of the lost weight.

If their weight is 'normal' after they lost a lot of weight, then that's 'weight suppression'. They're probably suffering from malnourishment, and could be at high medical risk. They're unlikely to recover from the eating disorder until they gain weight. So weight gain is your priority. Sadly, I've talked to parents who were told their child could keep their current weight, after a loss of many kilos, and the awful mental symptoms persisted. When this goes on, usually the child continues their downward trajectory, becomes very underweight and then they're given the treatment they needed all along.

This is a problem commonly faced by parents who have got themselves super-educated about eating disorders. Not all clinicians are updating their practices. Sadly, 'middle-size-fits-all targets are still common'.

And also, we're in a society that equates 'thin' with 'healthy' and being a 'good' person. This is called 'weight-bias' or fatphobia (like homophobia) and I offer resources for the education we all need about this here.

I've gathered quotes from experts on 'Experts say, "Recovery weight should be individualized" Some of these are the authorities who wrote manuals and may well have trained your clinicians. Some are professional institutions, some are researchers.

I also provide loads of learning in my main page on weight: Weight Restoration: Why and How Much Weight Gain? From there you'll find links to other pages on specific questions around weight restoration I hope this helps you make your case. After all, you could be speaking to another clinician in the next county who insists on the very same things you want. By the way, in any difficult discussion, it helps to agree to a time period, then review. Or… to agree to disagree.

Being underweight will keep your child stuck mentally. You should see progress as weight rises. Then one day, there'll be physical indicators that your child might be weight-restored. But nobody can be sure — not even super-experienced medics — because there is no scientific measure to define the precise weight that any individual needs. Certainly not BMI or weight-for-height percentages and not even growth charts.

And because your child still counts calories in their head, or compares their plate size to yours, or clings to rules and habits, you wonder if that's an indicator they're not really weight-restored, they need more. If increasing weight has helped your child's mental state up to now, should will more weight continue to provide mental benefits?

The thing is, weight is necessary but not sufficient. For a recovered mental state, for those habits and rules to go, there's work to do. And time is a healer as well. And for some youngsters there's also psychological work to do now.

You will reach a stage of uncertainty, where you don't know if there's more work to do that you missed, or if your child needs more time for healing, or if they need more weight. Welcome to the world of uncertainty. I say lots more in my posts on weight-restoration, and for this particular question, jump to here.

Your child's mental and physical state are what matter, not focusing on a particular number on the scale. Actually, the mantra would be better as 'State and Weight', because weight is one of the factors that are necessary to achieve a good state. I say more in this place on my page on weight restoration.

Lots of possible answers, depending on lots of things. In my Bitesize audio collection, I devote a number of audios to demonstrating a range of answers, and helping you get into your child's mind with compassion. Below is one of them, on how "You're not fat" fails to provide reassurance:

I also explain all this explain in detail in Chapter 14 of my book. And very briefly on this post.

Join the club! Most of us parents evolve in our own attitude, fat-phobias, healthy-eating guilt trips and so on, because we see the world through different eyes when our child has an eating disorder. Our current society is slightly mad and we're all bathing in that corrosive juice! I've gathered some great resources for you in 'How to overcome weight bias and fat phobia' .

If you mean individual psychotherapy — one-on-one time with a psychologist — then that's because it is usually a waste of time at first.

I answer this more fully on this page in the section on 'Working with clinicians', where I comment on 'My child needs individual therapy in parallel with family-based treatment'.

More detail in Chapter 12.

Of course our children need psychological support: the illness is distressing, and so is the treatment. I suggest that the way you demonstrate unconditional love, the compassionate stance you take (even while being firm), provides precious psychological healing.

This is common at any stage of the treatment. When they're very malnourished, do what you can to distract, allow plenty of rest, and refeed as fast as you can.

Sometimes the withdrawal is strongest when they're weight-restored. If they've heard they're supposed to now be well (they're not) then they have an extra burden of shame and hopelessness. Try to gauge where they need time for grief and rest (they've been through a huge illness, huge anxieties, the whole refeeding, and they are still worried about so much!), when to make time for side-by-side activities that engender connecting conversations,  and when they need you to give them some structure.

