Today I’m going to address the question of how parents can help a child recover from an eating disorder. I’ll talk about the most important thing that I think parents can do that nobody ever talks about.
My 12-year-old daughter went to a treatment facility for orthorexia six months ago. When she came back, I did everything I could to get back to normal. But after just a few months at home, she had to go back to the facility. It was devastating to me and I felt like a failure. Now she’s home again and I can see the same pattern on repeat.
I really just don’t know what I’m supposed to do. I know that I need to keep her in therapy, but we did that before and yet she’s back in treatment. I’m desperate.
Who can help her? Why, after all this treatment, time, and expense, isn’t she better yet?
Oh, Helen, I can hear how hard this is. And I know how devastating it feels to desperately try to get help for your child and to feel so hopeless. Every parent wants to help their child recover from an eating disorder, but it’s hard to know how.
Eating disorder treatment is costly and it varies greatly. And many people are readmitted to programs after returning home. And I wish there were a single treatment that has guaranteed results for everyone. I really do.
But I do have some information for you that is not generally common knowledge that I think will help you and it’s that parents can have a significant impact on recovery. In fact, there is a lot you can do.
Whose recovery is this?
Let me just start by saying that, of course, your child needs therapy, both psychological and nutritional. She may need psychiatric care and medication and medical supervision to support recovery for the foreseeable future.
And, of course, it’s important to achieve a minimum level of nutrition without basic nutritional needs being met. It’s very hard to recover.
You know this, I’m sure. But it’s important for me to say this before I start talking about parental behavior change, because sometimes parents think that when I talk about what they can do to help that I don’t think the child is responsible for their own recovery.
That’s a common misunderstanding. So I’ll say it again. It’s your child’s disorder. Your child needs treatment … as much as she will accept. And she needs to eat … as much as she will accept.
And here’s my ad-on: Parents can do their own work while their child works to recover from an eating disorder, and it will help.
Work smarter, not harder
Now, I know that you have already been working your butt off trying to help your kid. I completely understand that. And you’re probably already exhausted and frustrated to hear me suggest that you could do something more than you’re already doing.
But the truth is that many parents are working really hard, but they’re focusing on the wrong things. And what I’d like to help you do is work smarter, not harder.
Eating disorders, like most mental illnesses, are heavily influenced by social systems. This means that while the eating disorder is hers, it’s also something that developed in part in response to your family system.
And unless you work on the family system, it will be very hard for her to return from treatment and hold on to her recovery.
The family system
You’ve already seen this, so you know it’s true. So what can you do instead?
First, I think it’s important to think in terms of the family system rather than a single troubled individual. Most of our mental healthcare models are based on the idea that the person who is sick needs to get the treatment.
But this misses the systemic nature of mental illnesses, including eating disorders. Eating disorders are something that both come from the inside and they are often in response to things that are happening on the outside.
It’s both of these things.
So maybe your daughter has an inborn tendency towards perfectionism and anxiety. Maybe she has a highly sensitive temperament, which makes her more susceptible to an eating disorder.
But that tendency doesn’t guarantee an eating disorder will arise. In fact, someone who has a highly sensitive temperament may develop an eating disorder or they may not.
Some new skills
So the way I work to turn the tide of an eating disorder is by training the parents and some new skills. Because parents are in charge of how the family system operates. And when they take their rightful role as the leaders of their family system, great things can happen.
The most critical skill that I focus on is emotional regulation. Most of us parents were raised to tough it out and focus on the positive.
As a result, we have low emotional literacy and few skills for regulating emotions. Our own or our children’s.
And when our kids have an eating disorder, emotional regulation is a skill we urgently need to learn so we can teach it to our children and also respond to them more appropriately and more effectively.
When parents learn to process their own emotions and learn to help their child emotionally regulate, which involves the ability to recognize, label and process feelings, they can really support their child’s recovery.
