Category: Causes of Eating Disorders

Your child’s eating disorder and depression are likely linked. Depression is both a risk factor and maintaining factor of an eating disorder. This is important, because both eating disorders and depression are common and increasing among all populations, particularly children and teens.

As with anxiety, your child’s treatment for depression first and foremost needs to focus on eating regular meals containing enough nutrition. If your child is weight suppressed, restricting, purging, and/or skipping meals, then the lack of nourishing food is likely contributing to and maintaining their depression symptoms. Even with treatment, it is unlikely that your child’s depression will decrease if they lack nutrition.

Additionally, depressive symptoms are strongly associated with both stress and a lack of sleep. Evaluate your child’s lifestyle right now and determine whether you need to take things off their plate to reduce stress and ensure they are able to get the hours of sleep recommended for their age. Few people get enough sleep, but impaired sleep is both a risk factor and a symptom of depression, and it must be addressed for any other attempts to treat depression to work.

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Psychological symptoms of depression

Depression is both physical and psychological. Most people are familiar with and look for the psychological symptoms of depression, which include:

• Feelings of sadness, tearfulness, emptiness or hopelessness
• Angry outbursts, irritability or frustration, even over small matters
• Loss of interest or pleasure in most or all normal activities
• Anxiety, agitation or restlessness
• Feelings of worthlessness or guilt, fixating on past failures or self-blame
• Trouble thinking, concentrating, making decisions and remembering things
• Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide

Physical symptoms of depression

Parents should be aware that physical symptoms of depression are common. In fact, physical symptoms may be your child’s only symptoms of depression. There is a strong link between increased sensations of pain and depression based on a shared neurologic pathway. Physical symptoms of depression include: 

• Headache
• Joint pain
• Limb pain
• Back pain
• Fatigue
• Sleep disturbances
• Slowed thinking, speaking or body movements

Importantly, other physical symptoms of depression include gastrointestinal distress (stomachaches, nausea, etc.) and a change in appetite (either high or low), which makes it a major risk factor and maintaining factor for eating disorders.

Depression affects the way your child perceives food. Some kids with depression find that food looks and tastes “gray” and dull. This can exacerbate restrictive eating issues. Other kids will seek comfort and solace in food when they are depressed. It may be the one way they can “feel” something, which may lead to increased binge eating. In other words, your child’s depression is very likely interacting with their eating disorder behaviors.

What causes depression?

Many different factors cause depression. Like eating disorders, depression is a biopsychosocial disorder that combines biological, psychological and social risk factors, including:

Biological risk factors: Reduced production of the neurotransmitters in the brain including serotonin, norepinephrine, dopamine, gamma – aminobutyric acid (GABA), cerebral nerve growth factor and more.

Psychological risk factors: Other mental disorders including anxiety, eating disorders, and depression (people who have one depressive episode are more likely to have another). Low self-esteem, emotional repression, cognitive distortions, a lack of emotional regulation, and low self-efficacy or agency.

Social risk factors: Adverse childhood events, childhood trauma, early adversity including food insecurity, stress, parental depression and substance use, non-supportive school or family environments, and social forces of oppression like sexism, racism, weight stigma, etc.

Emotional Regulation Worksheets

Give your child the best tools to grow more confident, calm and resilient so they can feel better, fast!

• Self-Esteem
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• Mindfulness
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How depression works

Like anxiety, depression occurs along a spectrum. Most people feel sadness and even despair regularly – even daily. Sadness is a natural human emotion that is ideally noticed and processed when it arises. However, if a person avoids feelings of sadness and represses their experiences of sadness, leaving those feelings unprocessed, they may experience a depressive episode.

“I often think of depression as “stuck sadness.” In fact, when clients come in for therapy and tell me that they are depressed, my first thought is, “What is the sadness they are not allowing themselves to experience?”

Elaine Carney Gibson / Your Family Revealed

In a depressive episode, clinically called “major depression,” a person has persistent symptoms for at least two weeks. However, if the episode extends to two years, it is called persistent depressive disorder. Depression is the most common psychiatric disorder in people who die by suicide, making it an important condition to treat, especially when combined with an eating disorder.  

