Eating disorder resources for families & friends

Every parent is concerned about their child’s well-being, and an eating disorder like anorexia nervosa is no exception to the rule. Despite an ongoing misconception that eating disorders are somewhat benign illnesses, they can dramatically affect an adolescent’s life for the worse and often last for years. In some cases, they can even be fatal; anorexia nervosa has the highest mortality rate of any psychiatric illness according to many studies. Anorexia nervosa treatment comes in a variety of forms, ranging from weekly outpatient (such as PHP or IOP) sessions to day treatment on a regular schedule, and for the most intense cases, residential anorexia nervosa treatment.

With a mental health disorder with as many risk factors as anorexia nervosa, the margin of error for successful treatment is very small – and that’s why parents need to know what type of treatment is necessary. Better outcomes are often the result of early intervention, so getting started early is essential. Just as importantly, the adolescent who gets the treatment also needs to know what to expect when they go in for residential, the most intensive form of treatment.

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Day Treatment vs. Residential Treatment for Adolescents

The simplest way to determine if an adolescent needs residential anorexia nervosa treatment is to assess the physical and emotional risks they carry. A doctor and psychiatrist should be consulted for an official diagnosis. There are also various, less formal checklists and questionnaires that may be able to give parents a head start. If a parent is concerned about their child’s eating habits, they should talk to their child before making any moves – it’s usually not best to suddenly spring intense psychiatric treatment on anyone.

In the early stages, the signs of anorexia nervosa in teenagers are often subtle – dieting, excessive exercise, and some weight loss may not seem incredibly harmful, but when they progress, they can endanger their health. People with anorexia nervosa often obsessively count calories and are preoccupied with attaining a “perfect” body. Eating disorders often cooccur with other mental health symptoms; parents should be aware of potential triggers like depression, anxiety disorders, and especially PTSD. When the disordered behaviors surrounding the disease are endangering the teen’s life, parents should seek out a residential program.

How to Talk about Anorexia Nervosa with Your Teen

The number one point to remember when speaking to a teenager (or anybody) about a sensitive subject like this is to always remain judgment-free. The idea that a mental health disorder is somehow “bad” or shameful can wreak havoc on an adolescent’s mental state; it can even worsen the condition by triggering negative emotions that lead to disordered coping behaviors. When talking to a teenager about anorexia nervosa, don’t immediately react with a statement like “You have to start eating more” or even “But your body is nice!” These kinds of statements impose a value on what they are saying rather than just letting them be heard.

Instead, ask open-ended questions, and be prepared to simply listen to their answers. Some things may be hard to hear, and even harder to simply accept. Always remember to keep their agency in mind. Instead of proclaiming “You’re going to get treatment!”, ask “How can we help you with this?” Some other pointers about this discussion might include:

• Start with open-ended questions – Instead of diving right into a lecture about the dangers of anorexia nervosa, ask them about how they’re feeling. Are they feeling anxious or depressed? How do they feel about themselves? Is there anything that’s been bothering them? Remember that eating disorders are often paired with low self-esteem and negative feelings about their body, so be careful not to react sharply or accuse them.
• Keep the discussion focused on feelings, not food –Eating disorders aren’t about food as much as a person’s body image and mental state. Very often people with anorexia have a strong sense of perfectionism added to negative body image; although nutritional education and meal planning are major parts of treatment, more time is spent on psychotherapy and behavioral therapy. Stay focused on how they feel rather than what or how much they are eating.
• Validate their statements – Remember, there is no such thing as a “wrong” feeling. One way to show your teen that you are listening and to help them feel validated is to listen, then restate their sentiments. For example, “I understand. You are feeling that your body is too big and you want to lose weight.” Again, remember to be judgment-free. Understanding their point of view will help you understand what they are struggling with. With time and counseling, you can begin to help them replace disordered thoughts with healthier ones.
• Make a plan – before talking about a difficult subject like anorexia nervosa, think about what you’re going to say and how you’re going to say it. It’s all too easy to get caught up in an emotional response, especially if your child is emotional as well. Remember to never be accusatory or demanding. Instead, think about how you can be supportive, caring, and calm when broaching the subject at hand. A little preparation goes a long way.

How to Prepare Teens for Residential Anorexia Nervosa Treatment Programs

Residential treatment centers provide clients with the ideal recovery setting, separating them from the pressures of their day-to-day lives and making it easy to focus on treatment in a structured and safe setting. This kind of treatment by design puts the adolescent in a safe, focused setting so that all their energy can be focused on recovery.  However, these are major lifestyle changes and can be disruptive – so the teenager and her family should be ready. As you are preparing for treatment, make sure to learn all you can about the center, its programs, and what treatment will be like.

