The 3 types of stress and eating disorders

Monique is very worried about her daughter Maya. After a few years of struggling to deal with stress, Maya is now deep into an eating disorder. Monique and her husband Leonard are dedicated to helping her recover, but they are worried that stress is a major ongoing problem. 

“I worry that unless we address her stress, she’s still going to struggle,” says Monique. “Eating disorder treatment is hard, and it seems to me like if we don’t figure out how to reduce her stress, we’re just treading water with her mental health. I just don’t know what to do about it.” 

Maya, 16, has always been a sensitive child. “When she was a toddler, she was really picky about her food and clothing,” says Monique. “So I adjusted her diet and made sure I didn’t buy her any clothes with tags. She seemed to do OK for years, but when puberty hit, she started spiraling into stress. Now it seems like she just can’t handle life, and it’s not as simple as it was when she was little and I could control everything and reduce the stressors.” 

Everything that Monique says makes sense. And she’s right: without addressing Maya’s struggles with stress, it will be hard to achieve eating disorder recovery and, ultimately, mental health. 

Why so stressed?

To get started, I asked Monique some questions about what stresses Maya out. Based on her childhood experiences, it sounds like Maya is a highly sensitive individual. This means that she is naturally more sensitive to stressors. But what exactly is creating so much stress for Maya right now?

I started by defining the three types of stress and how they appear when a person has an eating disorder. Stress is an important part of the psychology of an eating disorder. The three types of stress are:

1. Healthy stress

Not all stress is bad! We need stress to learn and grow. Without stress, we would never achieve maturity. This stress is healthy and adaptive, but that doesn’t mean it’s comfortable. In fact, healthy stress can trigger all the troubling signs of emotional dysregulation, including yelling, crying, and avoiding tasks that seem impossible. However, when a person faces their healthy stress with courage, their struggles build emotional resilience and maturity. A person cannot mature without healthy stress! 

It’s not really the type or size of the stress that you experience but your ability to cope with the stress that defines whether stress is helpful or toxic. 

Some forms of healthy stress that your child must navigate if they have an eating disorder include:

• Eating enough food
• Eating regularly throughout the day
• Body changes (e.g. weight gain)
• Going to therapy, medical, and nutrition appointments
• Disagreeing with parents and siblings
• Being assertive about needs and boundaries
• Going to school
• Completing difficult school tests and assignments 
• Studying
• Having reasonable expectations of extra curricular activities
• Making new friends and socializing
• Having social media limits
• Getting to bed at a healthy time each night

🔑 The key if your child is experiencing healthy stress is to validate their experience (e.g. “this is hard”) while also expressing confidence in their ability to handle it (e.g. “I know you can handle this.”). Seek ways to support your child through healthy stress daily, and get coaching and support if this is a struggle for you.

2. Traumatic stress

This sort of stress is related to a specific event or action. It overwhelms a person’s coping resources and may become stuck if not processed. Common forms of traumatic stress include:

• Serious accident 
• Physical or sexual assault
• Physical or emotional abuse
• Exposure to traumatic events at home, including domestic violence
• Serious health problems, such as heart surgery, cancer, etc.
• Having a sibling or parent with a chronic illness (physical or mental)
• The death of someone close, such as a parent or sibling
• Divorce
• Vomiting, choking, and painful gastrointestinal episodes

The interesting thing about traumatic stress is that it doesn’t impact everyone equally. Two people can face the same traumatic event, and one may develop traumatic stress symptoms while the other may not. The difference between ongoing symptoms after traumatic stress is whether the event is processed healthily. Some people can do this by themselves, but many others need a lot of emotional support to process a traumatic event. 

For example, many kids get through their parents’ divorce without any PTSD, while others need some help processing their feelings about the divorce and its impact on the family.

🔑 If your child is experiencing traumatic stress, the key is to get them professional support to process their trauma. A therapist specializing in PTSD will support your child in facing their fear and overcoming the long-term impacts of traumatic stress. You can also learn skills to respond to your child’s PTSD appropriately.

3. Chronic stress

Chronic stress builds over time. A person experiencing chronic stress often feels stuck and unable to make changes to improve their life. This sort of stress is often entrenched and hard to break out of, but parents can help. According to Yale Medicine, some symptoms of chronic stress include: 

• Aches and pains
• Insomnia or sleepiness
• A change in social behavior, such as staying in often
• Low energy
• Unfocused or cloudy thinking
• Change in appetite
• Increased alcohol or drug use
• Change in emotional responses to others
• Emotional withdrawal

Common stressors to be aware of in your child’s life include:

• Difficult family relationships, especially with parents and siblings
• Lack of sleep
• Lack of family structure and support
• A heavy workload at school 
• Pressure to achieve certain grades and achievements
• Intense sports activities/expectations
• Pressure to perform at very high levels at school or in extracurricular activities
• Bullying
• Overuse of social media 

Chronic stress needs to be addressed to recover from an eating disorder. Your child’s lifestyle must change to reduce chronic stress and build experiences of healthy stress. 

🔑 There are two keys if your child is experiencing chronic stress. The first is to reduce unnecessary stressors in your child’s life. This can begin by looking at their schedule and removing non-essential activities and pressure to perform. The second is to turn the necessary stressors of life (e.g. eating, going to school) into healthy stress. With the right approach, you can help your child gradually turn chronic stress about eating and other stressors into healthy stress. 

Maya’s stress and eating disorder

I reviewed Maya’s stress with Monique using a worksheet I created. Together, we identified three primary issues that need to be addressed right away: 

Eating Stress (chronic)

Maya feels tremendous stress about eating. She is worried about food all day, and it is hard for Monique to calm Maya enough to get the nutrition she needs to recover. 

🔑  This is chronic stress that can be turned into healthy stress. In combination with Maya’s eating disorder treatment team, Monique can support Maya and help her face the stress of eating with courage and determination. Over time, she will learn to face eating and mealtimes as healthy stress. While eating may continue to be challenging for her, she can transform it from chronic stress to healthy stress. 

Sibling Stress (chronic/traumatic)

Maya and her brother Victor have a negative relationship. Victor is aggressive with Maya and frequently criticizes her. Sometimes he even gets physically violent and pushes or pinches her. 

🔑  This is chronic stress that needs to be eliminated. Monique and Leonard need to immediately seek therapy for Victor and set firm boundaries around how he treats his sister. Monique and Leonard must intervene whenever they observe Victor being aggressive, critical, and violent with Maya. There should be a zero-tolerance policy for these behaviors in the household. Additionally, they should have Maya see a trauma specialist who can determine how best to address any trauma resulting from her brother’s treatment.

Performance Stress (chronic)

Maya feels overloaded with homework and tests. She has a lifelong dream of attending an Ivy League university. The pressure to perform has become overwhelming, and Maya spends hours trying to motivate herself to do homework and study. Her grades have been steadily slipping, and she often stays up until 2 a.m. trying to complete her work.

🔑  This chronic stress needs to be adjusted. While academic goals can be a healthy form of stress, it is clear that they have crossed the boundary and become chronic stress. Maya needs support from her therapist to re-evaluate her goals and get healthy study habits and boundaries in place. Monique and Leonard should meet with Maya’s school counselor to determine reasonable expectations and help Maya manage her academic goals. 

Moving forward

Understanding Maya’s stress helps Monique and Leonard see how stress affects Maya and how they can help her start having less toxic stress in her life. Knowing the three types of stress affecting eating disorder recovery has given them the confidence to start making changes at home and in Maya’s treatment program. 

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

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