Treating depression and your child’s eating disorder

If your child is in a depressive episode, they should receive therapy to treat it. The most common treatment for depression is cognitive behavioral therapy (CBT). Another evidence-based treatment for depression is interpersonal psychotherapy (IPT), which focuses on improving interpersonal functioning.

I have seen success in treating depression with Internal Family Systems (IFS) therapy as well as somatic therapies. Your child’s doctor may recommend psychiatric medications. These medications are short-term interventions and should be used in conjunction with psychotherapy and emotional development. If your child does not learn emotional processing skills they remain at risk for future depressive episodes.

Keep in mind that feeling sad sometimes – even every day – is not the same as being depressed. Sad is a core human emotion and is both normal and natural. Support your child in feeling their feelings and emotions during eating disorder recovery. Most feelings, even the hard ones like anger, jealousy, and sadness, pass in about 30-90 seconds. The danger is not feeling sadness, but rather repressing or getting lost in it. If your child’s sadness is persistent and feels hopeless for two weeks, seek professional support for depression. 

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Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate their kid’s eating disorder recovery. Ginny has been researching, writing about, and supporting parents who have kids with eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.

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

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.

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• Self-Esteem
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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.

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Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate their kid’s eating disorder recovery. Ginny has been researching, writing about, and supporting parents who have kids with eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.

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

Jill is beside herself with worry. Her daughter Melody has an eating disorder and is struggling with loneliness. Between treatment, COVID restrictions, and starting high school, she has become very isolated. “She has always been more on the introverted side,” says Jill. “But it’s gotten to the point where I’m pretty sure she doesn’t have a single good friend.”

“She has people she talks to in class,” says Jill. “But there’s nobody she can call or share notes with or hang out with after class or on the weekend. I think that loneliness is making it harder to recover from her eating disorder. But loneliness is also partly driven by the eating disorder. I don’t know what to do.”

Jill’s worry makes a lot of sense. And she’s right that loneliness is both a contributing factor to and a symptom of an eating disorder. Melody is naturally introverted. But she’s also been hit with a triple whammy: a pandemic, the transition to high school, and eating disorder recovery.

Loneliness and social isolation

Loneliness is a major factor in mental and physical health. In fact, social relationships are the most important lifestyle factor in longevity. Social connections are even more important to health than avoiding tobacco and alcohol. Humans are social beings, and connecting with others is essential to our health and well-being.

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• Self-Esteem
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• Calming strategies

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How to help a child who has an eating disorder decrease loneliness

Of course parents like Jill desperately want their kids to form social connections and feel a sense of belonging. This is especially important during the teenage years, so it’s understandable that Jill is concerned. But what can she do? How can Jill help Melody reduce her loneliness during eating disorder recovery?

Friendships lead to positive life satisfaction, minimize stress, and even contribute to better physical health outcomes. And the good news is that there is a lot that parents can do to support social connections. Here are five places to start:

1. Reduce the pressure

The first thing to know is that every person has a different need in terms of social connections. And while most of us think about a large pack of kids getting together on the weekends, it’s perfectly acceptable if your teenager has just one or two good friends. In fact, set your sights very low: one.

“The biggest return we get in friendship is going from zero to one friend in terms of its impact on our mental health and well-being,”  says Marisa Franco, author of Platonic: How the Science of Attachment Can Help You Make — and Keep — Friends. “If you can get that deep with one person, it’s going to be powerful and it’s going to be impactful, and you don’t need to have a ton of friends.”

Taking the pressure off having a large number of friends can be a great place to start. Find ways to weave this idea into your conversations with your child. You can talk about your own friends individually vs. as a group. And when your child complains about having no friends (plural), help them understand that just one friend would be awesome. Encourage them to look around for just one person at school who they can eat lunch with. Set your sights low, and normalize the idea of just one friend.

2. Family relationships

Your child wants and needs peer friendships, but that doesn’t mean they can’t get a lot of benefits from their social connections with family.

Our first social group is our family. How strong are your family ties? Does your child feel integrated and as if they “belong” to your family? Start by building family traditions and telling stories that help your child see how they fit into the family. Spend time building family integration every single day. A great place to begin is a family meal, which has countless health benefits, probably in part because of the social belonging it builds.