More in Chapters 10 and 14 of my book, and I also cover this in my Bitesize audios.

Anxiety is central to eating disorders, and sadly, treatment can further raise anxiety. I believe parents benefit from becoming calming experts. My Bitesize audios take you through many calming skills, and for an overview you can see my page here.

Oh the whole you can expect your child to feel better and think more rationally as they get nourishment and weight gain. There will be blips, though — ours tended to be just a day or two of renewed resistance, before moving on to more progress. But some people have observed 'an extinction burst' as the person gets close to their healthy weight — say, 90 to 95% of target. It's not necessarily a deliberate show or resistance: I know of youngsters who are weighed blind and don't know their target weight, yet their parents note extra anxiety in the last few kilos.

What can you do? Probably to hold steady and keep up the weight gain. The anxiety will pass eventually and you would do your child a disservice in keeping them in a slightly underweight zone. Bring in all your calming skills. This is a good piece from Anna Vinter: 'The truth about anxiety during anorexia treatment'.

Self-harm and suicidality are both relatively common at times. They can be at their worst when the young person is at their most malnourished, or as they get a little more energy as nourishment comes in.

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 if you really want to know.

More usefully, dear parents, if your child is suicidal, or if they are self-harming, I've collected some great resources for you here.

One of the tennets of FBT is to teach you to 'externalise' the eating disorder. Rather than feeling cross at your child, tell yourself it's not them, it's the eating disorder. Some parents (and therapists) take this very literally and visualise a being, perhaps called 'ED' or 'Voldemort'. They may say, 'That's ED talking, not you. I don't have conversations with ED'.

It's all good if your child themselves relates to having a voice, which they see as an enemy.

It's not so good if your use of externalising makes your child feel unheard, unseen. If it means you miss chances to be compassionate.

More on this in Chapter 14 ('Love, no matter what: how to support your child with compassionate communication') and in some of my Bitesize audios.

Also my post: 'Could your rage at 'ED' show your child's progress?'

Well done for getting to this stage. If your child is not only weight-restored but eating without excessive anxiety, you're through the first phase of treatment.

Treatment continues and very gradually starts to be less about feeding and more about helping your child practice normal behaviours over and over again: normal eating, normal exercising, normal reactions to stressful events. This rewires the brain, removes irrational fears, brings back normal habits, gives your child the confidence that they can live normally, and gives the body time to restore itself to full normal health.

It can take a year or more for normal hunger and fullness cues to return, so for a while people cannot eat completely independently – they need some degree of checking and correcting. Some physiological processes, some hormones, take a long time to get back to normal. Psychological changes take time and repetition too:  your child will be scared of maintaining weight, of gaining weight, of eating various foods in various situations, of being among friends who are on diets.

Too often, treatment stops far too early, and then people talk of 'relapse'. You will know better.

See Chapter 9 on exposure therapy, many Bitesize audios, and a workshop. One of my free helpsheets gives you the main points.

Your final big piece of work is the careful handover of independence. See Chapter 10, more Bitesize audios, and a workshop. For just one page on this, read 'Steps to independence', one of my free helpsheets.

It may be that your child isn't getting the treatment phase that comes after weight-restoration — I list here in Chapter 10 some reasons to explore when someone is 'stuck'.

For some people, one of the reasons is that they are not truly weight-restored — that their body needs more weight for the mind to have a chance to heal. More on Weight Restoration: Why and How Much Weight Gain?

If your child was given a 'one-size-fits-all' target (using BMI or 'Weight-for-Height) then there's a high chance that their weight target was too low. More on: Is your child’s target weight a gift to the eating disorder? In that post I also demonstrate how clinicians plot a growth chart. That is just part of the picture, because growth charts are still statistical instrument that don't take into account the variability in a child's growth patterns, including the inevitable growth spurts.

This is a phase of uncertainty, where parents need more support, not less. Maybe your child needs more weight, maybe there is more work to do on normalising behaviours through exposure, maybe this is a good time for some psychological input, and maybe they just need more time for healing and for a good life to work its magic.

