My 16 year old daughter has made great progress in recovering from anorexia since the summer. She has gained weight, eats healthy amounts of food, and has stabilized. However, she is very rigid regarding what she eats. She has been seeing two treatment professionals. Until recently this was effective, but it is now causing conflict.
I feel she has hit a plateau, not medically in danger but unable to be flexible with food. For example she eats the same breakfast and lunch every day with a little variety at dinner. Eating out is stressful and she avoids it with friends by not going or goes but doesn’t eat. One professional favors challenging her to try new food gradually but after one attempt she has since refused. The other thinks the focus should be on why she is so controlling and not to push anything new.
I am concerned that these food preferences and eating behaviors, although not life threatening, may become more difficult to change the longer they go on. However if I push for change it causes arguing and no change anyway. What is the priority at this time and what do you think is the next step toward recovery?
Kara Fitzpatrick, PhD responds:
As a parent, you can clearly see the boundaries that anorexia nervosa has drawn for your daughter and the way it is keeping her from normal, healthy behaviors such as eating flexibly and socially and so should be concerned. And you are also right in recognizing that the longer we allow rigid patterns to remain in place, the harder they are to break. Typically such rigidity occurs when there are significant food fears and it may be that your daughter has learned to eat a limited number of foods that keep her “out of danger” but do not require her to eat foods that she may perceive as fattening. Although I say this somewhat tongue in cheek, I believe that normalized eating really occurs when we can go on vacation and find something to eat, no matter where we are, or go to a friend’s wedding with greater focus on the ceremony than on what is being served!
So how do you go about encouraging flexibility? First, encouraging flexibility does not mean just trying something once and deciding you do not like it. Remember when your child was a baby and you gave her different baby foods? She probably had some she liked the first time and others that you had to present a number of times before she would take them without struggle. It is the same at this phase of treatment, where you might find that you need to present more challenging foods several times. Remember that this will be a challenge, as you are asking your daughter to face significant food fears, but this also will help both you and her widen the range of healthy behaviors that support full recovery.
Kara Fitzpatrick, PhD
Dr. Fitzpatrick is a psychologist working with Eating Disorders at Stanford University/Lucile Packard Children's Hospital and serves as clinical advisor to Maudsley Parents. She is widely trained in a variety of models for treatment and performs research in applied clinical treatments for adolescents and neuropsychological factors associated with eating disorders.