Sometimes when a child has an eating disorder they may get aggressive and even violent with family members. This is a deeply upsetting situation for parents. It’s especially hard when parents are already worn out from months or even years of caring for a child who has an eating disorder.
The first thing to know is that getting angry, aggressive, and even physically violent are known symptoms that can accompany an eating disorder. They have been studied and observed in anorexia and bulimia. The most common symptoms are verbal and physical aggression against relatives and others who are close.
The most likely reason for the aggression is that it is a natural response to fear and anxiety. The two most common responses to fear are fight and flight. Fight typically looks like aggression and violence. It is often a signal that a person is experiencing extreme fear and anxiety.
Getting violent during eating disorder recovery can make sense through this lens. Anxiety often underlies and drives maladaptive coping behaviors. It makes sense, and it needs to stop.
What it feels like
When a child gets physically violent during eating disorder recovery, parents can feel shocked, overwhelmed, and afraid. There’s so much shame and stigma around kids hurting their parents, and it’s rarely spoken about.
Violent behavior can happen during eating disorder recovery, but it’s also not acceptable. And there are no conditions under which a parent should accept violence. Additionally, your child’s violence is a symptom of extreme emotional distress. This means that ignoring it or pretending it’s not happening is dangerous for both your child and you.
Often it feels like the only possible responses to violence are to fight back, endure/ignore the violence, or call the police. Fighting back rarely ends well for anyone. And it can add to the shame involved for both parent and the child. And enduring or ignoring violence is unacceptable and, like fighting back, is dangerous for both the child and the parent.
The other response, calling the police, is something you may need to do at some point in the future. But most parents want to avoid that. And there are some steps between doing what you’re doing right now and calling the police.
How to prevent and handle violence
Here are some steps you can take to help prevent and respond to violent behavior during eating disorder recovery and keep yourself and your child safe:
1. How you respond
The most common response to violent outbursts is to fight back with some form of physical or verbal wrestling. However, this rarely defuses the emotional tension that drives a person to a violent outburst. Fighting back is ineffective and often makes the outburst worse.
Violent outbursts are usually the result of extreme emotional disruption. And while it may feel as if it comes out of nowhere, there are usually patterns and signs that a violent outburst is coming.
Before a violent outburst, your child will show symptoms of emotional dysregulation. These may include shifty eyes, tense body posture, pacing, or loud voice. Some kids will signal their dysregulation by swearing or name-calling.
Parents should be aware of the signs of patterns that signal a violent outburst is building and take steps to try and soothe their child’s nervous system as soon as possible. Here are some ways to avoid and/or get through aggressive and violent behavior when your child has an eating disorder:
Manage your own emotional dysregulation
Possibly the hardest thing to do when your child is getting aggressive and violent is to maintain your own emotional regulation. But if you are not emotionally regulated then your child will have a very hard time becoming regulated in your presence.
Work with a professional coach, therapist, or guide who can help you identify your common forms of emotional dysregulation and learn to regulate yourself with self-compassion and mindfulness.
If at any point during an aggressive confrontation you notice yourself becoming dysregulated, try to calm yourself. But if you can’t, take a break. Don’t blame your child for this by saying something like “You’re out of control so I’m leaving!” Instead, tell your child “I’m very upset right now so I’m going to take a break.” Then leave. Give yourself at least 20 minutes, which is how long it typically takes to soothe your nervous system.
Always come back to your child and talk about what happened. Leaving is not a problem, but if you leave without talking about it later, that will put your relationship at risk.
Label and mirror their feelings
An essential emotional regulation skill is to label and mirror your child’s feelings. This is a way of soothing your child. This is because it shows that you are attuned to them and accept their feelings as valid and real. This step alone can transform your relationship with your child. This may not work if your child is already at the point of violence. But it can be used very effectively in the moments leading up to violence and may even prevent it.
Labeling is when you name your child’s feelings. You could say something like “I can see how angry you feel right now. You’re pacing and look agitated.” This video about the concept “name it to tame it” might be helpful:
Mirroring is when you repeat about three of your child’s words back to them. For example, if your child says “you never listen to me and you’re always telling me what to do!” You could mirror back something like “it feels like I don’t listen to you.” If your child says “you can’t make me do it if I don’t want to!” You could mirror back “you don’t want to.”
When mirroring your tone of voice matters just as much, and maybe more, than the words you say. Use what Chris Voss in his book Never Split the Difference: Negotiating As If Your Life Depended On It calls the “late-night DJ voice.” Imitate the voice of a late-night DJ: slow, steady, and soothing. With this voice, you comfort both your child’s and your own nervous system. It taps into your shared neurobiology to soothe and reassure. It communicates: we can handle this.
