The N.A.M.E.D. Parent Guide brings together in one convenient page all the information and resources that parents need to guide them along the difficult path of being a caregiver of a child with an eating disorder.
The information below is helpful for any concerned person who has a family member or friend with an eating disorder, but for the purpose of simplifying the writing, it has been directed to parents with a child with an eating disorder.
Eating disorders (EDs) are serious mental illnesses that can have harmful physical and psychological consequences and even be fatal. Like any illness or addiction, it is important to seek professional help for treatment, and the sooner the better.
With delays in treatment, the eating disorder worsens and the person’s identity becomes more enmeshed in the illness and the affected person becomes more set in habitual behaviors and thought patterns.
ACKNOWLEDGE YOUR FEELINGS
Parents often feel a host of negative feelings regarding their child's eating disorder, including feeling overwhelmed, worried, helpless, hopeless, frustrated, angry, depressed, and guilty. Acknowledge these feelings and express them to someone you can confide in, such as your partner, a close friend, or a counselor.
Parents should not blame themselves for their child's eating disorder. EDs are caused from a combination of predisposing factors, such as genetics, personality-type, cultural and media influences, peer pressure, family problems and communication styles, school and work pressures, other conflicts and stressors, etc.
Even when family issues are involved, a child needs other predisposing factors to move him toward this illness as a coping strategy. This is why one child of the same parents of several children may have an eating disorder while the other children do not.
There is no point in feeling guilty about believing you have contributed to a child’s eating disorder. Let go of blaming yourself, and instead, focus on offering your child support and modeling healthy behavior and attitudes to him now.
Educate yourself about eating disorders. Read the information on this website and other internet websites sponsored by non-profit eating disorder organizations. There are many books on eating disorders, some written for parents. Learn the facts from the misconceptions. See the bottom of this page for "Resources for Parents".
Warning: There are “pro-ana” or “thinspiration” websites that promote anorexia. If you discover that your child under 18 is visiting these sites, you should prohibit him or her from viewing these websites. If you are not aware that your child is on these sites, it is probably wiser not to draw their attention to them.
Parents need to understand that the eating disorder behaviors and problems with food are symptoms or expressions of underlying emotional pain, stress, conflict, and problems. The food is not the prime problem in and of itself; the underlying problems and emotional pain experienced by the person with the eating disorder are the root of his distress.
The child may not be conscious of the reasons for his emotional distress. The food restrictions, bingeing, purging, and compulsive exercising help numb his feelings and gives him a sense of temporary emotional relief.
These individuals feel compelled to follow their compulsions of restricting food, purging, bingeing and/or exercising. Following their rules and rituals makes them feel in control, safe, and good about themselves.
To force someone to eat an "unsafe" food or not exercise, for example, causes them mental anguish, which in their reasoning can only be rectified by giving into the compulsion or self-punishment. These habits are difficult to break without professional help.
People with eating disorders are not trying to hurt your feelings or cause you worry or counsciously trying to manipulate or control you and your family (allthough this inevitably happens as the illness progresses), but they are desperately trying in the only way they know how, to protect their emotional state from abruptly spiraling downward.
People with eating disorders feel embarrassed and ashamed of their problems. This accounts for their secrecy, lies, and denial of their illness. While you cannot be expected to keep his "secret" as this is enabling to him and unhealthy for you both, you must use discretion in whom you confide in about his eating disorder and not intentionally embarrass him by confronting him on the issue in front of others.
Treatment must deal with the underlying causes, building self-confidence and self-acceptance, finding healthy coping skills, and nourishing the body.
Be a model of healthy behaviors and attitudes about food, weight, positive body image, and moderate exercise. Be willing to change your own negative, unhealthy attitudes and behaviors to positive, healthy ones. Modeling healthy behaviors and attitudes helps prevent eating disorders in children and inspires a child with an eating disorder to make positive changes.
Here are some ways to model healthy attitudes and behaviors to those with EDs:
You can take action by:
* See "Resources for Parents" at bottom of page.
The more of these statements that apply to your child, the more likely he has an eating disorder:
For a child under 18, it is the parent’s responsibility as guardian to seek treatment for the child with an eating disorder, just as it would with any other medical condition. With minors, it is not the child’s choice to go into treatment or not. The parent must initiate making an appointment and taking the child for an eating disorder evaluation and getting the child into treatment.
REASONS FOR DENIAL OF ED
People often live in denial of their eating disorder for a long time, sometimes forever. Here are some excuses or reasons a person may give for his weight loss:
- Health reasons (such as to avoid a parent’s disease, like heart disease)
- Fitness reasons
- Claims of trying to optimize sports performance
- Being active
- Loss of appetite; not hungry
- Becomes a vegetarian
See Treatment page under “Tips for Encouraging Someone to Seek Treatment”
One’s primary care doctor is usually the first point of contact for evaluating one’s medical condition before one is referred to a specialist. The problem with this is that many primary care doctors will not recognize an eating disorder in a male. The lab work on someone with an eating disorder often shows no indication of any problems unless his condition is seriously compromised (and you do not want to wait until this critical point to get your son treatment). If the lab work looks fine, the doctor will not be alarmed. But, do not be fooled into thinking everything is okay, if your child is showing symptoms of an eating disorder.
