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Treat the parent, help the child recover from an eating disorder

Treat the parent, help the child recover from an eating disorder

Alicia knew she had to do something soon. Her daughter Eden had been stuck in a restrictive eating disorder for a few years. Eden was medically stable and in treatment. But Alicia knew that she was still deeply affected by her eating disorder. And the eating disorder was taking up a lot of space in the family and for Alicia personally. Alicia wanted to make sure she was doing everything in her power to keep things from getting worse. 

Alicia started a parent-based treatment called SPACE (Supportive Parenting for Anxious Childhood Emotions). The program included 12 Zoom calls, plus homework and practice in between. Alicia learned ways to support Eden without accommodating anxiety-driven eating disorder behaviors. At the end of the program, Alicia noticed improvements in her daughters’ eating disorder behaviors. And she gained a new perspective on how she was parenting and skills to support Eden’s recovery.

“I was unsure how I could actually do anything to change the eating disorder. Mostly I was afraid to even try. But deep down I had a suspicion (A dream! A fear!) that there was more I could do. In SPACE training I became aware of how much I was accidentally accommodating the disorder. And in fact, it was those moments when I felt like I was being most supportive and loving that I was accidentally making things worse,” says Alicia.

“Now, I am really supportive … even more supportive than before. But I also have really good boundaries and I’m not getting into dangerous waters by accommodating Eden’s anxiety. I no longer avoid the hard things we need to do to get better,” says Alicia. “When I first learned what I had to do I thought it would be harder to parent this way. But in fact, things are running more smoothly now than they were before.”

Parent training for eating disorder recovery

As a parent, you did not cause your child’s eating disorder, but you have a critical role in recovery. New research is revealing that you can help treat your kids’ anxiety-driven eating disorder behaviors, improve your relationship, and boost your child’s flexibility and resilience by participating in SPACE parent-based treatment. These skills will last a lifetime and might change the course of your child’s recovery from their eating disorder.

SPACE is about learning to recognize parental accommodation and establish a new way of responding to anxious behaviors. When applied in eating disorder situations, SPACE can address anxious behaviors like food restriction and rituals, body-checking, and body comments. It teaches you to focus on your behavior rather than your child’s behavior since that is what is within your control. Parent training can be done either as part of a group or one-on-one. The skills taught in SPACE for eating disorders include: 

1. Creating a daily routine of consistent family meals and building family connections.

2. Identifying which eating disorder behaviors are coming from anxiety and how your responses accommodate the anxiety.

3. Creating a plan for which accommodations you want to target and how you will respond differently to anxiety in the future.

4. Implementing your plan and removing your accommodation for one anxiety-driven behavior at a time.

5. Practicing and refining your approach and choosing additional targets.

How SPACE works

The SPACE parent treatment program was developed and validated by scientists at Yale University. Its original use was with kids who have anxiety disorders and obsessive-compulsive disorder (OCD). A more recent version of SPACE was developed specifically for kids with avoidant restrictive feeding intake disorder (ARFID). SPACE has also been evaluated in children who have ASD, ADHD, and challenging behaviors like physical violence and threats of suicide.

The evidence-based parent treatment usually takes place over the course of 8-16 weeks. Parents join one 1-hour meeting per week and complete homework and practice between sessions. The first several sessions focus on parent education, and the additional sessions involve the parents implementing their plans and refining their skills.

Is anxiety a factor?

If anxiety is a factor in your child’s eating disorder behaviors, then SPACE can be appropriate. Many eating disorder behaviors are driven by anxiety, including:

  • Food avoidance: eating only at particular times, in particular places, a very limited list of foods, etc.
  • Food rituals: measuring, counting, arranging, hiding, mashing, throwing food, etc.
  • Body checking: weighing, pinching, measuring, etc.
  • Body talk: frequent questions like “am I fat?” “will this make me fat?” “I’m so fat” etc.

If your child is not medically stable and/or is in Stage 1 of family-based treatment (FBT), then your targets will not be food behaviors. But if your child is home with you then it may be appropriate to apply the treatment to body checking, body talk, or other anxious behaviors that are not directly linked to the eating disorder.