What to Expect in Residential Anorexia Nervosa Treatment

Residential anorexia nervosa treatment, sometimes called inpatient treatment, isn’t the cold, fluorescent-lit hospital that often pops up in the imagination. That’s a Hollywood misconception. Normally, the facility will be comfortably appointed with furnished rooms and shared spaces, including entertainment rooms, classrooms, and kitchen/dining rooms.  A feeling of safety and comfort is essential for creating a conducive environment for treatment, so quality facilities will feel more like a home than an asylum.

Day-to-day activities are centered around moving steadily forward in treatment. There will be daily therapy sessions, and frequent group sessions which allow for peer support and growth, and for adolescents, there are normally educational programs as well. Continuing the teen’s education is key – some of the best centers even have certified teachers on hand to teach classes. Finally, experiential therapies like hiking, gardening, attending concerts, or going food shopping also round out the activities involved in residential treatment.

How to Prepare Teens Before Entering an Anorexia Nervosa Treatment Center

Managing expectations – positive and negative – is important for teens about to go into residential treatment for anorexia nervosa. Because they will be entering a highly structured environment, teens should understand that they may have designated free time and/or designated phone and visitation hours.

While parents should always listen carefully to their child’s fears, especially when making a major life change like entering residential treatment, they should frame the discussion about treatment in a positive way. This can help calm their nerves and give them an idea of what to expect over the next several weeks. It’s also important to find out what items can and can’t be brought to the facility, and how much outside contact will be allowed.

Some key facts to discuss with teens as they prepare for eating disorder treatment include:

• The length of the treatment program
• Therapy options available during treatment
• How their progress will be monitored
• When they can expect to phone/visit with family
• What an average day in treatment may look like

Make Sure to Answer Their Questions – and to Have Your Questions Answered

It’s also important to give children the opportunity to ask questions about the recovery process and the benefits of residential treatment programs. Parents should let them voice their concerns and do their best to provide accurate information. If necessary, it’s perfectly acceptable to reach out to the treatment facility for additional information.

Admissions specialists are available to help parents answer as many questions as possible before committing to treatment. The kinds of practical questions listed above should certainly be discussed but admissions specialists can also help you find a local therapist or psychiatrist to make a formal diagnosis, to help you make travel arrangements, to discuss tutoring and continuing education, and to help navigate insurance and other financial considerations. If your adolescent is struggling with anorexia nervosa or another eating disorder, reach out to a center’s admissions staff today – it’s the first step to a happier, healthier life.

Avoidant/Restrictive Food Intake Disorder (ARFID) has been getting more coverage in the media. While more and more people are becoming aware of this serious condition, it is still misunderstood and under-diagnosed. Many doctors tell parents that their child will grow out of the picky eating ‘phase.’ Picky eating can be a piece of this diagnosis, but there can be many other layers that complicate this condition.

Here are some helpful facts about ARFID that you may not have known.

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1. ARFID is an eating disorder that is listed in the DSM-5

ARFID is a diagnosable eating disorder that is in the Diagnostic and Statistical Manual of Mental Disorders 5^th Edition (DSM-5). It is defined by a lack of interest in or engagement with food. It can also include an aversion to food due to possible side effects of eating such as vomiting, choking or getting sick.

2. ARFID is more than just picky eating

In actuality, ARFID manifests as intense fear and avoidance of food or food groups as opposed to someone who doesn’t like veggies. Those who live with ARFID often avoid certain food textures, smells and colors because of sensory characteristics. Other times, ARFID can stem from trauma around food. For example, if a child eats a peach and chokes on the pit, that incident may lead them to avoid any foods that could recreate that scenario of choking. Examples may be orange foods, foods that have pits or any types of fruit.

3. ARFID doesn’t just impact children

Per the above point, ARFID symptoms are often dismissed as picky eating. As such, ARFID diagnoses often “fly under the radar” and continue throughout life. Adults with ARFID may avoid social situations that involve food or meals because they are self-conscious of their limited palette. Shame or embarrassment can increase anxiety and isolation which can make it difficult to get proper support.

4. ARFID symptoms may look similar to anorexia, but with one important distinction

Children who present with ARFID symptoms may lose weight and/or fail to gain weight in a similar way to children with anorexia. Anorexia is categorized by the fear of weight gain and the presence of a body image disturbance. Conversely, individuals with ARFID are typically not trying to lose weight. In fact, many people with ARFID (especially children) are very aware that they are smaller than their peers and want to gain weight.

