Anxiety and your child’s eating disorder

Anxiety disorders, which very often show up with an eating disorder, are both the most common and the most treatable mental disorders. And parents who have been trained in how to respond to kids’ anxiety are the most powerful treatment providers.

The biggest barrier to recovering from an anxiety disorder is the belief that “being anxious” is a personality type rather than a pattern that can be changed. When we have a child with an anxiety disorder and we say “oh, that’s just how they are,” we miss an important opportunity to help them learn the skills that will free them from the tyranny of an anxiety disorder.

Anxiety is a common underlying and co-occurring factor in eating disorders. And like eating disorders, anxiety is on the rise. Almost 12% of kids had anxiety in 2012, up 20% from 2007. In 2020, those numbers nearly doubled, with reports showing that more than 20% of kids struggle with anxiety symptoms.

The good news is that there are things that parents can do to reduce kids’ anxiety, and this work will benefit eating disorder recovery. The more parents understand and respond to anxiety strategically, the better their chances of success.

What is anxiety?

Anxiety is a feedback loop between the body and mind.  All animals have anxiety because it’s essential to survival. However, our modern lifestyles bear almost no resemblance to the environments in which our brains evolved. Today our most common threats are not to our bodies (predators, enemies, and natural disasters), but our emotional safety (attachment and self-worth). Instead of protecting us from physical danger and death, as they were designed to do, today our anxiety system reacts to non-deadly threats to emotional safety.

Our incredible minds are what makes us susceptible to anxiety disorders, and they are also the solution to anxiety disorders. Here’s how anxiety works:

1. Body-based anxiety

Anxiety is an emotion we feel in our bodies. It comes from the nervous system and is a body-based alert to perceived danger from things we see, smell, taste, touch, or hear, the sensation of our internal organs, and even other people’s emotional states.

When alerted to danger, our nervous system automatically sends an alert to the thinking mind. Think of it as a smoke alarm. There may be smoke, there may be fire, or the smoke alarm may be over-reacting. Regardless, the smoke alarm makes a noise to get the mind to pay attention to the risk and take action.

Something to consider is that a major reason for a smoke alarm to overreact is hunger. A hungry brain is an anxious brain. If your child is weight-suppressed, restricting, purging, and/or eating chaotically, this needs to be addressed immediately in order for anxiety symptoms to reduce. If you need help getting your child weight-restored, consider increasing their level of care. Weight gain and consistent eating should be a priority, since weight suppression and chaotic eating will interfere with all other treatment approaches. 

2. Mind-based anxiety

When the smoke alarm is triggered, the mind responds. This is a healthy response to feeling anxious. After all, if there’s fire, you need your mind to kick into action fast. If you are in physical danger, you need your mind to respond and tell your legs to run. But if there’s not actually a fire, the body and mind can get stuck in a loop of anxiety, ramping each other up. Here’s what this looks like:

Body: I sense danger!

Mind: We’re in danger!

Body: We’re in serious danger!

Mind: We’re going to die!

Body: Run!

But since we’re almost never in true physical danger, this is an over-reactive pattern. Here’s a more mindful response:

Body: I sense danger!

Mind: OK – let me look around and see if we’re in danger

Body: I feel nervous

Mind: Makes sense, but we’re actually safe. Thanks for the warning though!

Body: OK

Our bodies are going to alert us to danger because that’s what they are designed to do. Recovering from an anxiety disorder means learning to use the power of our minds to evaluate the risk rather than overreact to the body’s alarm system. Over time, our body’s alarm system learns that it doesn’t have to be quite so reactive, and our anxiety reduces though it never disappears because that would be dangerous. Anxiety is a feature, not a flaw. We just need to learn to work with it.

Luckily, there is a lot parents can do to reduce kids’ anxiety. Studies show that parents have a tremendous impact on kids’ anxiety. And the good news is that parents can learn to reliably reduce their kids’ anxiety by acknowledging it and helping kids mindfully engage with anxiety rather than automatically reacting to it. You can help your child interrupt the anxious body-mind loop and teach them to step back and recognize false alarms. With practice, the smoke alarm gets less alarming and life gets a lot easier.