If possible, schedule activities with extended family members. It’s OK if you don’t have a strong connection with biological family – can you build a family of friends? Do what you can to expand your child’s social interactions within the scope of your family. And don’t forget to help them integrate into family activities. This may be uncomfortable if your child is feeling lonely and vulnerable, but parents can help grease the wheels of interaction!

3. Social skills

If your child is struggling with loneliness and an eating disorder, combined with COVID and a major transition like starting high school, they may need to brush up on their social skills. This can be a tricky area for parents to get involved, but the first thing to consider is whether your family is upholding and modeling good social skills.

Many families slip into dysfunctional patterns of not being friendly, not speaking politely to each other, not managing their emotions, and acting out against other family members. If you see these dynamics in your family, then get some coaching or family counseling to work on interpersonal boundaries and emotional regulation. Before you decide that your child is the one who has a problem with social skills, consider whether this is a family dynamic. It will hurt your child’s chances of success if you treat a family problem as if it is a personal failure.

Next, talk to your child about social skills. The easiest way to do this is to talk about your own experiences or use characters on TV and movies. Ask questions like: How would that behavior make you feel? What do you like about that character? How do you think that character could be a better friend? Remind your child that relationships can’t be adequately portrayed in the media, and that just like bodies, we need to take media relationships with a grain of salt.

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4. Formal social groups

Teens have undergone tremendous upheaval in the past few years, and lots of them are struggling with loneliness. This is the perfect time to use formal social groups and organizations to help support social development. Ask your child to investigate clubs at school.

Many schools have a wide variety of clubs that appeal to a broad array of personalities and interests, but you can also look for clubs in the community and at your place of worship if you have one.

Encourage your child to join at least one club. This may require some well-placed parental pressure. Someone who is lonely may resist the idea of joining a club because they are stuck in a cycle of feeling low. It’s OK for you to insist on some participation. You can’t force your child to go, but don’t underestimate the power you have to influence them to give it a try. Sometimes lonely kids need a lot of verbal encouragement and requests to get out of their rut.

5. Get help

If you do all these things and your child’s loneliness is not lifting at all, then you and your child need more help. Talk to your child’s eating disorder care team. They are probably as concerned about loneliness as you are. Find out if they have any suggestions or can help your child get involved in activities. Sometimes having a non-parent make these suggestions is the key to getting them done.

A worthy focus

Loneliness is a contributor to the psychology of an eating disorder, so supporting them in addressing this is a worthwhile activity. You want to understand your child’s loneliness and support them in feeling better. Loneliness has been correlated with eating disorders and other mental disorders. It is also correlated with the No. 2 and No. 3 mortality factors: tobacco and alcohol addiction.

Jill was relieved to know that she wasn’t being silly worrying about loneliness. “There was a part of me that thought maybe I was worrying about nothing,” she says. “Or that this is none of my business. But now I feel as if my worries make sense, and I’m going to take some action to start helping Melody feel better.”

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Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate their kid’s eating disorder recovery. Ginny has been researching, writing about, and supporting parents who have kids with eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.

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

Research links

Social relationships and mortality risk: A meta-analytic review, Holt-Lunstad, Julianne, Smith, Timothy R., and Layton, Bradley J, PLOS Medicine, 2010

Loneliness and Social Isolation as Risk Factors for Mortality, Julianne Holt-Lunstad, Perspectives on Psychological Science, 2015.

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. 

Emotional Regulation Worksheets

Give your child the best tools to grow more confident, calm and resilient so they can feel better, fast!

• Self-Esteem
• Self-Regulation
• Mindfulness
• Calming strategies

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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.

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• Self-Esteem
• Self-Regulation
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• Calming strategies

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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

Emotional Regulation Worksheets

Give your child the best tools to grow more confident, calm and resilient so they can feel better, fast!

• Self-Esteem
• Self-Regulation
• Mindfulness
• Calming strategies

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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. 

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Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate their kid’s eating disorder recovery. Ginny has been researching, writing about, and supporting parents who have kids with eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.

