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A toolkit to cope with anxiety when your child has an eating disorder

A toolkit to cope with anxiety when your child has an eating disorder

Jamie feels helpless and frustrated. Her son Michael has an eating disorder and severe anxiety, and the combination is making life very hard for them. “I just want to be able to do things that other families do without thinking about it,” she says. “Like go to a restaurant or the movies without all the drama of the anxiety.”

I get it. Anxiety is stressful for everyone, and many parents feel helpless when anxiety shows up and takes over. This article will help you cope with anxiety when it shows up alongside an eating disorder.

Anxiety is a major underlying and co-occuring factor with eating disorders. And anxiety is on the rise for our tweens and teens. A study by the American College Health Association found a significant increase. Up to 62% of undergraduates reported anxiety in 2016, up from 50% in 2011. A more recent study conducted by the Health Resources and Services Administration (HRSA) found that between 2016 and 2020, the number of children ages 3-17 years diagnosed with anxiety grew by 29%.

Anxiety impacts almost every aspect of life. But anxiety is also a very treatable disorder. Things can get better! You can help by teaching your child to cope with anxiety when they have an eating disorder.

Coping tools for kids who have anxiety and an eating disorder

Anxiety disorders are hard to cope with, especially if they occur in conjunction with an eating disorder. Therapy for anxiety typically includes Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT). These treatments are designed to teach kids coping mechanisms and new thought patterns to get through anxiety.

If your child has an eating disorder, they should be receiving therapy to help them manage their anxiety. But some tools can help with short-term coping. While these tools don’t replace therapy, they can be very helpful for parents trying to cope with the stress of everyday living with anxiety and an eating disorder.

The tyranny of surprise

One of the hard things about having anxiety is that it can feel so surprising. Few people think of themselves or their kids as fragile. So we walk around expecting things to be fine. But then anxiety shows up apparently out of nowhere and surprises us. But the thing about anxiety is that it shows up reliably, usually every day. And often there are common threads before the anxiety shows up. We shouldn’t be surprised, and yet most of us are.

One idea is to start expecting anxiety to show up. This reduces the stress and anxiety about having anxiety. 

Parents can say things like “oh, here’s anxiety, I expected it, welcome anxiety!” Doing this takes some of the power away from anxiety. And it helps your child feel less vulnerable to its impact. When parents normalize and accept anxiety, it often feels less intense for everyone. 

That’s why I love using anxiety props and tools. They’re a great way to show that not only do you expect anxiety to show up, but you are also prepared for it and have your response ready to go. 

Build an anxiety toolkit 

I think it’s helpful to have some props or tools to cope with anxiety because it gives a visual and action-oriented response that shows you are not surprised or upset when anxiety appears. You can have one or two of these items available or even develop an “Emergency Anxiety Kit” with a few different options when you’re on the go. 

Talking with our kids about anxiety and discussing soothing tools that may help is important. Not every child responds similarly, so I have provided several options and ideas. Generally, we’re looking for tools that engage the senses. This helps ground the anxiety by responding neutrally when it shows up and stimulating the body’s five senses. 

Help your child find the tool or tools that help them get grounded during an anxiety episode. Here are some ideas:

1. Counting beads (touch)

Counting is very effective in soothing the mind during an anxiety episode. Many people who struggle with anxiety learn to look around and start counting items to help their brains regroup. This is a form of mindfulness. A good place to begin is with counting beads. You can get small beaded bracelets, (also called a prayer bracelet), which they can use to count silently.

The combination of touching the beads and counting can be very soothing. Your child may prefer one type of bead over another. Thus, it can help to test a few out if possible. The best part about beads is that they can be kept on the wrist or in a pocket. And it helps that they can be touched or counted without anyone knowing. 

2. Stress slime (touch)

Touching something during an anxiety episode can be very therapeutic, since anxiety often becomes trapped energy in our bodies. Slime can be a great way to provide our kids with a tactical outlet for their anxious energy. You can buy slime online. There are many types, including slime with styrofoam beads and other items that add to the tactile pleasure that slime provides.

You can also make slime using one of the hundreds of online recipes. Experiment with your child to develop different slimes. You can keep them in sealed containers or zip-top baggies so that they are always available for your child to use. 

3. Something soft (touch)

Sometimes there is nothing better than the feeling of something soft and furry when we’re stressed. This is the appeal of stuffed animals, which your child may keep in their room and stroke during stressful periods. Of course, a pet works well with that, too! Fur keychains are a popular trend right now that can be used as soothing tools without detection.

A very simple pocket-sized option to deliver softness is to go to the fabric store with your child and touch the fur and fleece fabrics. Select a few that feel best to your child, and purchase a quarter yard of each. Cut the fabric into pocket-sized squares or rectangles, and replace as often as necessary. Some children will find it soothing just to touch the fur with their fingers. Others may find it helpful to rub it on their arms or faces for soothing relief from stress.

4. Photos (sight)

When anxious, it’s easy to lose touch with our sense of place in the world. Even if plenty of people love us, anxiety can make us forget that momentarily. Kids may become flooded with fear that they will never belong and are all alone in the world. This is why photos can be grounding.

If your child has a smartphone, you can add some photos designed to remind them of the people and animals they love. Or you can print out photos to be kept in pockets or bags. 

For example, a photo of your daughter with her beloved cat can be an excellent reminder of unconditional love and acceptance. If your child has a deep affection for a cousin or extended family member, take a photo of them enjoying something together and add it to the collection. 

5. Music (sound)

Listening to music, playing an instrument, or singing can be a great tool for redirecting anxiety. You can create a playlist filled with songs to soothe anxiety so they can access music anytime anxiety strikes. Classical music is reliable in this way. Some great soothing classical music can be found on Baby Mozart-type albums.

If your child plays an instrument, you may suggest that they learn a piece by heart that they can play in times of stress. Choose something simple enough that they aren’t struggling yet challenging so that they engage their mind a little bit with the music. If your child enjoys singing, you may suggest they assign a favorite song to sing during times of anxiety. Ideally, this is a song to which they know all the words and that is inherently soothing. Lullabies and favorite childhood songs are a great choice.

6. Peppermint (taste/smell)

Studies have shown that people exposed to peppermint oil feel a sense of calm and alertness. When studying drivers, studies have shown that peppermint can reduce frustration, anxiety, and fatigue. The simplest way to get some peppermint into your child’s system is to provide them with some peppermint candies that contain real peppermint oil. They can keep the candies in their pocket and suck on them to help soothe their anxiety.

Another method is to smell peppermint oil. This can be done by adding a drop of peppermint essential oil to a cotton ball and putting it in a zip-top bag that can be kept in your child’s pocket. You can also add peppermint essential oil to slime, or you can make a small clay diffuser that your child can have available as needed.

Learning to help kids cope with anxiety and an eating disorder will help a lot with your child’s emotional regulation. And the good thing is that once you’ve learned it, it gets easier each time. Anxiety is normal – everyone has it. But we want to help our kids who have eating disorders cope with anxiety as best they can. 

Jamie saw a difference as soon as she put together her anxiety toolkit for Michael. “The biggest thing is that I felt like I knew what I was doing and was supposed to do when his anxiety showed up,” she said. “I never realized how stressed I was every time I detected anxiety. Now I feel like I know what to do. And it doesn’t work perfectly, of course, but it has helped us many times when he started to spiral and needed a little help grounding himself.”

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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

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Loneliness and eating disorders: a guide for parents

loneliness eating disorder

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.

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 satisfactionminimize 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.

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

Considering your child’s loneliness during eating disorder recovery 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.”

loneliness eating disorder

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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.

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When your child has an eating disorder and a drinking problem

eating disorder drinking problem

Many parents find themselves at the crossroads of an eating disorder and a drinking problem. The disorders are linked and often seen together. So how can a parent help?

  1. Understand why your child has an eating disorder and a drinking problem
  2. Learn the steps to recovery
  3. Support your child’s recovery

Many people who have eating disorders also have a problem with alcohol abuse. It helps to understand the correlation between alcohol and eating disorders. This requires looking closely at the true reason for disordered behavior.

1. Understand why your child has an eating disorder and a drinking problem

Let’s start by understanding why your child has an eating disorder and a drinking problem.

The surface reason for an eating disorder is to control things like weight, body shape, food and exercise. A person who has an eating disorder becomes obsessive and compulsive about eating or not eating, moving or not moving. They use their body as a way to communicate who they are and what is important to them.

Meanwhile, the surface reason for a drinking problem is to have fun, to relax, to be social. A person who has a drinking problem has taken something that a lot of people do (drinking) and become obsessive and compulsive about it. They use alcohol as a way to fit in, communicate, and feel better.

But both of these conditions are actually driven by a deeper need to numb. The underlying purpose is to protect against uncomfortable feelings and emotions. Therefore, eating disorders can be a way to avoid feelings of anger, loneliness, anxiety, and depression. Similarly, alcohol can do the same. A drunk person is less likely to feel unhappy, lonely, or stressed.

Some facts about drinking

  • By age 15, about 33 percent of teens have had at least 1 drink.
  • By age 18, about 60 percent of teens have had at least 1 drink.
  • In 2015, 7.7 million young people ages 12–20 reported that they drank alcohol beyond “just a few sips” in the past month.
  • 5.1 million young people reported binge drinking (for males 5 or more drinks and for females 4 or more drinks on the same occasion within a few hours) at least once in the past month.
  • 1.3 million young people reported binge drinking on 5 or more days over the past month.

Eating disorders and alcohol use can create a vicious cycle. The person avoids uncomfortable feelings and fails to adopt healthy coping mechanisms. Instead of learning to process stress and discomfort, people who have eating disorders and drinking problems rely on coping behaviors.

People who have eating disorders and problems with alcohol have common personality traits. These include impulsive and dramatic dispositions, anxiety and perfectionism. These personality traits are often considered the foundation on which eating disorders and alcoholism are founded. In other words eating disorders and alcohol disorders are a way to regulate emotions.

The signs of eating disorder and a drinking problem are very similar

  • Changes in mood, including anger and irritability
  • Academic and/or behavioral problems in school
  • Rebelliousness
  • Changing groups of friends
  • Low energy level
  • Less interest in activities
  • Problems concentrating and/or remembering
  • Coordination problems

People who have eating disorders and alcohol problems tend to use more even when they can see that it’s working against them. The alcoholic wakes up with tremendous remorse. They feel regret following a night of drinking and promise to stop drinking forever, only to begin again later that same day.

Similarly, someone who has an eating disorder may awake feeling disgusted by their binge and purge episode the night before. They feel ashamed of their need for this devastating behavior and promise to stop. They start out being “good” by restricting food the next day. But they will likely return to binging and purging at night.

Both the person with the eating disorder and the person with the problem drinking recognizes that they have a problem. They often feel ashamed of the problem. They want it to stop. But they also feel compelled to continue doing it. Therefore, they can’t stop.

The known contributors to eating disorders and problem drinking are very similar

  • Genetics
  • Social factors, such as media and advertising or the influence of peers
  • Family dynamics
  • Accessibility
  • High stress
  • Depression
  • Anxiety disorder
  • Abuse, neglect, or other traumatic experiences in childhood

Just like with eating disorders, trauma is highly linked to substance abuse. In fact up to 70% of adolescents who are being treated for substance abuse have a history of trauma. Teenagers who are exposed to physical or sexual abuse are even more likely (3x) to struggle with substances. And more than half of teens who have been diagnosed with Post Traumatic Stress Disorder (PTSD) develop substance abuse problems.

