Help Your Teenager Beat an Eating Disorder

1. Act Now: Eating Disorders Are Life-Threatening Illnesses Requiring Immediate Intervention.

To be complacent in the face of a possible eating disorder is the greatest risk a parent can take in the battle to prevent such serious problems from developing.

Recognize urgency. Eating disorders like anorexia nervosa and bulimia nervosa are not transient teenage phases but extremely serious illnesses that can threaten your child's survival. Delaying intervention allows these insidious conditions to become more entrenched, making recovery significantly harder. The research shows that early treatment offers the best chance for full recovery.

Serious consequences. Anorexia nervosa, characterized by severe weight loss, leads to a host of medical complications, including:

• Lower body temperatures, decreased blood pressure, and heart rate.
• Rough, dry skin, hair loss, and loss of menstruation.
• Osteoporosis and decreased cardiac mass, risking cardiac failure and death (6-15% mortality rate, highest for any psychiatric disease).
  Bulimia nervosa, involving bingeing and purging, also carries severe risks:
• Potassium depletion (hypokalemia) leading to cardiac arrhythmias and death.
• Erosion of the esophagus and stomach, causing bleeding, ulcers, and dehydration.
• Intestinal problems from laxative abuse.

Identify warning signs. Parents must be vigilant for specific behaviors that signal a developing or established eating disorder. These range from subtle changes to overt actions.

• Warning Signs: Diet books, pro-anorexia websites, sudden vegetarianism, increased picky eating, frequent bathroom trips after meals, multiple showers, unexplained stomach flu, skipping meals, large amounts of food missing.
• Act-Now Signs: Regular fasting, refusing family meals, two skipped periods (girls) with weight loss, any bingeing/purging, diet pill/laxative discovery, excessive exercise with weight loss, persistent refusal of non-diet foods, extreme calorie counting, refusing to eat with friends.
  If these "Act-Now" signs are present, immediate medical and psychological evaluation by an expert is crucial.

2. Parents Are the Solution: You Are Key to Your Child's Recovery, Not the Cause.

We believe, in fact, that you are key to your teenager’s return to health.

Challenging misconceptions. Many traditional approaches to eating disorder treatment have historically excluded or even blamed parents, suggesting they are the source of the problem. This perspective is not only unproven by scientific evidence but also disempowering, leaving parents feeling guilty, hopeless, and sidelined when their child needs them most. Most parents of children with eating disorders have other children who do not develop the disorder, despite similar parenting.

Your unique role. Unlike other illnesses where parents are instinctively involved in care, eating disorders often create a confusing dynamic where the child's illness-driven desire for control makes parental intervention seem like "interference." However, parents possess unparalleled leverage: their unwavering love and commitment. This deep connection, combined with intimate knowledge of their child, makes them indispensable in the recovery process.

Reclaiming your role. The book advocates for a paradigm shift, viewing parents as the primary resource in their child's recovery. This means actively participating in treatment, understanding the illness, and providing consistent support. Your involvement is not about "making things worse" but about "plugging those tiny cracks" where the eating disorder slips into your child's life, ensuring vigilance and consistent care that no professional can provide 24/7.

3. Don't Get Stuck on "Why?": Focus on Eradicating the Illness, Not Its Origins.

Dwelling on what may have caused the problem often diverts parents’ energies from helping their child.

Complexity of causation. The exact causes of eating disorders remain largely unknown and are likely multifactorial, involving a complex interplay of biological, psychological, and social factors. Theories range from genetic predispositions and neurotransmitter imbalances to early childhood experiences, family dynamics, developmental challenges, and societal pressures (media, cultural ideals, wealth, trauma). No single factor has been definitively identified as the cause.

Avoid the blame trap. Focusing on "why" the eating disorder developed often leads to self-blame for parents, paralyzing them with guilt and diverting crucial energy from immediate action. This is counterproductive, as psychological treatments, like medical treatments for many physical illnesses (e.g., cancer, diabetes), often target symptoms and effects rather than definitive causes. The mental health field has historically made this mistake with other severe psychiatric disorders like schizophrenia and autism, wrongly blaming parents.

Prioritize immediate action. With your child starving or engaging in dangerous behaviors, time is of the essence. The longer an eating disorder persists, the more difficult it becomes to treat.

