How long does recovery take?
If only we could answer this! We like to reframe this question with “What do I have to do for myself so that I can endure however long this takes”. It can be a very stressful and anxiety filled time caring for a loved one with an eating disorder so it is important to stay resilient.
Won’t this increased supervision and boundaries hurt my relationship with my teen?
Any intense medical intervention will leave some sort of impact on a family. There is no evidence that relationships are harmed through family treatment. However there is evidence that leaving an eating disorder untreated does more harm to the relationship as the young person resents that no-one stepped off the curb to help them. Don’t expect a return to your easy relationship until your young person is some distance from their illness.
Our young person is already sad and depressed. Won’t taking away their activities make them worse?
First and foremost activity/exercise must be stopped if it is likely to cause more harm. (e.g. heart is unstable). Secondly, yes, it may make them feel more unhappy but try to reframe with your young person that it is the ED taking these things away from them, not you as parents. And that leaving their ED behind is what will give them their life back.
Shouldn’t they show some responsibility for recovery?
There would be no need for eating disorder treatment if putting young people in control actually worked! Evidence shows that at a young age (under 18) insight is not required for recovery and that most young people are incapable of ‘owning’ their recovery until they are through all the stages of Maudsley/FBT. Easing up on supervision and boundaries too early leaves your young person prone to being chronically ill. Oversight will be needed for a long time as you very slowly and systematically hand back control. They may be weight restored but your work is not done yet!
How do I know what is ED behavior and what is normal teen behavior?
Any odd behaviours or heightened anxiety around food or exercise will most likely be the ED in charge. Behaviours and push back around things like phone usage, curfews, outings with friends etc is most likely normal teen stuff!
What do I say to “you will only make me fat”, “my tummy hurts”, “I am not hungry”
Nothing! “Mmm” is an acceptable answer. Try to resist the urge to reason. Their malnourished brains are no longer logical. Have a few mantras that you say and just rinse and repeat them! Examples: “ I know this is hard it’s time to eat” “ I know you are scared and I know you can do this” “I know you are scared. I’m eating icecream with you. This is exactly what you need”.
Remember – there is nothing that you can say that will completely reassure them in that moment.
Is it okay as long as they eat something? Isn’t that better than nothing?
Not challenging the eating disorder and allowing it to stay in the drivers seat leaves the young person in the illness for longer. Remember at the early stages of feeding your young person will have the same anxiety over a grape or a biscuit.
Regular eating of 3 meals and 3 snacks with no more than 3 hours in between (3+3+3) is recommended to “kick start” metabolism and not allow ED thoughts of restriction to creep in. Regularity can also aid in those prone to binge eating after a period of restrictive eating.
What happens if my child goes the other way and becomes overweight?
When we think like this it makes us co-conspirators with the ED! Reading about Set Point Theory may help our thinking around this.
It is important for ED to learn that nothing bad happens when pushed “above” it’s ideal number.
Is it important to challenge behaviours?
Some of these behaviours might be things like eating with tiny utensils or from small bowls, standing whenever possible, cutting food up into small pieces, excessive use of condiments such as pepper or chilli flakes. Whilst in isolation it may seem these things are unimportant in the scheme of an eating disorder in the house, our stance is that these behaviours should be interrupted as soon as possible.
The behaviours are just another rule the ED has imposed and our young person feels compelled to obey. Allowing the behaviours keeps your young person further imprisoned by ED’s rules and rigidity. Be aware that when interrupting behaviours try where possible to provide a positive distraction to ease anxiety such as stress balls, figit toys, silly putty etc.