With all of this information, it’s important for parents to understand why these disorders arise. We often focus on the behaviors without thinking about the underlying causes. However, when we pay attention to the causes of eating disorders and alcohol abuse, we can treat them with greater results.

2. Learn the steps to recovery

Now that you understand why your child has an eating disorder and a drinking problem, it’s time to look at recovery.

It makes sense to want to stop the behavior right away. But it’s important not to lose sight of how difficult this will be without learning new skills. And new skills require practice and reinforcement. Therefore, we like to look at recovery as having three parts:

  1. Stopping the behavior: in this part, your child learns to live without their eating disorder behaviors and drinking. This may happen in an inpatient treatment center or at home. Many treatment approaches tackle this first. But it’s also OK to take an individualized approach. Sometimes it can be helpful to work on the other two components first. It really depends on professional assessment of your child’s physical health and imminent danger.
  2. Learning emotional regulation: people who have eating disorders and drinking problems have trouble with emotional regulation. Emotional dysregulation is normal and natural. It’s a physiological response to stressors. Your child was using an eating disorder and drinking to regulate their emotions. So now they need to learn new skills.
  3. Practice and reinforcement: traditional treatment usually ends before a person is fully recovered. Recovery can be practiced and reinforced at home. But many times a person returns to an unchanged environment. In these cases we know they are likely to pick up their old patterns and behaviors.

As you can see, the third stage of recovery is critical for ongoing success. And it’s primarily something that’s done at home with parents. This gets us to the next part …

emotional regulation

3. Support your child’s recovery

You can support your child’s recovery at home by making some changes. Your main role is in the practice and reinforcement part of recovery. For instance, here’s what this might look like for someone who has an eating disorder and a drinking problem:

  • Parents learn emotional co-regulation to help their child calm down when dysregulated
  • Alcohol is removed from the home and nobody in the house drinks around the child
  • Dieting is not allowed in the home. And nobody in the house talks about weight or labels food as good or bad
  • The family regularly talks about and learns about the dangers of drinking and dieting. They take action to reduce harm in their community
  • Parents address issues in the family dynamics that may contribute to stress. For example, treating siblings appropriately, maintaining healthy family leadership, the parental role, etc.
  • The family focuses on building connection and belonging. In other words, they spend time talking and spending time together

Each family will do this a little bit differently. There is no one-size-fits all solution for eating disorders and alcoholism. But one thing is clear: parents should get help and support. Parents can can learn and grow and support their kids through recovery. If you’re facing this, consider getting a therapist or coach who can guide you.

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.


Alcohol Use Disorder Comorbidity in Eating Disorders: A Multicenter Study

How do eating disorders and alcohol use disorder influence each other?

Eating Disorders and Addictions Cause a Deadly Combination

Alcohol and Trauma: Drinking as a Way to Cope with the Past

Dual Diagnosis – Addiction and Eating Disorders

National Institute on Alcohol Abuse and Alcoholism

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5 ways to help a perfectionist who has an eating disorder

5 ways to help a perfectionist who has an eating disorder

What can you do if you love a perfectionist who has an eating disorder? Luckily, there’s a lot you can do! First, let’s take a look at some facts:

  1. Perfectionism is both a risk factor for and commonly co-occurs with eating disorders. Many people who have an eating disorder also have perfectionism. And perfectionism is damaging to almost every aspect of mental health.
  2. Perfectionism is preventable and treatable, especially in children and teens. Luckily, perfectionism, which is often a response to anxiety, is both preventable and treatable. Recovering from perfectionism is often a significant part of eating disorder recovery.
  3. Parents can have a significant impact on reducing and treating perfectionism. Almost nobody is as important to reversing the effects of perfectionism as parents. Perfectionism is not hard-wired; it’s a response to environmental factors in the family. This means parents and the family can help reverse it.

When a person is both a perfectionist and has an eating disorder they are attempting to find safety through their behaviors. Whether it’s making sure their hair and homework are just right (perfectionism) or limiting their food to only “healthy” choices (eating disorder), both impact quality of life and mental health.

Here are five ways that parents can help a perfectionist who has an eating disorder recover from both conditions. These efforts need to be done consistently and intentionally every day to help a child reduce performance anxiety and find peace.

1. Show your child that it’s safe to make mistakes

Many parents tell their kids they can make mistakes, but then when kids do make mistakes, parental behavior suggests that mistakes are unacceptable. Pay attention to how you feel and behave when your child makes a mistake. Loosen your body and face, and feel from within that your child is lovable and fabulous with their mistakes.

What this looks like: When a child comes home with a lower score than you would expect on a test, respond neutrally. Keep your face relaxed, and thank them for sharing their score with you. If they want to talk about it, keep your comments focused on reassuring them that everyone misses their goals sometimes. And one score doesn’t make a grade.

With an eating disorder: When a child complains that they didn’t “eat healthy” or don’t like their body, respond neutrally. Don’t try to convince them that they ate perfectly or look amazing. Instead, let them know that what they eat changes day to day, and food does not have the power to make or break their health. And remind them that looking perfect is an arbitrary, impossible goal, and there is no such thing in real life.

2. Hold off on fixing

Most parents jump in too quickly with advice and solutions. This perpetuates the belief that mistakes are intolerable. Part of how we show kids that mistakes are OK is by being supportive without trying to fix the problem. We can agree that making mistakes is hard, tell them we understand that it feels bad, and show them that we can handle any mistake without changing how we feel about them.

What it looks like: In the case of the lower score, you will be tempted to ask them about their studying techniques or how they can bring their grade up. Resist this temptation! A perfectionist does not need anyone to tell them how to fix mistakes. They need people who can accept their mistakes and trust that whatever happens next is all right. You generally don’t have to worry about a perfectionistic child under-performing unless they are suffering from performance anxiety induced by perfectionism.

With an eating disorder: Avoid trying to help them prepare the perfect meal or find the perfect outfit. Don’t get into long discussions about how they can achieve their goal weight. Let them find their own solutions to their problems rather than diving in to try and fix them.

3. Make mistakes & talk about them

Many parents try to hide their own mistakes or at least not talk about them. Normalize mistake-making by intentionally talking about how it feels when you make a mistake. Look for opportunities to talk about your mistakes on purpose. Make mistakes on purpose and talk about them. This may be challenging for you if you also have perfectionism. But most of us can achieve great things on behalf of our kids’ health.

What it looks like: Open the fridge and see that you forgot something. Say “Oops! I forgot milk again. Oh well, that’s OK, we can handle it.” Don’t say this to your child directly – it’s not an apology. Saying it out loud means they can hear how to handle mistakes with self-compassion.

With an eating disorder: If you make a mistake like commenting on someone’s body (including theirs or your own), just apologize and move on. You don’t have to make a big deal about it or over-apologize. Everyone makes mistakes, and every time you make a mistake is an opportunity to show your child that it’s OK.

4. Talk about other people’s mistakes with compassion

Many parents berate strangers, food servers, retail workers, drivers on the road, and others when they make mistakes. This is modeling to your child that mistakes are something to feel ashamed of.

What it looks like: Instead of criticizing others when they make a mistake, take a deep breath. If it’s your husband who forgot the milk, open the fridge door and say “Oops! Dan forgot milk again. Oh well, that’s OK, we can handle it.” Show your child that you accept other people’s mistakes readily and without criticism.

With an eating disorder: If someone talks about dieting or weight loss, you can recognize that it’s problematic but also normalized in our culture. You don’t need to get overly angry when people do this, though you should talk about it directly with your child. Let them know that you don’t blame the person for their comment, but you also don’t endorse weight loss in any way.

5. Talk about perfectionism

Talk about perfectionism with compassion and kindness. You don’t want to turn “being a perfectionist” into something your child feels ashamed of. Instead, you can treat perfectionism as a part of your child (not the whole). No child is all one thing. We want to be very careful about pathologizing our child and treating them as if they are a victim of their impulses or coping behaviors.

What it looks like: When your child is upset because they made a mistake you can say things like “oh, I see your perfectionism is feeling bad about this. Let’s talk about it.” Then let your child process and untangle their perfectionist part from the part of them that accepts mistakes and feels safe with you.

With an eating disorder: When your child is upset about their eating or body, say things like “oh, I understand what it’s like to have a perfectionist’s voice. I know how hard it is, so let’s talk about it.” Then talk about the part of themselves who criticizes their choices and body.

You are the difference-maker

If your child is both a perfectionist and has an eating disorder, follow these five steps to help them recover. Your child’s therapist cannot do this alone in a one-hour meeting. It’s really best if you can reinforce acceptance at home in every possible moment.

Perfectionism is a social response, so it’s best treated in social situations. Nobody is better situated to counteract perfectionism than a parent who has consciously and intentionally decided to help their child avoid the tendency toward and consequences of perfectionism. When parents take this on and learn new skills, kids feel better.

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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Understanding self-harm and eating disorders

Understanding self-harm and eating disorders

Self-harm and eating disorders often coexist, and both are on the rise. A recent study found that nearly 1 in 4 teenage girls ages 14-18 in the United States engages in non-suicidal self-harming behavior. (American Journal of Public Health) Self-harm is the act of hurting oneself on purpose. The most common methods are cutting and burning.

Self-harm often co-occurs with eating disorders. One study estimated that about 25% of people in treatment for bulimia and 23% of people in treatment for anorexia engage in self-harm. (Eating Disorders) Based on my interviews and research, I estimate the number of people who both self-harm and have an eating disorder to be much higher than that.

Eating disorders and self-harm:

  • Often occur together
  • Require immediate, specialized help
  • Are powerful emotional coping methods
  • Frequently misunderstood as manipulation tactics
  • Use the body as a communication vehicle

Why self-harm?

Self-harm may seem like a bizarre behavior. But it is actually a powerful self-soothing activity that is a way to manage otherwise inexpressible anguish. In other words, the person who engages in self-harm is in a tremendous amount of psychic pain. Like eating disorders, self-harm is a powerful form of non-verbal communication. Both can be a call for help when the person suffering lacks adaptive methods of seeking support.

Researchers have found that people who self-harm develop a conditioned response to pain similar to the numbing created by opiate drugs. This response is why many people who self-harm feel “addicted” to their behavior. They often experience powerful cravings and withdrawal-like symptoms when they try to stop.

Who self-harms?

Self-injurers are often bright, talented, creative achievers. Self-harm is common among perfectionist and people-pleasers who present a happy face even when they are suffering greatly.

People who self-harm often put on a mask of self-sufficiency and appear fiercely independent. Underneath their mask, people with both eating disorders and self-harming behaviors suffer from seemingly insatiable emotional hunger. They long for acceptance, love, belonging, approval, and nurturance. The self-harm becomes a way to soothe themselves.

Self-harm and eating disorders can be described as maladaptive coping mechanisms. They help relieve tension, release anger, regain a sense of self-control, and eliminate a sense of emotional deadness.

“I have come to regard these behaviors as morbid forms of self-help because they provide rapid but temporary relief from distressing symptoms,” says Marilee Strong, author of A Bright Red Scream: Self-Mutilation and the Language of Pain.

Self-harm and eating disorders

Researchers have observed common roots in both self-harm and eating disorders. They both have a strong correlation with childhood physical and emotional abuse, particularly sexual abuse. Oftentimes, the abuse was not acknowledged or adequately treated. As a result, the person may have suppressed the memory and “forgotten” it occurred.

