Treating anyone with an eating disorder is complex, but when your teenager has an eating disorder there are four reasons it’s hard to treat.
The teenage brain
Adolescence is a time of massive brain restructuring and expansion. These brain changes affect how teens think and behave. Even though in many ways teens appear fully grown, their prefrontal cortex is still growing. This means they often rely on the less-advanced region of the brain called the amygdala to make decisions.
The amygdala is sometimes called our lizard brain. It tends to be impulsive, emotional, aggressive, and instinctive. In other words, it’s not rational. As a result, teenagers tend to be more impulsive, emotional, aggressive, and instinctive. This can lead to eating disorder behaviors, which can be a perfect solution from the teenage brain’s solution even if they don’t make sense to parents.
It doesn’t matter how smart teens are or how well they scored on the SAT or ACT. Good judgment isn’t something they can excel in, at least not yet.
Stanford Medicine
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Mental health conditions
Eating disorders rarely show up alone. They often come with other psychiatric and medical comorbidities like depression, anxiety, Post Traumatic Stress Disorder (PTSD), and Obsessive Compulsive Disorder (OCD). They can also interact with and be caused by undiagnosed and under-treated autism and ADHD.
Since many of these conditions are first identified during adolescence, diagnosis and treatment is essential, especially since they both cause and are exacerbated by eating disorder psychology and behaviors. Professionals may treat only one condition at a time, which can result in frustrating outcomes since the conditions are usually intermingled.
Treatment team approach
Eating disorders are complex mental illnesses, and often require a multi-disciplinary team working together. Finding the right team, and working together with them can be a challenge. A team may include your child’s therapist, a therapist for you as a parent, a parenting coach, a dietitian, and more. Each member of your team needs to be a fit for your child and for you – they also need to have respect for each other in order to collaborate for best outcomes.
Therapy is extremely personal, and even a qualified therapist may not be a great fit for your individual child. Also, eating disorder specialists can be hard to find. Then there is the expense if you are paying out of pocket, and the stress of going through insurance, which is notoriously reticent to pay for mental health services, especially in a complex and highly stigmatized area like eating disorders.
Resistance and denial
Many adolescents with eating disorders resist treatment and are in denial about the severity of their illness. Adolescents, by design, are in a period of life in which rebellion and resistance are key. They are built to resist, and so when we are desperately trying to help them, they will often push back. Parents are critical participants in treatment, but they are also seen by the teenager as people to be resisted and defied. Adolescents lack trust in authority, so trust must be built in order to change behavior.
Adolescents also believe their thoughts – that is, if they think something, they believe it must be true. For an adolescent who has an eating disorder, thoughts conspire to justify the eating disorder behavior and protect it from being taken away. This results in powerful denial that there is a problem to be solved. If your child doesn’t believe there is a problem, it is extremely hard to treat the eating disorder.
The good news
The good news, however, is that eating disorders can be treated, and full recovery can and does occur. Early and comprehensive intervention is key. An eating disorder does not have to be a life sentence. And parents are uniquely situated to help their teens heal and go on to have a full life.
The important thing to know is that recovery is rarely linear. And teenagers with eating disorders often require significant attention from parents and caregivers as they heal. There will be good days, and bad days, and this will take time, energy and money. But it is possible.
Remember that you are not to blame for your child’s eating disorder. But you are uniquely positioned to help your child heal. Just do the best that you can, given everything else on your plate. Gather your forces, and strengthen your connections. You can do this!
Ginny Jones is on a mission to change the conversation about eating disorders and empower people to recover. She’s the founder of More-Love.org, an online resource supporting parents who have kids with eating disorders, and a Parent Coach who helps parents supercharge their kid’s eating disorder recovery.
Ginny has been researching and writing about eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.
Ginny’s most recent project is Recovery, a newsletter for deeply feeling people in recovery from diet culture, negative body image, and eating disorders.