What doesn’t work

There are a lot of things that parents do when anxiety shows up that are well-meaning and automatic but simply don’t work. If they worked, they would decrease anxiety, stress, and worry over time, but that’s not usually the case. They include:

• Reassuring, rescuing & overprotecting
• Providing certainty and making promises
• Identifying your child’s anxiety disorder as a personality trait rather than a treatable condition
• Allowing behavior like yelling, swearing, tantrums, hitting, refusing to eat, over-exercising, and purging because it’s driven by anxiety 
• Responding to your child’s anxiety with your anxiety 
• Pushing too hard to shut anxiety down, becoming angry, explosive, and punishing 

Unfortunately, most of the time, when we respond in these ways, our kids’ anxiety gets bigger (not smaller) over time.

An example of anxiety in an eating disorder

Anxiety feels terrible. There’s no fire, but the body and mind are activated. They want to take action. The want to DO SOMETHING! There are two ways people with anxiety disorders try to calm their anxiety. First, they seek certainty, and second, they seek reassurance. 

Seeking certainty typically looks like trying to control what’s happening or what could happen. For example, your child may feel anxious in fast food restaurants so they refuse to go into fast food restaurants. It seems like if they follow this rule, they will not feel anxious. But it doesn’t work. Soon it becomes all restaurants, then parties, then family meals. Their anxiety keeps expanding despite their best efforts to control it.

Seeking reassurance looks like getting people around you to tell you things are OK. For example, your child may complain about their body. You respond by engaging in long, fruitless conversations about their body, but it doesn’t make the anxiety go away. In fact, the more you debate, the worse it gets.

The key with anxiety is that the more your child tries to control things and seek certainty, the more anxious they will become. This is why anxiety and eating disorders typically worsen over time if this anxious pattern isn’t interrupted. 

An unintended impact

Well-meaning parents don’t want their kids to be anxious. Of course we don’t! Anxiety is terrible! But when we accommodate anxiety’s demands for certainty and control, we accidentally make it more likely the anxiety and eating disorder behaviors will get stronger over time. 

Parental accommodation looks like this: if the child is seeking certainty by not eating carbs, parents allow them not to eat carbs. If the child seeks reassurance by body-bashing themselves, parents engage in long, drawn-out conversations about how beautiful their child’s body is. 

Again, if these responses worked and made the anxiety and eating disorder better, that would be great. But typically, we see an increase in symptoms when we accommodate anxiety-driven eating disorder behaviors.

How parents can respond to anxiety differently

To help kids recover from their eating disorders, parents can respond to anxiety differently and ensure they aren’t accommodating certainty- and reassurance-seeking. Instead, try this:

1. Expect anxiety to show up. Stop being surprised by each new occurrence of anxiety. Look for anxiety, especially when your child is eating or thinking about their body.
2. Manage your emotions first. If you are anxious, your child’s anxiety is likely to get worse. Learn how to recognize your anxiety and respond to it with self-compassion.
3. Validate your child’s feelings of anxiety. Don’t ignore anxiety or jump into action with certainty and reassurance. Acknowledge that they are having feelings like worry, stress, and anxiety.
4. Support your child in doing and thinking things that make them feel anxious. Don’t accommodate them and help them avoid doing or feeling the things that make them feel anxious. 

My favorite phrase when validating and supporting a child through anxiety is: I get it – this is hard, but you can handle it.

Anxiety disorders are both the most common and the most treatable mental disorders. Anxiety disorders do not need to be a life sentence. Changing your natural, loving, and understandable accommodation patterns when your child is anxious is really hard. But it can also transform recovery and support your child in feeling much better. If you’d like to learn precisely how to stop parental accommodation, check out Supportive Parenting for Anxious Childhood Emotions (SPACE). Also, you can see our guide to psychology and eating disorders.

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