Many (not all) people who self-harm and/or have eating disorders have untreated Post Traumatic Stress Syndrome (PTSD). They feel unable to talk about and seek comfort for their trauma. Instead, a person who has an eating disorder or self-harms seeks to process their trauma within their own body, alone.

It has been proposed that both self-harm and eating disorders use the body to work out psychological conflicts. They appear to provide temporary relief from overwhelming feelings of tension, anger, loneliness, emptiness, and self-hatred. Many people use maladaptive coping mechanisms to manage PTSD symptoms such as dissociation, flashbacks, and hyperarousal.

Both self-harm and eating disorders can build a form of identity around the maladaptive behavior. A person can become strongly associated with their maladaptive coping mechanism and extremely resistant to stopping their behavior. “They come to believe that they are their symptoms, that there really is nothing but a void inside, and that if they were prevented from cutting they would fall apart, go crazy, disappear, cease to exist,” says Strong.

What parents need to know about self-harm and eating disorders

First, parents need to know that self-harm and eating disorders are complex coping behaviors. They are maladaptive, but that doesn’t mean they don’t provide a deep sense of relief. Self-harm and eating disorders are calming and soothing behaviors. It helps when parents recognize that the behavior is indicative of desperate emotional turmoil.

Parents cannot simply demand that a child stop self-harming or engaging in their eating disorders. They also cannot trust the child who self-harms or has an eating disorder to stop without treatment. The fact is that it’s hard to stop without help. And if parents push too hard, children may say they are “cured.” Meanwhile, they just find a better way to hide their disorder.

Self-harm and eating disorders are neither manipulative nor attention-seeking. But their existence indicates that a child needs professional treatment.

Parents can become focused on the physical behaviors. But they must know that the pain their child is inflicting on their body pales in comparison to the acute psychological pain they are experiencing inside. Parents must train themselves to pay attention to the unexpressed pain vs. focusing on the harm exhibited on the body. The act of self-harm can be viewed as a “form of language written on the body,” says Strong.

What parents can do to help their child who self-harms

Parents are in a powerful position when it comes to helping a child who self-harms and/or has an eating disorder. But to help our children, we must learn more about what is going on. And we must prepare ourselves for a challenging recovery. Both self-harm and eating disorders are powerful behavioral compulsions. They should never be taken lightly or without sincere dedication to education and treatment.

Before following the steps below, you must assess whether your child is in immediate physical danger. Contact the National Suicide Prevention Lifeline (24 hours): 1-800-273-8255 to determine whether hospitalization is necessary. Only consider these steps if you are sure your child is physically not in danger. 

1. Plan your approach

It is a common mistake to fly into a panic and approach your child immediately when you suspect self-harming behavior. This can backfire and create a greater obstacle to recovery. Take some time to learn about self-harm. Internalize the fact that self-harm is not “manipulative,” “disgusting,” “abhorrent,” or whatever it is that you naturally first assume. Only approach your child once you can find compassion for the behavior. Try to respect its role in your child’s life. Your goal is to get them into treatment. But they won’t go if they don’t trust you. Don’t think you can solve this by yourself. Once self-harm and eating disorders become known, they require professional treatment.

2. Seek help

If your child is a minor, then research treatment options. Ideally, find someone who is trauma-informed and has experience working with children. If your child resists treatment, don’t be afraid to attend treatment with them until they feel safe. Work with the therapist to determine the best course of action. You can do some work around identity, family roles, and boundaries if your child isn’t ready to address the behavior yet. If your child is an adult, then you can gently suggest treatment, but unfortunately, you can’t force it. Nonetheless, attend family therapy if your child is willing to go. Or get therapy for yourself to uncover ways you can build trust in the relationship so that your advice is more likely to be heeded.

3.  Begin treatment

Your therapist should help you identify the best course of treatment for your child. This may include various forms of therapy. For example, Dialectical Behavioral Therapy (DBT) has shown promise in treating people who self-harm. Also consider investing in family therapy. Self-harm is a private act your child is taking against themselves. But it is often indicative of larger challenges in your family structure. Your child may find greater success in recovery if everyone participates. This takes the entire burden of recovery off the child who is self-harming.

4. Become emotionally literate

Your child who is self-harming is suffering from a lack of language skills to express their pain and suffering. For whatever reason, they did not learn to process emotions in an adaptive manner. This means expressing negative feelings like anger, jealousy, grief, and fear. Parents can learn emotional literacy, which is the ability to accept, define, and express emotions. This will help children develop adaptive coping mechanisms to replace their self-harm and eating disorders.

5. Provide a balanced environment

Maladaptive coping mechanisms are responses that a person develops in response to emotional arousal. Emotional arousal is more likely in chaotic environments. This means that it really helps if you can create a calm, structured environment. Provide plenty of food, rest, play, comfort, and belonging.

6. Take it slowly

Never forget that self-harm and eating disorders provide a valuable form of self-care. If you try to remove the behavior before your child is ready, it may either dive deeper into the shadows or morph into another behavior like drug abuse, drinking, shoplifting, and more. Don’t try to control the behavior, but rather seek to replace it with kindness and compassion.

The most important thing a parent can do when their child is in recovery from self-harm is to trust that their child and the whole family can improve together. It takes a lot of effort, and will not be a perfect or linear process, but full recovery is completely possible.

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

Bright red scream book

A Bright Red Scream is a groundbreaking, essential resource for victims of self-mutilation, their families, teachers, doctors, and therapists.

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What to do about your child’s anxiety about food and eating

anxiety about food and eating

Having anxiety about food and eating shows up in many eating disorders, especially anorexia and orthorexia. If your child has an eating disorder, it’s very likely they are struggling with a lot of anxiety around food and eating. It’s really frustrating to watch a child refuse to eat and have complete meltdowns over meals.

This is advanced parenting, but you can learn skills to help your child learn to soothe their food and eating anxiety. This is a great way to support your child at home while they undergo therapy for their eating disorder. If you learn how to manage your child’s food and eating anxiety, you can help them recover from their eating disorder.

1. Check your own anxiety about food and eating

It’s important to start with yourself. This is because while we live in a highly individualistic society that emphasizes individual agency, humans are designed to attune with each other. Parents are our first attunement partners, and how they feel deeply impacts how we feel.

It’s completely normal if you feel anxious when your child gets anxious. In fact, it would be a little strange if you didn’t! But this is where we have to build new emotional regulation skills and learn to stay calm inside of ourselves even as our child escalates into anxiety.

This is not easy. You understandably want to get your child to eat. But the fact is that you will be unable to meaningfully help them without first soothing your own anxiety.

Here’s the hard thing about anxiety: your child knows when you feel anxious. They feel it on a subconscious level, and they have felt it since your first held them and every day since. Your emotional security is crucial to their survival. Any unresolved anxiety can make them feel insecure and anxious.

It takes effort to learn to regulate your anxiety, but you can do it! And when you invest in your own anxiety management skills, your child will benefit.

2. Food and eating anxiety is not breaking news

One of the most important concepts to internalize about your child’s anxiety about food and eating is that it’s not breaking news. You have probably noticed that it pops up repeatedly. Whether it’s every meal or just certain meals, the fact is that your child feels anxious about eating.

Most of us naturally jump in to try and soothe the anxiety with words and questions. This makes a lot of sense, and perhaps it worked when your child was younger. But if your child is feeling consistently anxious about food and refusing to eat, then you are in a new stage of anxiety management, and your old methods don’t work anymore.

Parents must stop responding to anxiety as if it is breaking news that must be interviewed, reported on, and discussed at length as front page headlines. Instead, it’s more like the weather in Los Angeles. It may vary a little bit, and sometimes we have significant weather events, but it’s rare. Most of the time, native Los Angeleans don’t check the weather because we pretty much know what’s coming tomorrow, next week, and even next month. It’s almost never breaking news.

Here’s a scenario:

Lulu’s daughter Amy is very anxious about mealtimes. Every time she puts a plate down, Amy starts to shake and cry. She physically shrinks away from the food. Lulu asks her what’s wrong, and she cries more. “I reassure her that the food is healthy, safe, and tasty, and that she has liked it before, and she screams at me,” says Lulu. “Her palms are sweaty and she’s shaking. I keep asking her questions and trying to convince her that it’s safe, but it’s not working, and she’s pretty much not eating at this point.”

Here’s another way it could go:

Amy is very anxious about mealtimes. Lulu knows this. So before it’s time to eat, they talk a little bit about the fact that it’s time to eat and acknowledge that anxiety often shows up for meals. “Then we’ll take a walk together or do some yoga poses, or I’ll just sit quietly with her,” says Lulu. “I work to connect with her and let her know that I know anxiety is coming and that it’s OK. We don’t make a big deal out of the reasons for her anxiety, we just assume it’s going to show up. After doing this for a while, we’re noticing that she’s coming to the table less stressed. I’m definitely less stressed, too!”

Parents who anticipate anxiety feel less stressed about it when it shows up. Since kids feel parents’ anxiety, this is a big deal. Remember that kids don’t want to be anxious, and they can sense that it’s upsetting for you, which is scary for them. So when you respond like it’s breaking news, they panic even more. When you normalize it and expect the anxiety, it’s not quite so scary.

3. Right channel, volume too high

The problem is not that your child is afraid. The problem is that their brain is over-reacting to fear.

One way to think of anxiety is that our child is on the right channel, but the volume is too high. What they are thinking about makes sense. It’s true that the food might taste bad. It’s true that they might feel worried about eating too much. They may be worried about getting fat or eating something unhealthy.

Whatever fears they have make sense to them right now. The problem is that the volume is up way too high. Instead of having a thought and moving on like a healthy brain would, their anxious amygdala blows up and overreacts.

This video provides a great overview of how this works:

Sounds familiar …

You might recognize this response in yourself. As soon as you sit down and you can tell that your child doesn’t want to eat, your amygdala immediately jumps to the fear that they are going to die if they don’t eat. Of course you are worried, and you have every reason to be.

At the same time, missing a single meal is not the end of the world. Both things are true: you are afraid, and this single meal your child is refusing right now is not a life-or-death situation. (If a single meal is life-threatening, then stop reading and take your child to the Emergency Room!)

What I am saying is that the channel is right – the fear makes sense, but the volume is way too loud.

Calm the amygdala

High-volume anxiety means our amygdala is freaking out. Once our amygdala freaks out, it’s impossible to be rational and effective. Until we calm our amygdala down, we’re not going to believe that our child is safe, and we’re not going to be able to help our child eat.

Likewise, until our child’s amygdala calms down and stops shouting, they’re not going to be able to eat.

Don’t try to talk your child out of their anxiety and into eating until you sense that the volume is lower and their amygdala is calmer. When you try to reason at high volume, it’s like screaming into a speaker blasting Iron Maiden. Nobody can hear you. No matter how perfect your words are, you won’t accomplish anything. You will, however, get exhausted and hoarse.

Your job is not to convince your child that they’re on the wrong channel. Your job is to help them lower the volume of their amygdala so they can figure that out for themselves how to eat.

emotional regulation

4. Say less, be more

Most of us respond to anxiety by using language and words. We desperately want to help our child feel better and eat a healthy meal. So we try to use our words to convince them to eat. We think that if we say just the right thing, it will fix the problem. But remember that until their amygdala lowers its volume, we will not succeed. The amygdala does not respond to language. It responds to feelings.