I provide SPACE parent-based treatment for eating disorders because it gives parents evidence-based skills to treat anxiety-driven eating disorder behaviors. It’s an excellent option for dedicated parents who want to do more.

“There’s a sense of action and empowerment in SPACE, and I found myself feeling more hopeful than I’ve felt since Eden first started showing signs of an eating disorder,” says Alicia. “I felt so powerless so many times in the past few years, and this is the first time I’ve seen real progress in a long time.”

“I felt really connected to the other parents in my SPACE group,” says Alicia. “It was as if we could all take a collective deep breath and feel less alone in all of this. I think we were all like shaken soda cans in the beginning. We looked fine on the outside but we were ready to burst. By the end, we were sharing our successes and sometimes laughing together. There was a real sense of community and shared safety.”

Setting goals

A key goal of SPACE parent training is seeing a reduction in anxious behaviors. Parents identify the eating disorder behaviors they want to see reduced and then work towards their goals by changing their (the parents’) behavior. You can help treat your kids’ anxiety-driven eating disorder behaviors with this parent-based treatment. Target behaviors might include: 

1. Food refusal goals might include expanding the list of “safe” foods. 

2. Food ritual goals might include eating a meal without hiding food.

3. Weight ritual goals might include not using the bathroom scale.

4. Body talk goals might include fewer meltdowns over body appearance.

5. Treatment resistance goals might include less debate and negotiation about treatment plans and participation.

At the end of SPACE treatment, parents review the goals they are achieving and the goals they still have. The parents’ focus remains on ending their accommodation of anxiety-driven eating disorder behaviors since parental accommodation is a “maintaining factor” in eating disorders. But the results of the treatment will also be apparent in the child. There is good evidence showing that SPACE parent treatment results in a reduction in the quantity and severity of anxious behaviors by the child.

What results can I expect?

Could SPACE parent treatment be what your child needs to get further into their recovery? That depends on many factors, including how entrenched your child’s eating disorder is, your own ability to commit to and follow the treatment, and the consistency with which you practice your new skills at home. 

Kids may need to continue their own treatment even when parents change their behavior. Eating disorders are complex and multi-factorial, so the ongoing involvement of a therapist, dietitian, and physician may be necessary for the foreseeable future. The main opportunity with SPACE parent treatment is for you to know that you are doing everything in your power to support your child’s recovery and nothing that will interfere with recovery.

Some parents who complete SPACE treatment see improvements very quickly, but while things will feel easier and you’ll feel more confident in your own behavior, this is not a miracle treatment. It will take time for you and your child to learn a new way of relating to anxiety-driven eating disorder behaviors.

Facing difficulties

Sometimes your child’s behavior may get worse before you see improvements. This is a known phenomenon called an “extinction burst.” You’ll learn the skills you need to stay steady in the face of anxiety escalations and will work on your own emotional regulation in times of stress. Anxious behaviors are driven by “body-up” sensations and are therefore not intentionally manipulative or coercive, but to parents, that’s exactly what they feel like. 

Your desire to reduce your child’s distress and disruption will feel overwhelming at times, but you’ll have the knowledge and skills you need to respond without accommodation. Being a sturdy, strong parent when your child desperately wants you to accommodate their anxious demands will take time and practice. The SPACE parent-based treatment helps you treat your kids’ eating disorder behaviors and face these difficulties with confidence.

Extinction bursts don’t typically last long, and if you can stay the course, maintain the plan, and practice your skills, both you and your child will feel better soon. The result is fewer anxiety-driven eating disorder behaviors, confidence that you are doing the right thing, and a more connected and relaxed relationship with your child. 

Give it time

Learning to hold yourself steady in the face of a powerful anxiety-driven eating disorder escalation is hard. While every parent wishes for overnight success, SPACE parent-based treatment is more about consistent improvement. You might not see the magic happening every day, but if you stick with the plan you’ll see big changes over time.

A major side effect of SPACE treatment is a reduction of “caregiver burden,” which is significant with eating disorders and can impede recovery. You’ll feel more confident and less overwhelmed and hopeless. And that alone is a major benefit of the SPACE parent-based treatment to treat your kids’ anxious eating disorder behaviors.

