I think my child has an eating disorder. What can I do?
First, pay attention to your intuition. You know your child best. If you think s/he has a problem, you’re probably right.
Next, act quickly. Early intervention is strongly linked to recovery. Taking a "wait and see" attitude, or hoping that your child will "grow out of" an eating disorder typically delays treatment and allows your child to become sicker. We encourage you to schedule an appointment with your child’s pediatrician as soon as possible.
Before you go, we recommend reading Help Your Teenager Beat an Eating Disorder, by James Lock and Daniel Le Grange, which gives a thorough overview of eating disorders and the most current and comprehensive thoughts on treatment, including the Maudsley approach. We also suggest you read the "Background Information on Eating Disorders" in the Learn More section on this website.
These resources will give you plenty of solid information no matter what treatment approach you decide to pursue. We invite you to explore this website. Reading about other families who have helped their children recover from an eating disorder will help you understand that eating disorders don’t have to be chronic or long -term. There’s every reason to hope for your child’s full recovery—with your help.
I want to do Family-Based Treatment (the Maudsley approach) but my doctor/therapist has never heard of it (or disagrees with the approach).
We strongly believe that parents should be aware that they have a choice regarding eating disorder treatment. As with any kind of serious illness—and anorexia nervosa is a very serious illness, with the highest mortality rate of any psychiatric disease—it’s critical that you find out as much as you can about the illness, available treatments, and outcomes. As with any health-care decision, you are the consumer and deserve to work with a professional team that will support you and your family and help you make informed choices.
Some eating disorders therapists and medical professionals—especially those with a more old-fashioned approach to the disease—believe that family dysfunction or "controlling" parents are part of the etiology of eating disorders. This may make parents feel they shouldn’t be involved in choosing treatment or actively participating in helping their child recover. Family-Based Treatment is based on a very different perspective, viewing families as vital resources in the battle against an eating disorder. We encourage you to set aside the impulse to blame—whether that blame comes from a professional or is self-blame—and instead concentrate on solutions that work for your child and family.
If you feel FBT is the right treatment for your son or daughter you have the right to be supported by your health care team. Conventional therapies may not support a model that encourages parent involvement and an early emphasis on restorative nutrition. Remember, you’re in the driver’s seat. If you feel you’re not getting the help your child needs, keep looking. You’re under no obligation to settle for treatment that doesn’t feel right, doesn’t support your family’s priorities, and/or doesn’t help your child’s recovery.
This site’s treatment section and "Working with a Non-Maudsley Team" article are two starting points for finding the kind of professional help that supports you and your family.
How can I make my child understand so she wants to get better? What can she read? What can I say?
We wish there were "magic words" that would inspire your child to eat. If teens with anorexia were motivated to recover on their own, recovery would be much simpler. Most families find that they can make progress once they set aside concerns about "motivation" and concentrate on weight restoration, while offering lots of emotional support.
The idea that kids have to "choose" recovery, or it somehow doesn’t count, has been part of the conventional wisdom in eating disorders treatment for a long time. Unfortunately most teens can’t "want to get better" while they’re in the grip of an eating disorder. Plenty of parents have found that once their child was weight-restored, psychological recovery followed. Think about it: The brain is part of the physical body. When it’s malnourished, it doesn’t work right. When it’s well-nourished over a period of time, rational thinking resumes. For some kids the change happens fast; for others, weeks or months of full nutrition must pass before cognitive and emotional responses improve. But it does happen.
The end goal of Maudsley treatment is for kids to eat healthfully and happily on their own. Once a sufferer is physically well and able to maintain a healthy weight, treatment shifts to Phase Two, returning control over eating to the recovering teen. Typically at this point the sufferer is able to handle responsibility for eating.
What about nutrition?
Malnutrition has devastating psychological as well as physical effects. Learning about the impact of starvation on the mind may help parents understand why restorative nutrition is crucial for complete mental and physical recovery. The Minnesota Semi-Starvation Study offers insight into the ways in which inadequate food intake influences mental as well as physical health. Many of the psychological symptoms commonly seen in anorexia nervosa, including depression, anxiety, social isolation and obsessionality, are the result of malnutrition. Read more about it here.
In the earliest phase of Maudsley treatment, parents work together to make sure their child regains weight to a healthy level. Once weight restoration is accomplished, a recovering child is better able to return to healthful independent eating and get on with his or her normal teenage life. Good nutrition over the long term will help reverse both the physical and the psychological effects of starvation. Our collection of high-calorie recipes and feeding suggestions can be found here.
