Your Comprehensive Guide to Understanding and Addressing Eating Disorders
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We reference children, but in effect there’s no age limit on who qualifies as a child. People in our community have “children” who are older adults in their 40’s and 50’s. Don’t be put off by the language, we have resources for parents of people of all ages.
Absolutely not! F.E.A.S.T. has resources for parents and caregivers at every stage of their journey. We would recommend starting here to learn more about our organization.
No, we don’t. Unfortunately, we don’t have the resources to offer phone support, but we do offer excellent email support via our parent support team. They can be reached 365 days a year at . The phone number on our website is for administrative purposes only; please do not leave messages there asking for phone support since we do not offer it.
It’s important to choose a provider who specializes in eating disorders and who uses evidence based treatment, meaning treatment that has evidence supporting that it works. The treatment with the highest efficacy among adolescents with anorexia is FBT (Family Based Treatment) where the refeeding is done by parents at home.
Ask about the goals of treatment. Immediate goals should include stopping dangerous behaviors, weight stabilization/ nutritional restoration through normalized eating, and medical stabilization (if needed). Eating disorder treatment is multidisciplinary in nature, and includes medical, psychological, and nutritional care. Psychiatric care can be added if there are comorbid psychiatric conditions, suicidality/self harm, or for the use of medications which can reduce anxiety and enable people with eating disorders to eat more freely.
Also ask about their treatment methods and philosophies. Make sure that you’re comfortable
with their approach and with how they will work with the family as a whole. Good treatment includes parents as part of the treatment team, educating and empowering them to support their loved one’s recovery.
Key points for parents:
Read more about treating eating disorders here.
Answer by By Sarah K. Ravin, Ph.D.
First and foremost, your child should get a thorough physical examination to ensure that they are medically stable for outpatient treatment. This can be done through your child’s primary care doctor or an urgent care facility. The physician should check your child’s vital signs and blood work and may order other tests if indicated. Individuals of any size who suffer from eating disorders can deteriorate rapidly and run into medical danger, particularly if there is marked food restriction or frequent purging. If heart rate or blood pressure are too low, or if electrolyte imbalances are present, the person may need to be hospitalized for medical stability before beginning residential or outpatient treatment.
Second, loved ones can help the person regulate and stabilize their eating patterns by sitting down to meals together each day. Most individuals with eating disorders should be eating three complete, balanced meals per day, plus two or three snacks, at regular intervals. It is often helpful to provide support and supervision after meals, when anxiety and guilt often arise and purging can occur. Families can provide this support and supervision by playing a board game, watching a TV show, or walking the dog after a meal. This distraction and support may help the person refrain from purging and may also help to ease the psychological distress they feel. If the person struggles with binge eating, it may be helpful to ensure that they are not left alone at home. Encourage them to talk to you when the impulse to binge eat arises so that you can provide support and distraction.
Finally,begin to educate yourself about eating disorders so that you can become an informed, empowered caregiver. FEAST has excellent information on this website. Sign up for the FEAST 30-Days program to become an empowered caregiver in a month.
This is a very complicated question, and the answer will depend on a number of factors, including how severe the eating disorder is and what the co-occurring condition is. For many, treating the eating disorder will result in improvement in co-occuring conditions like anxiety and depression, though the converse is not often true; treating depression and anxiety does not generally improve the eating disorder. If, however, your loved one struggles with both an eating disorder and suicidality, it will likely be helpful to consult with someone who understands both conditions to help you and your family prioritize how to treat these conditions simultaneously. It is our experience that focusing on one condition without addressing the other means you will be playing the proverbial “whack a mole”. A therapist who is skilled in Dialectical Behavior Therapy (DBT) as well as eating disorders should be able to help you think through the issues in a way that is going to help find the right treatment path.
The short answer is yes! It has been the collective experience of our parent community that people can recover without motivation. Resistance to treatment is normal. Having no motivation to recover is normal; it’s not indicative of an inability to recover.