We are hard-wired from birth to respond to our parents’ internal state of mind. We are highly attuned to our parents’ feelings. That means that what’s going on emotionally for you matters to your child more than anything you say.

Don’t get into debates about the value of the meal, the number of calories, and whether it is healthy or not. Don’t get sucked into discussions of how much is enough, how their stomach feels right now, or anything else. You don’t want to get into an argument about what’s on the plate or the fact that there is a plate. You will never win a debate with an amygdala.

So what do you do instead?

You need to find a calm place inside of yourself to accept the anxiety your child is in. If you can find a way to believe that their anxiety will not kill them (or you!) and that it will pass like clouds in the sky, they will pick up on your emotional state and their amygdala will calm down.

Think of yourself as a solid boulder in the ocean of your child’s emotions. No matter how hard it storms, you stay steady. Trust that your child will get through their anxiety and that they will be OK.

Sit with them while they rage and storm. Be a calm and loving presence in the face of their anxiety. Let them know that you care, but that you will not get into arguments about the value of food and eating. You know they are anxious right now, and you are going to sit with them through the anxiety.

What to say

Here are some things you can say when they start to try and engage you in a debate:

  • That may be true, but right now we’re just going to sit here so that your amygdala can settle down.
  • I hear what you’re saying, and I know you’re feeling very anxious. For now, we’re just going to sit here together and wait for our amygdalae to chill out.
  • I understand that you’re afraid, so let’s just accept that right now. I’m all right with all your feelings.
  • I know that when you yell at me, it means you’re feeling anxious. It’s OK – I’m still here and I’m not going anywhere.

Your calm, loving presence will help calm their amygdala. Your refusal to engage in debate and steady belief that food is good and healthy will help them know that you expect them to eat. You don’t have to tell them that you want them to eat – they know what you want. Don’t engage with the anxiety, and instead let them feel it like a passing storm.

This takes practice and self-compassion. Be kind to yourself!

5. Celebrate successful anxiety resolution

Remember that anxiety is not breaking news. That means that getting through one meal does not mean the next one will be easy. It just means that the next meal is very likely to have anxiety as well. Try to never be surprised by anxiety.

It takes patience, time, and compassion to resolve anxiety, but it helps to have hope. This is why celebrating successful anxiety resolution can help. It reminds everyone that this is a process that you are all learning.

The goal is not to never experience anxiety, but rather to endure anxiety without actually dying (which is what anxiety feels like). Anxiety always resolves.

Journal ideas

Get a journal or a calendar, and take a few minutes together to write a quick recap of anxiety events. For example:

  • I sat down at the table, and I thought I was going to die. Seriously, my anxiety was HUGE. Mom and Dad sat with me. I started to feel a little better.
  • Dad called me to dinner and I fell down on the floor and refused to get up. I was so MAD. Mom sat with me on the floor. It took a while, but it passed. And it really wasn’t comfortable on the floor 😉
  • Mom served mac and cheese and I felt so ANGRY. I cried and yelled and told her that she was so mean. Mom put the plate down in the kitchen and sat with me while I calmed down. Then we tried again and the mac and cheese was actually pretty good.

Notice that we’re allowing the child to talk about the anxiety and how it felt. Anxiety is big and scary. It’s terrifying and enormous. People go to the emergency room for anxiety symptoms because it is so hard to endure.

But like a huge thunderstorm, anxiety never lasts forever. So let your child acknowledge the pain of having anxiety as well as recognize that as big as it gets, it always passes. If it’s possible to add some humor in the retelling, that may help lighten the mood and laugh a little together.

Frequently Asked Questions

Q: But isn’t this catering to the anxiety?

A: This is catering to your child’s biological need to be in a state of homeostasis in order to eat. I know that most of us were raised in environments when feeling feelings wasn’t allowed, but when you have a child who has an eating disorder you simply must recognize that emotional literacy is your number one goal to support their recovery. Trying to shut down anxiety, ignore it, or treat it as if it’s bad is only going to hurt recovery.

Q: This is so much work! Will I have to do this every single time we eat?

A: I know it’s so much work, and I’m so sorry that you have to experience food and eating anxiety. It’s very stressful. Luckily, you can learn to regulate your own emotions, which will reduce stress for everyone. And your child is in therapy, so they’re learning emotional regulation skills, too. Over time and with proper treatment, you will be better-regulated, your child’s anxiety will reduce, the eating disorder will recede, and you will not have to put so much effort into every meal. But for now, yeah. It’s a lot of work.

Q: That’s all fine, but what if they still don’t eat?

A: This is a question that you have to work on with your child’s treatment team. The point of this article is to help parents who have kids who are eating sometimes, but feel tremendous anxiety around food and eating. If your child is truly not eating and is deep in their anorexia behaviors and medically unstable, then they need a higher level of care. This article is not intended to replace any professional care – it’s only intended to help make mealtimes less stressful, which is good for everyone’s appetite.

A final note

Having a child with anxiety is scary and frustrating. A child who is anxious about food is at high risk of having their anxiety create a major health problem. You are right to be scared.

But please know that anxiety is the most treatable mental disorder. There is tremendous hope for your child. While the eating disorder is multi-layered, food and eating anxiety often lie at the heart of it. Helping your child navigate anxiety is possibly the single most important skill you can learn right now.

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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The link between depression, eating disorders, and being female in western industrialized cultures

There is a strong link between being depressed, having an eating disorder, and being female in a western industrialized country. Here are some facts about these conditions:

1. Females are twice as likely as males to be depressed, and the vast majority of eating disorder patients are female.

2. The depression sex difference emerges at puberty, and eating disorders emerge at puberty.

3. The depression sex difference is only found in western countries, and eating disorders are present in western countries and far less common/virtually absent in non-western countries.

4. There is more depression today, and there are more eating disorders today.

5. The average age of onset for depression is younger now than in the past, and the average age of onset for eating disorders is younger now than in the past.

Because of these correlations, it has been proposed that there is a relationship between the thin ideal that permeates western cultures, eating disorders and depression. Some studies report that episodes of depression precede the onset of the eating disorder and even that eating disorder behaviors are an attempt to combat depression.

In such a case, a person who is depressed subconsciously attempts to modify their mood state by utilizing eating disorder behaviors such as restriction, binge eating, purging, and over-exercising. By engaging in these behaviors, a person may feel a sense of taking corrective action to improve their life circumstances.

The thin ideal

The cultural ideal of hard-to-achieve thinness (the “thin ideal”) for women could be a driver of both depression and eating disorders. There are two ways this can happen.

First, if a girl perceives her body as not meeting the thin ideal, body dissatisfaction can arise. Since a very small proportion(~5%) of female bodies can meet the thin ideal without extreme control and modification, body dissatisfaction can occur at any body size, shape, and weight.

Second, there is a powerful belief that a thin body is the only way a woman can be attractive to others. The need to be seen as attractive to others is an element of self-esteem, and thus a pervasive sense of being unattractive (due to higher weight than is deemed “attractive”) may lead to eating disorder behaviors. This may also explain the observed trend of depression and eating disorder onset during puberty, a time when the body is changing at the exact same time as a desire to be attractive to others increases.

It has been shown that people who have eating disorders have high levels of body dissatisfaction coupled with low self-esteem and feelings of ineffectiveness and inadequacy. It has also been shown that people who are depressed tend to have higher levels of body dissatisfaction and feelings of ineffectiveness and inadequacy.

Diet culture

This is where diet culture comes into the picture since dieting is strongly associated with body dissatisfaction and feelings of ineffectiveness and inadequacy. First, dieting causes extreme psychic and physical stress, which can drastically impact mood states, leading to depression.

Second, dieting fails 95% of the time. A person may lose weight but will regain it all plus more almost every time. This failure is almost always attributed to personal behaviors rather than the fact that diets are proven to lead to weight gain. Feelings of ineffectiveness and inadequacy based on weight regain after weight loss almost always occur.

It has also been observed that one in four people who diet will develop an eating disorder. This may be a natural response to the proven weight cycling inherent in dieting. A person can quickly notice that unless they take extreme measures, they cannot control their weight. Those extreme measures are the primary eating disorder behaviors of restriction, purging, and over-exercising. Binge eating is a natural and primal response to all of these behaviors.

Lack of control

Western cultures believe that weight is something that can be controlled, and yet the evidence points in the exact opposite direction. Research has shown for more than 50 years that intentional weight loss almost always leads to weight gain. This disconnect between a cultural belief and the reality of weight control leads to feelings of failure.

Attempting to control weight, which is a fruitless effort, leads women to feel more dissatisfied with their bodies. Repeat dieters report lower self-esteem than do non-dieters, which can lead to both depression and eating disorders. In a cruel twist of fate, the more a person diets, the higher their weight climbs. Additionally, many people who are depressed turn to food to soothe their depression. This can create an endless and lifelong cycle of body dissatisfaction, dieting, and depression.

Puberty changes everything

Body dissatisfaction is a symptom of both depression and eating disorders, and both are more common in females and typically arise during puberty.

During puberty, the female body changes, often dramatically. The thin ideal resembles a pre-pubescent girl (flat stomach, long legs, slender hips, flat chest). The process of puberty includes weight gain and the addition of new curves and rolls, which can be destabilizing for many females. Puberty takes girls further from the thin ideal while it typically brings boys closer to the masculine ideal.

Several studies have noted that girls become increasingly less satisfied with their bodies as they progress through puberty. At every age, girls are less satisfied with their bodies than boys. Girls also have higher rates of body dysmorphia and the belief that their bodies are larger than they actually are.

Protecting females

The trends linking our societal beliefs, being female, depression and eating disorders need to be openly addressed in order to reverse worrying trends of increasing rates of both depression and eating disorders. Both depression and eating disorders are increasing, and beginning at younger ages. There are many societal factors to be considered in these conditions in western females, but one known factor is the thin ideal.

Some actions we should take to protect females from higher risk of depression and eating disorders include:

1. Talk to girls about the thin ideal and its dangers.

2. Talk about the devastating impact of dieting on the body and mental health.

3. Seek ways to show girls the diversity of body size, shape and weight in the real world compared to what we see on television, social media, advertising, etc.

4. Don’t ever diet, or allow dieting in your home.

5. Speak up against companies that use Photoshopping, editing, and other techniques to take an already unrealistic body ideal to new extremes.

6. Demand that companies feature diverse body types in advertising and in entertainment programs.

7. Support companies that promote body size diversity in their advertising, social media, etc.

8. Learn about Health at Every Size

Also, monitor for signs of depression and eating disorders, especially during puberty. We have two quizzes available. The first is Does My Child Have an Eating Disorder? and can be taken by a parent. The second is an adaptation of Burn’s Depression Checklist, which should be taken by the person who is being evaluated for depression.

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

Reference: McCarthy, M., The Thin Ideal, Depression and Eating Disorders in Women, Journal of Behavior Research and Therapy, 1990

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What parents should know about the intersection of substance addiction and eating disorders, by Becca Owens, Foundations Recovery Network

No parent wants to see their children fight the battle of an eating disorder or substance addiction, but parents who spot one in their child may also see signs of the other because the two often co-occur. Recognizing ongoing struggles in your kids can hurt deeply, and it’s easy to feel overwhelmed when you contemplate the best way to get them help. Thankfully, there is help available for both eating disorders and substance addiction, and the best way for parents to find help for their kids is to understand both conditions individually and in relation to each other.