That’s what happened with Alicia. The first few weeks of SPACE challenged everything she thought she should be doing to support Eden. But a few weeks later, she could sense a difference in their relationship. “There was a lot less stress at mealtimes and other times we spent together,” she said. “I didn’t even realize the burden I was carrying. But now I see that I was trying to do everything right, and I was constantly walking on eggshells, afraid to make things worse. I worried all the time. But then I learned that my avoidance had actually empowered the eating disorder. Now that I know how to safely stand up to anxiety, I feel stronger and more effective.”

“Eden is still seeing her therapist weekly, but she is firmly in recovery now,” says Alicia. “We still have work to do individually and as a family, but I’m at least sure that I’ve reduced my accommodations and am doing everything in my power to keep Eden healthy.”

You can learn more about the SPACE treatment for parents who have kids with eating disorders here.

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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Why I think eating disorder treatment often doesn’t work

Why I think eating disorder treatment often doesn’t work

Many parents who have a child with an eating disorder face years of treatment that doesn’t seem to work. It’s frustrating to try so hard and spend so much money and energy working against an eating disorder that won’t budge. So what’s missing? Why is this so common?

First, of course, eating disorder treatment works for many people. But it’s also true that eating disorder treatment doesn’t work for other people.

I’m not criticizing any of the hard-working professionals in the eating disorder field. Nor do I suggest we throw out what’s already working, but I do wonder: what’s missing? What else could we be doing to make a greater impact on shortening the duration and reducing the severity of many eating disorders?

What’s missing?

A big part of the problem is that eating disorder research is chronically underfunded. So compared to almost any other serious condition, there is relatively little scientific data to work with, particularly with non-anorexia diagnoses. Most of what we know about treating eating disorders comes from small studies, trial and error, and is the result of tremendous effort by parents, professionals, and people who have/had eating disorders. 

My unique perspective on eating disorders comes from a combination of research and lived experience. I had an eating disorder for most of my life. Since recovering, I’ve been dedicated to understanding, decoding, and writing about eating disorders. 

My coaching work with parents who have kids with eating disorders has shown me just how frustrating traditional treatment can be. Meanwhile, my work with professionals shows me how much they care and how much they want to help. And in talking with people who have/had eating disorders, I know they’re frustrated, too. 

So what do I think is missing from most eating disorder treatments? Why does eating disorder treatment often have frustratingly elusive results?

Here are some of my current opinions and thoughts about why eating disorders remain so difficult.

emotional regulation

Why an eating disorder?

When working with a family that has an eating disorder the first thing I want to know is “What is driving this behavior?” When eating disorder treatment doesn’t work, I wonder whether we understand what’s driving it.

Eating disorders don’t come out of nowhere. They have a reason and a purpose. When we address the reason and purpose for the eating disorder we can treat it more effectively.

When a child rejects food, binge eats, or purges, I want to know what’s going on beneath the behavior. What’s driving it? 

*I realize that in FBT the premise is that we don’t worry about the “why.” I’m trained in FBT and agree that when we’re facing a medical crisis, we need to address the medical crisis (e.g. weight suppression) first and foremost. We need to get the medicine of food into the body. But to ignore the “why” is missing the big picture in a mental health condition like an eating disorder.

The old way of thinking about negative behaviors was that the child was “abnormal,” “manipulative,” or “looking for attention.” But what we’ve learned from recent developments in neuroscience is that in fact, behavior is a way for a person to meet a primal need for emotional safety. 

💡 Emotional safety: when a person’s nervous system, beliefs, and thoughts are cohesive, calm, secure, engaged, relaxed, and open to other people.

Once we learn to address emotional safety, we can help the person feel better. And most of the time when a person feels better they will have less need for the behavior and be in a position to learn cognitive skills for managing the urge to perform the behavior. It is virtually impossible to utilize cognitive skills and knowledge when you lack emotional safety.

💡 Cognitive skills: using your prefrontal cortex to acquire knowledge, manipulate information, and reason.

Diving in with cognitive skills for managing eating disorder behaviors is where most treatment begins. But its effectiveness is limited because an eating disorder is not typically a cognitive, conscious process. It does not arise from conscious thought. Therefore it’s not a choice. It is in response to the need for emotional safety. 

