How to use punishment, rewards, and boundaries for an eating disorder

Bridget and Tom are struggling to figure out how to support their child Lex without enabling her. “We’ve tried punishment, rewards, and boundaries,” says Bridget. “But nothing seems to be working. The eating disorder isn’t budging. In fact it’s getting worse, and we’re getting so burned out. What can we do?”

I get it. When parents are using punishments and rewards, they’re trying to motivate a child to recover. But while punishment and rewards are commonly-used parenting techniques, they tend to fail with an eating disorder for various reasons. Many parents try to establish boundaries instead, but because they misunderstand what boundaries are (and what they are not!), this can backfire, too. 

The only way to motivate someone to recover from an eating disorder is to build their autonomy and identity, and punishments and rewards directly interfere with that. Meanwhile, boundaries are how parents can make sure they aren’t enabling or accommodating eating disorder behaviors. But not all boundaries are the same and understanding what does and doesn’t work makes all the difference.

Using punishment to deter eating disorder behaviors

A large portion of parenting advice has historically been based on punishing the behavior we don’t want our child to do. Since punishment feels pretty harsh to most of us, modern parents prefer the word “consequences.” Whether you call it punishment or consequence, the idea is something like this: if you don’t get off your phone, I’ll take it away for a week. Using punishments to teach a child makes perfect sense intuitively. After all, if you do something and receive negative feedback for it, shouldn’t that mean you won’t do it again? 

But unfortunately we know with certainty that as much as this approach makes intuitive sense, it is not actually effective parenting. Punishment is strongly associated with defiance, opposition, rebellion, and giving up. 

Punishment does not motivate kids to do the things we want them to do. Instead, it teaches them to avoid getting caught doing it. That’s why punishment can backfire when it comes to an eating disorder. The last thing we want is for a child to take their eating disorder underground where it becomes invisible. If we can’t see the eating disorder behaviors, we have almost no hope of motivating a child to change their behavior. 

There are a few limited situations in which you might use consequences/punishment for eating disorder behavior, but I would be very, very careful about this. Punishing a child for using a coping behavior (even one that is dangerous) is misguided at best, harmful at worst. And keep in mind that negative words, criticism, and judgment are just as punishing as physical consequences.

Using rewards to incentivize eating disorder recovery behaviors

The opposite of punishing negative behavior is rewarding positive behavior. This approach to parenting is also well-established. The idea is that rather than focusing on what you want your child to stop doing (e.g. restricting, binge eating, purging), you focus on what you want them to start doing (e.g. eating regular meals, going to therapy, etc.). And instead of punishing the behavior you want to stop, you reward the behavior you want to start. This is how most animal training works: when my dog sits, I give him a treat. 

This makes sense, and there is some good evidence for focusing on rewards rather than punishments. However, it can have unfortunate consequences in eating disorder treatment and recovery. Because while rewarding behavior makes intuitive sense, in humans it tends to reduce intrinsic motivation, or the desire to make behavior change for oneself vs. for external reasons. 

When parents reward a child for doing something, they can accidentally reduce their child’s intrinsic motivation to keep doing it. Getting a reward for taking positive action can, unfortunately, reduce a person’s perceived autonomy, or the idea that they are doing the action for themselves vs. someone else or exclusively to gain a reward.

This doesn’t mean you can’t ever reward your child for taking positive steps towards recovery. You just want to make sure you’re keeping in mind that their autonomous drive can be negatively impacted by doing so. To motivate recovery, you want to reinforce their sense of independence and agency at all times. Just like punishment, when your child has an eating disorder you must use rewards intentionally and with forethought.

Setting boundaries when your child has an eating disorder

The difference between punishment, rewards, and boundaries is mainly about who is taking action. When you punish or reward your child for an action they took, it’s about their behavior. When you set a boundary, it’s about your own behavior. 

For example, you may be in a situation in which your child is often yelling at you, which upsets you. You could either punish a child who yells at you or reward a child who speaks calmly. But this keeps the focus entirely on their behavior. On the other hand, boundaries mean that you tell your child during a calm moment that you don’t like being yelled at and are going to change the way you respond when it happens. Then when you are being yelled at, you tell them that you don’t like being yelled at. If they continue, you tell them that you don’t like being yelled at and are going to walk away. Finally, you follow through and consistently act on your boundary every time you are yelled at.

The focus is all about you. “I don’t like being yelled at” is very different from “stop yelling at me.” And “I’m going to walk away” is very different from “Why do you always yell at me? You’re so mean!” A boundary does not ask your child to change anything, do anything, or feel anything. It doesn’t make the child responsible for how you feel. It focuses entirely on what you like, dislike, and will do for yourself.

Focus on boundaries

This is the area you want to focus on most when your child has an eating disorder. Because short of force-feeding a child, which is rarely but indeed sometimes medically necessary, you can’t really control eating behavior. And even if you do, in the process you might damage your child’s sense of agency and their intrinsic motivation to recover. 

However, you can decide what you will do when your child refuses to eat, binge eats, or purges. How will you respond? What boundaries will you set about your own behavior? How will you make sure you aren’t enabling or accommodating the eating disorder? And to be clear, your boundaries should not feel like punishments or rewards. They should be clearly explained in advance and carried through without judgment or criticism. 

Clear boundaries about parental behavior is how parents can be supportive without enabling the eating disorder. It’s a tricky balance, but it’s possible. 

Checking in with Bridget and Tom

Bridget and Tom have agreed that punishments and rewards are not working to help Lex. And while they tried boundaries, they see now that their boundaries have actually been another form of punishment and reward. “I didn’t really see the difference between focusing on our behavior vs. focusing on what Lex is doing,” says Bridget. “In hindsight, I can see that our boundaries didn’t work because we were still trying to control her. Controlling myself, I’ve discovered, is actually even harder!”

I get it! When you switch the focus from changing your child to changing yourself, you realize how hard it is to build new patterns of behavior. Families all have patterns that unconsciously drive and support our behavior. Parenting a child with an eating disorder is about both supporting the child in getting treatment and also changing any parental behaviors that may be accommodating the eating disorder.

Bridget and Tom are working hard to disrupt their unconscious patterns and intentionally build parent-focused boundaries. “I’m already seeing a difference in how our household operates,” says Bridget. “And there are a lot of ways I can see we’ve been accommodating the eating disorder. Lex has resisted most of the changes we’ve made, but I’ve been surprised to notice that she ultimately accepts our boundaries. I think she feels more secure with our boundaries in place. I’m noticing small but important changes in her behavior now that we’re focusing on what we’re doing.”

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

See Our Guide To Parenting A Child With An Eating Disorder