• Analogy: Trying to do therapy with someone inebriated is futile; you must first get them sober. Similarly, with eating disorders, the priority is to stop the harmful behaviors and restore physical health.
• Focus on "how": Concentrate on how to get your child eating normally and stop purging, rather than why they started. This practical, symptom-focused approach is more effective in the initial stages of recovery.
  By deferring the "why" question, parents can shed guilt, regain confidence, and actively engage in the urgent task of saving their child's life.

4. Understand the Enemy: Cognitive Distortions Drive Your Child's Eating Disorder.

The thinking of someone with an eating disorder is so firmly lodged in cognitive distortions that there is no way you are going to argue your child out of her eating disorder.

Distorted reality. Eating disorders profoundly alter a teenager's perception of food, body image, and self-worth. Your child sees the world through a lens of cognitive distortions, making their behaviors seem perfectly logical to them, even when they are self-destructive. This makes rational debate futile and often counterproductive. These distortions are often direct consequences of starvation.

Common cognitive distortions:

• Pride in self-starvation: Your child may feel immense pride in their ability to diet, exercise excessively, or resist food, viewing it as an achievement or a sign of superior willpower. They may see attempts to make them eat as cruel interference.
• Illusory control: Despite being "out of control" in their behaviors, your child perceives the eating disorder as their only means of maintaining control and expressing independence. They will vigorously resist attempts to intervene, often saying, "I can take care of this myself."
• Denial of danger: Your child may be flippant about severe medical complications (low heart rate, anemia, electrolyte imbalance), failing to appreciate the life-threatening nature of their illness. Anorexia is "ego-syntonic" (cherished), while bulimia, though "ego-dystonic" (shameful), still involves denial of seriousness.
• "Too much food": Even after consuming mere crumbs, a child with anorexia may genuinely feel "full" or believe they've eaten "tons" due to slowed gastric emptying and diminished hunger cues. For bulimia, "one more crumb" can trigger a binge fear.
• Body image distortion: Many with anorexia see a "fat person" in the mirror, even when emaciated. This "feeling fat" persists despite objective reality, driving further weight loss.
• Purging as coping: For bulimia, purging, though ineffective for weight control and shameful, provides immediate psychological relief, becoming a coping mechanism for various life stressors beyond just food.
• Obsessive checking: Constant weighing and body pinching are attempts to manage anxiety about weight gain, offering only momentary reassurance before the cycle repeats.

Separate illness from child. Recognizing these distortions is crucial for parents to remain compassionate and effective. Instead of interpreting refusal to eat as defiance, understand it as the illness speaking. The eating disorder is the enemy, not your child. This perspective helps you avoid counterproductive arguments and focus on interventions that address the illness directly.

5. Embrace Family-Based Treatment: Take Direct Charge of Normalizing Eating Behaviors.

The leverage you have as parents that no one else has is your love and commitment to your children.

Direct parental responsibility. In family-based treatment (like the Maudsley approach), parents are empowered to take direct responsibility for normalizing their child's eating patterns and weight at home. This approach views the family as the most powerful resource for recovery, not the cause of the illness. It's a practical, symptom-focused intervention, especially effective for adolescents with anorexia who have been ill for less than two years.

Fundamental principles for action:

• Expert guidance: Work with experienced professionals who can advise and support you in implementing the plan, helping you refine strategies and understand your child's distorted thinking.
• Clear expectations & consequences: Establish what, when, and how much your child will eat. Set clear, pre-determined consequences for non-compliance, viewing them as protections for your child's health rather than punishments.
  • Example: If a child refuses to eat, they might be restricted to their room for rest, or face hospitalization if medical parameters worsen.
• Availability & presence: Parents (and siblings) must be present for all meals and snacks, especially in the initial weeks. This may require significant adjustments to work and school schedules, but it sends a clear message about the priority of health.
• Structured eating: Implement a regular schedule of three meals and two to three snacks daily. This helps regulate the body's physical needs and reduces the urge to fast or binge.
• Expand food choices: Gradually reintroduce a variety of foods, including those previously deemed "forbidden" or "fattening." Challenge food rules (calorie counting, fat gram restriction) that reinforce disordered thinking.
• Limit excessive exercise: For underweight children, exercise should be prohibited. For others, reintroduce it gradually and in moderation, ensuring it's for health, not weight control or purging.
• Prevent bingeing & purging: Control access to trigger foods, monitor high-risk times (after school, late night), and understand your child's purging methods and locations to disrupt the cycle. Offer alternative coping strategies and distractions.

