Fear & worry in eating disorder recovery

If you have a child who has an eating disorder, then you should expect to see fear and worry. This is because eating disorders often show up with, and in response to, anxiety. Eating disorder behaviors can be an attempt to cope with anxious feelings and thoughts. And luckily, parents have a significant impact on kids’ anxiety.

But unfortunately, our instinctual responses to our kids’ anxiety can accidentally make it worse over time!

In fact, there are treatment programs in which parents of anxious kids are the only ones who are treated. That’s right: while it’s ideal if your child is also getting treatment for anxiety, it’s not a requirement for them to start feeling (and acting) better. You can do a lot to change the course of their anxiety. Anxiety is highly responsive to relationships. You will either see it grow or decrease depending on how you respond. 

What does anxiety look like in an eating disorder?

Anxiety can be a bit tricky to see without some practice. Many people who develop eating disorders have learned to cloak their anxiety with anger, sadness, fighting, and withdrawal. Here are the top signals of anxiety, fear, and worry when there’s an eating disorder:

1. Worry about weight
2. Fear of food
3. Anger about rules, restriction, and efforts to control eating disorder behaviors
4. Sadness about perceived failure and disappointing their parents, friends, etc.
5. Fighting and negotiating about recovery steps and expectations
6. Withdrawal, shutdown, or a refusal to talk or engage in family activities

Anger, fighting, and sadness are the most distracting versions of anxiety. And parents typically respond to them with confusion and surprise. It seems like you’re asking your child to do something that makes perfect logical sense, so why are they so upset about it? 

The key is to know that they are upset about it because their anxiety has been triggered, and one of the ways anxiety maintains control is to put out distractions from the bigger issue, which is the fact that their anxiety response is over-reactive. 

The solution if your child has a lot of worry and fear, or if they are angry, sad, fighting you, or withdrawing when they have an eating disorder, is to learn how to respond to anxiety better. 

How to deal with fear and worry in eating disorder recovery

First, let’s set the table. I want you to start talking about worry, fear, and other scary feelings regularly. Have regular conversations with your child about what anxiety is, how it shows up, and how you’re going to respond to it now that you know this. 

The most important message I’m sharing today is that worry, fear, and other big feelings will show up, and that’s OK, but we’re not going to let them make important decisions about what we do and don’t do.

Demystify anxiety. It follows a predictable pattern. It’s rarely helpful to be surprised by it, try to ignore it or force it to go away. Instead, it’s best to talk about it, recognize it, and even welcome it into your life without letting it control your life.

Never threaten anxiety. Let it exist; just don’t let it run the show.

1. Expect anxiety to show up (it will!)

One of the most confusing things about having a child with an eating disorder is how resistant they can be to recovery. Even if they say they want to recover, it may seem to you as if they are not taking the action they need to recover. 

It’s important to think a bit differently. While it’s true that your child may not be taking the action they need to recover, it’s not because they don’t want to. It’s because anxiety keeps showing up and telling them it’s not safe to recover. 

Anxiety’s job is to warn us of danger and keep us from doing things that make us uncomfortable. 

But the only way to heal from an eating disorder is to feel things like fear and worry and do the thing you need to do anyway. 

The only way out is through!

So the first thing you need to do as a parent is to stop being surprised by anxiety. Start to expect it. Expect anxiety to show up every time you put food in front of your child, and lots of other times, too. 

A child who has an eating disorder typically has a hair-trigger response to even small threats. Their amygdala is highly-responsive right now. So you’re going to see anxiety a lot. Don’t be surprised; expect it.

2. Tell your child that it’s OK to feel afraid and worried sometimes (it makes sense!)

Most parents automatically respond to anxiety reactions like worry, fear, and anger by trying to shut it down or ignore it. This makes sense because your own anxiety senses danger and wants to keep you safe. I get it.

But instead, you need to face your own anxiety about your child’s anxiety head-on. Remember: the only way out is through!

When you try to debate, diminish, or ignore anxiety, it gets stronger, digging in deeper and justifying its existence as the savior.

Instead, when you see your child getting anxious, name it. Say something like “oh look, here’s some worry. It makes sense that you get worried sometimes. I get it.” 