Co-occurring Eating Disorders and Addiction

When individuals struggle with both a mental health disorder and a substance use disorder or addiction, these are referred to as co-occurring disorders. Co-occurring disorders are very common, but they often go undiagnosed. It is also common for one condition to be treated without the other, leading to a non-integrated recovery process. Dual diagnosis patients need specialized treatment in order to better understand the connection between the diagnoses and how they may exacerbate or influence each other.

Many people with an eating disorder like anorexia, bulimia or binge eating disorder also have a co-occurring mental health disorder such as depression, anxiety or addiction. “Up to 50% of individuals with eating disorders abused alcohol or illicit drugs, a rate five times higher than the general population. Up to 35% of individuals who abused or were dependent on alcohol or other drugs have also had eating disorders, a rate 11 times greater than the general population.” (NEDA)

The Scope of Eating Disorders

Eating disorders are considered biopsychosocial conditions because they stem from a complex combination of contributing factors. Consequently, eating disorders affect multiple facets of a person’s health, including physical, mental, social and emotional. A person’s health will likely deteriorate as the eating disorder persists, showing signs of weight fluctuation and stress as well as less obvious symptoms from long-term malnutrition like inconsistent menstruation in females, infertility, heart disease and kidney disease.

Individuals with an eating disorder may also fight negative thoughts about themselves and deal with self-hate. For many, symptoms of depression and anxiety will develop over time, and all these factors combine with the fear of eating in front of others, which will keep them away from social gatherings. All of these areas must be adequately addressed to help an individual find true healing and have the tools necessary to fully recover.

How Eating Disorders and Addictions Affect Each Other

Both eating disorders and substance use disorders have similar effects on the brain, particularly the pathways controlling feelings of reward and pleasure. When these neurotransmitters become disordered, they wreak havoc on the body. In addition, the body physically craves the substance. With an eating disorder, the body craves the feelings. In both cases, they pursue the behavior that led to those enhanced feelings, whether through food rituals or substances.

Eating disorders and substance addictions share several risk factors, including genetics, family history, temperament, depression, anxiety, low self-esteem and low self-worth. People who have eating disorders often abuse substances include alcohol, amphetamines, heroin, cocaine, diuretics, laxatives, and emetics. (NEDA)

Substance abuse often enhances personality traits like impulsivity, lack of self-control and moodiness. All of these issues make healing from an eating disorder much more difficult. Also, substance abuse can cause a decline in health and a decreased concern for personal nutrition. Poor health will only exacerbate the problems of an eating disorder, which can lead to additional, more serious physical complications.

Help for Eating Disorders and Addiction

For both eating disorders and substance addiction, early treatment improves the likelihood of full recovery.

Treatment providers for eating disorders and substance addiction are often separated. Both fields have specialists, but it is important to work with experts who are familiar with treating both conditions. If you have recognized that your child has both an eating disorder and substance addiction, it can be very helpful to seek treatment from providers who are trained to treat co-occurring conditions.

Parents who have a child with both an eating disorder and substance addiction should educate themselves about both conditions. Work with specialists who have experience addressing both substance abuse and dependence. If you are considering sending your child to inpatient treatment for their eating disorder, consider whether you need to find a facility can accommodate a patient who requires medical detoxification from substance addiction – many cannot. If you are considering sending your child to inpatient treatment for their substance addiction, find a facility that is qualified to treat eating disorders – many are not.

By Becca Owens, Foundations Recovery Network

Foundations Recovery Network’s mission is to be the leader in evidence-based, integrated treatment for co-occurring mental health and substance use disorders through clinical services, education, and research. Our vision is to be the best at delivering effective, lasting treatment and providing superb experiences across our continuum of care in all places.

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Scary things your child may say while having an anxiety attack and how to handle it

Anxiety is one of the main underlying conditions that occur alongside eating disorders, which means that if you have a child who has an eating disorder, it’s very helpful to learn about anxiety disorders and how loved ones can help someone through an anxiety attack.

If you are a parent who has no experience with anxiety disorders, then it can be helpful to understand that while everyone feel fear, stress, and anxiety on a normal basis, someone who has an anxiety disorder suffers on a much greater level, and the fear and worry do not go away, and often get worse over time. While someone who has normal fear will be able to identify a particular stressor causing the fear, those of us who have anxiety disorders feel a generalized sense of fear and panic that appears separate from any particular event or situation.

Not everyone who has an anxiety disorder experiences anxiety attacks (also called panic attacks), but those of us who do find ourselves feeling acute physical symptoms of anxiety. For many of us, our anxiety manifests in physical symptoms even when we have no idea what we’re worried about. The physical symptoms of panic can feel completely disconnected from our current life circumstances, and it can seem as if they are coming out of nowhere.

Since many of us feel our anxiety symptoms in our chests, an anxiety attack can feel very much like a heart attack or other major life-threatening event. Hence, many of us worry that we are going to die when we experience an anxiety attack. Everyone experiences anxiety attacks differently, and many of us will have different symptoms each time we have an anxiety attack. This makes it very difficult for loved ones to know how best to help us weather the storm.

Here are some common symptoms of an anxiety attack or panic attack:

1. Chest pain: One of the most notable symptoms of an anxiety attack is chest pain, heart palpitations, and an accelerated heart rate. Some people describe it as pressure on their chest, fluttering in their chest, stabbing pain in their chest, etc. These sensations are overwhelming and terrifying, and often fuel our anxiety attack since we believe we are under immediate threat of dying.

2. Sweating, trembling & shaking: Many times we sweat, tremble and shake during an anxiety attack. This may or may not be visible to our loved ones, but we feel a deep sense of discomfort over these sensations, as well as a deep lack of terrifying lack of control. As our mind races to make sense of these symptoms, we may demand that our body stops sweating, trembling and shaking RIGHT NOW! Unfortunately, such demands have no bearing on our anxiety, and often only serve to make it worse.

3. A sense of choking, shortness of breath & smothering: It is common to feel some level of constriction in our airways. This can increase our panic because we feel unable to access air at a normal level. During the anxiety attack, we believe that this restriction of air will continue and get worse, which can increase our anxiety attack symptoms. The fear of dying from lack of air feels very real.

4. Dizziness and Fainting: During an anxiety attack, our senses are overwhelmed with fear, which can overwhelm our sense of balance and even lead to a complete mental shut down in the form of passing out. Some of us have passed out in public, and in dramatic fashion, which adds to our experience of shame about our anxiety attack. Many times we have no idea that we are having a panic attack or that we are about to pass out until the moment it happens.

5. Fear of dying: Almost all of the sensations described above lead to a severe fear that we have lost control of our bodies and are “going crazy.” We sincerely believe this is a life-threatening event that will not resolve itself. Depending on the severity of our symptoms, we often believe that we are dying during an anxiety attack. Many of us have called 911 or had bystanders, employers and loved ones do so on our behalf. We frequently go to emergency rooms with the full belief that we are dying, only to be told that it’s “just” an anxiety attack.

The experience of having an anxiety attack is extremely terrifying. Never hesitate to take your child to the ER or call 911 if you feel afraid. Paramedics and ER doctors see anxiety attacks regularly, and will be able to identify whether there is something life-threatening going on vs. anxiety symptoms.

Unfortunately, some professionals are not very thoughtful when presenting the diagnosis of an anxiety attack, which can lead to shame and increased anxiety. Often a doctor’s diagnosis that “it’s just anxiety” can make us feel as if we have wasted everyone’s time and are pathetic and needy. This, of course, just increases our anxiety. This is why it’s so important for parents to understand panic attacks and help their children get through them and move on with minimal shame.

Here are some things parents should know about anxiety attack symptoms:

1. Timing: Panic attacks typically build in severity over the course of about 10 minutes or less. Those 10 minutes can be incredibly scary, but symptoms will subside gradually after they reach a peak.

2. Call for help if you need it: During an anxiety attack, your child will be in extreme distress. If you feel unable to handle the situation in any way and at any time, don’t hesitate to call 911 or go to the ER.

3. Acknolwedge how your child feels, and accept how bad it feels. It’s all right to say to your child that they may be having a panic attack. Say this in a calm, confident, accepting tone, and your child may find relief in having a name for their experience. Allow the anxiety symptoms to arise under your care and acceptance. Help your child name the symptoms, and write them down if that seems to help your child recognize that their feelings are real and valid. Don’t ask questions about why the anxiety is happening – many times we actually don’t know the cause of our anxiety attack until we have reflected after the event.

4. Calm them, but not by saying “calm down.” Telling someone who is having a panic attack to calm down can make the symptoms worse, because we desperately want to calm down, and feel guilty and more stressed if we perceive that you need us to hurry up. Instead, find a truly calm place within yourself. You may need to practice mindfulness to access this calm place quickly in the face of your child’s anxiety attack. When you can find calm during our storm, and hold confidence that the anxiety will pass and we will be OK, we will feel safer under your care.

5. Reassure them by saying that you are here for them. During panic attacks, many of us feel deeply ashamed of bringing anyone around us “down” with us. We often experience feelings of worthlessness, helplessness, and hopelessness. It’s important for loved ones to assure someone who is having an anxiety attack that they can take all the time they need to recover, and that it’s absolutely no problem for you to sit there and be with them. Say things like “this is exactly where I want to be,” and “I am here for you as long as you need me” to help them understand your unconditional positive regard in the face of a debilitating anxiety attack.

6. Breathe with them. This only works if you have practiced some breathing exercises with your child in advance (which is a good idea). If you have not practiced breathing exercises, then skip this step for this anxiety attack, as it may cause irritation. If you have practiced breathing together, try some breathing exercises. We may push back or even become angry with you when you attempt this, but don’t take it personally – our anger is just the anxiety talking. Just try a few breaths together, listening and paying attention to whether it is helping. Consider downloading a deep breathing podcast on your phone that you can use to help both of you breathe during the panic attack.

7. Tools help some people recover from an anxiety attack. For example, some people find aromatherapy, a cold compress, a heavy blanket, a glass of cold water, or meditative music helpful. Some people find it helpful to listen to guided meditation or yoga nidra podcasts during an anxiety attack. Once you know your child has anxiety attacks, keep these tools on hand so you can pull them out as needed. For example, if smelling something helps, carry a small bottle of essential oils at all times. If listening to yoga nidra helps, then download a favorite podcast on both your own and your child’s phone. Be aware that these tools may work sometimes and not others. Try not to get frustrated or take it personally if a tool doesn’t work – just try something else, or just stay calm, attentive, and present for a while.

8. Medication may help your child recover faster, and may be the route recommended by their care team. If your child’s doctor has prescribed medication to reduce the symptoms of anxiety, then keep them avialable in various places around your home and other locations so that you have medication ready to go when necessary.

Once the anxiety attack seems to be coming to completion, your child may need to take a nap or at least rest for a while. Anxiety attacks are physically and emotionally draining, so don’t rush off to do something right away. If you have plans or are supposed to be somewhere, try to delay your arrival by at least an hour to provide time for recovery.

When your child appears to be fully recovered, set an appointment with a care provider to talk about the anxiety attack. Anxiety attacks can seriously impact your child’s eating disorder behaviors, so take every attack seriously and talk to your child’s treatment team so they know about it and can recommend a course of action.

Finally, check in with your child periodically about their anxiety levels. Especially in the days following an anxiety attack, your child may have residual symptoms. Many of us with anxiety hide our symptoms for fear of being a burden or being seen as weak, and parents can be of tremendous help by actively checking in and allowing us to acknowledge our anxiety symptoms without fear or judgement.