A bottom-up behavior

Treatment often involves telling people that their eating disorder is dangerous, will hurt their health, etc., and provides strategies for overcoming urges. This may give us insight into why eating disorder treatment often doesn’t work. While these top-down approaches may be perfectly logical and technically useful, they are all cognitive. And since eating disorder behaviors are bottom-up vs. top-down behaviors, they often fail to make a difference. 

💡 Bottom-up: arising from the nervous system, primitive areas of the brain, embedded memories, etc

💡 Top-down: arising from conscious thought; using cognition and language

I believe that almost all eating disorders begin with bottom-up issues. Therefore to help a child recover from an eating disorder we need to address bottom-up processes. This is done using something called emotional regulation

💡 Emotional regulation: the act of noticing, accepting, and processing signals from the nervous system to achieve a calm, engaged emotional state.

Once they have learned emotional regulation, a person’s urges for eating disorder behaviors are greatly reduced. In this place, they are available to do cognitive work on the eating disorder. 

Bottom-up processes drive most compulsive behavior. Therefore until we address these processes, we will not be successful in our top-down treatments.

💡 Compulsive behavior: a behavior that is not driven by logical, conscious choices, including most eating disorder behaviors. The person feels “driven” to complete the behavior even if consciously they do not want to and/or are ashamed of the behavior.

Why the eating disorder exists

Unless medical weight gain is needed, rushing into mental health treatment without understanding the “why” of the eating disorder is typically an exercise in frustration for everyone (the child, parents, siblings, treatment providers, etc.). 

You can tell your child that they need to eat or stop purging for months and years with very little impact. This isn’t because what you’re saying isn’t true. It’s also not because your child is hopeless or disrespectful. It’s because treatment is working on the wrong end of the equation

The more we push cognitive processes in eating disorder treatment, the deeper the eating disorder may dive. It can be incomprehensible that with all this knowledge and expensive treatment a child still doesn’t get better. Especially because many times the child is engaging in treatment and telling you they want to get better. But once you understand the role of top-down vs. bottom-up processes it makes a lot of sense.

Typically we focus on the behaviors of making them eat, stopping the binge or purge, etc. And don’t get me wrong: parents can and should set up structures for behavioral change. But without understanding and addressing the “why” or the driver of the eating disorder, which typically lives in the emotional (non-cognitive) system, we will likely see very little change. 

Seeking behavioral compliance without understanding why the behavior exists is a recipe for frustration and ineffective treatment.

Bottom-up treatment for eating disorders

I’m not suggesting that all eating disorder treatment is ineffective. After all, I teach behavioral strategies to my clients. And many people do recover using current standards of care. What I do think we need to see happen however is the addition of bottom-up treatments.

Today we have the power of neuroscience. We understand the nervous system in ways we never did before. Research and insights from people like Drs. Daniel Siegel, Tina Payne Bryson, Pat Ogden, Peter Levine, and Stephen Porges help us understand behavioral problems through an entirely new lens.

This new lens is being applied in many areas, including treatment for ADHD and autism. It’s revolutionizing the way we treat addiction. I believe it should be applied in the treatment of eating disorders. And parents and professionals who are doing this are seeing positive results.

I don’t think we need to overthrow current treatment, but I do think we’re missing out on huge opportunities to treat the bottom-up side of eating disorders. Here are the things I’d like to see added to treatment:

Professional therapies

Today most treatment focuses on medical (weight and bloodwork), psychological (cognitive therapy), and nutritional. These are all necessary and helpful. But I’d like to see an expansion into therapies that address the nervous system. These can include things like: 

  • Somatic therapy
  • Hypnotherapy
  • EMDR (eye movement desensitization and reprocessing)
  • Vagus nerve exercises and toning
  • Yoga
  • Mindfulness meditation
  • Trauma-informed massage and bodywork

These therapies don’t rely on cognitive processes but instead tap into the body to soothe and regulate the nervous system. Just like with traditional therapies, it is important to check the professional’s credentials, training, and track record in working with trauma and eating disorders. One caution is that working with the body like this requires a great deal of skill and conscious attunement. This is still a new and growing area of treatment, so pay attention to how it feels and seek another option if you sense it’s not having a positive impact.