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

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

If your child has an eating disorder, recovery means more than simply gaining weight and/or stopping eating disorder behaviors; it means becoming mentally healthy. Eating disorders are frequently misunderstood, and people don’t always realize that mental health, not just eating disorder recovery, is the goal. 

That’s why I’ve put together a mental health checklist to help you set expectations and goals as your child recovers from their eating disorder. This mental health checklist is especially important if your child is returning to college or independent living after undergoing recovery in your home and/or a treatment facility.

Eating disorders are often layered on top of poor mental health and other mental disorders, so if parents don’t pay attention to mental health overall, they risk having a boomerang effect of having a child leave and return to eating disorder treatment. While you can’t control their recovery, you can do your best to set your child up for success. Nobody wants your child to feel they are ready to return to independent living or go to college only to discover that they are not yet equipped to care for themselves, so the more you can help them build the skills they need to be mentally healthy, the better. A mental health checklist to be used during and after eating disorder recovery can help.

Free Download: Mental Health Checklist for Eating Disorder Recovery

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How to measure mental health

Mental health sometimes feels arbitrary. But in fact, we can measure mental health based on the behaviors that lead to and indicate mental health. It’s just like eating disorders. Except for medically-underweight anorexia, eating disorders don’t often have measurable physical symptoms. Instead, they are diagnosed based on the behaviors observed. 

For example, eating disorders are measured by how often a person eats, how much they eat, and how they feel about eating. Similarly, mental health can be measured by how well a person takes care of themselves and how they feel about themselves.

In addition to your child’s recovery process, they should be learning to take care of their physical health, which includes at a minimum: 

• Getting adequate food and water
• Moving their body appropriately
• Getting enough sleep
• Basic hygiene

Beyond basic physical healthcare, your child should also take care of their emotional health, which includes at a minimum: 

• Connecting with others
• Managing social media use
• Practicing mindfulness
• Getting outdoors
• Asking for help
• Taking breaks
• Having self-compassion

Physical self-care after an eating disorder

Even if your child is cleared of an active eating disorder diagnosis, they are still at risk of mental illness. They will need to care for their bodies and minds intentionally for life. This is important for every person, but particularly for someone who has/had an eating disorder. Here are the basic physical care steps that your child should take to improve mental health. 

Getting adequate food and water

All bodies need enough food and water to function. And a lack of food and water has a significant impact on both mental and physical health. When someone has/had an eating disorder, it’s an indication that they may need to be more vigilant than others about caring for this most basic element of self-care. As your child transitions to living independently from you, they should demonstrate an ability to feed themselves adequate quantities of food every 3-4 hours and drink at least 6-8 glasses of water daily. 

Moving their body appropriately

Our bodies are made to move. Regular movement is essential to both physical and mental health. The tricky part is that many people who have eating disorders incorporate excessive exercise and/or are at risk of serious health complications if they exercise. However, as your child recovers from their eating disorder, they should work in regular movement to maintain health. This can be functional like having a walking commute to work or school, going for a short walk each day, doing a brief home exercise routine, or joining a gym or attending fitness classes. Your child should demonstrate an ability to move their body regularly, not too much and not too little.

Getting enough sleep

Getting enough sleep is a cornerstone of mental health. Your child needs 8-9 hours of sleep per night. People with eating disorders and other behavioral and mental health problems often experience sleep loss. Your child may have insomnia or struggle to settle down and get to sleep. While it’s easy to dismiss sleep as unimportant, it is as important as food, water, and movement to the human body and mental health. Sleep loss is no joke for anyone, but it is particularly risky for someone who has been diagnosed with a mental disorder like an eating disorder. Losing sleep is a major risk for someone with a history of mental disorders. Therefore, your child should demonstrate an ability to get adequate sleep each night and wake up at an appropriate hour in the morning. 

Basic hygiene

While basic hygiene may seem like a given, it can be a major struggle for someone with an eating disorder, anxiety, depression, or other mental disorder. On the one hand, if your child has OCD, they may lead towards overdoing hygiene. Some people will wash and clean themselves excessively. On the other hand, someone who is depressed or has ADHD may feel unable to clean themselves adequately. Either way, taking care of basic hygiene is essential to mental health. Like exercise, you’ll need to measure whether your child’s challenge is doing too much or too little and work from there. Set some basic expectations, like flossing and brushing teeth twice daily. Bathing can vary per person, but discuss the maximum number of days between showers and/or the maximum number of showers per day. Your child should demonstrate an ability to take care of their basic hygiene. 

