Last updated on March 11th, 2020
For parents of a child with an eating disorder: how to use exposure therapy to end your child's fears
On this page I outline how to help your child let go of rigidity around foods or situations which, because of the eating disorder, have become fearful.
When you've read this, you will find a lot more on fear foods and exposure in Chapter 9 of my book: 'How to free your child of fears: exposure therapy'.
Below, the exposure therapy tips reproduced from my free helpsheet (which you can download here).
What will ‘normal’ look like?
You have taken charge of food, exercise and all health-related decisions. Or you’re about to do so. Maybe you have avoided rocking the boat too much to get your child to eat something, anything! For instance:
- You’ve avoided foods that your child strongly resists
- You’ve avoided car travel because sitting is stressful
- You’ve avoided restaurants
These crutches have served a purpose. Aim to let go of them as soon as you can. Rules and fears tend to grow. To make progress, promote flexibility, variety, and normality.
Ideally you would not tolerate any eating disorder (ED) rules once you take charge of treatment, but in practice most parents have to pick their battles. It’s important to work on flexibility, but not at the cost of your main priority: rapid weight gain/physical restoration.
Why does your child have rules?
An ED puts your child in a state of fear, which they just about manage with avoidance, calculations and rigid rules. Your job is to help your child experience that they are safe without their rules.
With some children, the eating disorder rules are linked to OCD or autism, and you may need more specialised help.
List what’s not yet normal
- Make a list of all the foods and situations (exercise, restaurants, parties, clothes) where your child still has fears or rules.
- Plan to ‘expose’ your child to each of these till the fear is extinguished and the rule abandoned.
Extinguish fears with exposure
- The principle is that as your child does the fearful thing, with loving support, and does this often enough, the fear goes away.
- You can ‘flood’ (rip the Band-Aid) by exposing to the whole fearful situation. The benefit is rapid progress. The risk (real or imagined) is your child’s resistance might peak, creating a crisis that delays progress.
The gentler, slower alternative is to break down the challenge into small steps. For example you could start with the tip of a spoon of ice cream, and within a week build up to a whole scoop.
Keep up the momentum
- Repeat regularly till the fear is gone, e.g. every day or two, then 1/week, then 1/month.
- Judge how many fearful foods or situations you want to expose to in parallel. One fear food a fortnight is very slow. Three fear foods a day, each at various stages of extinction, is fast.
Where to start?
- You could use the ‘ladder’ approach, where you start with the foods or situations that are the least fearful. Systematically work your way up to the most scary ones.
- Or you could prioritise the foods and situations that will provide the most benefit, e.g. foods that will make weight gain easier, or a sociable food like pizza which will help your child enjoy outings with friends.
- Support with compassion and calm confidence.
- The distress will not be logical, so what they need is your compassion, not logic.
- Judge whether to plan exposure in partnership with your child, or whether to take complete charge.
- Practice self-compassion. It takes courage and resilience for a parent to poke the beast.
What if it doesn’t work?
- If your child’s resistance is too high, next time break down the challenge into smaller steps. E.g. if your child can’t stop doing squats, help them do fewer each time. Give smaller portions of a fear food.
- If your child can’t manage a fear food that they needed for nutrition, provide a replacement. Repeat the fear food a day or so later.
It gets easier
- At first the fears may be very specific (this restaurant, this brand of pizza), and you may need to work on each of them.
With repetition, the mind tends to generalise and perceive more and more situations as safe. Some items on your list will go all by themselves. Your child may feel a sense of achievement and liberation.
Relevance to Family-Based Treatment (FBT)
These tips help parents treat their child/teen for a restrictive eating disorder (e.g. anorexia) using Family-Based Treatment (FBT) or similar. Some tips are relevant to bulimia, binge eating disorder and OSFED. May not all be suitable to ARFID sufferers. This is not a substitute for professional advice. Please check with your child’s clinicians as your child’s needs may be different.
Other help sheets
For lots more on this topic, read Chapter 9 of my book: 'How to free your child of fears: exposure therapy'.
To hear me modelling support at the table, check out my Bitesize audio collection.
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