*Of note, an individual does not need to be underweight to be diagnosed with ARFID.

5. ARFID can impact all food choices.

People with ARFID do not typically restrict food based on caloric value or how ‘healthy’ they are. Some clients avoid all fruits, others may have a hard time with creamy foods like yogurt. Some people may avoid crunchy foods or strong-smelling foods.

Learn How to Seek Help for ARFID

If you or someone you love is showing signs of ARFID, we are here for you.

Our empathetic and experienced team of care professionals can help you. We use evidence-based approaches that can increase comfort around fear foods. We also help our clients to build a more robust menu of palatable foods.

Becky Henry​ is trained as a Certified, Professional Co-Active Coach (CPCC), ACC and provides radical support for caregivers to become effective guides for their loved one in eating disorder recovery. In this post, Becky discusses Enabling and Support.

Full disclosure, I dislike the term “enabling” a lot.

The line between being a supportive caregiver or parent, and enabling a family member struggling with an eating disorder can become blurry when fears run the show.

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What Does "Enabling" Really Mean in Eating Disorder Recovery?

Enabling is defined as ‘​Protecting someone from experiencing the full consequences of their behavior.’

We are absolutely terrified beyond description that our loved one is disappearing before our eyes – regardless of their weight…they are absent from their body as if their true self has been hijacked by this ‘ed monster’ and we cannot find them. What we see in front of us and hear talking back to us is not the person we knew. Now and then we will get glimmers, much like when a loved one has Alzheimer’s. It gives us momentary hope…and pain.

Family members do not want to see a loved one suffer. And being labeled as “enabling” or “enmeshed” or as an “anxious parent” increases everyone’s suffering. We are not trained on how to tolerate a loved-one’s distress and how to manage our own distress at seeing them suffer. We need support and training on how to enable my child toward healthy recovery behaviors, not support the eating disorder. We are having a normal reaction to an abnormal situation.

At some point all family caregivers learn how deadly eating disorders are. That is terrifying. We need help to calm the fears. Then we can be calm, compassionate, confident caregivers.

In the realm of eating disorders, terrified parents can get involved to the point of unintentionally and unknowingly supporting their eating disordered child/loved one’s behaviors. As a result, the child/loved one can become overly reliant on the parent/family member for help, feeling as though they need their parent to be able to recover.

Parents may invest all of their time and energy into helping their child while neglecting their own feelings and needs. To an outsider, it may seem as though the parent or caregiver is simply being self-sacrificing in order to help their child to the best of their ability. However, this type of relationship begins to take a toll on the child and the parent, and may leave the parent feeling as though they need to “fix” their child.

How family members can help eating disorder recovery

It is essential for family members to be involved, and include these 4 things:

1. Separate your child/family member from the eating disorder.
2. Practice EXTREME self-care.
3. Learn as much as possible about these complex, deadly illnesses.
4. Get support from someone who knows eating disorders well.

How do we do these things when we need to protect someone from experiencing the potentially deadly consequences of their behavior? We love them and don’t want to see them suffer. We want them to live.
When we see what enabling does for us and our loved one and what having healthy behaviors does for us and our loved ones we can see the benefits of learning different ways to provide support.

When we enable eating disorders we can:

●  Try to fix the ED

●  Stop Living

●  Worry all the Time

●  Are Held Hostage by ED

●  Lose Hope

●  Stop Sleeping

●  Jump Down the Well

●  Get on the Emotional Rollercoaster

●  Become Resentful

●  Feel Exhausted

Results:​ Burn out, anger, bitterness, sickness, frustration, and ED gains the upper hand.

When we use healthy behaviors we can:

●  Can Feel Guilt at First

●  Be Engaged Part of the Team

●  Support the Therapeutic Process

●  Can Enjoy Life Again

●  Reduce Distress

●  Model Health Behaviors

●  Increase Compassion

●  Reduce Burnout

●  Increase Hope for Recovery

●  Learn to Validate

●  Communicate Effectively

●  Remain Calm

●  Stop Accommodating ED

●  Reduce Drama

●  Practice Self Care

●  Raise Confidence

●  Lower our own Distress

●  Increase Capacity to Tolerate Child’s Distress

Results:​ We stop losing ourselves and become more effective at supporting our loved one.

I hope that this gives you some ideas and hope to begin to experience the benefits of learning different ways to provide support.
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Keep loving, keep supporting, be present and keep YOU on your TO DO LIST. Remember, self care is not selfish.

For more information about our adolescent treatment programs, please call 888.228.1253.