Free Download: Mental Health Checklist for Eating Disorder Recovery

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Emotional self-care after an eating disorder

An eating disorder is a mental illness. This means that while physical symptoms and/or behaviors are used to diagnose an eating disorder, it is emotional and mental in nature. This means that your child needs to care for their emotional health. This is important for everyone, but particularly for someone who has/had an eating disorder. Here are the basic emotional self-care steps that your child should take to maintain their mental health. 

Connecting with others

Human connection is as important as food, water, sleep, and movement. It is a sign of mental health to reach out to other people. It doesn’t have to be lengthy or intense. Still, you should feel confident that your child has some human connection daily. It might be a phone call to a loved one, but it could also be as simple as going in person to get groceries or food and speaking to someone while getting it instead of ordering contactless delivery. 

Managing social media use

Social media can be a major impediment to mental health for numerous reasons. It is particularly dangerous for people who have/had eating disorders due to the algorithmic preference for very thin people who promote “healthy lifestyles” that include eating disorder behaviors and beliefs. While zero social media use might be ideal for mental health, it’s not realistic or necessary for most people. Your child should demonstrate that they can set limits on their usage. 

Practicing mindfulness

One of the symptoms of an eating disorder is a disconnection between the mind and the body. It’s as if the brain-body connection is severed. To recover and maintain mental health, your child needs to practice a mindful connection between the brain and body. Your child should have a daily mindfulness practice that actively connects the brain and body.

Getting outdoors

Studies have shown that being in nature, even for a few minutes daily, has numerous physical benefits, including less pain and lower diastolic blood pressure. It improves mood and reduces the risk of mental illness. Support your child in getting outdoors for at least a few minutes daily. They can combine this with either exercise or mindfulness, or both. They should take a few moments to feel the air in their lungs and look at the sky, a tree, or anything natural and not human-made.

Asking for help

There is a tendency when someone has a mental disorder like an eating disorder, anxiety, depression, etc., to self-isolate. They reach out less to people who care about them and say less about how they are feeling. You want to support your child in reaching out for help when they feel sad, scared, or angry. Nobody can take their feelings away, but sharing our feelings with other people is soothing and improves mental health. 

Free Download: Mental Health Checklist for Eating Disorder Recovery

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Taking breaks

The brain-body disconnection common in eating disorders often translates to ignoring signs of mental or physical fatigue. A mentally healthy person recognizes when they need a break and takes breaks to improve their health and performance. Help your child learn to take breaks when they are overwhelmed or having physical or mental symptoms of fatigue.

Having self-compassion

A mentally healthy person has compassion for themselves. They don’t beat themselves up when they make mistakes and don’t speak cruelly or dismissively to themselves. They know how to soothe themselves when things go wrong and treat themselves as they would a good friend. Help your child learn to speak to themself with self-compassion and love.

Giving your child a mental health checklist for eating disorder recovery

Discussing mental health with your child while they are still recovering from an eating disorder and preparing to leave your daily care will help them build mental health. You can create your own checklist or use the one I created. The checklist I created includes both daily actions and warning signs to keep in mind. You can provide this to your child and talk with them regularly about both elements: are they doing daily self-care, and are there any warning signs to address? This can help you communicate your concern for their mental health, even if your child isn’t living with you.

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Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate their kid’s eating disorder recovery. Ginny has been researching, writing about, and supporting parents who have kids with eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.

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

If you have a child who has an eating disorder, then you should expect to see fear and worry. This is because eating disorders often show up with, and in response to, anxiety. Eating disorder behaviors can be an attempt to cope with anxious feelings and thoughts. And luckily, parents have a significant impact on kids’ anxiety.

But unfortunately, our instinctual responses to our kids’ anxiety can accidentally make it worse over time!

In fact, there are treatment programs in which parents of anxious kids are the only ones who are treated. That’s right: while it’s ideal if your child is also getting treatment for anxiety, it’s not a requirement for them to start feeling (and acting) better. You can do a lot to change the course of their anxiety. Anxiety is highly responsive to relationships. You will either see it grow or decrease depending on how you respond. 