Only if you know for sure that:

• they are eating as required in school (at first, they most probably need help and supervision)
• not over-exercising (are they doing sports and running around the playground without your knowledge)?
• and of course, are they medically fit to be up on their feet and using all that energy the brain uses

More in Chapter 10 of my book.

Sometimes parents think it's OK for their child to miss lunch in school because they're serving plenty of food before and after. I notice that these young people are not progressing, and I reckon one reason is they need to eat every 3 or 4 hours.

Very much so. If your school is not helping to accommodate your child's needs — such as supervising meals — your country may have a legal tool that makes it clear they must.

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.

If your child is binning food in school they probably need more support than you thought. More  on school support here.

Yes, lots. It's all here.

A thorny subject! I researched it carefully and produced guidance here.

My guidance for schools on this subject is, again, here.

See also my page 'How to overcome weight bias and fat phobia'.

As I explain here the best prevention approach we have is to use a validated body confidence program. I also highlight common mistakes to avoid.

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.

Here's a checklist to remind you of issues to discuss with the school.

And I've also produced lots of guidance for schools here.

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.

I give guidance to schools on this subject here.

You're not alone. Both the illness and the treatment are hugely demanding on parents. I believe every single parent should be offered counselling or therapy just for themselves.

There is also lots you can do for yourself:

There are psychological and wisdom tools to help us when we are going through terrible hardships. I put them together in Chapter 15 of my book. It's about coping and avoiding burnout, but also to be open to the possibility of having periods of feeling great, of forging meaning.

Like my book, my Bitesize audio collection includes many short clips, mostly just a couple of minutes each, to give you practical and compassionate tips so you can cope better, manage your temper or tears, your thoughts and emotions, and even perhaps begin to thrive.

For a quick read I have a page for you: Preventing burnout.

And I offer you some free guided meditations to help you find your calm, your courage, your self-compassion and compassion for your child.

If all you've been told about self-care is to take bubble baths, my resources will open your eyes.

Take a break from reading and listen to this podcast with Tabitha Farrar, 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.

And you may feel supported and inspired by my YouTube 'The hero's journey'

Here's one and a half minutes from my Bitesize audio collection, on 'The best psychological tools for these extraordinary times':

Yes! 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. One of them is designed to let you drift off to sleep… Yay!

Those meditations follow principles of self-compassion, and I describe those in my guide: 'Self-compassion: how to recover your inner strength'

I point you to more resources on 'Help with compassion, self-compassion and sleep'

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".

See also my page 'Help with compassion, self-compassion and sleep'.

This is a real thing and I'm really sorry you are suffering like this. On the internet, some parents report suffering from PTSD. Sometimes they're surprised how their suffering bubbles up once their child starts to be well. For others, there's suffering during the treatment but they are happy to enjoy life once the work is done.

Many report that therapy has fixed PTSD or similar. See my summary of three treatment approaches for  PTSD.

Take heart — 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. You might enjoy my YouTube 'The hero's journey'.

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'). Also in my Bitesize audio collection. Also, if you can prioritise getting yourself regular therapy or counselling — you are doing extraordinary work and it's normal you should need top-ups of wellbeing. I offer a guide in 'Psychotherapy approaches: which might help?'.

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.

Your clinicians may have taught you to separate the illness from your child. If this is leading you to be outwardly critical 'of the illness', you might like my post: 'Could your rage at 'ED' show your child's progress?'

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.

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.

If you don't have my book, read my page on the why and how of self-compassion on 'Self-compassion: how to recover your inner strength'. And there's plenty in my Bitesize audio collection.

I guide you step by step through self-compassion in one of my 'Four guided meditations'. The shortest one is great to get you in a useful state of mind to support the next meal.

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 (that's allowing present reality, not resignation about the future). 

Mindfulness 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 on my page 'Books & Links on Mindfulness'. And Chapters 13, 14 and 15 of my book are all based on mindfulness.

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'

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. I explain in ‘OK’: two letters for two steps to mindfulness and compassion.

If that's too simple for you, I give more guidance on more steps on I say more on the why of self-compassion on 'Self-compassion: how to recover your inner strength'. And more in my book and my Bitesize audios.

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.