If your child does not calm down and moves aggressively towards you, calmly narrate what is happening in a supportive and non-judgmental manner. You could say things like:
- I sense how furious you feel, but it’s not OK to push me. I’m confident we can get through this without pushing.
- I can see that you are very angry, but I will not allow you to hit me, so I’m going to leave now. I’ll come back in about 20 minutes and we can try again.
- I understand that this is making you feel very upset, and you get to feel that way, but I’m not OK with you threatening me. Let’s sit here together and I know we can get through it.
These statements do the same thing:
- Label the child’s feelings and name the inappropriate behavior
- Set a clear boundary
- Show confidence that you can handle it
Your child may not like it when you do this, but that doesn’t mean you’re doing it wrong.
Keep your narration short, simple, and factual. Don’t editorialize or debate what you’re saying with your child. Use the “late-night DJ voice” and keep your voice calm and regulated.
One key in responding to anger is to not engage in debates with it. You will never win a debate when a person is in extreme emotional dysregulation. Most parents believe there must be a perfect verbal response to violence that will stop it. They think that other parents have figured it out and are doing better than them. But that’s simply not the case.
Eli Lebowitz, author of Treating Childhood and Adolescent Anxiety suggests you focus not on debating but on simply getting through or getting out of the moment.
“Parents are not expected to be able to manage the disruptive situation, and instead focus on getting through it. Their only role while the child is acting in the disruptive manner is to ensure physical safety and resist being drawn into the interaction.” – Eli Lebowitz & Haim Ober, Treating Childhood and Adolescent Anxiety
The passage continues with this advice: “remain silent, or state in a quiet way that the behavior is unacceptable. If necessary, parents should attempt to distance themselves from the child in order to minimize the potential for escalation.”
Once everyone has calmed down, talk about what happened. Begin by telling your child that you know they are a good kid who was having a hard time. Tell them you are going to work with them on this because even though you know how angry they get, you know that they can handle their anger without getting violent.
Violence must be named clearly and in a detailed but non-emotional manner. Avoid pointing fingers, blaming, or criticizing. Think of yourself as a dispassionate reporter. State what you observed during the violent episode.
Don’t ask questions like “What were you thinking?” or say things like “How dare you!” Because these will shut the conversation down or escalate another outburst. They will not be useful in preventing future violence. Maintain your own emotional regulation.
Talk through what you did in response to their outburst, and why. For example, if you narrated what was going on, tell them you did that because it’s important to name feelings and behaviors. If you left the room, tell them you needed to do that because violence is not acceptable.
If you did something that you regret, like wrestle with them verbally or physically, take responsibility for that and apologize for it without defending yourself. “When you approached me with your fist raised, I pushed you away. I’m sorry for doing that, as I have no intention of wrestling with you.” Or “When you called me that name, I cursed at you. I’m sorry for doing that, as I have no intention of swearing at you.”
You will likely need to follow all of these steps consistently a few times before you see a change in behavior.
2. Write a letter
A written letter is a way to make clear your beliefs and what you intend to do in response to violence. It is a way to formally escalate your attempt to solve this problem and make it clear to your child that you take it seriously.
The letter I’m describing here and the next section about calling in supporters is largely based on a treatment called SPACE developed and scientifically tested by Eli Lebowitz and his colleagues. The process is much more extensive than what I’ve written in this article. If this sounds like something that may help you, please consider reading his books, Breaking Free of Childhood Anxiety and Treating Childhood and Adolescent Anxiety.
I have a treatment program for parents that teaches SPACE.
Lebowitz suggests printing this letter and giving it to your child, then reading it aloud. He also says that even if your child’s response is to put their fingers in their ears and rip the letter into pieces, it has still sent a meaningful signal to your child that you are serious about ending the violence.
The goals of the letter are to clearly define the specific problem of physical violence and say exactly what will happen in response. This makes clear exactly what is happening and escalates the situation in your child’s mind.
One of the biggest problems with physical violence and intimidation is that families don’t talk about it. This letter states clearly what the behavior is and how the parents are going to respond from now on.
There is a very important thing that the letter does not do. It does not tell the child what they need to do differently. This is strategic and by design. Lebowitz says that the parents need to take responsibility for what the parent will do and how they will respond, but they should not tell the child what they should do, as this will be perceived as criticism and blaming, no matter how carefully done.
Here is a sample letter:
August, we love you very much and know how hard you have been working over the past year. We know you have been struggling to control your anger, and we’ve also noticed that lately, you have become violent with Mom. For example, on Friday when she asked you to take out the trash you called her names, cursed, pushed her, and scratched her face with your fingernails.
This has been really scary for all of us, and we know it’s a sign that you’re really struggling. We also know that you are a strong person and that you can manage your anger even when it feels so big and out of control.