What should I feed my recovering child?
Anorexia can throw even the most confident parents off track, causing them to question themselves and second-guess their decisions, especially when it comes to feeding their child during the weight restoration phase of treatment. But most parents make good decisions about what and how much to feed their recovering child. After all, they’ve successfully managed the feeding process for years before anorexia, and probably still manage to feed their other children well. Have confidence in yourself.
Healthy teenagers require a diet with a balance of fats, protein and carbohydrate—and lots of calories. Teens in recovery from anorexia nervosa need the same sort of diet and even MORE calories. The amount of food a recovering child needs to eat in order to reverse malnutrition can be surprisingly large, as shown here. Our collection of high-calorie recipes and parent-to-parent tips can be found here.
Why is re-feeding making things worse?
Parents naturally want to see their child happy and free from anxiety. Unfortunately, eating during anorexia recovery will cause tremendous anxiety. It's common for mindset to temporary worsen once re-feeding is underway. Be persistent and consistent. Many parents back off when they see how much anxiety re-feeding can cause. Continuing to insist on full nutrition in a compassionate and loving way will see your child through—if you don’t give up. Standing firm against eating-disordered behaviors while offering healthy support is the key to turning the situation around.
How can parents work together to help?
In Maudsley therapy, the parents are a major asset in supporting recovery. The key to success is for all the adults in a recovering child’s life to deliver consistent messages, follow the same rules, and communicate fully.
Often parents come to the recovery process with different senses of timing, urgency, and natural response to crisis. They must work together to get on the same page and explore any disagreements away from the recovering child. This may entail working through, or putting aside, any former disagreements on discipline, lifestyle, and past events, all of which can and will be exploited by the illness to cause dissent.
But take heart: You don’t have to be "the perfect couple" to succeed at Maudsley. All kinds of families--including single parent families--have been able to make the approach work. Some parents have found the following helpful:
Present a united front.
Troubleshoot and plan privately, not in front of the child.
Use each adult’s strengths: one parent may be better at supervising mealtimes, another at cooking. One parent may be good at research, the other at communicating with clinicians.
Prioritize your own relationship by taking time to talk and concentrate on each other.
Remember that a threat to the family is also an opportunity to demonstrate love and commitment.
Keep siblings’ needs in mind in all decisions. Read an article about the effects of eating disorders on the rest of the family here.
What about medication?
We recommend that parents develop a strong partnership with their child’s prescribing physician. Good communication is important. If medication is being considered, your child’s doctor should take a careful personal and family history, explain options, and answer any questions you have. Parents need to be informed advocates for their children. Research on medication may give you a jumping-off point for discussions with your doctor. For an overview of pharmacologic treatment of anorexia nervosa, see here (Click on Wiley Interscience link for free full text article.) For a review of medication use for children and adolescents with eating disorders, see here.
Since responses and reactions to medications vary among individuals, careful observation is important. Parents may find it helpful to keep a dated written record with all medications, dosages, and reactions. This can help in sorting out a complicated situation later on. Parents should also remember to note any ED behaviors—restricting, eating on an irregular schedule, purging, water loading, and dehydration—that may have an effect on an anorexic’s mental state (and perhaps on the absorption of medication).
One common medication question is whether oral contraceptives should be prescribed for amenorrhea (absence of menstrual periods) to treat the side effect of bone loss. While this practice used to be common, recent research shows that oral contraceptives are not helpful for increasing bone mineral density in anorexic girls(1). Normal hormonal function typically returns with the restoration of healthy body weight. Oral contraceptives make it impossible to tell whether a girl is menstruating normally, an important measure of health. Parents should be sure to ask their daughter’s doctor about current research if oral contraceptives are being considered or prescribed.
(1) G. Strokosch, A. Friedman, S. Wu, M. Kamin. 2006. Effects of an Oral Contraceptive (Norgestimate/Ethinyl Estradiol) on Bone Mineral Density in Adolescent Females with Anorexia Nervosa: A Double-Blind, Placebo-Controlled. Journal of Adolescent Health, Volume 39, Issue 6, Pages 819-827
These responses to Frequently Asked Questions are not meant as a substitute for medical or therapeutic advice; rather they offer a parent perspective on eating disorder treatment.