Patients with anorexia nervosa often have a condition called “anosognosia”–they do not feel as if they are ill in any way; they experience their own behaviors and thoughts as normal, leaving them unmotivated to recover since they don’t believe that they are even sick. This is not a choice or conscious denial, but rather a feature of brain dysfunction that happens as the result of weight suppression. Proper nutrition and full weight restoration can repair this dysfunction and allow for recovery.
It is not uncommon for some young people with eating disorders to have very intense responses when asked to put their eating disorder aside.
Your previously calm, obedient child may scream, throw things, hit, and perhaps even run away when asked to do something as mundane as eat dinner! Although this type of behavior will likely be distressing or disturbing to you, our recommendation is to respond to it as calmly and without emotion as possible. Fighting “fire with fire” will usually end up with an explosion!. This can be very difficult to do, especially if you are somebody who has intense emotions yourself. You may want to learn skills from Dialectical Behavior Therapy (DBT) in order to learn to manage your own emotions so that you can care for your child.
Full recovery from an eating disorder is a complex and lengthy process that typically takes about 12 months, and often longer. There are three main components of recovery:
Answer by Sarah K. Ravin, Ph.D.
Physical recovery, which is the most urgent aspect of recovery to address, entails repairing the physiological damage that has been caused by food restriction, binge eating, purging, and compulsive exercise. A person who is physically recovered will have normal vital signs, normal blood work, healthy muscles and bones, regular menses (if female), healthy hormone levels, healthy digestion, normal metabolic function, and a healthy heart. A physically recovered person will also have restored their weight fully to their body’s unique set point. For children and teens, this typically entails returning to their historic percentiles for height and weight where they tracked before the eating disorder began.
Behavioral recovery involves maintaining a consistent pattern of full nutrition and eliminating eating disordered behaviors. In most cases, full nutrition involves three balanced meals and 2-3 snacks each day at regular intervals, consuming enough quantity and variety of food for good health and weight maintenance. Eating disordered behaviors that must be eliminated include calorie counting, binge eating, purging, fasting, excessive exercise, body checking, and food restriction.
Psychological recovery involves developing healthy thoughts and beliefs around food, weight, and body image, nurturing body acceptance, improving mood, reducing anxiety, engaging in meaningful relationships with family and friends, and establishing a healthy self identity without the eating disorder. A person who is psychologically recovered will be able to engage fully in school, college, work, and / or family relationships, have a vibrant social life, and participate in activities and hobbies that they enjoy.
Physical recovery and weight restoration must happen as soon as possible after diagnosis. Other elements of behavioral recovery, such as eliminating binge/purge symptoms, body checking, and compulsive exercise, often take 3-6 months or longer to tackle. Psychological recovery is typically the last element to achieve. Most people report that the eating disordered thoughts have disappeared, or are greatly reduced, within about 12 months after full weight restoration and behavioral recovery. Other individuals may experience eating disordered thoughts even while in a strong recovery and living a healthy lifestyle, but have developed the skills to maintain their physical and mental well-being even in the presence of these disturbing thoughts.
Answer by Sarah Archer, LMFT
Movement will inevitably be a part of your child’s life, whether through physical education classes, social activities with friends, family bike rides, or participation in recreational and competitive sports. Exercise can offer numerous benefits and can also serve as a significant motivational factor for recovery. However, returning to movement can also be stressful and confusing, posing a vulnerability factor in the recovery process. It may trigger the eating disorder directly, expose your child to environments focused on body image, exacerbate perfectionism, and lead to caloric deficits. Considering these pros and cons, it is essential to ask yourself the following questions:
Discuss these questions with your treatment team to identify your child’s specific pros and cons of returning to movement and sports, as well as their vulnerable areas.
F.E.A.S.T. has multiple support platforms which allow for parents to connect with one another:
Around the Dinner Table (ATDT) forum
F.E.A.S.T. ATDT Facebook Group
Men of FEAST (for dads and other male caregivers)
Learn more from Dr. Lauren Muhleim, one of our F.E.A.S.T. advisors. Read her article here.
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