We’ve been trying to ignore that this is happening and not talking about it with you, but we realize that by doing this, we’ve not actually been helping you to manage your anger. Now that we understand this, we’ve decided to make a change so that we can help you better.
We want you to know that we recognize that your behavior is because of how you’re feeling. It’s not a sign of a flaw in your character or personality. We believe in you, and we know that if we work on this together it will get better.
From now on, when your anger gets to the level of physical violence and intimidation (such as getting too close, waving your arms around, hitting, slapping, scratching, biting, or pinching), Mom is not going to argue with you, talk you down, or try to hold your arms at your sides. Instead, she’s going to tell you what she sees and what she’s going to do. Then she will walk into our bedroom and lock the door until she feels it is safe to come out.
We know that this will be hard for you, but we also know that you can handle it.
If this happens, the three of us will talk about exactly what violent behaviors Mom observed in detail. It is important to us that we specifically discuss violence and don’t keep any secrets about it even when we know that you are not intending to hurt your mom.
We know you have been working really hard on your mental health, and we believe this is an important way that we can help you get better.
Love, Mom and Dad
3. Bring in supporters
If your child continues to physically threaten and attack you, then it’s time to enlist help from your community. This may feel like an extreme response, but it’s much less extreme and often more effective than calling the police.
This is based on the strength of our social and community relationships. We are social beings, and the thought of someone outside the family witnessing the child’s violence can help end unacceptable patterns of violence. When done with support and love, bringing in supporters can make a huge difference.
“The role of supporters is not to shame children or embarrass them but rather to rally round the children, giving them the message ‘We all care about you, believe in you, and are going to help you.’” – Eli Lebowitz & Haim Ober, Treating Childhood and Adolescent Anxiety
Make a list of people in your family and community who might be able to help you. You are looking for people who have high levels of compassion and a good relationship with your child. Possible options include grandparents, uncles, aunts, friends and family, sports coaches, teachers, school psychologists, guidance counselors, your child’s eating disorder treatment team, and others.
Lebowitz suggests a list of 5-10 supporters, at least some of whom are in your physical community. Then reach out to them and explain the reason for your request.
August has been really struggling with anger, and sometimes he gets violent with me. We are working really hard on this, and we’re reaching out to see if you’d be willing to lend a hand sometimes. We’ve been told that violence thrives in secret, but that bringing in supportive others from our community can help end it. I guess this is what they mean when they say “it takes a village!”
The first thing I’m asking you to do is call, text, or talk to August and tell him that he is important to you, that you care about him, and you understand he is working hard. However, you are aware that he is sometimes getting violent with me. Say you feel strongly that violence is a problem, and you support us (his parents) in this issue. If you’d like, you may offer to help such as being available by text or phone to support him.
Next, I’d like to tell you each time there is an incidence of physical violence. This will be embarrassing for all of us, but it’s important that we stay honest about what is going on. If this happens, I would like you to contact August and tell him you are aware of the violence. As before, please begin by telling him you care about him and believe in him. However, you are aware of what happened and that his behavior is unacceptable. If you’d like, you may offer to help such as being available by text or phone to support him.
Finally, I’ll also let you know when things are going well. This part will be much more fun, as you could reach out to August and let him know you’re proud of him. If you’d like, you could offer to do something fun with him to celebrate.
Telling your child about supporters
Once you have contacted your supporters, tell your child what you have done. You can say something like “August, your violent behavior has been escalating, so we have decided to get some community support. We have contacted [list the names] and told them about what’s going on. They’re going to contact you in the next few days, and we will also tell them each time you get violent with us.”
Your child will not like that you have told outsiders about their violent behavior. Be unwavering in your belief that this is the best approach, as your next option is calling the police, which is really a last resort. Don’t debate why you did this, who you chose, or whether it’s a terrible idea. Stay firm in your conviction that this is the right thing to do.
“Any objection on the part of the child to this step should be met with a simple statement: ‘When you act in a violent way, we will not keep that a secret.’ Parents should adamantly avoid any further discussion of this point.” – Eli Lebowitz & Haim Ober, Treating Childhood and Adolescent Anxiety
When things get violent during eating disorder recovery
This article is designed to give you ideas about how to handle violent and aggressive behavior during eating disorder recovery. As I mentioned, there are two excellent books that describe these concepts in much greater detail: Breaking Free of Childhood Anxiety and Treating Childhood and Adolescent Anxiety.
If your child is getting violent while they are in recovery from an eating disorder, then I encourage you to seek professional support for yourself as you navigate this difficult situation. You will likely need it, and you definitely deserve support. You will also be more effective if you have someone who can help you weather this storm.
Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.
She’s the founder of More-Love.org and a Parent Coach who helps parents handle their kids’ food and body issues.