This is the time you need to be assertive with your son's doctor. Explain your concerns that you suspect your son has an eating disorder. The doctor may wish to rule out other medical conditions causing weight loss or lack of appetite. This is a reasonable course of action. Find out if your son's physician can provide a referral to an eating disorder specialist for further evaluation.
It is important to initiate getting a second opinion. You should get a second opinion from an eating disorder specialist – psychiatrist, psychologist, or psychotherapist. These professionals will be able to determine if your son has an eating disorder by assessing what his attitudes, beliefs, and feelings are toward weight, food, and eating and finding out what eating disorder behaviors he engages in.
First, you need to decide what type of treatment you want for your son – inpatient, residential, hospital day program, intensive outpatient or outpatient treatment.
If you are not sure what level of treatment your son needs or you have no insurance, you might want to start by having your son be evaluated by an outpatient eating disorder specialist. Regardless of what level of treatment the treatment provider works, he or she can recommend a level of treatment for your child to start.
The N.A.M.E.D. website has a Treatment Provider Directory listing therapists and facilities that treat males with eating disorders. You are also welcome to e-mail Chris@NAMEDinc.org or call the N.A.M.E.D. Helpline at 1-877-780-0080 for assistance with finding a treatment provider.
For questions to ask a treatment provider in an initial consultation, see the Treatment page under “What Questions Should I Ask A Potential Therapist?” and “What Questions Should I Ask About a Treatment Program?”.
The Treatment page on this website can give you more detailed information on treatment. Here is a summary of treatment information to keep in mind:
- The level of treatment will depend on the seriousness of the eating disorder
- There are several levels of treatment, including outpatient, intensive outpatient, hospital day program, residential, and inpatient treatment
- A well balanced treatment program should include working with a team of professionals – psychotherapist, nutritionist, psychiatrist, primary care doctor, and any other professionals deemed beneficial to the recovery process
- Therapists have different treatment philosophies. They may use a combination of them. These treatment styles, include but are not limited to, Cognitive Behavioral Therapy (CBT), Psychodynamic, Dialectical Behavioral Therapy (DBT), Person-Centered, and others. Be aware which style the therapist uses
- Consider using the Maudsley Approach, a family-based treatment program, for children and young adults living at home
- Consult the therapist for recommendations on your level of involvement in your son’s recovery process
- Understand the objectives and goals set by your son’s treatment team
A common question for parents is, “How much and in what ways should I be involved in my son’s treatment?”
It is important to meet with the therapist and your son in session to discuss the level of involvement your son needs from you. This will help clarify your role in his treatment process and help minimize resistance when you help him in agreed upon ways. Talk specifics on how you will help and support your son.
You have the right as a parent of a minor to be in communication with his treatment team. While the therapist for confidentiality reasons cannot disclose certain details, the therapist can inform you of overall progress and goals and give suggestions on how to offer support.
If you are following the Maudsley Approach (see Treatment page), a family-based treatment approach, you will be intricately involved in the treatment process.
See the “Insurance” page on this website for information on paying for treatment and dealing with insurance companies.
See “Treatment” page under “Tips on How to Support Someone in Treatment”
The time it takes to recover varies from person-to-person. The more serious the illness and the longer one had the eating disorder, the more likely the path to recovery will be longer. Parents are anxious for their child with the eating disorder to return to health and his old happy self and for their relationship to be restored.
Patience with the recovery process is essential. Parents need to realize there will be set-backs and progress will be slow at times. Help children learn from their set-backs rather than see them as failures, gently encourage them, compliment them for their successes, listen to them, encourage them to express their feelings, keep them focused on their recovery and life goals, and help them in ways they agree upon for help. Do not pester them or engage in power struggles. Do not monitor them (unless instructed to do so by the therapist). They must have control over their recovery and engage in it freely.
It is a lonely place to be when you have a child with an eating disorder and are at a loss of how to help the child. Connect with other parents to get support.
Join the online support group for Concerned Others on this website. Click on “Support Groups” in the red box at the top of this page.
Two websites for parents with children with eating disorders are Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T.) at www.feast-ed.org and Maudsley Parents at www.maudsleyparents.org.
