Last updated on June 14th, 2020
This is a section from Chapter 6 of 'Anorexia and other eating disorders – how to help your child eat well and be well'
An eating disorder affects almost every aspect of our children’s lives. Here is an overview of what you can do to systematically weaken its grip and get your child back.
Helping a child with an eating disorder ought to be pretty intuitive. You just want to get your child to eat, right? Or you want her to stop bingeing or purging. But she fights you. She tells you you’re making it worse, that she doesn’t have a problem, that she hates you, and then she freaks you out by behaving totally out of character. You’re at a loss for what to do next, and you’re scared that whatever you do will make her worse.
In this chapter I cover each aspect of treatment. These are all things you can do right now to get your child well. My emphasis here is on the first phase, when you will be focusing on food – and usually weight gain. The following chapters give you more of the much-needed ‘how-tos’. Then in Chapter 10 we move on to the questions that are most common after the first phase of treatment: how to bring back some normality and move towards full recovery.
Every day you have decisions to make: what to allow, what to prevent, what to try next. I’m going to tell you what worked for us and for other parents, and what experienced therapists recommend.
For every step you take, even when you encounter resistance, you are moving forward. If right now the journey I propose seems impossible to you, hang in there. Even a single tool, if it works for you, can make all the difference.
[Jumping to another section of the chapter…]
Food and love
As we saw in Chapter 4, food is the main component in the treatment of an eating disorder. It provides much-needed fuel for the brain and the rest of the body. There is also healing through the regular exposure to normal eating without purging. Yet for a while, regular eating is the most scary, horrible, anxiety-inducing thing you could ask your child to do. That’s where love comes in. A parent’s love is a healing force. Your child will not have to walk through hell alone because you’re going to be right by their side. sticking with them no matter what. It may not look like it right now, but you are building a relationship that will sustain your child’s recovery and support their wellbeing for years to come.
Remove choices: Magic Plate
For us, as for many parents, the key tool for helping our child to eat was to take control of all food and health-related decisions until they could safely do this for themselves. Some parents call this Magic Plate, and their experiences show, over and again, how effective it is.
Here’s how it works. You inform your child in a clear and loving manner that from now on you and your partner will be in charge of all decisions relating to food and health. Whenever she tries to negotiate for smaller quantities, asks you to swap one food for another or refuses what you give her, you remind her that for now, you are in control, you are highly competent, and that you’d like her to trust you to take good care of her.
This is because she is physically, biologically and neurologically incapable of making competent decisions for herself in this area. She is plagued by internal conflicts that cut her off from the ability to take care of herself. For any other aspect of her life, you continue giving her age-appropriate levels of freedom and choice. But in the areas where her autonomy has already been removed by what anorexia does to her brain, you step in and make decisions until she recovers her mental health.
Six times a day (some prefer to make it five times), you ask your child to sit down and you put food in front of her. Breakfast, lunch, dinner, and snacks in between. You expect your kid to eat all of it. No negotiation.
You decide which foods to serve. You decide on quantities. The food is already plated up in the correct amounts. It’s on a Magic Plate because it simply appears at the right time, and your child hasn’t been involved in its preparation at all. You’ve kept her out of the kitchen and out of the supermarket. You don’t discuss if the food quantities are greater or smaller than yesterday’s or different from what the hospital used to give her. You make sure that she cannot get rid of food by hiding it or purging.
You don’t ask her to choose between two types of biscuit, and you don’t check whether she’d prefer cheddar or brie in her sandwich – that will come later. This spares your child the agony of decision-making when she’s racked by internal conflict or being bullied by an eating-disorder voice.
Say you present your child with a choice of two biscuits. This is what might be going on in her head:
- She tries to guess which has the fewer calories. The thought of getting it wrong is highly stressful. Her eating-disorder voice won’t allow her to take any risks. In the end, she’s so focused on calorie avoidance that she eats neither of the biscuits, and also turns down her milk.
- She knows which biscuit has the fewer calories, and it happens to be her all-time favourite. What luck! But just as she begins to feel some pleasure, the principle of self-denial kicks in. The eating-disorder voice reminds her she’s unworthy, and punishes her for enjoying food.
Of course, our children need to learn to make choices in order to recover. They will need to recover their autonomy. But that’s for later, when most of the fear has gone.
Magic Plate is by no means the only method available to you. A family-based treatment therapist will not tell you to do Magic Plate; they’ll ask you to devise your own way of ensuring your child eats and restores weight. Some people with eating disorders are able to participate in setting themselves challenges and in teaming up with their parents to get the motivation they need. With my daughter, along with most (but not all) of the young people I’ve heard of, lack of motivation and strong resistance were part of the illness, and removing choices was an effective approach.
[Jumping to the end of the chapter…]
Conclusion: parents take charge
Parents, never doubt that your child needs you to take charge of his or her recovery. They may appear capable because they can still solve quadratic equations, but this illness transforms part of their brain, robbing them of the ability to do a whole lot of things safely and wisely. For those particular things, you are their surrogate wise person. You’ll carry them until their body and mind learn that normal behaviours are indeed normal and safe. Then gradually you will give your child practice at taking care of themselves until they have age-appropriate autonomy. You will have the delight of seeing your wonderful child fly with their own wings. We are so lucky that out of all the terrible mental illnesses, eating disorders are perfectly treatable. Here’s one young person’s account, which I think says it all:
“Before, I’d say, ‘Mom, Dad, I’ll just eat more, I really will. I don’t need any more help.’ And they’d say, ‘Oh, good, glad to hear that.’ And they’d believe me. Now, I say that same thing, and they don’t believe me. They know they need to help. And knowing that they don’t take my ‘bullshit’ is SUCH a relief. It makes me KNOW that this will end. Knowing that I can’t convince my parents that I can do it on my own makes me know that I will be able to do it with them – and it all will end … thank goodness.”
In this chapter:
- Food and love
- Give your child containment and ammunition against the eating-disorder voice
- Hear how your child speaks in code
- Remove choices: Magic Plate
- ‘You’re making me fat!’
- Meal plans: should your child determine the menu?
- Do parents benefit from a meal plan?
- What if my child doesn’t eat?
- How long should we persist with a meal?
- How much food? Which foods?
- Target body weight
- Weighing your child: open or blind?
- Hiding food and lying
- Eating rituals
- Exercising, moving and standing
- Purging and bathroom visits
- Post-meal anxiety
- Running away
- Self-harming and suicidality
- Being cold
- Compulsive behaviours
- Body-checking and fat talk
- Protection from the internet
- Baking, recipes and images of food
- Your self-care
- Planning how you will take charge
- Conclusion: parents take charge
You can also hear me cover the main questions parents ask in my Bitesize audios.