Emotional regulation and an eating disorder

A child who has an eating disorder will benefit from emotional regulation skills, and parents can help by learning co-regulation techniques. When we co-regulate with our kids, they learn to do it for themselves. In fact, we are in the best possible position to improve our kids’ capacity for emotional regulation.

Often when we learn a child has an eating disorder all our attention goes to the child’s disordered behaviors. We focus on feeding them and getting them to therapy. This is important, necessary, and makes a lot of sense. 

But when we focus exclusively on behaviors we may miss the cause of the behaviors. And emotional dysregulation and disengagement are often at the heart of eating disorders. This is why emotional regulation is key to lasting recovery.

What is emotional regulation?

All of us have a nervous system that is attuned to internal and external threats. When it perceives a threat, it triggers our amygdala and raises cortisol levels and the flight, fight, or freeze response. A highly-sensitive person has a more reactive threat response, meaning they find themselves frequently dysregulated (over-reactive) or disengaged (under-active).

People who are frequently in a dysregulated state typically have symptoms of anxiety, while those in the disengaged state have symptoms of depression. Either way, the body diverts attention from the digestive process, focusing instead on seeking safety. Thus, appetite tends to be low and it is very hard to eat and digest food. Many people with eating disorders struggle with emotional regulation.

Parental co-regulation

Children are not born with emotional regulation skills. They learn them through a process called co-regulation.

Parental co-regulation is when a parent’s nervous system regulates the child’s nervous system. With practice, the child gradually learns to regulate their own nervous system without the aid of their parent. This is something we know based on recent developments in neuroscience, which is teaching us how children’s emotional systems develop. 

When there isn’t enough co-regulation in the parent-child relationship, our kids don’t develop a healthy self-regulation system. We often see signs of this through kids’ negative behavior.

Benefits of co-regulation:

• More balanced and calm state of mind
• Able to cope with worry and regulate thoughts and emotions
• Ability to think more clearly and make decisions
• Increased ability to respond rather than react
• Process worry, stress, and anxiety in a healthy way
• Emotional balance
• Relationship balance
• Self-awareness
• Social awareness

Adults can learn emotional regulation when they are older, but it is much harder and takes a lot of time and effort. A child/teen, on the other hand, can learn emotional regulation through co-regulation with a parent much faster due to the neurobiology of the emotional regulation system. A parent who co-regulates with their child, especially when there is an eating disorder, can make a huge impact on the child’s lifetime mental health.

Understanding attunement

Co-regulation begins with parental attunement. This is when a parent tunes into how a child is feeling – the feelings that lie beneath the behavior we’re observing – and responds in a way that will bring the child into an emotionally-regulated state. Attunement is something that we’re designed to do for our children, and it’s something our kids need us to do to build a healthy self-regulation system.

Attunement begins with tuning in to how your child is feeling. Your first trigger that there’s a feeling to pay attention to is that you might notice you are getting irritated or frustrated with them. That’s typically a good sign that your child is having feelings and needs you to tune in and help them regulate their emotional system. 

Once you notice a behavior that bothers you and therefore indicates hard feelings, take a deep, calming breath and look at your child. Think about what they might be feeling, and try to sense it with your body. 

We have a vagus nerve that is automatically attuned to our child’s distress. The vagus nerve winds throughout our brain, face, neck, and trunk. “Gut feelings” are actually the vagus nerve sending feedback to your stomach and intestines. Vagus nerve feedback is powerful and embodied, and it’s one of the best ways we can become attuned to our child’s emotional needs.

Being attuned to your child takes practice, but it’s something you can learn. 

Childhood emotional regulation

Behavior is often seen as something we need to fix or get rid of. But when we shift our thinking to recognize that behavior holds critical clues, we can decode our kids’ emotional state and respond appropriately. Our kids’ negative, annoying, and dangerous behavior, including eating disorder behavior, tells us they need this from us. 

This approach is a critical shift from thinking our kids’ behavior is something that needs to be overcome, fixed, shut down, or controlled. Instead, we want to learn to translate behavior and use co-regulation to help them learn self-regulation. 

Often we get frustrated with our kids’ irritating behaviors. We all wish our kids would self-regulate their emotions better. But emotional regulation is a learned skill, and our own irritation is our signal that we need to tune in and help them with co-regulation. 

No matter how convenient it would be, we don’t improve nervous system regulation with cognitive skill-building. Rather, we improve nervous system self-regulation through co-regulation.

Windows of tolerance

One helpful way to visualize this is to consider our kids as having different emotional “windows.” I created a visual way of seeing these three windows, or emotional states: dysregulated, co-regulated, and disengaged. You can get a copy in my free eBook. This illustration is based on materials provided by Mona Delahooke. It interprets the “Window of Tolerance” concept developed by Dr. Daniel J. Siegel, a leader in neuroscience research particularly as it relates to the parenting relationship. I also integrated concepts from the work of Dr. Stephen Porges.

The behaviors and feelings are scientifically validated. However, the information for “eating disorder behaviors” is based on my professional observations, research, and lived experience. Please use this information as guidance, not fact. Every eating disorder is unique.

