My daughter is 12 and has anorexia. Using the Maudsley FBT approach, she is starting to gain back weight. She is very anxious about the weight gain and is complaining of feeling fat, not fitting into clothes, etc. Is there advice on how to address her anxiety as she gains weight? My fear is that she will regress into some of the disturbing negative behaviors she exhibited when we first began re-feeding.
Katharine Loeb, PhD responds:
First, congratulations on accomplishing some weight restoration as a family. Your questions are excellent – how can you manage your daughter’s corresponding anxiety about her weight and shape as you persist in your refeeding efforts? And more importantly, will heightening her anxiety inadvertently set your progress back by increasing resistance? I will address these in reverse. While it may seem that you are making the situation worse by potentiating her shape and weight concerns, you are not. As a field, we have not been able to successfully convince patients with anorexia nervosa to eat by working on body image first; conversely, food is medicine, and weight gain to a point of the body returning to normal functioning (physiologically, and especially hormonally) provides the best chance for the cognitive distress to lessen. While there are no good research data to support this, my clinical experience is that the time from weight restoration to this psychological relief is positively correlated with duration of illness. If you use your daughter’s anxiety to guide your efforts at nutritional rehabilitation, she is unlikely to gain weight and be able to put this pernicious illness behind her. In response to your first question, the best way to respond to her anxiety is with empathy and an emphasis on the distinction between the anorexia nervosa and herself. For example, you might say, “I’m sorry that the illness is torturing you like this, making you feel bad about my helping you become healthy again. Telling you you’re fat is one of anorexia nervosa’s tricks to try to get you to stop eating again, but I am here to make sure it doesn’t win. Soon you will not feel like this anymore.”
Katharine Loeb, PhD
Dr. Loeb is Associate Professor of Psychology at Fairleigh Dickinson University, Director of Research at the Eating and Weight Disorders Program at Mount Sinai School of Medicine, and serves as Clinical Advisor to Maudsley Parents.