Emotional Regulation Worksheets

Give your child the best tools to grow more confident, calm and resilient so they can feel better, fast!

• Self-Esteem
• Self-Regulation
• Mindfulness
• Calming strategies

Learn More

What does anxiety look like in an eating disorder?

Anxiety can be a bit tricky to see without some practice. Many people who develop eating disorders have learned to cloak their anxiety with anger, sadness, fighting, and withdrawal. Here are the top signals of anxiety, fear, and worry when there’s an eating disorder:

1. Worry about weight
2. Fear of food
3. Anger about rules, restriction, and efforts to control eating disorder behaviors
4. Sadness about perceived failure and disappointing their parents, friends, etc.
5. Fighting and negotiating about recovery steps and expectations
6. Withdrawal, shutdown, or a refusal to talk or engage in family activities

Anger, fighting, and sadness are the most distracting versions of anxiety. And parents typically respond to them with confusion and surprise. It seems like you’re asking your child to do something that makes perfect logical sense, so why are they so upset about it? 

The key is to know that they are upset about it because their anxiety has been triggered, and one of the ways anxiety maintains control is to put out distractions from the bigger issue, which is the fact that their anxiety response is over-reactive. 

The solution if your child has a lot of worry and fear, or if they are angry, sad, fighting you, or withdrawing when they have an eating disorder, is to learn how to respond to anxiety better. 

How to deal with fear and worry in eating disorder recovery

First, let’s set the table. I want you to start talking about worry, fear, and other scary feelings regularly. Have regular conversations with your child about what anxiety is, how it shows up, and how you’re going to respond to it now that you know this. 

The most important message I’m sharing today is that worry, fear, and other big feelings will show up, and that’s OK, but we’re not going to let them make important decisions about what we do and don’t do.

Demystify anxiety. It follows a predictable pattern. It’s rarely helpful to be surprised by it, try to ignore it or force it to go away. Instead, it’s best to talk about it, recognize it, and even welcome it into your life without letting it control your life.

Never threaten anxiety. Let it exist; just don’t let it run the show.

1. Expect anxiety to show up (it will!)

One of the most confusing things about having a child with an eating disorder is how resistant they can be to recovery. Even if they say they want to recover, it may seem to you as if they are not taking the action they need to recover. 

It’s important to think a bit differently. While it’s true that your child may not be taking the action they need to recover, it’s not because they don’t want to. It’s because anxiety keeps showing up and telling them it’s not safe to recover. 

Anxiety’s job is to warn us of danger and keep us from doing things that make us uncomfortable. 

But the only way to heal from an eating disorder is to feel things like fear and worry and do the thing you need to do anyway. 

The only way out is through!

So the first thing you need to do as a parent is to stop being surprised by anxiety. Start to expect it. Expect anxiety to show up every time you put food in front of your child, and lots of other times, too. 

A child who has an eating disorder typically has a hair-trigger response to even small threats. Their amygdala is highly-responsive right now. So you’re going to see anxiety a lot. Don’t be surprised; expect it.

2. Tell your child that it’s OK to feel afraid and worried sometimes (it makes sense!)

Most parents automatically respond to anxiety reactions like worry, fear, and anger by trying to shut it down or ignore it. This makes sense because your own anxiety senses danger and wants to keep you safe. I get it.

But instead, you need to face your own anxiety about your child’s anxiety head-on. Remember: the only way out is through!

When you try to debate, diminish, or ignore anxiety, it gets stronger, digging in deeper and justifying its existence as the savior.

Instead, when you see your child getting anxious, name it. Say something like “oh look, here’s some worry. It makes sense that you get worried sometimes. I get it.” 

You can replace the word “worry” with other words like sad, angry, frustrated, irritated, scared, etc. Try to find the word that makes your child feel seen, heard, and understood. This takes some practice, but you can do it!

This removes the need for the child to justify and defend their anxiety. When you remove the opportunity for debate, you take away an essential part of anxiety escalation. 

Emotional Regulation Worksheets

Give your child the best tools to grow more confident, calm and resilient so they can feel better, fast!