An eating disorder in one family member affects the entire family. A dysfunctional environment is created as family members try to:
- Appease the individual with the eating disorder by doing this or not doing that
- Avoiding certain conversations
- Closely monitoring everything they say and do to avoid upsetting the person with the eating disorder
- Complying with the way the person with the eating disorder wants food prepared and the types of food served at meals
- Not being able to eat food specially bought for the person with the eating disorder
- Keeping the child’s eating disorder as the “family secret”
Unfortunately, this behavior only enables the person with the eating disorder to thrive in his illness. See the next section on, “Do Not Be an Enabler”. The family becomes entangled in the eating disorder, thus creating a dysfunctional family system.
Due to your concern for your son with the eating disorder, it is easy to be overly attentive to him. Show equal love, caring, attention, and time with all your children and partner.
The concept of being an “enabler” is more familiar in the context of substance abuse addictions, but it also applies to eating disorders. Basically, being an enabler means allowing the addict, in this case the person with the eating disorder, to continue in his destructive attitudes and behaviors and protecting him from the consequences of his actions.
When people see others hurting emotionally, it is natural to want to rescue them and help them to feel better. In the case of anorexia, parents cling to the hope that if they just let their child have his way, then he will experience less anxiety and eat more. But unfortunately for parents, their protection, compliance, compromising, fear, and secrecy only enables the child to continue in his destructive attitudes and behaviors.
When an enabler unwittingly supports the destructive behaviors of another that is called a “codependent relationship”. Here are some examples of how misguided parents may enable their child’s eating disorder:
- Not putting a stop to eating disorder behaviors such as purging and bingeing
- Not making the child responsible for cleaning up after purging or bingeing when it does occur
- Allowing a child to prepare and eat something different from what the parent has prepared for the family’s meal
- Letting the child eat his meals alone while the rest of family eats together
- Buying special food that only the person with the eating disorder can eat
- Not confronting the child over secretive behaviors, such as after finding evidence of hoarded or thrown out food
- Avoiding social situations in or outside the home due to the child’s discomfort with eating in public
Hopefully, the above list gives you enough examples of enabling to allow you to have insight into how you might be an enabler in other ways in your situation.
A counselor can help you understand the difference between being supportive and enabling as well as give you guidance about what reasonable rules you need to set for your child and how to implement them.
When setting rules, always have a reason for the rule and explain that to your son with the eating disorder. Let your son know you love him, explain how following and not following the rule affects you and the family, say how you feel, be honest, and tell him the rule is for his, your's, and the family’s best interests. Explain the consequences for not following the rule.
If an adult son’s eating disorder is taking a toll on you and your family, you have the right to give the child 18 and older with an eating disorder an ultimatum to abide by certain rules and seek treatment or move out. When giving such ultimatums, do so when you are not emotionally upset and can approach your son with sensitivity and love, express your feelings and concerns calmly, and explain your reasons for the ultimatum. By appropriately handling the delicate situation of giving an ultimatum, you are minimizing the chances of the individual becoming more depressed and developing resentment toward you.
Despite what may happen when imposing reasonable rules and ultimatums, realize that these are necessary steps to reclaiming your's and your family's life back. You and the rest of your family need to protect your emotional well-being and enjoy your own lives without the depressive cloud of the eating disorder constantly over you. Care and support, but do not get sucked into the dysfunction of the illness.
- Prepare three nourishing meals each day for your children
- Eat as many meals as possible as a family and enjoy conversation
- Discourage children from skipping meals; telling them they need the food for energy
- Encourage healthy snacking
- Teach children to eat when hungry; stop when full
- Encourage children to eat a variety of foods
- Do not force children to eat everything they are served on their plate as this takes away their sense of control over food
- Let children eat sweets and treats in moderation as long as they are eating nutritious meals
- Avoid talking about diet and weight
- Don’t equate thinness with beauty, happiness or success
- If you are unsatisfied with your weight, size, or shape, feel “fat”, and want to diet, seek help, but do not express these thoughts and feelings to children as they learn from parents and others how to feel about themselves
- Do not direct attention to a child’s weight, shape, size, or the amount of food eaten unless the child is obviously overweight and you are trying to take corrective action to help the child not overeat and eat healthier meals and snacks
- When children do need to lose weight; take a non-diet approach
- Compliment children on their positive internal qualities instead of their external physical traits
- Encourage children to be active
- Encourage social interaction
- Spend quality time with your children and actively listen to them
- Encourage children to express their feelings in words
- Carefully listen to what children say about being teased and help them deal with it and boost their self-esteem
- Don’t speak about or tolerate other people’s derogatory comments about other people’s weight, size, and appearance as children will personalize these comments.
- Model the healthy attitudes and behaviors you set for your children
Model and advocate healthy coping skills
Do not expect perfectionism or place too high expectations on children
Discourage excessive behaviors in any activity
If coaches require too stringent rules or practices that you believe to be excessive and unhealthy, be prepared to withdraw your child from the sport
RESOURCES FOR PARENTS
Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T.) at www.feast-ed.org
Gurze Books, a publisher of eating disorder resources, at www.gurze.com