We’re going to hear from a parent who has a son who is purging and wants it to stop. The dad is trying to stop the purge by monitoring bathroom time, but it’s not really working. So I’m going to talk about what I think he can do to help in this situation and also what he might start thinking about in terms of his response to the purge.
My son has been purging. To deal with this I go with him to the bathroom every time. Sometimes I go inside. Sometimes I just sit right outside the door with my ear up against the door to hear what’s going on. This seems to be sort of working, but of course, I can’t do it when he’s at school or at friends’ houses, which is often.
In fact, I’ve noticed he spends less and less time at home. Also, sometimes I find bags and tissues crumpled in his trash can, and it seems like he’s using them to purge into. What can I do to stop the purging short of being physically next to him all the time?
I can hear how hard you’ve been working to stop the purging, and I can imagine it’s taking tremendous effort on your part. Thank you for taking your son’s health so seriously and for trying to keep him healthy.
I often hear from parents in your situation, and my advice is a little nontraditional.
So I first want to assert that I hope your son is in treatment for his bulimia and that he’s getting medical and psychological care. What you’re describing to me really requires direct treatment of your son. This is not something you can treat alone, so I hope he’s in treatment and getting the support he needs.
If not, I think that should be your first goal is to get him into treatment. Meanwhile, let’s address how you can handle his purging at home.
Why people purge
First, I want to start with why people purge, and this is something that we don’t talk about enough. When we talk about bulimia, we focus so much on what is happening that we don’t really think about why it’s happening. When we want to stop purging, we have to understand the drive to purge.
While this may seem strange, purging is a coping behavior, which means it’s a way to self-soothe.
Now, of course, we would like our kids to learn other ways to self-soothe, but when they’re purging, we need to start with the understanding that this is why they’re doing it. Unless we get to the why, we’ll find ourselves in a situation of not being able to control the behavior because the fact is that we can’t keep our kids under 24/7 surveillance.
Control and surveillance, while sometimes necessary, will have limited power over stopping the urge to purge. To do that, we really need to dive deeper than the surface behavior and get to the root of the problem.
A need for comfort
Purging is a self-soothing behavior. That means he needs to be soothed, which means he’s feeling emotionally dysregulated. Your son’s need for comfort is natural and adaptive. There is nothing wrong with his need for comfort.
What we want to do is find ways to comfort him and give him the skills he needs to comfort himself without using purging. Unless we address the need for comfort, he will continue to seek his own form of comfort, which is purging.
When you stop or cut off his ability to soothe himself with purging, you’re cutting him off from comfort. And what you’re seeing is that the more you try to stop the purge, the more creative he gets, and the more he distances himself from you, the very person to whom he should be turning for comfort.
As parents, we’re biologically designed to comfort our children. It’s part of our DNA. But in our culture, many parents don’t know how and are actually discouraged from providing the emotional care our kids crave. And that’s particularly true with boys.
When I hear about a child purging, I want to know what emotional need is unmet? What is hidden? What needs to be expressed but cannot?
We are emotional social beings. Without emotional care, our kids suffer and struggle, and sometimes they turn to self-care practices that are destructive and unsustainable.
What’s the purge replacement?
So what I want you to consider is, what are you offering as a replacement for the comfort he gets from purging? What will help him stop the urge to engage in purging? Rather than focusing on the behavior of purging, I’d suggest you focus on meeting the emotional needs that are driving the purge.
I’d like you to focus on how you can soothe and comfort him emotionally. What I’m suggesting is that rather than trying to control the top-level behavior, the purging, you focus on the underlying cause of emotional dysregulation. When a child is purging, it’s a signal that he needs comfort.
So let’s learn how to comfort him.
The first step in soothing a child is tapping into your own emotional state.
Many of us go through our days not really paying attention to our emotions. This means we tend to react to situations rather than reflect on how they make us feel and then respond. Reacting without reflecting means that we often either over or under respond.
In any given situation, we often react in the wrong way, sabotaging our best efforts to improve our lives and those of our children. This is why we need to tune in to our emotional state to reflect and regulate so that we can respond appropriately to our kids when they need emotional support.
Regulating our kids’ emotions
When we do this, we help our kids regulate their emotional states. This is a process called co-regulation, and it’s something all humans have. Co-regulating with a parent is actually how humans learn to self-regulate themselves. We are not solitary beings, but social beings, and we constantly communicate with each other nonverbally through our nervous systems.
So start by learning about and understanding your own emotional states, responses, and needs.
Once you’ve learned to tune into and regulate your own emotional state, you’re better equipped to tune in to your son’s emotional state. This means instead of monitoring where he is in the house and whether he’s approaching the bathroom, you’re going to start monitoring how he’s feeling and whether he needs emotional support.
I know this sounds like a lot of work, but it’s actually less work and more empowering than trying to control bathroom time, which has limited effectiveness. What I recommend is that you start sensing your son’s emotional dysregulation, which precedes the urge to purge and respond with comfort.
Does this require vigilance? Yeah, quite a lot. But as I said, it’s no more challenging than monitoring his trips to the bathroom, and it could be much more effective in turning the tide on his eating disorder.
When you sense he is emotionally dysregulated, it’s time to offer your soothing presence.
How to soothe a child
This varies a little bit for everyone, but there are four basic components to soothing a child:
- Look at him with kind eyes
- Speak in a gentle voice
- Touch his arm or shoulder very lightly
- Say something that recognizes his emotional state like “it seems like you’re upset”
These four steps are fundamental to connecting with a distressed child and changing the path he’s on in seeking soothing through purging.
If this feels awkward or uncomfortable to you, I get it. It may feel totally out of your comfort zone, and if it does, then I’m going to guess you didn’t receive this sort of emotional care from your own parents.
I’m really sorry about that.
But luckily, it’s never too late to learn and grow. And even if we missed things in our own childhoods, we can still be the parents our kids need us to be.
An emotional disorder
An eating disorder, while it has dangerous behavioral symptoms, is an emotional disorder. This means that we simply have to address the emotional conditions.
Responding to a child’s distress with a calm, confident, and soothing demeanor requires vulnerability and practice. I say it takes vulnerability because many times when we’re learning to respond in this way, our child will reject any attempts to emotionally connect. That’s normal and should be expected.
A child who has an eating disorder is attempting to solve their emotional dysregulation all by themselves.
They are using their eating disorder behaviors to address their emotional state. It does not occur to them that there is another way to feel better. They believe they’ve got this under control by themselves. They do not know there is another option to feeling OK. So when a parent learns new emotional skills and starts practicing them, it’s often uncomfortable for both of you.
Most often the child will look at you strangely and pull away. They might even yell at you, tell you to go away. But that doesn’t mean you’re doing it wrong or that it’s not the right response. It just means you’re trying something new and it will take time for both of you to get used to it.
Relationships are a dance. We get into patterns with each other. We get used to each other’s steps. When one person changes the steps, it’s uncomfortable for both people. Learning new relational skills is always awkward. It takes time, practice, and dedication to come up with a new dance.
And what I believe is that this is the single most powerful thing you can do in response to your son’s eating disorder.
Learning to relate to him on a different level and practicing new emotional skills will make a difference in his disorder, in your relationship, and in his whole life.
This is our greatest opportunity and responsibility as parents.
Dan, I know this is not easy and I so appreciate all the effort and thought you’re putting into your son’s recovery.
I hope you will consider this approach and give it a try. I know you want to stop the purging, and I hope this will help.
Here’s a guide I have to help with emotional regulation. It might help to get a copy for some more support as you face this incredible challenge.
I wish you and your son all the best.
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