Persistence and patience. Recovery is a "sand hill" climb – constant effort is needed to avoid sliding back. Parents must be doggedly persistent, outlasting the eating disorder's grip. Celebrate small victories and remember that your love and authority are powerful tools in this battle.

6. Maintain a United Front: Parents Must Be Consistently Aligned Against the Illness.

You and your child’s other parent have to “be on the same page” regarding the urgency of the problem, when and how to pursue professional help, what to do at home...

The "divide and conquer" strategy. Eating disorders are adept at exploiting any cracks in parental unity. Disagreements between parents, even subtle ones, create loopholes that the illness can slip through, undermining treatment efforts. This means not just agreeing on the goal of recovery, but on the exact same way to achieve it, every minute of every day.

Common pitfalls and solutions:

• One parent unconvinced: If one parent doubts the need for action or treatment, the eating disorder will leverage this ambivalence.
  • Solution: Discuss concerns privately, present a united decision to the child, and keep the child out of health care decision-making.
• Parental denial: One parent's inability to accept the eating disorder diagnosis (e.g., preferring a medical explanation) feeds the child's own denial.
  • Solution: Focus on objective facts, seek therapist mediation to address denial, and ensure both parents accept the diagnosis.
• Blaming each other: Parents criticizing each other's efforts (e.g., "You're too strict," "You're not doing enough") in front of the child.
  • Solution: Agree on a unified approach in private, present a consistent message to the child, and avoid criticism during mealtimes.
• Softening blows: One parent constantly trying to "protect" the child from the other parent's firmness, leading to compromises that benefit the illness.
  • Solution: Both parents must reiterate the same instructions and expectations, supporting each other's stance against the illness.
• Anxiety about weight gain: As the child approaches a healthy weight, one parent may become anxious about "overfeeding" or "making them fat," undermining progress.
  • Solution: Reiterate agreed-upon healthy weight goals, seek therapist reassurance, and remind each other that the child needs to reach and maintain a healthy weight.
• Divorce/multiple caregivers: Disconnected caregivers (divorced parents, grandparents) create a "porous" system for the eating disorder to exploit.
  • Solution: Establish clear communication protocols (e.g., daily check-ins), designate a "point person," and ensure all involved adults are aligned on the treatment plan.
• One parent feels defeated: One parent takes on all the "bad cop" roles and becomes exhausted and resentful, while the other abdicates responsibility.
  • Solution: Even if one parent leads, the other must provide unwavering emotional and verbal support, especially in the child's presence, to prevent the illness from finding refuge in the absent parent's inaction.

United against the illness, not the child. Parents must consistently remind themselves that they are battling the eating disorder, not their child. The child's deceptive or resistant behaviors are symptoms of the illness, not willful malice. This perspective helps maintain compassion and prevents parental frustration from being misdirected, ensuring that the united front is a force for healing.

7. Navigate Treatment Options: Understand Research-Backed Therapies and Your Role.

Although anorexia was first recognized at least 130 years ago and bulimia almost 25 years ago, all of these studies were conducted within the last 2 decades.

Limited but growing evidence. While research on eating disorder treatments, especially for adolescents, is still relatively sparse, some approaches have demonstrated effectiveness. It's crucial for parents to understand these options and their supporting evidence to make informed decisions. Early and good treatment significantly improves outcomes.

Outpatient psychological treatments:

• Family-Based Treatment (Maudsley Approach): Strongest empirical support for adolescent anorexia, especially for those ill less than two years. Focuses on empowering parents to refeed the child and restore weight. Promising for bulimia in adolescents.
• Ego-Oriented Individual Therapy (EOIT): A psychodynamic approach for anorexia, focusing on maturational issues, emotional awareness, and fostering independence. Shows effectiveness, though slower than family therapy. Parents are involved in collateral sessions to support the adolescent's development.
• Cognitive-Behavioral Therapy (CBT): Treatment of choice for adult bulimia, likely beneficial for adolescents. Focuses on normalizing eating patterns, challenging distorted thoughts about shape/weight, and preventing relapse. Parents can assist with meal structure, limiting trigger foods, and monitoring.
• Interpersonal Psychotherapy (IPT): Effective for adult bulimia, also a reasonable option for adolescents. Focuses on resolving current interpersonal problems (grief, role disputes, role transitions) that contribute to the eating disorder. Parents are often included to facilitate negotiation and support transitions.
• Nutritional Counseling: While not sufficient as a standalone treatment, it can be a helpful adjunct to provide meal plans, caloric recommendations, and support for healthier food choices.

