The set-up for success

Last updated on March 11th, 2020

How to get started with family-based treatment when your child has an eating disorder

On this page I outline the main things you need to know, as parents, to get started.

It shows the contents of the first of my free helpsheets, which you can download here.


set-up for success with FBT for eating disorder

Your priorities

Priorities at the start of treatment are physical restoration – usually weight gain (‘refeeding’), limiting physical activity and stopping any purging. As soon as possible you’ll also do ‘exposure’ work to normalise your child’s range of foods and behaviours.

Get ready

  • Get an expert clinical team that supports a family-based treatment approach
  • If this isn’t possible, organise medical monitoring
  • Get your child risk-assessed for refeeding syndrome to check it is safe to refeed rapidly
  • If your child is suicidal, find how to keep them safe while getting expert support with feeding
  • Take time off work
  • Mobilise regular practical and emotional support. Get family members on board. Plan how to care for your other children while prioritising eating disorder (ED) treatment.
  • Your child can only go to school if someone checks they eat
  • With a young adult who needs to come home, some parents halt financial support rather than finance the ED

Compassion for your child

  • It’s not that your child won’t eat – they can’t. Not without your help.
  • To stay loving you can picture your child and the ED as separate, with the ED as a bully or hijacker. Careful: some children find this imagery infuriating.
  • The eating disorder is driving your child’s anxiety. The restricting behaviours are your child’s way of managing distress.
  • Their outbursts come from their terrified state (fight, flight, freeze). Your judgements, anger or distress reinforce this, while your kindness and confidence move them out of their fear state.
  • Reassurance and logic rarely work (“I’m so fat”, “How many calories?”…). Stick to compassion for your child’s very real distress.

Take charge

  • You are a wise, loving and competent parent, taking charge of health-related decisions until your child can safely be autonomous again
  • No negotiation around food or exercise. It activates the internal bully.
  • Your child is probably hungry, secretly relieved that you are giving them no choice but to eat, that you are stronger than the ED tyrant
  • Refeeding may increase your child’s distress, so they need your love. They may reject you – this is temporary and shows you’re fighting the ED.
  • Some parents have their children sleep in their room to prevent exercising, self-harm and to reduce distress

Weight

  • Healthy weight is individual and must increase with growth. Take care with target numbers as your child may make it their maximum.
  • Make swift weight restoration non-negotiable
  • Studies validating family-based treatment are based on regular open weighing, with skilled therapist support to handle weight fears. Blind weighing is also common: some parents find this helpful at the refeeding stage.
  • Hide the scales

Exercise

Stop your child from exercising while it interferes with health or weight gain or while your child’s reasons to exercise are ED-driven.

Next steps

After physical restoration, the priority is to extinguish fears with exposure and practice normal behaviours. When your child’s resistance is mostly gone you gradually move to another phase of treatment, aiming for your child to resume age-appropriate independence. If you rush this you could be back to where you are now.


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

Onwards

I hope this brief helpsheet gave you a good overview so you can get started.

Lots more on this in Chapter 6 of my book: 'Practical steps to help your child beat the eating disorder'.

In my Bitesize audio collection you will also hear ways to talk with your child so you can get started in spite of their reluctance.

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