• Self-Esteem
• Self-Regulation
• Mindfulness
• Calming strategies

Learn More

3. Remind your child that the path to feeling better is not to avoid fear but to face fear (and do it anyway!)

Once you have acknowledged that anxiety is present in the form of worry, fear, anger, etc., take some time to let your child feel that you believe them when they say they feel however they feel. 

When you sense that they “feel felt,” then you can move on to the next stage. It’s OK if you need to try this a few times. This takes practice and is almost never perfect. That’s OK!

Now you want to remind your child that feeling worried and nervous is perfectly normal, but that we can’t live our lives according to anxiety’s demands. 

Of course, this means that you should have those pre-conversations with your child about what anxiety is, how it shows up, and how you’re going to respond to it now that you know this. 

Your response to anxiety is: worry, fear, and other big feelings will show up, and that’s OK, but we’re not going to let them make important decisions about what we do and don’t do.

4. Believe that your child can learn to tolerate their fear (they can!).

One of the biggest impediments to kids learning to tolerate anxiety is that parents worry it is not possible. Here again, we recognize that your worry as a parent can impact your child’s relationship with worry. 

So come up with a mantra for facing your fears and doing it anyway. The only proven way to reduce anxiety is to train the amygdala and your thoughts to face anxiety and build up the muscles of tolerance and acceptance.

Remember that trying to avoid anxiety will make it get stronger, but facing it and doing the scary thing anyway will build the muscles that are needed to respond to anxiety appropriately. With practice, your child will do this by themself over time. But it’s very hard to do this without help and support at home.

How this looks at the dinner table

Here’s a quick scenario about how worry and fear can show up at the dinner table with an eating disorder. 

Take 1: letting anxiety run the show

• Child: I can’t eat. I’m full. You can’t make me!
• Parent: You have to eat! It’s important! You promised! 
• Child: I already ate enough. You know I can’t handle more. I’ll throw up! 
• Parent: You have to eat this food. It’s good for you. Just eat it so we can get on with life, will you?
• Child: You gave me too much! I can tell you added butter and oil – look! It’s just sitting on top. Gross!
• Parent: No I didn’t! It’s the same thing I make every time. I didn’t change anything!

In this scenario, the parent is accidentally engaging in a debate with anxiety. This gives the anxiety a sense of power and control. And it usually makes the situation worse, not better.

Take 2: standing up to anxiety

• Child: I can’t eat. I’m full. You can’t make me!
• Parent: Yeah, you often feel this way at dinner. I get it. 
• Child: No you don’t! You don’t understand anything!
• Parent: It seems like you’re really upset.
• Child: Yes I am! I hate this!
• Parent: I get it. I really do. But remember that we talked about this, and we’re not letting worry run the show anymore. Let’s put worry aside for dinner tonight and we’ll talk to it some more after we eat if we need to.
• Child: You’re just trying to control me!
• Parent: Yeah, I know that’s what your worry says, and I understand that’s how it feels. Like I said, let’s get through dinner and then see what worry has to say to us later. 
• Child: that’s stupid (they take a bite).

In this scenario, the parent is not fighting with or trying to make the anxiety go away. They’re acknowledging and validating the existence of anxiety and asking the child to do the hard thing even though they feel anxious.

Practice, not perfect

This is a practice, and it takes time for parents to learn a different way of responding to anxiety. If this sounds impossible right now, I get it. But trust the process. It works.

Anxiety is one of the most common mental disorders, and we have thousands and thousands of research papers examining what it is and how it works. There is a lot of data to support this treatment approach to a child with anxiety. 

One of the things we know is that for most parents, their instinctual response to anxiety will accidentally increase a child’s anxiety over time rather than decrease it. But at the same time, when parents learn and practice new skills for responding to anxiety, they will see a decrease in anxious outbursts and behaviors. 

Anxiety is the most treatable psychological disorder, and since it underlies and drives so many other disorders, including eating disorders. Emotions during eating disorder recovery are hard to handle, so it makes sense to learn some new skills for responding to anxiety differently. 

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Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate their kid’s eating disorder recovery. Ginny has been researching, writing about, and supporting parents who have kids with eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.

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