Psychiatric medications:

• Anorexia: Limited benefit, especially during acute malnutrition. Antidepressants (SSRIs) show inconclusive results for relapse prevention. Food remains the primary medicine. However, if comorbid depression or anxiety exists, medication for those conditions may be helpful.
• Bulimia: Antidepressants (SSRIs like Prozac) are effective in reducing bingeing and purging in adults, but less so than CBT alone. Combining CBT with medication is more effective than medication alone, but only modestly better than CBT alone. Long-term effects are uncertain.

Intensive treatments (inpatient, residential, day programs):

• Purpose: For severe cases requiring medical stabilization, rapid weight restoration, or when outpatient treatment has failed.
• Effectiveness: Specialist units are often successful at refeeding and weight restoration, but relapse rates post-discharge are high (40% readmission).
• Parental role: Even when not directly managing meals, parents must seize every opportunity to participate: parent education, observing staff, trying to feed their child, meeting with nutritionists, and attending support groups. Location matters for consistent involvement.
• Day treatment: A good alternative or step-down from inpatient care, allowing more parental involvement (e.g., overseeing evening snacks and weekend meals).

8. Stay Empowered: Work Collaboratively with Professionals and Advocate for Your Child.

You should feel confident in asking your child’s doctor why he or she has decided on medication to treat your child’s bulimia and why medication A as opposed to B was chosen.

Partnership, not passivity. While professionals are dedicated to your child's well-being, their treatment philosophy may not always align with active parental involvement. You must be prepared to advocate for your role, ensuring you remain informed and empowered throughout the process. Your goal is a collaborative alliance where everyone is on the same page.

Common dilemmas with professionals and how to address them:

• "Not an eating disorder": If a doctor dismisses your concerns, ask for their rationale, inquire about all tests performed, and reiterate your observations. If unsatisfied, seek a second opinion from an eating disorder specialist.
• Exclusion from treatment: If told to "stay out of it," politely but firmly ask for the rationale, inquire about symptom monitoring (weight, purging), and how you will be kept informed of progress. Refer to research supporting parental involvement.
• Disagreeing with advice: Don't hesitate to question recommendations (e.g., inpatient vs. outpatient, specific medications). Frame your disagreement as a request for clarification, allowing the professional to explain their reasoning. Trust your gut instinct if the rationale is unconvincing.
• Conflicting advice: If different professionals offer contradictory guidance, ask each to explain their reasoning, the evidence base, and whether their approach is standard. Encourage them to communicate directly with each other.
• Professionals not communicating: If multiple specialists are involved (pediatrician, psychiatrist, therapist), ensure they are sharing notes and aligning their plans. If you hear conflicting directives, point this out to the team leader and request clarification.
• "Too many cooks": If too many professionals are involved, ask the lead doctor for the rationale behind each's involvement, their specific goals, and timing to avoid overwhelming your child and family.
• "Nothing more can be done": Challenge any professional who gives up on your child. Most adolescents can recover with good treatment and perseverance. Be prepared to seek another team if necessary, but avoid constantly switching providers without giving a treatment a fair chance.
• "Pillar to post" referrals: If you're sent to multiple specialists or distant facilities, invest time in researching and choosing a team with true expertise in adolescent eating disorders. Ensure the chosen facility has a plan for parental involvement and post-discharge follow-up.

Your child's advocate. Your child's eating disorder will try to undermine treatment by convincing them (and you) that professionals are wrong or ineffective. It's your responsibility to gently but firmly remind your child that you, as parents, make health decisions, and that everyone is united against the illness. Your informed and persistent advocacy is vital for your child's recovery.

Last updated: December 31, 2025