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

Disclaimer: This article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this Website. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately.

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Major depression is on the rise for adolescents and young adults – here’s what this means for parents

A new report from Blue Cross Blue Shield shows that major depression is on the rise among Americans from all age groups, but is rising fastest among teens and young adults. [1] In a report issued May 10, 2018, BCBS announced the following important data:

1. The number of people of all ages and genders diagnosed with major depression has risen dramatically by 33% since 2013.

2. The groups experiencing the most significant increases are millennials (up 47% from 2013) and adolescents (up 65% for girls and 47% for boys from 2013).

These numbers are likely an under-representation because they are limited to people who are part of the BCBS system and only measure those who receive a formal diagnosis of major depression. It is well known that the majority of people who report symptoms of depression have not been diagnosed treated for it.

For example, the Centers for Disease Control and Prevention reported that just 20% of an estimated 15 million children ages 3 through 17 who have a diagnosable mental, emotional, or behavioral disorder in a given year are ever diagnosed and receive treatment.

Major depression is the second most impactful health condition for the nation. BCBS reports that 85% of people who are diagnosed with major depression also have one or more additional serious chronic health conditions and nearly 30 percent have four or more other conditions. These health conditions include heart disease, stroke, cancer, diabetes, alcohol and drug abuse, and, of course, eating disorders. (Mental Health America) People who are diagnosed with major depression use healthcare services more than other commercially insured Americans. (BCBS)

What this means for parents

An increase in rates of depression among all our children, especially among our girls, should cause significant alarm for parents. For centuries, our culture has chronically discounted the importance of mental health care. This lack of societal awareness for mental health is resulting in devastating lifelong effects for all of us.

Most parents are under-prepared for the emotional caregiving necessary to raise healthy children in today’s fast-paced, high-stress, lonely, and distracted emotional ecosystem. This is not because parents are bad – it is an indication of a societal breakdown. Our children are growing up in emotional deserts, and it is taking a toll on their health.

Here are the societal factors that are likely contributing to our kids’ increasing rates of depression:

Fractured communities: Our kids are being raised in an environment that is distinctly not conducive to human emotional health. We are social animals, designed to live in close-knit communities. Most families today operate more like islands than communities.

Lack of emotional hygiene: Our kids are taught to wash their hands constantly, but with so much disease linked to depression, we should actually be teaching them the emotional hygiene needed to maintain peace of mind.

Stressed parents: Kids are acutely attuned to the emotional states of their parents. Both parents work full-time than ever before, yet our society provides woefully inadequate support for working parents. Parents are under more stress than ever before and are often unable to provide the level of care they want to their kids.

Social media: We can’t discuss mental health without addressing social media, which has infiltrated our kids’ lives and resulted in significant damage to their mental health. Studies have found that the more time young people spend on social media, the more likely they are to report sleep disturbances and symptoms of depression. [2] Social media has a distinct impact on body image especially, and people who spend the most time on social media experience 2.6x higher risk for eating concerns and body image concerns. [3]

What parents can do

We cannot individually fix our society – that is something that we must take on as a group culture. It’s a long-term effort that is overwhelming even for the most dedicated social activists. But we can make changes in how we parent to help protect our own children from the impacts of our emotional deserts and hopefully reduce their chances of developing a mental illness like major depression or an eating disorder.

Here are five things parents can do to counter-balance the societal forces that are building an ecosystem of mental illness for our kids:

1. Build a community: Humans evolved, mentally and physically, to exist in small group communities. These communities provided children with access to multiple sources of information and care outside of their two parents. In other words, communities meant less pressure for individual parents! Find ways to build a community of other adults who your child can learn from and lean on.

2. Learn (and teach) emotional hygiene: Our brains develop emotionally before they develop intellectually. Our society tends to discount the emotional experience, but it’s hurting everyone. Learn about emotional hygiene, which involves recognizing emotions, naming them, and processing them in adaptive, healthy ways. Emotions that are repressed will always come out in some way and at some time, and they are usually much angrier and uglier after having spent time in the mind’s “jail for bad thoughts.”

3. De-stress your life: Parents are feeling pulled in far too many directions today, and the result is high-stress lifestyles. This stress is unhealthy for us, and it has a trickle-down effect on our children. We need to set healthy boundaries with work and our cell phones while investing in reflective time alone and pleasant relationships with others. Most of us have to learn what boundaries are and how to set them. We also need to learn to be more assertive for our own needs, preferences, and desires. Doing this work will make a huge impact on your child’s lifelong mental health.

4. Limit social media: Our kids believe they have a right to be on social media, and it can feel impossible to pry their phones away from their hands. But we can do this, and we absolutely must. We don’t need to outlaw social media, but we do need to put controls on it as long as we are paying the bills. Our kids’ brains are not mature enough to handle the addictive and damaging nature of social media. Parents must stand up to our kids’ phones and make them a privilege, not a right.

Parents alone cannot prevent depression, but we can help reduce our kids’ chances of developing depression. We can also help our kids who already have depression recover faster by recognizing the signs and getting comprehensive treatment (not limited to medication) as soon as possible. Remember that emotional disorders are family affairs, and one child’s depression may be a good reason for the whole family to make some changes to improve the home’s emotional ecosystem.

[1] Major Depression: The Impact on Overall Health, BCBS. The BCBS Health of America report is an ongoing effort by BCBS to document meta-data on American health by aggregating and analyzing anonymized health data from its 41 million member health records.

[2] Levenson, JC, et al, “Social Media Use Before Bed and Sleep Disturbance Among Young Adults in the United States: A Nationally Representative Study,” Sleep, 2017 Sep 1;40(9).

[3] Sidani, J., et al, “The Association between Social Media Use and Eating Concerns among US Young Adults,” Journal of the Academy of Nutrition and Dietetics, September (2016), Volume 116, Issue 9: Pages 1465–1472.

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Trauma plus an eating disorder requires specialized treatment

treatment Trauma plus an eating disorder requires specialized treatment

by John Levitt, PhD

Estimates tend to vary, but data suggests that approximately 68%-98% of people who attend eating disorder treatment programs report histories of sexual, and other, abuse or trauma. This suggests that when we treat eating disorders we need to be prepared to treat a potentially underlying trauma history and even, possibly, Post Traumatic Stress Disorder (PTSD).

When I work with someone who has a persistent eating disorder, coupled with potentially long-term Post Traumatic Stress Disorder (PTSD), they have often had a very hard time receiving comprehensive treatment. Unfortunately, many providers who treat trauma regularly are not as well-versed in how to treat eating disorders; and many people who regularly treat eating disorders are not as well-versed in how to treat trauma. That is, they struggle with providing a unified approach to treating both!

Indeed, while most of our treatments for eating disorders are interdisciplinary in nature, models of treatment for long-term persistent problems that include trauma generally need an integrated approach to address both.

Trauma-specific treatment

The majority of evidence-based trauma-specific treatment models are 12 -16 weeks or so. These approaches may be effective for treating cases of an immediate response to a distinct traumatic event. In such situations, therapists can move quickly to address the trauma before symptoms can be entrenched and before the client develops trauma-related symptoms such as dissociation and/or other complex secondary coping mechanisms such as an eating disorder.

But I find that eating disorder/trauma clients’ treatment generally requires considerable time, skill, and patience! The majority of my clients have experienced multiple traumas over a long time. Their eating disorders, drug use, cutting, and other behaviors are often employed as one of their way of managing trauma symptoms.

The greatest challenge I frequently face is that I must support a person undergoing treatment for an eating disorder without re-traumatizing the person by addressing the trauma too quickly or too aggressively. It has been my experience that if I push too hard on the trauma, I can actually exacerbate the eating disorder behaviors. That is why I have developed an integrated approach to organizing treatment for both eating disorders and trauma-related disorders or symptoms.

Getting started

The first thing I do when I’m working with a client who has PTSD-like symptoms and an eating disorder is to teach them how to manage both the eating disorder as well as the trauma-related experiences. Trauma-related reminders such as body changes, like arousal and numbing, along with traumatic intrusions (e.g., memories) often serve as “triggers” for eating disorder behaviors.

I educate the client about how to regulate their behavior and emotions in such situations as well as how to modulate their mood, eating, and sleep patterns. Once those elements are stable, there may be an opportunity for addressing the memory components of the traumatic experience.

The clients I work with are very sensitive to re-traumatization, so exposure therapy too early can kick their eating disorder and other coping mechanisms into high gear. Instead, I work over time to educate and empower the client. With time, the person is able to reduce their reliance on self-defeating coping mechanisms and regulate much more effectively.

Eating disorder as comfort

In cases of PTSD, the eating disorder has often become a comfort. It is a powerful management tool, and if we take it away too soon, or if we don’t adequately support the development over time of new alternative coping skills, then we can leave the person in a tenuous recovery situation. At this point, relapse, or exacerbation of eating disorder symptoms, may become more likely. I see relapse as a sign that more time and more practice are needed to integrate understanding, skills, and support mechanisms. This is one reason why complex eating disorders individuals often require time to fully recover. And, importantly, we need to remember that healing looks different for everyone.

Once we have built confidence in terms of handling traumatic feelings and experiences with adaptive behaviors, we may choose to address the trauma head-on, but that is always dependent on the client’s individual choice and situation. Not everyone who has undergone trauma must re-experience the events to recover from PTSD. It is definitely case-dependent.

Something that we have to address when working with PTSD and eating disorders is the acknowledgment that we live in a victimization-oriented society. We tend to see people as victims, especially when they are traumatized as children. It’s true that trauma is devastating and often criminal, but my goal as a therapist is to move a client from being a victim to being a survivor who can cope, and who is empowered to live a full, satisfying life. People who have been traumatized are not responsible for what happened to them, but that doesn’t mean we need to view them as victims. They are capable of becoming responsible for how they interact with their current world.

Considering abuse

When I’m working with someone who has an eating disorder and has PTSD stemming from abuse, my goal is to take steps to help that person accept responsibility and implement efficacious actions for their own recovery. Rather than potentially re-traumatizing the person by “taking away” the eating disorder, I believe that healing must remain within the person’s own power, control and choice.

In the case of working with children or adolescents, this is why I tell parents that I’m not “fixing” their child, but I am here to help the child to become empowered to make more effective choices in their life rather than feel victimized by others, or their disorder.

How parents can help

Parents can be really helpful when they recognize that their child’s PTSD treatment is not generally about what the parents did or did not do to protect their child, but is focused instead on supporting the child’s coping skills over time. It doesn’t take long to learn coping skills conceptually, but they take time to become integrated; especially if they are replacing a powerful behavior like an eating disorder.

It should be said that if parents do feel “guilt” for what happened to their child, whether from abuse or the eating disorder itself, they would be best advised to seek out their own individual, and/or couple treatment.

I’d also like parents who have a child with both PTSD and an eating disorder to remember that their child’s behaviors are not criminal acts. Yes, it is frustrating, unhealthy, and hard to watch one’s child struggle with any problem. An eating disorder can appear to a parent as disobedient or possibly even “crazy.” This does not mean parents should not set limits or expect healthy behaviors, It does mean that the less charged the parents are around the eating disorder behavior itself, and the more they can support their child in learning new coping skills, the easier it is for the child to find their way towards recovery (and the easier it will be for the parent to live with the child).

