What to do when your teenager refuses to get treatment for their eating disorder

Teenagers are biologically driven to differentiate and individuate from their parents. This is the main reason why parenting a child from ages 10-20 can be especially tricky. Adolescent brains are working very hard to prune childhood neural connections while building powerful new adult connections that will stay with them for life. This work can fundamentally change the way your child relates to you and can be confounding to even the most grounded parents.

Eating disorders often begin during these important growth years. There are many reasons for this, including the development of individual identity, which for most children is closely tied to their body. The mistaken belief that we are defined by our bodies is accelerated by diet culture, which promotes the lie that we can and should control our body size and shape.

It is also true that a child’s family may have inadvertently caused some misguided beliefs about the child’s body, emotional expression, and sense of self-worth. Parents are critical players in developing our children’s emotional health. When our teen develops an eating disorder, we must take action and change our parenting approach to help our child heal.

If your teenage child has an eating disorder but refuses treatment, you’re in a tough spot. Your teen will not recover from an eating disorder by the sheer force of your will. In fact, until your teen willingly enters recovery, you can waste a lot of time and money on attempting treatment that will never work. You also don’t want to turn your child’s eating disorder into something over which you argue, because teenagers are built to debate, and the more they defend and protect their eating disorder, the harder it will be to get them into treatment. Avoid turning this into a power struggle at all costs.

Of course, if your child is medically underweight, you must seek medical treatment immediately. Your teen may require hospitalization to achieve a minimum weight. Please know that once your child achieves the minimum weight, they will likely still be living with an eating disorder. And it should be noted that the vast majority of people who have eating disorders never become medically underweight and may be “average,” “overweight” or “obese.”

As long as your child is not in imminent physical danger, treatment can and should begin at home, and parents are tremendously powerful in helping their children heal from an eating disorder. When your child is above their minimum weight, you can take the long road and trust that the following steps will make a huge impact on the likelihood of full recovery.

Here is what you can do to help your teen willingly seek treatment for an eating disorder:

1. Get treatment for yourself

You may find this a strange recommendation, but while your child is the one who has an eating disorder, you must seek support in how you parent them. Find a qualified therapist who works with parents of adolescents. At this point, you don’t need an eating disorder specialist, but you should clarify that you are looking for a therapist who is familiar with Health at Every Size (HAES) and will not mistakenly discuss your child’s body as a problem. There are likely some parenting skills you can work on to help you parent your child effectively right now. Your therapist will provide a sounding board and also help you learn some parenting techniques and approaches that will help your child enter eating disorder treatment willingly.

2. Repair your relationship with your child

You have probably been experiencing increasing arguments, slammed doors, and cold shoulders from your child for months. It’s likely that your child denies they have an eating disorder and refuses treatment or perhaps attends treatment but does not fully participate. While you may be dismissing your child’s volatile behavior as “normal” teenage behavior, when it is combined with eating disorder symptoms, it is not healthy. You must realize that the first emergency at hand is your relationship with your child.

Your child may say they do not have an eating disorder and call you ridiculous for thinking they do. They may abuse you and tell you that it’s all your fault they have an eating disorder. These statements may make you want to pull away, but they are actually a sign that your relationship needs improvement. Many of us mistakenly believe that our teens want to be completely self-sufficient, but they desperately crave our caregiving, love, and unconditional acceptance.

Your child’s recovery is unlikely to truly begin until you repair your relationship with them. Your therapist should be able to help you get this process started. Once you have made some changes to the way you are parenting, you should gain your child’s confidence and be able to take the next step: family therapy.

3. Attend family therapy

Once you have made some progress on your relationship with your child, you should be able to convince them to join you for family therapy. Take your time setting this up, and get help from your therapist to optimize your chances of success. Interview different therapists to find someone who will help, not hurt the process. You are looking for someone who has experience with parent-teen relationships and, again, is HAES-informed.

Your child may refuse family therapy until they believe that the purpose of family therapy is to help you be a better parent. If your child believes the family therapy is because they are a bad child, they will refuse to go. If the child believes the family therapy is meant to “fix” their eating disorder, they will refuse to go.

The purpose of family therapy is for you to build a stronger connection with your child, to gain some parenting skills, and to help them express themselves fully to you in a safe space. You are likely going to learn some communication skills and work on expressing yourself authoritatively and compassionately while unconditionally accepting your child exactly as they are. Your child is hopefully going to remember that you are dedicated to supporting and loving them, and will eventually agree to see a therapist individually and begin eating disorder treatment.

4. Get your child into eating disorder treatment

Once you are in family therapy, you can work with your family therapist to discuss the eating disorder. Your family therapist can help you discuss your concerns about your child’s eating disorder and support you in getting your child to meet some potential therapists and begin treatment.

Depending on your treatment provider and insurance, you may need to say goodbye to your family therapist at this time, as a new family therapist may be assigned to help you during your child’s eating disorder treatment. Regardless of the process, you should continue attending family therapy during your child’s eating disorder recovery. Hopefully, by now you can see that working on your family dynamics is making a positive impact on everyone. Your continued active pursuit of being a better parent will mean your child is more likely to succeed in their healing process.

Your child’s eating disorder treatment will vary, but keep it as close to home as possible. Sending your child away to attend inpatient treatment should be considered only in extreme cases. READ: What I want parents to think about before sending their child to an Eating Disorder Treatment Center, by John Levitt, PhD

5. Get nutritional counseling

Once your child is in eating disorder treatment, you should seek support from a non-diet dietician who is HAES-informed. You need someone who follows the Ellyn Satter philosophy and feeding program. You are looking for someone who can help you put together a feeding structure for your family. Depending on your child’s treatment program, they may be assigned a nutritionist. If that is the case, make sure you get to have meetings with their nutritionist so that you can learn what you need to do at home to help your child’s recovery.

The focus is more on the approach you bring to food and the importance of shared family meals and less about the food itself. Your nutritionist may provide you with basic guidelines for nutritious meals, but you may be surprised that these meals are not as rigid or “healthy” as you were expecting. This is because a non-diet dietitian is looking for balance, pleasure, and satiety as much as nutritional value. For long-term health, the best diet is one that provides pleasure.

6. Enjoy your family

Your child’s eating disorder may feel like the worst thing to ever happen to you, but many parents who embrace the changes required by a child’s treatment for an eating disorder find that the whole family gets healthier than ever before. An eating disorder is not a life sentence for either you or your child. Most people who have eating disorders can and do recover, and taking the steps outlined above, and embracing your potential to change and improve your parenting techniques will help make that happen. The happy side effect of all of these steps is that your family will become more bonded and stronger in every way.

Disclaimer: This article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this Website. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately.

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