A child who has an eating disorder will likely have periods of emotional regulation. That is to be expected. However, the eating disorder behaviors are unlikely to be a problem while the child is in a regulated state, which is why I put “N/A” in that column. Eating disorder behaviors are most often triggered by emotional dysregulation and/or disengagement.

Co-regulating with your child through recovery

A child’s eating disorder recovery will go through many stages. The main thing to keep in mind is that when a child increases their emotional regulation, their eating disorder behaviors will almost always decrease. 

This rarely happens all at once, but rather in stages. And the goal is not to achieve a state of constant emotional regulation. Instead, we just want to shift the balance and have more periods of regulation than periods of dysregulation and disengagement. This is normal and healthy human emotional functioning.

I’ve come up with a model: Emotional Stages of Eating Disorder Recovery based on my research, observations, and lived experience. 

The key here is that parents can play an integral role in eating disorder recovery by focusing on co-regulating with their child, which will build the child’s ability to self-regulate and therefore not seek eating disorder behaviors as a coping mechanism.

How to co-regulate with your child

So how does a parent co-regulate with a child who has an eating disorder? Remember that the first step is to be attuned to your child’s emotional state. Keep in mind that often your first signal that your child needs co-regulation is that you’ll feel irritated or upset with them. Use that signal to determine where your child falls: are they dysregulated or disengaged? Once you know that, you can start to intuit the feelings they are experiencing.

Once you are tuned into your child’s emotional state, you can begin co-regulating by: 

• Making gentle, non-threatening eye contact
• Using a soothing vocal tone
• Saying kind words of understanding and validation
• Touching them gently and respectfully
• Breathing deeply to keep your nervous system regulated
• Using compassionate self-talk to keep yourself centered

The most important part of co-regulation is to keep your nervous system centered and confident. What you feel is more important than what you do or say.

Remember that you can always come back and talk about the problematic behavior that tipped you off to your child’s need for co-regulation. But you cannot have useful conversations about behavior while your child is in a state of dysregulation or disengagement.

Activities you can do together

The steps above are the most important part of co-regulation. But sometimes it will help to move into activity. Be thoughtful here and make sure activity is called for. Adjust your activity and expectations based on the level of dysregulation or disengagement. It’s unlikely that you will want to use the same activity all the time. These are a few go-to activities that can help your nervous system get in touch with theirs if they are resisting connection:

• Art: color, paint, or doodle
• Play: play a simple and non-competitive game from childhood
• Stretch: do some gentle stretches
• Exercise: go for a walk or run
• Pets: talk about your pets and/or pet your pets
• Eat/Drink: make a cup of tea or a piece of toast to share
• Go outside: look up at the sky, look at trees or grass
• Read: read a book out loud in a calm voice. You could choose something from childhood that holds good memories
• Light a scented candle: smell is a powerful and underutilized way to soothe and calm the nervous system
• Listen to music together

While you do these activities, don’t worry about what you say. Worry about how you feel. The goal is to stay in your child’s presence so that your calm, confident emotional state will automatically transmit to their dysregulated or disengaged nervous system.

Be careful of the talk trap

Avoid getting stuck in the trap of thinking that co-regulation relies on talking about feelings. It does not. Your child cannot have useful, meaningful conversations with you when they are dysregulated or disengaged. Therefore, while soothing talk may be helpful, trying to talk about the behavior or even the feelings may not be helpful and can even get in the way. Focus on feeling calm and being with your child and rely on your senses rather than words. 

If your child wants to talk, validate what they say and help them clarify their feelings and thoughts. But avoid debating, offering advice, or providing guidance when you see signs of dysregulation or disengagement.

You can have longer and more meaningful conversations once they are regulated, which means they are showing signs of being calm and confident. But trying to do this when they are not emotionally regulated can backfire.

How we can do this better

As parents, our nervous system is constantly communicating with our kids’ nervous systems. This is why attending to our own emotional health will help our kids feel better. 

In fact, there are several validated interventions in which only parents are treated for childhood emotional disorders. In these cases, therapists never work directly with the child, but instead, teach the parent emotional regulation skills. And they work just as well if not better than direct intervention with the child. 

How to strengthen your emotional regulation as an adult:

• Work with a therapist/coach to discover and address your own dysregulation and disconnection patterns
• Practice meditation
• Learn self-compassion 
• Nourish your body with food you love
• Move your body joyfully
• Get outdoors every day
• Learn self-acceptance
• Find a hobby or something you do enthusiastically just because you enjoy it
• Build/deepen your friendships and relationships with others

Supporting our kids’ eating disorder recovery

Parents can make a significant difference in kids’ recovery from eating disorders. And while feeding your child and getting them to therapy are important, your emotional growth can also make a big difference. 

Learning emotional regulation for your child with an eating disorder may be the difference-maker you’ve been looking for! You can download my eBook: Emotional Regulation Skills for Parents Who Have Kids With Eating Disorders. In this eBook you’ll learn how to recognize the different emotional states and how to respond, plus powerful worksheets to help you get started.

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This article is informed by the work of Stephen Porges, Daniel Siegel, and Mona Delahooke

See Our Guide to Emotions And Eating Disorders