The risks of accommodating an eating disorder

Rachel was at the end of her rope. After years of trying to help her daughter Lily claw her way out of anorexia, it simply wasn’t getting any better.

Sure, there was COVID to blame. The pandemic made Lily even more socially isolated, and online treatment didn’t seem to be as effective. But overall, Rachel knew that Lily’s problem pre-dated the pandemic. And she was worried that it would extend way beyond the pandemic if something didn’t change fast. 

“The truth is that I’m completely burned out,” says Rachel. “This is my last hope. If this doesn’t work, I really don’t know what I’ll do or how I’ll keep this up. Something’s got to give.” 

Rachel has decided to try a treatment program called SPACE that focuses on changing her own behavior rather than trying to change Lily’s behavior.

“It’s just been a brick wall to try and convince Lily to recover,” says Rachel. “I know I’m not supposed to say this, but she just isn’t choosing recovery. She’s not taking any steps on her own to get better.”

Rachel is struggling under the caregiving burden. “When she was younger, she was a bit more self-sufficient, and being at school motivated her,” says Rachel. “But now she’s done with school, and she’s doing almost nothing. She lives with me, and I try to feed her six times per day like I’m supposed to. She’s nowhere close to feeding herself, and I can’t see her being able to get a job or move out.”

Rachel, like so many parents and caregivers, is terrified for her daughter. She’s also frustrated and fed up. Her diligent, valiant work feels like a drop in the bucket. The eating disorder is powerful, and she’s losing hope.

What is accommodation?

When someone is afraid of something, they naturally want to avoid it. 

Parental accommodation is a way that parents make it easier for their children to avoid doing the things that scare them. 

If your child screams when they see a spider, you whisk it away quickly and then soothe your child, trying to calm them down as soon as possible. This accommodation makes perfect sense.

But the next day, your child asks you to check under their bed for spiders before going to sleep. This, too, makes sense to you. You accommodate their wishes – it’s not a big deal! 

But the next day, your child asks you to check that their windows are locked tightly and check under the bed, scan the walls, and peer into the darkest corners of the closet with a flashlight to ensure there are no spiders. 

The accommodation snowball effect

You can see where this is going. Your child’s fear of spiders makes sense. But their avoidance of possibly encountering a spider ever again is becoming a problem. Even though you sense it’s wrong, you can’t imagine not accommodating them because they get so upset just thinking about spiders. It seems faster and easier to do what they ask than to convince them to go to sleep without it.

Sometimes you try to talk your child out of it. You prepare deeply-researched and highly-rational arguments to persuade them that spiders aren’t scary or dangerous. Sometimes you lose your temper and yell that you aren’t their personal spider valet and you won’t do this tomorrow night … this is the last time! 

But, of course, the next night, your child cries and seems so terrified that you give in one more time and look in all the nooks and crannies. Later they come into your room at midnight, wake you up, and beg you to check again.

You’re half asleep, and it seems like less trouble to just look than to try and convince your child there are no spiders, so you grudgingly get up, stomping your feet and huffing as you walk to their room and look in all the corners for spiders. 

You’re feeling angry, but you can’t see a way out of accommodating your child’s avoidance of possibly seeing a spider. You feel trapped and frustrated, stuck in a web.

How does accommodating impact eating disorders?

I started with a spider story because it feels less charged than an eating disorder. Eating disorders are complex, multi-layered mental disorders. Also, parents are not responsible for either their child’s fear of spiders or their eating disorder. It typically doesn’t work that way.

But parents may be responsible for accommodating their child’s anxiety-driven eating disorder behaviors.

Parental accommodation is called a “maintaining factor” in eating disorders. This means that it is not the cause of an eating disorder. But accommodation can make it easier for an eating disorder to dig its heels in and stick around for the long haul.

Eating disorder accommodation examples

There are many ways parents accidentally accommodate eating disorder behaviors. Let’s break down how accommodating can sneak into some of the common eating disorder recovery goals:  

• Goal: have the child eat regular, healthy meals.
• Accommodation: the child cries and yells at the dinner table. The parent becomes so distressed that they excuse the child before the meal is finished.

• Goal: cut down on ingredient checking and calorie counting
• Accommodation: the child refuses to eat until they know exactly how many calories are in the yogurt. It just seems easier and faster to tell them.

