What to do when you are told or suspect that your child has an eating disorder

by Beth Mayer, LICSW

No parent wants to hear that their child has a problem, and eating disorders, like all mental disorders, carry a stigma that can be especially hard to handle. I wish we lived in a world in which we treated mental health disorders in the same way we do physical health. If your child had a sprained ankle, you would know exactly what to do and could trust that they were going to receive the care they needed. Unfortunately, that is not the case with mental disorders like eating disorders, so parents need to be provided with more information so they can come to terms with what’s going on and navigate the healing process.

Every person will have their own experience and their own specific needs, but there are some steps that apply to almost every parent who has just found out that their child has an eating disorder:

1. Don’t panic

A lot of times parents find out about a child’s eating disorder from teachers, friends, or coaches. Depending on the reporter who is sharing the news with you, this may not be handled very well. Ideally, we would like reporters to approach a parent with gentle compassion and some informed questions rather than abrupt and scary statements.

No matter what the reporter says, take a deep breath and ground yourself. First, address the shame storm that may engulf you with this news. Many parents notice that their first reaction is fear, shame, and judgment. Be gentle with yourself. First of all, it may not be true. Second of all, even if it is, it’s not your fault you didn’t know – most parents don’t!  People who have eating disorders typically work hard to hide the symptoms from their parents, so it is not a surprise that you needed to be alerted to a possible problem.

Ask the reporter some questions about their suspicions. For example, what have they seen or noticed? Try to get specific details if possible. This will help you as you begin doing your own investigation into your child’s health. For example, some kids who have eating disorders eat fairly normally at home but engage in their disorder everywhere else. Ask questions, and write down what you hear so that you can think about it some more. You’re likely to be in a high state of stress during the conversation, so writing things down can really help you focus and move forward.

Don’t be afraid to call the reporter back or set up a time to meet in person so that you can ask questions when you have calmed down a little more. Reporters are typically more than happy to provide as much information and support as you allow them.

I realize you may feel a lot of shame right now, but please know there is so much you can do to help your child recover if they do have an eating disorder. You didn’t cause this. It’s something that has happened, and you have tremendous power to do the next right thing.

2. Look for patterns

Once you suspect or have been told that your child may have an eating disorder, look for patterns. One of the biggest warning signals is an abrupt change in body weight. This may be a significant weight loss or gain. We live in a culture that applauds people of higher weights when they lose weight, but any weight loss in an adolescent should be considered a red flag.

Your child’s healthiest body is typically along a fairly even weight trajectory that begins at birth, and a big spike or dip is cause for concern. Be very careful about the assumptions you make about your child’s body – we live in a society that mistakenly believes that people living in larger bodies are unhealthy and that intentional weight loss is healthy. It simply isn’t true, and the more you learn about this, the better position you are in to help your child.

But eating disorders go beyond weight gain and loss. A person who has an eating disorder often has distorted beliefs about their body and food. Often a child who is heading for, or already has an eating disorder talks about hating their body. They may mention that they’re “cleaning up” their eating, which typically means removing certain foods like sugar, carbs, and animal products. These changes don’t always lead to eating disorders, but they are cause for concern.

Notice patterns during and after eating. A child who is flirting with or has developed an eating disorder may often say they “already ate,” or “aren’t hungry” at the dinner table. Or you may notice that they go to the bathroom or out for exercise immediately after eating.

Look for behavioral changes outside of eating and body size, like anxiety, defiance, and changes in who they spend time with. These signs are often not immediately identified as eating disorder symptoms, but they often occur at the same time as an eating disorder is building strength.

Overall, observe your child. See if you can notice patterns around eating, body, behavior, and mood. Notice if your child is eating more or less, losing weight, going to the bathroom after dinner, and otherwise behaving in a manner that is different than before. Write down your observations and talk to someone else – ideally a professional – before you approach your child so that you have a clear message and approach.

3. Approach with inquiry, not accusation

Eating disorders are very tricky and secretive. Parents who want to approach a child about a possible eating disorder must tread carefully and look for ways that will not be scary. This is really important, because when an eating disorder is driven further underground by poorly executed confrontation it may morph into other disorders and/or become even more embedded. It is natural for your child to become defensive, so it’s good to be prepared.