You can replace the word “worry” with other words like sad, angry, frustrated, irritated, scared, etc. Try to find the word that makes your child feel seen, heard, and understood. This takes some practice, but you can do it!

This removes the need for the child to justify and defend their anxiety. When you remove the opportunity for debate, you take away an essential part of anxiety escalation. 

3. Remind your child that the path to feeling better is not to avoid fear but to face fear (and do it anyway!)

Once you have acknowledged that anxiety is present in the form of worry, fear, anger, etc., take some time to let your child feel that you believe them when they say they feel however they feel. 

When you sense that they “feel felt,” then you can move on to the next stage. It’s OK if you need to try this a few times. This takes practice and is almost never perfect. That’s OK!

Now you want to remind your child that feeling worried and nervous is perfectly normal, but that we can’t live our lives according to anxiety’s demands. 

Of course, this means that you should have those pre-conversations with your child about what anxiety is, how it shows up, and how you’re going to respond to it now that you know this. 

Your response to anxiety is: worry, fear, and other big feelings will show up, and that’s OK, but we’re not going to let them make important decisions about what we do and don’t do.

4. Believe that your child can learn to tolerate their fear (they can!).

One of the biggest impediments to kids learning to tolerate anxiety is that parents worry it is not possible. Here again, we recognize that your worry as a parent can impact your child’s relationship with worry. 

So come up with a mantra for facing your fears and doing it anyway. The only proven way to reduce anxiety is to train the amygdala and your thoughts to face anxiety and build up the muscles of tolerance and acceptance.

Remember that trying to avoid anxiety will make it get stronger, but facing it and doing the scary thing anyway will build the muscles that are needed to respond to anxiety appropriately. With practice, your child will do this by themself over time. But it’s very hard to do this without help and support at home.

How this looks at the dinner table

Here’s a quick scenario about how worry and fear can show up at the dinner table with an eating disorder. 

Take 1: letting anxiety run the show

• Child: I can’t eat. I’m full. You can’t make me!
• Parent: You have to eat! It’s important! You promised! 
• Child: I already ate enough. You know I can’t handle more. I’ll throw up! 
• Parent: You have to eat this food. It’s good for you. Just eat it so we can get on with life, will you?
• Child: You gave me too much! I can tell you added butter and oil – look! It’s just sitting on top. Gross!
• Parent: No I didn’t! It’s the same thing I make every time. I didn’t change anything!

In this scenario, the parent is accidentally engaging in a debate with anxiety. This gives the anxiety a sense of power and control. And it usually makes the situation worse, not better.

Take 2: standing up to anxiety

• Child: I can’t eat. I’m full. You can’t make me!
• Parent: Yeah, you often feel this way at dinner. I get it. 
• Child: No you don’t! You don’t understand anything!
• Parent: It seems like you’re really upset.
• Child: Yes I am! I hate this!
• Parent: I get it. I really do. But remember that we talked about this, and we’re not letting worry run the show anymore. Let’s put worry aside for dinner tonight and we’ll talk to it some more after we eat if we need to.
• Child: You’re just trying to control me!
• Parent: Yeah, I know that’s what your worry says, and I understand that’s how it feels. Like I said, let’s get through dinner and then see what worry has to say to us later. 
• Child: that’s stupid (they take a bite).

In this scenario, the parent is not fighting with or trying to make the anxiety go away. They’re acknowledging and validating the existence of anxiety and asking the child to do the hard thing even though they feel anxious.

Practice, not perfect

This is a practice, and it takes time for parents to learn a different way of responding to anxiety. If this sounds impossible right now, I get it. But trust the process. It works.

Anxiety is one of the most common mental disorders, and we have thousands and thousands of research papers examining what it is and how it works. There is a lot of data to support this treatment approach to a child with anxiety. 

One of the things we know is that for most parents, their instinctual response to anxiety will accidentally increase a child’s anxiety over time rather than decrease it. But at the same time, when parents learn and practice new skills for responding to anxiety, they will see a decrease in anxious outbursts and behaviors. 

Anxiety is the most treatable psychological disorder, and since it underlies and drives so many other disorders, including eating disorders. Emotions during eating disorder recovery are hard to handle, so it makes sense to learn some new skills for responding to anxiety differently. 

See Our Parent’s Guide To Mental Health And Eating Disorders