I really help you have, as we did, therapists who never, ever blame or shame you. I know everyone is not so lucky. Not every therapist really 'gets' that we're good parents, whether or not our child got an eating disorder.

For now, you might like the self-compassion and acceptance exercise in my example: "Self-compassion and how to mediate arguments in your brain". I'd encourage you also to nourish yourself with a lot of loving, validating people and if you can, a regular therapist to keep topping up your wellbeing.

Communication is so important in eating disorder treatment that the answers are everywhere in my book and in my Bitesize audio collection, where you can hear me modelling conversations. I also occasionally run an online workshop on the subject.

Communication is how you will make your child feel safe and loved and make the treatment possible. Chapter 13 gives you the big principles of compassionate communication (or Nonviolent Communication (NVC)), and Chapter 14 applies them to the most common situations with your child.

Here's what a parent wrote me. I hope it will inspire you:

An eating disorder just seems to do that to our children. Maybe it's the malnutrition, or the stress of internal conflicts, but either way their nervous system is detecting threats and putting our children in a state of fight, flight or freeze.

Think of when you have been in that state. It's normal to feel isolated, defensive, aggressive. We are wired to prioritise this state until the threat has gone.

So for our children, it's, 'Nobody loves me, nobody understands me, I'm unlovable, despicable, responsible for all the chaos in my family.' We often discover our children are ashamed of their behaviours, and feel awful about every nasty comment they threw at you.

All this could be going behind a polished, aggressive front, but later, many of us discover it was all there, hurting underneath.

With love, you calm the nervous system. The sense of threat lifts a little, leaving more space for a bit of rationality, a bit of happiness, more ability to be connected, and gradually, the ability to eat without fear again.

Notice that what I've described might serve you better than the externalising model that is taught: you can go from 'It's ED who's so hostile. I will not give ED any airtime' to 'My child is in fight, flight or freeze, not yet able to regulate their nervous system, so I'm going to use my own wisdom to help them out of this state (while also making sure I get the action I need)'.

Gosh, that sounds harsh! When I hear 'tough love', 'brick wall', 'metal apron', I fear that this means I will blank my child out, I will ignore or punish them because of their behaviour.

Your child definitely needs love. Love doesn't mean you're a doormat or that you accept terrible behaviours.

Which brings us to the 'tough' of 'tough love'. I would replace that with 'persistence', 'firmness', 'determination'. Generally, our children cannot lift themselves out of the pit they are in. We need to pull them out. That means supporting meals they don't want, that raise their anxiety. Same with exercise and purging. So yes, it's tough. But it should never be nasty, exasperated, punitive.

Instead of thinking 'though love', think 'compassionate persistence' or 'loving persistence'.

You may have heard this mantra from parents on forums. Originally, it was an instruction for parents: Parents, put your life on hold until your child has eaten. Cancel your appointments. Get off your phone. Give your whole support to your child during this meal. I approve.

But for many nowadays, 'Life stops until you eat' has become something parents tell their child to impress on them that there will be no school, no friends, no TV, no phone, no bed even, until they have eaten every last morsel. It is often tied to 'consequences' (punishments). It works for some. But I think it's a blunt instrument, and that compassionate persistence is (usually) more effective and definitely less risky. Plenty of help on being effective without being punitive in all my resources.

Yes!!!!

It could be your only tool is now silent empathy. It sounds like nothing, but it can be very powerful, if you can put yourself in a loving state of mind.

There's also a lot you can do to keep up the connection even while your child goes:

• "You don't listen!"
• "You don't care!"
• "You're so patronising!"
• "Why are you not doing x,y,z?"

The short answer: listen well, be interested, try and get into a non-judgemental state. Wait for a sense of connection and understanding before you give explanations, make suggestions, give fixes. Mealtimes is the exception: don't let empathy take up all the time: keep coming back to eating prompts.

Lots in my book (Chapters 13 and 14) and in Bitesize. I also do a workshop focusing on communication.

Of course, it's hard for you to tap into your empathy if you yourself are depleted. Hence the importance of for self-care and great support for parents: Chapter 15 of my book, Bitesize and a workshop for that too.