Nobody told us about this
This is the job they never told us about when they lectured us about breastfeeding and potty training, the best stroller, the best crib, the best preschool, getting good grades, playing piano, and getting on the basketball team. All those things that we thought were what we really had to do as parents. Sure, they may be important.
But what they never told us about was the importance of teaching our kids emotional regulation and being regulated ourselves so that we can co-regulate with our children’s nervous systems while they’re developing under our care.
Most likely nobody ever told you that you needed to do that. Me either! But I’m telling you now, because I had to learn, and now I teach parents to do this and help their kids do it, too.
Of course, the food and eating and weight are all a big deal. They are symptoms of an eating disorder and they need to be treated. But the reason the symptoms exist, the cause of most eating disorders, which are mental disorders, often comes down to poor emotional regulation.
The power of emotional regulation
Most people who have eating disorders are not great at emotional regulation, and this is what therapy is designed to do. It’s supposed to give them emotional regulation skills.
Emotional regulation can be taught, and your child’s therapist will be working on this.
But you can make a big difference if you learn how to teach and practice emotional regulation at home, mainly because you’re the one who’s around way more often. You just have more of an opportunity.
But also, as mammals, our children’s nervous systems are actually tied to us, their parents. A key function of parenting is using our own nervous systems to help our kids’ nervous systems to calm down, feel safe and return to homeostasis.
We can only do this for our kids when we are emotionally regulated.
Think back to when she was a baby and she cried and you calmly picked her up and she calmed right down. That’s the beauty and the power of parental regulation. It’s the wonder of our nervous system’s ability to influence our child’s nervous system.
That was one of our first ways of teaching our child emotional regulation. But a lot of times as they grow up, we do it a lot less often.
An eating disorder is a way a person has learned to cope with emotional dysregulation. It can be a way to calm down, feel safe, and return to homeostasis. But we don’t want our kids to rely on an eating disorder for emotional regulation. We want them to learn to emotionally regulate without using the eating disorder.
And often the fastest path to learning emotional regulation without an eating disorder is having a parent who can teach and model emotional regulation and even co-regulate with the child while they learn the skill for themselves. This is an important way that parents can help a child recover from an eating disorder.
You can hear an example of what this looks like if you read my article about getting through a panic attack and pretty much all of my articles address emotional regulation in some way.
And to me, this is the difference-maker. And we know it’s valid based on the science of interpersonal neurobiology that’s come out in the last two decades.
From my experience and from the data, we know that when parents learn emotional regulation skills, kids feel better. And when parents teach emotional regulation skills to their kids, kids learn faster how to do it for themselves.
You can help!
So my answer to your question of can anybody help is twofold. First, you can help. And second, you probably need to learn some new skills to be helpful.
So as your child’s getting help, you may need help, too. There are evidence-based ways that parents can teach and support emotional regulation and help kids who are dysregulated and struggling.
But these methods are not natural for most of us. They often feel counterintuitive because few of us were raised by parents who knew and practiced them.
But they work. They have significant science behind them and they can be learned at any age.
How to get help
A coach, a therapist or even a book can help you learn these skills and start using them with your daughter. I think this will really help when she returns from her treatment center because while I understand that you want things to get back to normal, we actually need things to be a little different.
A book I recommend is: The Power of Showing Up: How Parental Presence Shapes Who Our Kids Become and How Their Brains Get Wired, by Daniel J. Siegel and Tina Payne Bryson
Something I see in my work a lot is that when parents learn emotional regulation skills, their kids usually feel better, safer, and more secure. And while recovery may still be rocky because that’s the path they’re on, we can be by their side on the journey rather than feeling as if we’re on the sidelines, helpless, hopeless, and often frustrated.
Helen, I know how scary eating disorders are, and I know how very hard you have already been working to help your daughter recover.
And I hope that my advice, which is that it would probably help to learn some emotional regulation skills to support her recovery, is helpful. I wish you all the best on this challenging journey.
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