How to handle violence during eating disorder recovery

Sometimes when a child has an eating disorder they get aggressive and even violent with family members. This is a deeply upsetting situation for parents. It’s especially hard if you’re already worn out from months or even years of caring for a child with 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.

During eating disorder treatment, your child may have verbal or physical outbursts for seemingly minor things. The key is to work on understanding why they are getting so upset and to manage your own reaction to their emotional outburst. Trying to shut down violet behavior during eating disorder recovery isn’t typically effective, but managing your reactions to the behavior can defuse the situation and make things much better.

Someone with an eating disorder is living in a state of extremely high emotional dysregulation. This is a physiological state that is designed to keep us safe from predators. When it goes into overdrive, it can lead to a near-constant state of fight, flight, or freeze.

When your child is violent and aggressive in eating disorder recovery, it means they’re in a fight response. It is a signal that they are experiencing extreme fear and anxiety. It is not a sign that they have a character flaw or aren’t trying hard enough. When we soothe their physiological state, they will start to feel better and the violence will reduce.  

What happens when a child with an eating disorder gets violent

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 does happen during eating disorder recovery, but it’s also something that needs to stop. There are no conditions under which a parent should accept violence. Additionally, your child’s violence is a symptom of extreme emotional distress. Living in a state of constant “fight” is not healthy. This means that ignoring it or pretending violence isn’t 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 during eating disorder recovery

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. Respond to food aggression

The most common response to violent outbursts is to fight back with some form of physical or verbal wrestling about food and eating. However, when parents do this it rarely defuses the emotional tension that drove your child to their 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:

2. 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.

3. 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.

4. Narrate what’s going on

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.

5. Don’t debate

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.”

6. Follow up

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.  

If violence continues: 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.

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.

If violence continues: 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.

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. If your child is struggling with emotions in eating disorder recovery, then I encourage you to seek professional coaching and 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.

See Our Guide to Emotions And Eating Disorders