A short YouTube from me on this: 'Connect before you Direct'

Sadly, 'setting limits' is often, like 'setting consequences', a euphemism for punishing or shaming your child.

I have learned that setting limits should mean this: you tell your child, very clearly, when something is not acceptable, and you ask them, very clearly, to do something else. If necessary, you leave, or do whatever is needed to not get hit, not get abused, not be a doormat.

Such as, "DO NOT HIT ME!!! Speak! Use words. In this family we try and respect each other. I am listening. Come, darling, tell me what you have to say." Note the de-escalation — you are modeling going from high intensity to a calmer, more connected state.

When I see advice to 'take away privileges', I disagree. Your child is hitting you, and you scream "That's it, you lose your mobile phone for a week!!!" How is that going to make your child considerate and connected?

As I demonstrate in Chapter 14 of my book, and in my Bitesize audio collection, there is plenty you can do to be neither a victim nor a persecutor.

My book and Bitesize are packed with guidance for you to connect using compassionate persistence. In my experience this is usually the most risk-free, productive way, of guiding your child, step by step, to manage a meal, to refrain from throwing their plate at a wall, to stay in the house when they were going to run away, to speak politely.

In Chapter 14 I say more about 'leverage', 'consequences' and so on. Since you are here, let me give you the basics.

Compassionate persistence is more rational than 'taking away privileges'. Your child doesn't choose to find eating terrifying. Your child doesn't choose for their nervous system to be in such a state of threat that they become unrecognisable.

Your greatest strength, in getting done what needs to be done, is in your connection. And if you're wondering "Is it the eating disorder speaking, or the stroppy teenager?", I suggest that is irrelevant. The use of  'consequences' is a poor tool, whatever is driving any kid.

The carrot and stick approach gets far too big a airing on TV parenting shows, starting with 'the naughty step' for toddlers. It is only one method in a vast toolbox — in my view it's the most risky, the most likely to backfire, the most shaming and disconnecting, the least likely to promote thriving and wisdom.

Listen, it has worked for some, and on forums, and among plenty of therapists, there's frequent advice to find whatever 'leverage' works. The message is, 'Take away one thing after another, until your child complies'.

If it can save a life, it has a place in your toolbox.

But… 'consequences' are a scarily blunt instrument. I speak to parents who don't dare to speak their truth on forums: that when they used a punishment, the hostility or disconnect accelerated, and they're having a hard time getting any traction back on their child.

Sometimes it's therapists who recommend punishments to get results. When one doesn't work, they escalate to tougher sanctions. I've spoken with parents in this situation who expressed relief when I introduced them to compassionate persistence skills. It's a relief not just because it was closer to the parent's values but also because it worked.

Bribes (incentives) are very close to punishments: if your child can't manage what you asked of them, they lose the promised reward, and that can induce helplessness, despondency or lots of bargaining and resentment. Having said that, I know of situations where bribes can work: that's when it's collaborative: when your child has worked out with you some things that will help them stay motivated.

Step out of the power play. Your child can always win power games: all they need to do (and many do that) is say, 'I don't care'. Often, they truly don't care: why care about their phone when they are in complete shut-down — when their life is so painful that they don't even want to live?

If this is strange to you, and you're wondering how to bring up any child or teen without carrot or stick, you'll find lots more in my resources.

I have a whole lot of audios in my Bitesize audio collection, and I summarise them on my page 'How to calm your child when the eating disorder heightens anxiety and panic'.

Many of the great tips to reduce anxiety come from the field of autism. For lots of tips from parents in helping their autistic child recover from an eating disorder, see my page here.

Our children can go through periods of extreme panic, where they disconnect from reality, perhaps screaming, hitting themselves, and perhaps getting pretty delusional about their body shape.

As you expect, lots of help on this in my book (Chapter 14) and in Bitesize. I also do a workshop on communication. And because all this is exhausting for you and you need to top up your own wellbeing, see Chapter 15, Bitesize and a workshop.

In short: of course you will aim to use your skills of compassion. But if your child is locked in their nightmare, they may not hear you, so your empathy doesn't get a way in.

In these situations it's often most effective to connect our children to reality.