• Goal: have the child eat various foods, not a limited menu of “safe food.”
• Accommodation: when serving meals, the parent doesn’t offer new foods. They know their child will throw a fit or simply refuse to eat. Sometimes they try to add something new to the plate, but it goes so badly that they rarely do this.

• Goal: have the child eat comfortably with other people.
• Accommodation: the child becomes so upset about the idea of multiple people at the dinner table that the parents feed the child separately. Or they excuse the child from family meals because they are so distressed.

• Goal: for the child to accept their body and not worry about its appearance.
• Accommodation: when the child asks if they look bad, the parent freezes and ignores the question. Then, when the child doesn’t stop, the parent says in a falsely cheerful voice, “you’re just being silly – of course you’re beautiful!”

• Goal: the child attends scheduled meetings with professionals.
• Accommodation: the child insists that the therapist is useless. The nutritionist makes them eat unhealthy food, and the doctor is fatphobic and clueless. The parent spends hours every week convincing the child to attend just one more meeting. They use bribes and rewards, which work only some of the time.

All of these parental responses make perfect sense. If you do these things, you are not bad! Occasional accommodations make sense. But it can be a problem if parents repeat the same accommodation at every meal and/or the list of accommodations keeps growing. We want to stop accommodating eating disorder behavior even though it’s really, really uncomfortable for both the parent and the child. 

How can parents stop accommodating?

Parents can stop accommodating eating disorder behaviors, but it takes some careful thought, a solid strategy, and practice. It’s not a good idea to remove all your accommodations at once. A strategic, steady approach is best. 

First, you need to understand how you are accommodating the eating disorder behaviors and why you are accommodating. You will naturally think you are accommodating to avoid your child’s distress. But you are also accommodating to avoid your distress about your child’s distress. Make sense?

When your child yells and screams or slams their door in your face, you feel upset. You worry that your child will never get better. Of course you do!

This is what drives the accommodation. You want to avoid your child’s upsetting outburst, so you do whatever you can to avoid it. 

Start with you

Understanding your own worry is the first step to addressing and ending accommodation. Because ending accommodation is all about what you do. How your child responds must be relatively unimportant and not change your approach. 

You will take unilateral action to remove your accommodation lovingly and compassionately. And your child is going to be distressed. Both of you will be able to handle this distress. But you may need some support to prepare and get through it.

Next, you will pick a specific accommodation and make a detailed plan to stop doing it. You’ll tell your child what you’re going to do, why you’re doing it, and when you’ll begin doing it. 

Finally, you’ll follow through. You’ll stay steady even in the face of your child’s worry and anguish. This will be hard, but you know that continuing the accommodation, while possibly easier in the short term, will not help in the long term.

You’ll stay dedicated and single-minded in your commitment not to accommodate eating disorder behaviors anymore. Over time, your child will learn your boundaries. Your child will feel less anxious. You’ll interrupt the anxious cycle of an eating disorder and invite recovery to take root.

Rachel and Lily

Rachel was terrified of ending even her most minor accommodations. For example, she told Lily what was in her smoothie every day. This was happening even though it was exactly the same every day.

She made a plan and told Lily that she would not answer smoothie ingredient questions anymore. Lily asked a few times on the first day, and Rachel was near tears but held her boundary lovingly. 

The next day, Lily asked ten times and started to cry when Rachel held her compassionate boundary. She refused to drink her smoothie. Rachel worried that she was making a mistake or doing it wrong.

But on the third day, Lily asked Rachel once, then, shockingly, drank her smoothie. 

Progress!

“I nearly fell out of my chair,” says Rachel. “I couldn’t believe it didn’t keep getting worse.”

Lily asked about the smoothie ingredients every few days throughout the next few weeks. And if it was an especially stressful day, she asked several times in a row. But Rachel was confident that not reviewing the ingredients was the right thing to do to help Lily recover, so she held her boundary lovingly and firmly.

Over time, Rachel removed more and more accommodations. Some were easier than others, but she could see the benefits. Mealtimes were less stressful for Rachel, which meant she could better support Lily through the stress of eating. 

“I feel more hopeful today than I’ve felt in five years,” says Rachel. “This is the biggest improvement I’ve seen in a long time. I feel like I’m really getting the hang of not accommodating her eating disorder behaviors. I’m focusing on controlling myself rather than trying to control her.” Parenting a child with an eating disorder is challenging, and Rachel is doing a great job!

For privacy, names and identifying details have been changed in this article.

See Our Guide To Parenting A Child With An Eating Disorder