Lots of parents who have kids with eating disorders ask me why they can’t talk about weight. This is because whether you’re mentioning it as praise or criticism, weight is a highly sensitive topic that parents should be really careful about. I’m going to tell you why that is and give you some ideas for what to do instead of talking about weight.
Our daughter was diagnosed with anorexia a few years ago. She’s been hospitalized multiple times, goes to the ER and urgent care regularly, and has been in inpatient treatment twice. She’s a young adult and is currently seeing a professional team for treatment. But it’s obviously not working. My family and I are all exhausted by all the drama, not to mention the expense.
We want her to realize what this is doing to us, and we’ve all tried different ways to tell her how dangerous this is in an attempt to get her help so she’ll get better. It’s not working. All of her treatment providers have told us not to talk about her weight with her, but that seems ridiculous. It’s obvious she’s underweight.
Why can’t we talk about it? Why must we avoid the obvious? It seems like we’re enabling the disorder by not talking about her weight.
Hi, Grace, I’m so sorry to hear about what you’ve been through. Eating disorders are so challenging, and it makes a lot of sense – for so many reasons – that you want her to recover.
So let’s dive in and try to understand why her providers want you to avoid confronting her about her weight right now. First, I can understand why you want to. While most eating disorders are invisible, this type of anorexia is painfully obvious to everyone.
You may be feeling things like fear, sadness, frustration, and shame when you see your daughter.
Also, you likely have extended family members, family friends, and even acquaintances asking you about her weight.
Since they can see that something’s wrong, they want to know what’s going on and you’re in the challenging position of having to educate them about something that is both upsetting to you and hard for other people to understand.
Most people will accidentally say things that upset you when they talk about the eating disorder. This is unfortunate but true.
Given all this, it makes sense that you want to talk about the most obvious problem you see her weight, but let’s take a minute to think about your goal here.
What’s the goal?
I think most likely your goal in talking to her about her weight is to positively influence her recovery.
So the first thing I want to tell you is that, of course, you can talk to her about her weight, but if your goal is to positively influence recovery, talking about her weight is not likely to help, and it could even backfire.
And that’s because when you bring up weight to her it triggers a stress response. Maybe you’ve seen this already.
The stress response
Think back on previous times that you have mentioned her weight to her and consider how she has responded.
She might have gotten defensive argued with you, fought back, told you you don’t understand. That you’re wrong. That’s the fight response that we know about from the fight or flight anxiety responses.
Or maybe she just left the room or walked away from you. That’s the flight response.
There’s a third type of anxiety response and that is freeze. In this one, you might have seen a panicked look on her face and she just didn’t say anything. She had a complete emotional shutdown and became unresponsive.
Or you may have a child who responds to anxiety with what is called the fawn response. In this case, she reassured you, empathetically, that she is working really hard and is getting better. She may lovingly say she knows how hard this is for you and is desperate to make you happy with fawning. She is trying to make you feel better and will say almost anything to soothe you.
None of these four anxiety responses will help your daughter recover from her eating disorder.
Impossible to hear
When you see these responses, you may be tempted to dig deeper, talk louder, or add more words to your argument, but it doesn’t work because when a person is in any of those four anxiety responses, they can’t process what you’re saying. They can barely hear it. They are in a state of acute stress.
Their only goal is to get out of the conversation intact.
Meaningful conversations happen when both people are emotionally regulated. That means they’re relaxed, engaged, curious, and open to discussion.
It is very unlikely that any conversation about weight will be meaningful while your daughter is in the midst of anorexia. Her treatment team is trained and experienced in working with this, but typically parents, family members, and friends quickly find themselves in hot water.
Talking about weight is unhelpful and even harmful because it adds stress to an already over-stressed nervous system.
Defending the disorder
Also, counterintuitively. It puts the person who has anorexia in the position of defending their weight, defending their anorexia.
That’s why it strengthens rather than weakens the disorder.
A dopamine hit
Another unintended consequence of commenting on a person’s low weight is that it can trigger a dopamine hit. Anorexia is characterized by the cognitive distortion that a very low weight is good.
So when you say she’s too thin or critically underweight the anorexia perks up, it feels a hit of pleasure and success.
While you think you are positively influencing her by sharing your fear about her health and pointing out that she is thin enough or too thin, you are accidentally strengthening the anorexia, which I know is not what you want to do.
Understanding the “why”
What I know from working with parents in your situation is that while everyone tells you not to mention weight, nobody has explained why this is so important.
As a result, you may feel as if her team is enabling the eating disorder, not good at their jobs, coddling her and shutting you down, locking you out, making you feel powerless and controlled by your child’s disorder.
You desperately want to help.
You want to change the course of the illness. I get it. So the reason I’ve been so direct here is that I find when I explain the why of this, most parents understand.
Not only are you not obligated to talk about weight to help turn the eating disorder around, but talking about weight can backfire and create the very conditions you’re trying to avoid.
As long as your child is being treated for her eating disorder, I would let the professionals focus on the weight and you can do other things. For lots of parents, it can feel as if not being able to talk about weight means standing by and doing nothing, therefore enabling the disorder.
I can assure you that there are lots of other options. Your child is an adult and she’s in treatment. You have said and done everything you can to try and change the course of the disorder.
I get that, and there’s something else I’d like to suggest now: instead of focusing on her weight or trying to figure out how to talk about weight with her, focus on building deeper, stronger emotional connections and relational safety with your daughter.
You can do this by learning about coregulation, which is when one person’s nervous system impacts another’s.
Parents are particularly influential when it comes to coregulation. Our emotional state influences our kids’ emotional state.
Your daughter with anorexia is likely living with very high levels of stress. You can help by supporting her to get into a calmer state through coregulation.
The more you do this, the deeper and safer your relationship will become. The safer she feels in your relationship, the better she will feel.
How to coregulate
So how do you do this? First, you focus on building your own skills of emotional regulation. Learn how to bring your nervous system into a regulated state.
I have a little cheat sheet that shows you how you can recognize which emotional state you are in and your child is in and also see what it means and what it looks like when you’re in a regulated emotional state.
Staying emotionally regulated when you’re with your kid will be hard. Probably when you see her or talk to her, your nervous system is immediately triggered and scared, irritated, or even angry with her.
You want her to get better so badly and she can feel the tug of your need, and this can be scary or overwhelming for her. Your feelings are valid, they make sense. But you can also learn to calm your nervous system and this will help both of you feel good when you’re together.
A child who has anorexia can push all their parents’ buttons quickly and effectively. So parents have to work hard to stay emotionally regulated.
I recommend working with a coach or therapist to learn skills of emotional regulation so you can get yourself into a calm regulated state when you’re with her.
A sense of calm and peace
When your nervous system is regulated when you’re with her, she will feel a sense of calm and peace. She will feel accepted and understood, and that is healing. Our kids need to feel accepted, seen, and safe with their parents.
Remember that she is an adult, she is in treatment, and you have tried everything else. Now it’s time to give this a try and see the power of co-regulation and action.
Look, I’m not saying you can cure your daughter all by yourself or with your own nervous system. I think you already know that we’re dealing with a complex disorder.
This is not all up to you, but you can be the calm in her storm.
Grace, I hope you’ll reach out for help and support and that you’ll give this a try. Thank you for everything you have done and will continue to do to support your daughter. It matters.
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