Give them clear instructions that will make their body move, and that will distract them from their nightmarish thoughts: "Come brush your teeth. Yes, now. Come on."

Get them to reconnect with their physical senses: "Let's count five blue things in the room. Come on, I'll help you. There's the blue mug over there. What else?" Some youngsters have prepared a kit ahead of time, with items that are tactile. Some come back to reality when parent hugs them, or runs an ice cube over their face. You can also ask your child to guess what letter you are drawing as you run their finger on their arm or in the palm of their hand.

And obviously, model calm confidence. Your child needs to know there is no real danger. If you're not scared, maybe there's nothing to be scared about.

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 ideas in 'Mending the relationship after a bust-up'.

And in my Bitesize audio collection, there are audios on relationship repair too. Whether you regret what you said, or want to give your child the chance to express regret about their own actions.

It's going to be scary and confusing for your child if the caring adults are not all on the same page. Your child is scared of food and hungry, so they need to trust the instructions they're given.

As parents, you can have different styles but you need to speak privately to agree on your lines in the sand. If your child is terrified of finishing their plate, it's hard to get progress if one parent keeps up the support so that everything is eaten, while the other parent quickly allows the meal to end.

It's common for marital stress when there is so much at stake. Concentrate on your common ground. You are both desperate for your child to be well. You are both very scared of doing the wrong thing. Your arguments stem from that fear. I speak to so many parents where one is accused of being "too tough" (shouting at their child in the hope it will make them eat), while the other is "too lenient" (prioritising kindness and connection over action). Both parents are desperately wanting their child to be well, and they get angry and scared that the other parent is making things worse. They get polarised, each in their extreme role.

And of course, parents get exhausted, and sleep-deprived, and their nervous system is in a near-constant state of threat. They're not in a good place to work out their differences.

What can I say? Get help. Ask the therapists for sessions just for yourselves. Seek out your own therapist. Take turns supporting meals, so you each have at least two fun outings a week to replenish. Have long hugs: that will reduce cortisol and increase oxytocin in a way that words can't.

More in Chapter 11: 'Partners, family, friends and work: help or hindrance?'.

Yes, it is hard on the siblings. My book gives you pointers and links in Chapter 11: 'Partners, family, friends and work: help or hindrance?'

Here's the main thing: you can't possibly give all your children the same amount of attention as their ill sibling gets. Let them know you care. Ask them how things are for them. Make all thoughts, all emotions acceptable. Don't preach.

Most of all, tell your children that you are strong, that you know what you're doing, that you have great resources. You have space for them. They don't need to protect you from their own miseries. They don't need to close down and become 'tough' and go into extreme self-reliance.

Family-based treatment or similar approaches is supposed to include siblings. Some siblings don't want to come — fair enough. Some may benefit from extra therapy support, or from extra care from the school.

Think very carefully about any role you give siblings. The general rule is they should not be tasked with feeding or supervising their ill brother or sister. That's your job.

Kim Piekunka provides great resources on siblings.

Yes, for sure. At the same time, give people a chance. The minute you use a word like 'anorexia', it's normal that the person should jump to a whole history of notions of what that means. Take a few minutes to educate them, even if it's just "I've learned so much about it. It's not at all what I used to think — it's not about being vain, or having deep psychological issues or all that stuff you see in the media." And then give them a brief genetic explanation, or an analogy like "It's like he has a hijacker holding a gun to his head, saying that if he eats he'll be shot".

When your friend starts giving you unwelcome advice, see if you can tell them, "You know, I have learned so much about this, and I'm confident I know we're getting the best advice. From you, what would be most precious is your lovely friendship… listening to my woes, taking me out for drinks, sending me messages of encouragement…"

And of course, there are some people you won't even try with. More in Chapter 11: 'Partners, family, friends and work: help or hindrance?'

Amazon, bookshops, ebook stores… anywhere worldwide. As a paperback or ebook. Links are here.

You can get the ebook from this site, and you'll then have to install it on your device. That will give you access to updates, which I tend to publish annually. It's easier to buy the Kindle ebook from Amazon (but sadly that doesn't give you automatic updates).

There is no audiobook version of the book.