John Levitt, PhD

John Levitt, PhD, CEDS, FAED, FIAEDP has been treating people who have complex eating disorders, including trauma and self-injury, for more than 40 years. He teaches classes at Argosy University on trauma and counseling which covers the complexities involved in treating trauma-related disorders such as PTSD and associated disorder, such as eating disorders. John is the co-editor of the books Self-Harm Behavior and Eating Disorders: Dynamics, Assessment, and Treatment, Personality Disorders and Eating Disorders, and Handbook for Assessing and Treating Addictive Disorders. He was on the Editorial Board of Eating Disorders: The Journal of Treatment and Prevention. He can be reached at Email: Phone: (847) 370-1995

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Childhood trauma and eating disorders

Childhood trauma and sexual abuse frequently underlie eating disorders. Parents must help children process trauma to heal.

Unfortunately, a parent who has a child who has an eating disorder must also look for possible childhood trauma. Childhood trauma is incredibly common and is often an underlying factor driving in eating disorders. When childhood trauma has occurred, it needs to be treated.

What is the Adverse Childhood Experiences Study?

The Adverse Childhood Experiences Study (ACE Study) was conducted by Kaiser Permanente and the Centers for Disease Control and Prevention. It tracked long-term health outcomes and found a strong connection between adverse childhood experiences (ACEs) and lifetime health problems.

“Adverse childhood experiences are the single greatest public health threat facing our nation today”

Dr. Nadine Burke Harris

Significant health, social, and behavioral problems are associated with a higher ACEs score.

Childhood trauma is common

The study found that adverse childhood experiences are very common. Sixty-seven percent of people have at least one ACE. Forty percent of people have two or more ACEs. And 20% of people have four or more ACEs. ACEs tend to occur in clusters: 87% of individuals who reported one ACE reported at least one additional ACE. Twenty-eight percent of participants reported physical abuse and 21% reported sexual abuse.

The top 10 Adverse Childhood Experiences are:

  • Physical abuse
  • Sexual abuse
  • Emotional abuse
  • Physical neglect
  • Emotional neglect
  • Mother treated violently
  • Household substance abuse
  • Household mental illness
  • Parental separation or divorce
  • Incarcerated household member

It is important to note that the ACE Study spans a broad socio-economic population. Adverse Childhood Experiences are common among the best-protected populations (white, college-educated). They are likely even more common among less-protected (marginalized) populations.

Health impact of childhood trauma

The science is clear: early adversity dramatically affects a person’s health across their lifetime. The ACEs results show that adverse childhood experiences contribute to health problems decades later. These include chronic diseases such as heart disease, cancer, stroke, and diabetes. These are are the most common causes of death and disability in the United States.

Behavioral impact of childhood trauma

The number of ACEs is strongly associated with adulthood high-risk health behaviors. These include smoking, alcohol and drug abuse, and more. ACEs are correlated with mental health conditions including depression, heart disease, cancer, chronic lung disease and shortened lifespan.

Four adverse childhood experiences is associated with:

  • A seven-fold (700%) increase in alcoholism
  • A doubling of risk of being diagnosed with cancer, and
  • A four-fold increase in emphysema

An ACE score above six was associated with a 30-fold (3000%) increase in attempted suicide.

Childhood trauma and eating disorders

Several clinical studies link childhood trauma and eating disorders. For example, one study found a history of sexual abuse is common among individuals who exhibit disordered eating (). Women in larger bodies were 27% more likely to report a history of childhood physical or sexual abuse ().

There are numerous studies linking sexual trauma, in particular, to the development of eating disorders. Women with a history of childhood sexual abuse had a higher prevalence of problematic eating and eating disorders. (Fuemmeler, et. al., J Trauma Stress 2009 “Adverse childhood events are associated with obesity and disordered eating”)

While most people assume the term “eating disorder” means anorexia, the most common eating disorder is binge eating disorder. Binge eating has been directly linked to ACEs. Binge eating may be a method for soothing anxiety, fear, anger or depression caused by ACEs.

Those who have bulimia may use the binge-purge process to self-soothe. Those with a diagnosis of anorexia may find restriction to be the most soothing behavior. This is why ACEs trauma must be treated to heal from an eating disorder.

Childhood trauma leads to chronic stress

The link between ACEs and poor health outcomes and negative chronic behavior is likely because exposure to early adversity:

  • Affects the nucleus accumbens
  • Inhibits the prefrontal cortex
  • Causes measurable differences in the amygdala

Childhood trauma causes brains and bodies to undergo physical changes. Adrenaline and cortisol response rates are altered, and the body lives in a chronic fight/flight response, under tremendous chronic stress. This chronic stress impacts the immune system, hormonal system, and even the epigenetic code. This can increase the likelihood of developing an eating disorder.

ACEs can drive maladaptive coping mechanisms. These behaviors, such as eating disorders, can be a way to self-soothe when faced with anxiety and negative arousal. It makes sense to reach for a self-soothing behavior to feel better. This hypersensitivity may be physiologically driven based on adverse childhood experiences.

What we can do if our children experienced trauma

“This is treatable. This is beatable. The single most important thing we need today is to look this problem in the face and say this is real. And this is all of us.”

Dr. Nadine Burke Harris

When a child has an eating disorder, parents must open the door to the possibility of childhood trauma. The purpose of this is not to accuse a parent of neglect or mistreatment. It is to help the child heal.

Parents will feel pain and regret about what happened to their child. But they cannot stay stuck in that place. It’s important to move forward and help the child process the trauma in an adaptive manner. When a child (or adult) processes trauma, often that is the beginning of full recovery.

Try to take the focus off you as the parent, and focus instead on your child’s experience. Get therapy or coaching for yourself if you need to process your own trauma around the trauma.

For example, if you were in a relationship and were hurt by your partner, this impacted your child. It also impacted you. If your partner sexually or physically abused your child, it also impacted you.

Take care of your own need to heal for the trauma. This will free you up to help your child.

Help your child process the pain

Take your time to heal. Once you feel ready, offer to help your child process the pain. When you approach this without defensiveness, you can help.

You want to help your child learn emotional regulation. This is a learned behavior that can be developed in anyone. The path to resilience involves being brave enough to go through, not around, the pain. It will be difficult emotionally for everyone. But the end result will be an ability to begin the important repair process physically and emotionally.

When a person has emotional regulation skills they can actively process past events without becoming stuck in them.

The negative outcomes shown in the ACE Study are based on people who did not receive care and intervention for their traumatic experiences. But people who get treatment and process past pain are able to reverse much of the damage inflicted by adverse childhood experiences.

TED Talk: Childhood Trauma

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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The fear parade: a simple mindfulness trick to help kids manage anxiety and stress

Anxiety is a common co-occurring condition with eating disorders, and both anxiety and eating disorders are on the rise for our kids. It’s important that we learn some tools to help them manage their anxiety so that they can avoid triggering eating disorder behavior.

The reasons our kids are more anxious are real and pervasive. Our kids today are facing more pressure to achieve academic success from an early age. While many of us didn’t start worrying about college admission until high school, our kids often worry about college beginning in middle school or even earlier. The pressure to perform is constant, and even if we manage to avoid adding pressure at home, there is plenty to go around at school.

In the midst of this increased academic pressure, we also expect our kids to compete in their sports and participate in enrichment activities like chess, piano and computer coding. And then there are the expectations to volunteer, give back, and participate in society in a meaningful way, which supposedly “looks great on college applications.”

Meanwhile, our kids’ social structures are completely different from how we experienced them. The advent of smartphones, which have completely transformed socialization, is impacting the current generation in ways we cannot fully grasp. Social media, texting and other offline interactions have replaced hanging around together in the same room or talking on the phone. We have no idea how this change in socialization will impact our kids, but initial signs are not great.

So, there is a lot of reason for anxiety, and our kids are suffering as a result. Mindfulness – the ability to step aside and separate the “self” from feelings of fear – can help our kids manage this tremendous stress, and simultaneously reduce symptoms of anxiety and eating disorder behavior.

We came up with a short video about one trick we like to use, called the Fear Parade. Check it out!

The Fear Parade (Mindfulness in Action)

There you are, just minding your own business … when suddenly you remember that you have a test tomorrow, and you haven’t studied! And that’s when the fear feelings start circling. They say terrible things like:

  • You’re going to fail!
  • How could you do this to me?
  • You’re so stupid!
  • You’re going to die!
  • This is the worst thing ever!
  • This is the end!
  • It’s all over.

Suddenly, it’s not just the test tomorrow, it’s everything. Your feelings turn into gigantic monsters and they take over your mind. They start in your head, but within a fraction of a second, they change your

  • Heartbeat
  • Breathing
  • Eyes
  • Muscles

And Adrenaline pumps all through your body, shutting down rational thought. It is impossible to think rationally during the fear response. When this happens, it feels like there is nowhere you can go. You feel trapped.

Mindfulness can help. Here’s how it works. The first thing you must do is realize that you are in a fear-state. Take a step back, and notice that you are being overwhelmed by fear.

Now, take a look at the fear monsters in your head. They are trying to talk, but they are tripping all over themselves. Tell the feelings you’re willing to listen, but they have to behave. Ask them to line up. Now, that’s better.

Let’s have a fear parade, with a float full of feelings that you can watch as they pass. The fear feelings can all jump on the float so you can see them. The float can pass in front of you, and you can watch it go by, but you know that you are separate from the feelings. Your feelings are real, but they aren’t always the truth.

As you watch the parade, your fear feelings are still there, but you notice that they seem smaller. Your body starts to relax, as you see the fear feelings getting smaller and smaller. And, suddenly, you notice that your body is calmer.

Without the fear shutting down your brain, you can think clearly again. Now you can start taking action based on what you learned from the fear. In other words, start studying!

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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ADHD, ASD, OCD and PTSD may show up with an eating disorder

It’s not uncommon for a person who has an eating disorder to also have ADHD, ASD, OCD, and/or PTSD. These conditions may be recognized before or after the eating disorder diagnosis. And they play an important role in the development of eating disorders. Therefore, they should be addressed in order for full recovery to take hold.

In many cases, eating disorder behaviors are a sort of secondary condition that lies on top of other disorders. For example, the foundation may be Attention Deficit Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD), Post Traumatic Stress Syndrome (PTSD), and/or Autism Spectrum Disorder (ASD).

As a parent who has a child with an eating disorder, it’s important for you to understand that it’s very possible that your child’s disorder goes much deeper than food, eating, and weight, and includes an underlying condition.

Obsessive Compulsive Disorder

Obsessive Compulsive Disorder (OCD) falls under Anxiety Disorders, and both Anxiety Disorders and OCD are highly correlated with eating disorders. A research study in 2004 found that 64% of people who have eating disorders also suffer from an anxiety disorder. And up to 41% have OCD in particular. The study also found that 42% developed anxiety disorders in childhood before the eating disorders began. (ADAA)

Some researchers even place eating disorders under the umbrella of OCD rather than stand-alone disorders. This causes some real challenges when treating someone with an eating disorder. This is because the clinician may not be clear about where one disorder ends and the other begins. (IOCDF)

Eating and weight obsessions

Most of us think of OCD as being about obsessively washing hands. But weight and food obsessions, body checking, and eating rituals fall well within the spectrum of OCD. Many people who have eating disorders have obsessive and compulsive thoughts about food and weight.