Once you have clarified patterns that are worthy of concern, you want to voice your concerns with your child – don’t wait for your child to come to you or for some other dramatic confirmation of your fears.

Rather than diving in with a direct “I think you have an eating disorder,” present some information about the patterns you have observed. Say things like “I notice you are going to the bathroom after you eat, and I’m feeling concerned.” Focus on the facts and the behaviors, not your child’s physical appearance. You don’t want to say “I’ve noticed you’ve lost a lot of weight,” but instead say “I’ve noticed that you’ve changed your eating patterns.”

The most important thing to do is to not accuse or pass blame. You need to be calm and confident when you tell your child what you have observed and state your concerns. Then listen to your child. Ask questions to open up the conversation. If your child has an eating disorder they will most likely be resistant to getting help. Eating disorders feel like lifesavers when a person is in them, and your child is probably terrified that you’re going to take it away.

Say something like “you may not feel like it’s a big deal, but we are keeping an eye on this because I am concerned because your eating patterns have changed dramatically. We want you to enjoy your body and enjoy your food, and clearly, that’s not what you’re experiencing.” Then tell your child what the next step is.

4. Get help

A good next step is a meeting with a physician. Call the physician in advance and tell them your concerns. Make sure the physician has experience with eating disorders and is informed about them. Unfortunately, few physicians have training in this area so you may need to ask for a referral to find someone who will provide a good assessment. One challenge you may face is the bias that all eating disorders look the same (i.e. underweight). Some physicians will even praise a child who has lost a dangerous amount of weight. A child who has been considered “overweight” for their whole lives, may get applause from a doctor whose only goal is to get that child into the “normal weight” range. But that is misinformed and dangerous.

You can also go to a therapist first, with the understanding that the therapist will likely recommend a physical exam as the first step in the diagnosis and treatment of a possible eating disorder. Again, you want to speak with the therapist in advance and make sure the therapist has experience with eating disorders. In both cases, you should attend the meeting with your child. Bring your list, and share your concerns in a non-accusing way.

Your child may be in the early stages of an eating disorder, or they may be what I call “fiddling.” The symptoms you are observing may be more heavily linked to anxiety or depression than a full-blown eating disorder. Regardless, immediate treatment is necessary. The earlier we start treatment for any mental distress, the better our chances of success in treatment. Your child’s eating disorder could be what I call a “blip” – it comes into your life, it’s used as a coping mechanism, and it can be treated. The longer it stays, the higher the likelihood that it will become persistent and even lifelong.

Seek support for yourself. Talk to a professional who understands body image and eating disorders. Read up about what to do and what not to do. Assess and treat your own fear as a parent. This is a tough situation for any parent. You deserve compassion and understanding. If you feel as if everyone is blaming you for the disorder, seek help immediately. You need to be treated for your own trauma in this experience.

What I really want parents to know about eating disorders is that they work. They are a very effective way for your child to deal with a tremendous amount of pain. For eating disorders to stop working, your child needs to relearn how to feel pain. Learning to go through pain is a big part of treatment. Our kids have to learn that they can tolerate pain and get through it without their eating disorder. This is entirely possible, and parents can be wonderfully helpful when they are empowered to help.

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Beth Mayer, LICSW, has been working in the eating disorders field for 35 years. She was the Executive Director of MEDA for 16 years. She is nationally recognized for her clinical work with eating disorders and has spoken at conferences around the country. In addition to eating disorders, Beth specializes in treating adolescents and families. Beth has served as an adjunct professor at Simmons College, Boston University, Boston College, Lesley University and Salem State College, supervising MSW and LMHC graduate student interns. She is currently the co-chair of the NEDA network and serves on many local and national committees. Beth holds a B.S. in Clinical Psychology from Quinnipiac University and a Master of Social Work Degree from Boston College. She can be reached at  bethmayerlicsw@gmail.com / 617-325-1013

See Our Guide For Parenting a Young Child With An Eating Disorder