I do provide a different kind of audio: my Bitesize audio collection. It's is a vast, searchable library of very short audios, each addressing one simple question that parents often ask.

Practical tips and emotional support for parents, for all stages of the recovery journey. I outline what's in the book here. The table of contents is here.

Bitesize is a library of audios, each less than 5mn long, addressing the topics parents need the most. Just like my book, it covers all aspects of the treatment journey.

Get Bitesize if you don't like reading much, or if you want to hear me modelling conversations, or if you want to learn easily on the go. It complements the book nicely — what it doesn't have is all the references to back up what I say.

If you’re the parent of a child suffering from anorexia nervosa (including the ‘atypical anorexia’ type) then my resources are definitely for you, because that’s where my experience lies.

Go ahead even if you think your child doesn’t (yet) tick all the diagnostic boxes, because the sooner you treat, the easier it will be. Your child needs help, for instance, if they’re caught up in an obsessive drive to eat ‘healthy’, to exercise excessively, or to increase muscle bulk and eliminate body fat.

All eating disorders have areas of overlap, so if your child has bulimia nervosa, binge-eating disorder, OSFED or ARFID (more on these diagnoses in Chapter 3), or if they are autistic, many sections of this book will also be relevant to you: helping your child with regular meals, dealing with anxiety, communicating. For all these I do recommend 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.

My resources are mostly aimed at parents of children and teens, but parents of adults and of young adults tell me they get lots of useful help from them.

Good question, as anybody can set themselves up as an 'expert'.

Many parents find me because their treatment professional has recommended my resources.

I work hard at keeping my resources up to date with the science. I'm also keen for you to learn from the experiences of many parents, and of professionals. I bring in my own experiences but if that's all I had it would not give you the breadth of knowledge you need to problem-solve for your own child.

My book has been checked by experts. See reviews from professionals here. I've collected some parent reviews here and there are loads on Amazon.

I am lucky that quite a few top clinicians and researchers give me their time when I need something checked. I check whenever I am dealing with something that is a grey area, that could be controversial.

At the moment I'm updating my book at the start of each year, and unless you're buying a used copy, you'll always have the latest.

The book's endnotes have many references to studies as well as links to help you dig deeper into any particular topic. So when I give you tips, you know I'm not just giving you just an unfounded opinion based on narrow personal experience.

Of course, my resources are not a substitute for the personalised professional advice you should be getting from your clinicians. If you can't get professional treatment, you should still check in with your instincts, with your knowledge of your own situation.

Yes and no. FBT therapists recommend my resources because they're compatible and they help parents carry out the tasks of them.

But I give you a broader lens, based on published research and a wide range of parents' and clinicians' experiences. I tell you if I'm giving you tips or an opinion that deviates from the FBT manual or from what experts in a family-based approach say. I share tips on individualising decisions for your child, where a decision might deviate from the manuals.

I tend to refer to 'a family-based approach' so as to acknowledge my resources are not pure FBT.

Mine is the only book that gives you a detailed 'how' of supporting your child along family-based treatment lines. 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, communication and emotions. As a parent said, it covers all the bases.

There are other books give you the 'why', the theory and history, more than mine does. There are a couple of shorter books from therapists that tell you what to do your part of FBT treatment, just as I do. My book is much longer because I also cover the many questions that parents struggle with. How to deal with particular situations that come up, what to say, how to stay compassionate, and how you yourself can stay well.

My book is absolutely not a memoir. I take care of my readers' emotions: my book is sympathetic and upbeat – the furthest you can get from a misery memoir. There are many memoirs from parents or sufferers, and I am not sure they're a wise choice for you right now. Inevitably, they relate to treatment, or lack of treatment, that has little in common with the up-to-date treatment I am talking about. So they tend to paint a rather horrific picture of the journey.

My book is only in paperback or ebook form. Also available to you is a vast collection of very short audios, called Bitesize.

Online workshops I run myself are here. Any workshops or conferences I'm due to speak at, organised by others, are listed here.

Certainly. I'll be delighted to meet you. Details here, where you can see pricing and my calendar.

All my posts are listed here. At the top of most posts you'll see some keywords. Clicking on a keyword will lead you to more of my pages on the same topic.