People who use eating disorders may use restriction, purging, and/or binge eating as a way to manage feelings of anxiety. Anxiety is often described as the persistent sense that something is terribly wrong. Some experience heart palpitations, stomach upset, and trouble breathing. Others faint when facing especially stressful situations. It’s very common to think an anxiety attack is a near-death experience. The physical sensations of fear are as pervasive and terrifying as being chased by a lion.

Working with both OCD and an eating disorder involves a combination of therapies. Most professionals who work with OCD use exposure therapy. They may also use Cognitive Behavioral Therapy (CBT) and/or Dialectical Behavioral Therapy (DBT). Both have been shown to be highly effective in treating Anxiety Disorders. If your child has OCD they will likely require ongoing mental health support beyond eating disorder recovery.

A program called SPACE has been found to be highly effective in reducing symptoms of anxiety, eating issues, and OCD. SPACE teaches parents how to respond more effectively to anxiety. Studies show that teaching parents these skills is as effective as working with the child using CBT.


Several studies have found a link between ADHD and eating disorders, particularly bulimia. The working theory on why this happens is that impulsivity is recognized as a trait for both conditions. The treatment for an eating disorder is distinctly different from and may even contradict the treatment for ADHD. This is why it’s important that both conditions are considered in treatment.

For example, treatment may begin either with managing the symptoms of ADHD or managing the symptoms of the eating disorder. Often the choice is made based on the experience of the team and the severity of the symptoms. ADHD is frequently missed in girls. Thus, this underlying condition is often missed in female eating disorder treatment.

One study found that for girls, ADHD significantly increases the risk of eating disorders. They showed a particular risk of developing bulimia nervosa. Girls with ADHD and an eating disorder had increased rates of mood, anxiety, and disruptive behavior disorders.

One of the most commonly-reported relationships between ADHD and eating disorders is the issue of eating regularly. ADHD often interferes with planning and regularity. Therefore skipped meals can become a problem, resulting in binge eating later in the day. It can be hard to tease apart the two issues, but doing so can greatly improve treatment efficacy.


Research has found links between Autism Spectrum Disorder (ASD) and Anorexia Nervosa. (Eating Disorder HOPE) People who are on the autism spectrum often exhibit repetitive behaviors and restrictive behaviors and interests. They also can have sensory sensitivities.

Since the current diagnostic tests for ASD are based on males, many experts say that females are under-diagnosed. Some say that under-diagnosis and subsequent lack of treatment may mean that many girls with anorexia are suffering from ASD. (Scientific American). Autism is also highly correlated with ARFID (Avoidant Restrictive Food Intake Disorder).

One symptom of Autism is the ability to hyperfocus. This may translate into extensive rituals around logging calories and body weight as seen in someone who has anorexia. The continued hyperfocus even when other people suggest relaxing food rules can also be seen as a symptom of ASD.

Another symptom of Autism is being highly sensitive. Many people who have ARFID have a strong aversion to specific food textures, smells, and even colors. Some will talk about the discomfort they feel when chewing, swallowing, and digesting food. This could suggest high sensitivity in the mouth, throat, and digestive tract.

These overlapping symptoms can make it hard to tease apart ARFID from anorexia. The term Avoidant/Restrictive Food Intake Disorder (ARFID) is now used to differentiate people who restrict food for non-weight reasons. Meanwhile anorexia is a disorder in which the active pursuit is low body weight.

The SPACE-ARFID program has been developed specifically to address non-weight-based food restrictions. It’s been found to be highly effective in reducing food and eating anxiety and increasing food and eating flexibility.

Post Traumatic Stress Disorder

Many people who have eating disorders have serious trauma in their history. This includes physical and emotional violence, sexual abuse, emotional neglect, having a serious accident or illness, witnessing a serious accident or illness, and more. Some research has shown that up to half of those who have an eating disorder have experienced sexual abuse. These traumatic experiences often lead to Post Traumatic Stress Disorder (PTSD) and very often pre-date eating disorder development.

Most of us think of soldiers returning from war when we hear about PTSD. But the disorder is found in 10% of women and 4% of men. The the higher prevalence of PTSD in women is likely because they are more likely to experience sexual assault. Such a violation is more likely to cause PTSD than many other types of events. The most common trauma for women is sexual assault or childhood sexual abuse. About 33% of women experience sexual assault during their lives, many before they reach adulthood. (National Center for PTSD)

Trauma rewires the brain

Trauma rewires the brain and nervous system. It results in chronically increased stress hormones and reduces the ability of the brain to communicate with the body. People suffering from PTSD may confuse fear and pain with pleasure. They will commonly push their bodies beyond reasonable boundaries. This includes extreme restriction, binge eating, self-harm, substance abuse, over-exercising, and extreme risk-taking (The Body Keeps the Score). One study found that +33% of individuals who have PTSD are still suffering from the full syndrome a decade later. In other words, it is frequently undiagnosed and undertreated.

It has been suggested that Bulimia Nervosa, in particular, may emerge as a coping method for the pain of PTSD. Women who have anorexia exhibit standard rates of PTSD (10%). But about 25% of women with Bulimia Nervosa are diagnosed with PTSD. (Eating Disorder HOPE)

If you suspect that one of these diagnoses may impact your child’s eating disorder, ask their treatment team whether they have been assessed. If not, you can request testing for any one of these conditions.

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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Sexual trauma and eating disorders

Sexual trauma eating disorder

Eating disorders rarely have a single cause, but we do know that sexual trauma can play a part. And unfortunately, sexual trauma is a major problem for girls and women.

One study found that 1 in 6 teen girls was harassed in the last six months. One in 5 girls between 14 and 18 years old reported being sexually assaulted. And 6% of girls surveyed said they had been raped. Another survey found that 48% of 7-12 graders experienced sexual harassment during the 2010-2011 school year.

A social crisis

We know that women are more likely to develop eating disorders in our culture. And we know there is tremendous pressure for girls and women to pursue beauty and thinness. But that doesn’t tell the full story. Women in our culture are frequently harassed and abused simply for their gender. And few speak of it due to the fear of retribution. We also have a very low rate of action against people who are accused of sexual crimes.

*Quick note: I know that boys are both sexually traumatized and develop eating disorders. In this article, I’m focusing on girls, but the advice holds true for any gender.

sexual assault statistics

No matter how good our parenting is, we can’t control the social situations our child enters. Schools, church groups, sports teams, and all social settings can be places where our girls may be sexually targeted.

Our culture does not currently hold sexual abusers accountable for their actions. Nor do we train people to not become sexual abusers. Until that happens, we must take steps to help our daughters recognize and address sexual harassment, assault, and rape. We must provide them with knowledge and tools that they can use to protect themselves from sexual harassment whenever possible. If the worst happens, we must intervene quickly and aggressively.

What is sexual trauma?

Sexual trauma is usually caused by sexual harassment, assault, or rape.

Sexual harassment may include making comments about a person’s appearance, body parts, sexual orientation, or sexual activity. These comments may be said out loud, performed using gestures, or written using texts or social media. Their intention is to hurt, offend or intimidate another person. Regardless of how they are communicated, they are always inappropriate and need to be addressed.

Sexual harassment turns into assault when it gets physical. This is when someone tries to kiss or touch someone who doesn’t want it. Rape is when a person forces someone else to have sex with them.

Given the statistics, it’s not uncommon for parents to have been sexually harassed, assaulted, and even raped in the past. This may make them hesitant to treat sexual trauma too seriously. They may have developed a coping mechanism of downplaying the impact of their own sexual trauma. But it’s important to know that our girls need protection against and action when sexual trauma occurs. Every person deserves to have sovereignty over their body.

Taylor swift sexual assault
Taylor Swift was involved in a case of sexual assault. Her testimony in court was powerful.

Eating disorders and sexual trauma

Sexual trauma is associated with the development of eating disorders. There are many reasons for eating disorders. But traumatic experiences, especially those involving the body, are some of the most strongly correlated event-based triggers for eating disorders.

Alisa was 12 when she was sexually assaulted by some boys from school. She thought they were friends, but one night their sexual innuendos crossed the line. Alisa froze and felt trapped and afraid about what would happen next. She didn’t feel like she could tell anyone. Even though she was close to her parents, she felt ashamed of what had happened. She felt that it was her fault because she flirted back in the beginning.

Alisa became increasingly anxious, which decreased her appetite. She found it more and more difficult to eat. By the time her parents became aware, she was deep into an eating disorder. She refused almost all foods except a few that she had identified as safe.

Her parents got her into treatment and her care team uncovered the assault. Once they knew about it, they were able to work with Alisa on processing her trauma. Her parents pursued reformative justice for the boys involved. With her parents’ support and care, she began to heal.

What parents can do about sexual trauma and eating disorders

Eating disorders arise when a person’s body feels unsafe. This means that sexual trauma can be a trigger. The thing that really needs to happen is for people to be trained to NOT sexually traumatize others. But we live in a society in which sexual trauma frequently occurs with very few consequences. Therefore, we need to raise our girls to identify and speak out against sexual harassment, assault, and rape.

1. Talk about boundaries

Have frequent conversations with your daughter about sexual boundaries. Sexual harassment often begins with a small innuendo or joke, which she may not know how to handle. Help her build some language for responding to jokes, even from friends. Discuss the three levels of sexual abuse: harassment; assault; and rape. Talk to your daughter about consent. Remind her that she has the right to say no when someone tries to violate her boundaries. This stays true regardless of her relationship status, behavior, dress style, or past history.

2. Pay attention to school, work, sports, and church groups

Talk to your daughter about who she is in contact with on a daily basis. Does she feel comfortable with her peers and adults involved in the activities she’s involved in? Pay attention to any abrupt changes in her willingness to attend places and events. Especially if they were previously comfortable, fun places for her. Ask whether something happened and whether there is anything you can do to help. Remember that she may not be able to talk to you with words. But her behavior may show you there is a problem.

3. Set digital boundaries

Text groups and social media apps can be filled with sexual innuendo and harassment. Group conversations can go from fun to dangerous very quickly. Talk to your daughter about what is and what is not acceptable in digital media. For example, taking photographs of body parts, discussing body parts, and other sexualized activities online should be strongly discouraged. Determine whether you need to monitor conversations. This may be necessary to support your daughter as she learns to identify sexual harassment situations.

4. Report problems immediately

Don’t hesitate to discuss sexual harassment with your daughter’s school, sports team, church, etc. There is a good chance that your child will not be comfortable doing this herself. And this is a time when she needs your active participation as a parent. Don’t let her, or anyone else, tell you to just “let it go.” Be persistent in following your complaint through the system. And engage an attorney specializing in sexual harassment if necessary. Your rigorous defense of her body is critical to her sense of safety and healing.

5. Get treatment for your child

Many girls find themselves living with PTSD following sexual trauma situations. Don’t wait for signs of distress. If your daughter has sexual trauma, schedule an appointment with a qualified therapist. She will likely need help processing what happened. Even if she is not traumatized by the event, she may find herself traumatized by the aftermath. Reporting someone for sexual crimes is extremely stressful in our society, and she will need support in handling the fallout.

6. Continue to watch for signs of distress

Many times, victims of sexual trauma go months – even years – before the impact of the trauma makes itself known. A delayed response to a traumatic event is common. In fact, many survivors forget it happened to protect themselves. This is where behaviors might be your best sign that there is something wrong. Numbing behaviors like substance abuse, self-harm, suicidality, and eating disorders may be symptoms of PTSD. Be vigilant in continuing the conversation with your child. And watch for signs of distress so that you can help your child heal from the trauma, no matter when it presents itself.

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.