In this story, we look at parent coaching for Christina, whose daughter Olivia has an eating disorder, which triggered a mental breakdown for Christina. Olivia was originally diagnosed with anorexia when she was 11 years old and underwent treatment. Christina thought the eating disorder was gone until she found out that Olivia, now 15, has bulimia.
Olivia refuses to go back to a treatment center, and Christina has no idea what to do. She can see evidence of Olivia’s binge/purge behavior, but Olivia refuses to talk about it at all.
Christina has long struggled with her own mental health. She’s suffered from anxiety and depression since she was young. The stress of knowing about her daughter’s active bulimia and not being able to do anything about it is deeply painful.
Last week Christina was hospitalized for exhaustion. Her mental breakdown was triggered by thoughts about Olivia’s eating disorder. She was stabilized and returned home, but still feels anxious and depressed about Olivia’s health. Christina knows that she needs to get it together if she has any hope of helping Olivia, but she doesn’t see a path forward right now.
Christina has had mental health issues her whole life. Her family was deeply dysfunctional, and her parents both abused alcohol. Christina did her best to manage. “I had an amazing high school counselor who really helped,” said Christina. “She gave me counseling and insisted that my parents send me to a psychiatrist, who prescribed anti-anxiety medication.”
After college, Christina began her career and met and married Mike. They had Olivia, and it seemed like everything was going really well. Then Mike had an affair, and Christina filed for divorce when Olivia was 10. “It was incredibly stressful, and I know it impacted Olivia,” said Christina. “I tried to shield her from the worst of it, but I admit that my behavior wasn’t the best during that time. My anger was huge, and I felt so helpless. I just didn’t know how to handle the betrayal Mike put me through.”
The start of the eating disorder
A year later, Olivia lost a dangerous amount of weight and was hospitalized. “I’ve had a lot of bad days, but finding Olivia passed out was definitely up there,” said Christina. “I had to call 911 and felt so much shame for allowing her to get to that point in the first place.”
Olivia entered a treatment center and slowly recovered her weight. She was angry with both her parents, especially Christina, whom she blamed for the divorce. “I don’t know why I was blamed – he’s the one who screwed around!” said Christina. “But I guess that’s just how she’s processing the divorce.
Olivia returned home, and Christina did her best to maintain a stable, healthy environment for her. But six months ago she realized that Olivia has been bingeing and purging, the symptoms of bulimia. She confronted Olivia, but Olivia shut down and refused to talk about it.
Christina had no idea what to do. When Olivia was released from treatment, they told Christina to look for signs of recurrence. But she didn’t feel prepared for a relapse.
Every day seemed to be getting worse. “I would go to work and it felt better than being at home,” said Christina. “And then I just felt more guilty for preferring work to being with Olivia. Mike has been absolutely no help. He has two toddlers with his new wife and has no time for us.” Christina felt her health declining, and had a feeling that the eating disorder might trigger a mental breakdown.
Sure enough, one day Christina couldn’t get out of bed. “I couldn’t even lift my hand to call in sick,” she said. “I just laid there, frozen in place. It was awful. My mind was going a million miles a minute, but my body was immobile.”
This time it was Olivia who had to call 911. Sobbing hysterically, she went in the ambulance to the hospital with Christina and stayed there as much as she could through Christina’s recovery.
“All I could think of is how this is just adding more trauma to Olivia’s life,” said Christina. “But I just don’t know how to cope. I don’t know what to do to make things better.”
Week 1: Turning shame into self-compassion
Christina felt she was as rock bottom. She had called a therapist, but there was a 5-week waiting list. Parent coaching was a way to bridge the gap and try to get her through the five weeks. She knew she couldn’t risk another mental breakdown while caring for Olivia’s eating disorder.
The first thing we focused on was shame. Christina was carrying so much shame that it was hard for her to even talk to Olivia. Shame is a deep and pervasive sense that we are bad people. When parents get stuck in shame, it’s hard to parent because we believe they will only make things worse by trying. This creates a negative spiral in which parent and child both suffer.
We did some exercises to address Christina’s shame. We started by talking about the difference between shame and guilt:
Shame: I am bad. >> This leads to thoughts like “I should just give up. I will just make everything worse. I’m incapable of fixing this.”
Guilt: I did something bad. >> This leads to thoughts like “I can fix this. I just need to think about how I can make things better. I’m capable of doing better in the future.”
I gave Christina some worksheets and asked her to practice actively recognizing and responding to her her shame thoughts with self-compassion every time they arose. She said that she entered more than 100 shame-based thoughts and the balancing self-compassionate thoughts in the week between our sessions. With time, this simple self-compassion practice will help Christina believe that she can make changes in her life and improve Olivia’s life.
Week 2: The hard conversation
Olivia and Christina have been gentle with each other since the hospitalization, largely avoiding each other. And they haven’t talked about what happened. Christina was too afraid of making things worse. After a week of self-compassion practice, we prepared some rough guidelines for the conversation that Christina needed to have with Olivia:
- Recognize how scary it must have been for Olivia.
- Let her talk openly about her fear and anger.
- Hold in your mind that no matter what Olivia says it’s coming from fear. She needs her mother to validate her fear and thank her for enduring a scary situation.
