Parenting a teenager with an eating disorder

Parenting a teenager who has an eating disorder is not easy. Eating disorders are complex illnesses that must be treated comprehensively. Since most eating disorders begin during adolescence, parents are on the front lines of treatment and care. But few feel prepared to handle it.

When an eating disorder shows up in your teenager, it’s important to know that it doesn’t happen in a vacuum. Eating disorders are biopsychosocial disorders, meaning they combine biology, psychology, and social factors. The impact of social factors on eating disorders may be one of the reasons we see so many of them develop during the teenage years. After all, teens are probably under the most intense social pressure out of any age group.

Here are three key things about parenting a teenager with an eating disorder you should know:

1. Adolescence sucks

It is important to understand, and truly connect with, how difficult it is to be an adolescent today. Every teenage cohort believes they have it rough. But this group of teens is correct when they say they are under unique pressure.

The main things that have changed for today’s teenagers include:

• Social media: every misstep, angry outburst, and embarrassing behavior and experience can be chronicled. Brutal comments and endless opportunities for comparison are an integral part of the platforms.
• Parental pressure: parents are more engaged in teens today. And this means that teens feel more pressure to perform and succeed than before.
• Higher mental illness: teens today have higher rates of all mental illnesses, including anxiety and depression. This is not just caused by the fact that we’re measuring these things more. Statistics show that it is an actual effect, and our kids are suffering more than we did.
• COVID-19: obviously, parents did not grow up in a time of COVID-19. And the specific impacts of the pandemic are yet to be measured. But we can clearly anticipate lifelong effects.

Maybe you had pretty good adolescence, but chances are that even if you did, you still struggled at times. Maybe you have forgotten about the really hard year in the midst of good ones. Or maybe the last two years of high school were great. But you’ve forgotten the terror of the middle school years. Chances are good that if you look closely, you will uncover your own challenges during adolescence.

A rough time in life

During adolescence, our emotions are all over the place. We are also biologically driven to separate from the people who we love and trust most – our own parents. This leads to seemingly ridiculous power struggles. these struggles are an integral part of developing into independent adults. And they’re hard.

Then you add on the elements of today’s society. There’s increased pressure for school performance, extracurricular activities, getting into the right college, looking good, and feeling happy. And, of course, social media makes it all harder. Sure, some of it is fun, and our kids enjoy themselves some of the time. But never forget that the years between 10-20 are rife with stress and anxiety. And both stress and anxiety are heavy contributors to eating disorders.

Tip: Help your teenager feel safe and secure at home. This will reduce their stress and anxiety, which contributes to eating disorders. Keep in mind that when your teenager says “life sucks,” it may be true. It doesn’t mean you have failed as a parent, it just means the world is tough on teenagers. Yours likely needs your love and support.

2. Eating disorder behavior is prescribed as “good”

Eating disorders are scary, but most of us can recognize the behaviors of an eating disorder. In fact, they are prescribed and recommended in our culture. They include:

• Obsession with weight and shape: there are very few people in our society who are not a bit worried about or concerned about their weight and shape. Weight control is promoted in healthcare, schools, the media, and almost everywhere. This obsession drives a +$70B industry.
• Restriction: if you’ve ever been on a diet, then you have restricted your food. Diets prescribe eating disorder behavior.
• Binge eating: when the body is starved of food, such as when restricting, it will demand fat- and sugar-filled calories. Thus, restriction is the precursor to binge eating. And almost everyone who has been on a diet can relate to the insatiable drive to eat high-calorie food.
• Purging: when the body becomes over-full, or when you are worried that you have eaten “too much,” you might feel as if you need to purge the food from your body. Not everyone turns to vomiting, using laxatives, and other purge behaviors. But most people who have tried to control their weight can relate to the urge to do it.
• Over-exercise: excessive exercise is seen in our society as healthy, but it is not. In fact, it can be a form of purging. Many people feel they must exercise when sick, feeling run-down, or injured. Rather than a sign of health, this means exercise has become compulsive.

Sound familiar?

Most of these eating disorder behaviors probably sound familiar to you. In fact, you may use some of them yourself. Teenagers are in the throes of developing their identity and have very little impulse control. Thus, they are susceptible to eating disorders. And it’s no surprise – our society literally prescribes eating disorder behaviors every day.

The normalization of eating disorder behaviors also means that recovery can be hard to measure. As long as eating disorder behaviors are prescribed, parents struggle to define “health” for their kids.

Tip: Prohibit eating disorder behaviors in your home. That means nobody should be restricting, weighing themselves, or pursuing a particular weight and shape. This may be a big shift for you. Check out our article on the non-diet approach to health.

3. Mental healthcare is expensive and hard to get

When you have a child with an eating disorder, you seek out the best path to care. And at that point, you realize that there are many paths, and it all seems to be up to you. The challenge with a mental health crisis is that mental healthcare is patchy, expensive, and hard to navigate. Finding care can be surprisingly difficult.

Going through your insurance provider may be very challenging. Your provider may limit eating disorder treatment only to extreme “medical” cases. And even then, care may only extend through a minimum of weight restoration, which falls far short of full eating disorder recovery.

Insurance companies are technically required to cover mental health. But it’s common for claims to be denied or held up. It’s also common for the best therapists to require direct payment. This is because they frequently don’t get paid by the insurance company. Even good coverage may limit your treatment options.

It’s a challenge to get care

There is a good chance that you will need to pay out of pocket to provide your child with comprehensive eating disorder care. Treatment requires a team of an experienced dietitian and therapist over a period of months to years. This can get very expensive, very quickly. In many cases, even if you choose to pay out of pocket for treatment for your teenager with an eating disorder, the best therapists may not have openings or may not be physically nearby your location. This adds to the burden of care, further complicating recovery.

Tip: I’m afraid I don’t have a solution to our lack of good mental healthcare. Have compassion for yourself as you navigate the system. And get as much support as you can. Also, know that your behavior matters. You can help your child recover. Parenting a teenager who has an eating disorder is hard. But the fact that eating disorders are partly social means that parents actually have a tremendous opportunity to impact recovery.

See Our Guide For Parenting a Teenager With An Eating Disorder