Leave Me Alone. Help Me Recover. How to participate in your teen’s eating disorder treatment.
Very few teens will say that they want their parents to participate in their eating disorder treatment. This makes sense—teen brains are wired to seek independence, treatment is just one more place where they wish to be without their parents. Always in the quest for data, we actually asked teenagers what they wanted; not surprisingly, the majority wanted their parents to stay at home. However, when we asked them after treatment for their thoughts on parent participation—the overwhelming majority said that while they may not have enjoyed it, they would not have recovered without their parents participating in treatment. So how can you participate in your child’s treatment?
Family Therapy. The gold-standard treatment for anorexia nervosa in children and adolescents is Family Based Therapy (FBT), also called Maudsley Method. There is also promising data that FBT may be efficacious for teens with bulimia and even for young adults with anorexia. In this type of therapy, parents and teens align against the eating disorder, using a medical model, empowering parents to restore their child to health.
If your child had cancer, you would have dozens of different chemotherapies to choose from—each with different doses, chemicals, and schedules. No single chemotherapy cocktail works for everyone. Most parents choose to start with the treatment that has worked for the most people. Then, if that does not work, they move on to the next most efficacious medication. Would you choose the medication that caused the least amount of pain, or the medication that saved the most lives?
Just like the popular cancer metaphor, while FBT is a good fit for many families, it may not work for 30-40% of patients. There are numerous other types of family therapy to try including Systemic Family Therapy, Emotion Focused Family Therapy, Dialectical Behavior Therapy (DBT) for Families, among others. Family therapy can be uncomfortable—that doesn’t mean it’s not working. Your child will likely protest you going—that doesn’t mean it’s not working. Commit to four sessions in four weeks before you re-evaluate.
Advocate & Ask Questions. No one will ever know your child as well as you do. Ask questions, listen to your gut, advocate for your child. You are your child’s best chance at recovery. Many children have individual therapists in addition to family therapists. Ask the therapist and/or the treatment center for the treatment goals. While it is wonderful when treatment feels good—what is most important is that it works. Track and monitor symptoms—if your child is weight restoring, are they gaining 1-2# per week. If not—ask why. If your child is working to stop binging, purging, and/or self-harming—are the number of weekly episodes decreasing? If not—ask why.
If your child had epilepsy, and they loved their physician and going to appointments, but they continued to have the same number of seizures each week—would you consider treatment a success?
Ditch Your Guilt. Chances are, as a human, you are imperfect—which means you are also an imperfect parent. We all are imperfect. Parenting does not cause eating disorders. Talk to your family, friends, therapist, clergy member—whatever you need to do to move past the guilt. Guilt makes people feel stuck—treatment is active and you need to help your child move away from their eating disorder.
Family Skills Groups. If you think that family therapy sounds fun, get excited for (multi) family skills groups! Your child is learning new skills: how to eat when they don’t want to, how to socialize when they want to stay in bed all day, how to cope with feeling sad or anxious without turning to binging or purging, how to prioritize their health above societal ideals of beauty. Go to skills groups with your child so that you can learn the same skills, speak the same therapy jargon, and most importantly—model using these skills in front of your children. Every day, we experience the same, uncomfortable, human emotions that our children do: worry, sadness, guilt, shame, frustration, overwhelm. Your children have been using eating disorder behaviors to cope with these emotions—now they are learning new coping skills. You can use these same skills when you feel these same emotions.
If your child had a learning disorder, and went to a specialist to learn new skills for reading, solving math problems, or holding a pencil—would you observe the sessions so that you would know how to help with homework?
Parent Skills Groups. Parents do not cause eating disorders, and parents may be doing things that accidentally reinforce ED behaviors or negate recovery efforts. All parents inadvertently reinforce behaviors in our children that we do not want. We’ve all been there—I’ll go first. If my 3-year-old whines enough, I will let him watch videos on my phone (to make the whining stop). In short, he’s learned that whining is rewarded with getting my phone?! These accidental pairings (negative behavior = reward; positive behavior = ignored) happen to all parents—and the good news is that they are not permanent, you can change course! An ED parent skills group can help you examine your habits and make sure you are reinforcing what you want more of and ignoring/punishing the behaviors you want to decrease.
If your child had diabetes, but hated blood draws and insulin injections—would you let them skip them? Or would you learn new skills to make sure you could get them to follow through with their treatment plan?
Mentor Groups. Find a parent mentor who has gone through treatment with their child—and then lean on them. Our center offers every parent a mentor for phone support and has weekly mentor groups. If you do not have access to these in-person, use online parent communities to receive mentorship, ask questions, and get support.
Education. Eating disorders affect 1% of the population—there is no reason for the average parent to be an expert in eating disorders. But here you are—so it’s time to learn. The most important thing to know: you didn’t cause this, eating disorders are neuro-biologically based illnesses, prioritize weight restoration and symptom reduction, and you can help your child recover and lead a full, happy, healthy life.
About the Author: Dr. Erin Parks is a clinical psychologist and the Director of Outreach and Admissions for the UC San Diego Eating Disorders Center for Treatment & Research. She is passionate about educating clinicians, parents, and the community about the neurobiological basis of eating disorders and the evidence-based treatments that are now available. Dr. Parks wants to help society view mental illness as brain illness–narrowing the funding and resource gap between physical and mental disorders.