- Don’t interrupt her, shut her down, or defend against her thoughts.
- Tell her what you are doing to get better. Tell her that you’re working with a coach to get through the next few weeks until you can get into therapy. Reassure her that you are taking care of yourself, and it’s not her job to take care of you.
- Thank Olivia for her role in calling 911 and during your hospitalization. Tell her how much you appreciate what she did, and that you wish she hadn’t had to do that. Tell her that you hope she never has to do that again and you will do everything in your power to get better.
- Let Olivia know how sorry you are for the sadness in your lives. Ask her if she wants to talk about the divorce, her dad, or anything else that is weighing on her.
- Hug Olivia if she will let you. Pay attention to her cues, and try to provide physical comfort if possible. Even just holding her hand or even just touching her finger with your finger will make progress in your bonding.
It’s OK to get help for parenting
I gave Christina a copy of these guidelines. I let her know that it’s OK if Olivia knows that she’s getting help and has to write things down. The more that Christina feels grounded and safe, the greater her chance of connecting with Olivia.
I also asked Christina to do four days of 10-minute guided Loving Kindness meditation. Then, on the day of the conversation, do 20 minutes of Loving Kindness meditation before talking to Olivia. This would reduce Christina’s anxiety and increase her chances of connecting with Olivia.
She told me that the conversation was really hard. There was a lot of crying. But she felt as if she and Olivia connected in a way that they had never done before. “I think that being relaxed and confident, even when I was scared, really helped,” said Christina. “Olivia was all over the place with her emotions, but I stayed steady and I think she really appreciated that. And I feel like clearing the air about my mental breakdown will help us start to talk about the eating disorder.
Christina really wanted to start working on Olivia’s bulimia. Since she didn’t have a lot of experience with bulimia, I explained how it works and the common triggers for its development. For example:
- It’s not uncommon for someone to go through treatment for one type of eating disorder and then develop a different eating disorder or other maladaptive coping mechanism.
- Many people who have bulimia have a history of Adverse Childhood Experiences (ACEs). Divorce is one of the most common ACEs, and even peaceful divorces can impact highly sensitive children.
- Bulimia can be a form of self-soothing. While it may sound strange, the person using bulimia often finds it helpful in managing their anxiety.
- A cornerstone of recovery from bulimia is learning to manage anxiety. This involves developing a toolbox of anxiety responses that become more powerful and preferable to the bulimia.
While I recognized that Christina really wanted Olivia’s bulimia to stop right away, we agreed to focus on building their relationship for now. Olivia recently had a medical check-up and is physically healthy. So while we don’t want the bulimia to continue indefinitely, we want to try and inspire Olivia’s own motivation for recovery rather than forcing her into treatment.
Christina spent the week continuing her self-compassion practice and meditation practice. She found ways to connect with Olivia, and they had several deep conversations. Sometimes Olivia was angry, but Christina went back to the guidelines we created for the difficult conversations and they helped move the conversations forward.
Week 4: Should we tackle the bulimia?
While she was glad we addressed her mental breakdown, Christina felt like she needed to address the eating disorder.Christina was understandably scared that Olivia’s bulimia would get worse. She agreed to give it a few more weeks to get herself into therapy and feeling stronger. After that, with her therapist’s help, she could figure out how to get Olivia treatment for her bulimia.
I told Christina that parents who have anxiety can learn to help their kids who have anxiety. Since anxiety is contagious, it’s important for parents to learn to soothe their own emotional state before engaging with a child who is anxious. I reinforced the importance of self-compassion and meditation to help keep Christina grounded and stable. She had already noticed that her anxiety level was much lower since we began these practices.
What parents can say when a child is stressed
Since bulimia behaviors are frequently triggered by stress, I gave Christina a few phrases and statements to say to Olivia when she is stressed to try and begin the healing process:
- I can see how upset you are when you return from visiting your dad, and I’m sorry that you have to experience that. I’m here to talk if you would like to.
- School seems especially stressful for you right now. Would you like me to sit with you while you do your homework tonight? I won’t interfere, but maybe it would be nice to have company?
- It seems like you feel stressed after spending time with Dawn. Would you like to go for a walk with me to blow off some steam? We don’t have to talk about it at all, but it might make you feel better.
This approach will help Christina acknowledge and validate Olivia’s stress, which is the first step in helping a child who has an eating disorder. It’s important for Olivia to feel as if her mom doesn’t just want to take away her bulimia, but is interested in helping her cope with stress.
Christina and Olivia had a lot of work to do, both together an individually. But I was glad to participate in a short-term engagement to help them connect with each other and soothe both of their anxiety after the trauma of hospitalization. After a month of therapy, Christina checked in with me and told me that she had kept up the work we did together and that, combined with her own work in therapy, Olivia agreed to go to therapy.
Olivia and Christina are both in therapy to address their anxiety and trauma from a lifetime of unfortunate circumstances. With time and effort, they can both make a full recovery to a life free from anxiety and eating disorders.
If you have a child who has an eating disorder and need some help, please reach out for private coaching.
This story is inspired by true events, but the names, identifying details, and other aspects have been edited for the sake of sharing the story publicly.