Parent treatment

Today most treatment focuses on the child who has an eating disorder. When parents are involved, it’s typically in the areas of feeding, possibly attending some family therapy (cognitive), and getting the child to treatment appointments. These are necessary and helpful. 

But I’d like to see an expansion of the parent role into learning how to use emotional co-regulation to help the child. Our children are not born with the ability to self-regulate. They learn how to do this with our support and through repeated experiences of co-regulating with us. Parents who learn to intentionally co-regulate with a child who is struggling with behavioral disorders can make a huge impact. It takes some training and practice, but it can also transform your relationship and ability to support your child’s recovery.

To get started, you can download my eBook: Emotional Regulation Skills for Parents Who Have Kids With Eating Disorders. In this eBook you’ll learn how to recognize the different emotional states and how to respond, plus powerful worksheets to help you get started.

A new way forward

My experience in working with parents and professionals is that everyone desperately wants to help kids recover from eating disorders. I do not believe there is a lack of trying or love in the treatment of eating disorders. But I do think there is room to expand professional treatment and empower parents to engage more fully in effective treatment. 

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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How emotional regulation can help with an eating disorder (and what you can do)

How to use emotional regulation to help your child who has an eating disorder

A child who has an eating disorder will benefit from emotional regulation skills, and parents can help by learning co-regulation techniques. When we co-regulate with our kids, they learn to do it for themselves. In fact, we are in the best possible position to improve our kids’ capacity for emotional regulation.

Often when we learn a child has an eating disorder all our attention goes to the child’s disordered behaviors. We focus on feeding them and getting them to therapy. This is important, necessary, and makes a lot of sense. 

But when we focus exclusively on behaviors we may miss the cause of the behaviors. And emotional dysregulation and disengagement are often at the heart of eating disorders. This is why emotional regulation is key to lasting recovery.

Parental co-regulation

Children are not born with emotional regulation skills. They learn them through a process called co-regulation.

Parental co-regulation is when a parent’s nervous system regulates the child’s nervous system. With practice, the child gradually learns to regulate their own nervous system without the aid of their parent. This is something we know based on recent developments in neuroscience, which is teaching us how children’s emotional systems develop. 

When there isn’t enough co-regulation in the parent-child relationship, our kids don’t develop a healthy self-regulation system. We often see signs of this through kids’ negative behavior.

Benefits of co-regulation:

  • More balanced and calm state of mind
  • Able to cope with worry and regulate thoughts and emotions
  • Ability to think more clearly and make decisions
  • Increased ability to respond rather than react
  • Process worry, stress, and anxiety in a healthy way
  • Emotional balance
  • Relationship balance
  • Self-awareness
  • Social awareness

Adults can learn emotional regulation when they are older, but it is much harder and takes a lot of time and effort. A child/teen, on the other hand, can learn emotional regulation through co-regulation with a parent much faster due to the neurobiology of the emotional regulation system. A parent who co-regulates with their child, especially when there is an eating disorder, can make a huge impact on the child’s lifetime mental health.

emotional regulation

Understanding attunement

Co-regulation begins with parental attunement. This is when a parent tunes into how a child is feeling – the feelings that lie beneath the behavior we’re observing – and responds in a way that will bring the child into an emotionally-regulated state. Attunement is something that we’re designed to do for our children, and it’s something our kids need us to do to build a healthy self-regulation system.

Attunement begins with tuning in to how your child is feeling. Your first trigger that there’s a feeling to pay attention to is that you might notice you are getting irritated or frustrated with them. That’s typically a good sign that your child is having feelings and needs you to tune in and help them regulate their emotional system. 

Once you notice a behavior that bothers you and therefore indicates hard feelings, take a deep, calming breath and look at your child. Think about what they might be feeling, and try to sense it with your body. 

We have a vagus nerve that is automatically attuned to our child’s distress. The vagus nerve winds throughout our brain, face, neck, and trunk. “Gut feelings” are actually the vagus nerve sending feedback to your stomach and intestines. Vagus nerve feedback is powerful and embodied, and it’s one of the best ways we can become attuned to our child’s emotional needs.

Being attuned to your child takes practice, but it’s something you can learn. 

Childhood emotional regulation

Behavior is often seen as something we need to fix or get rid of. But when we shift our thinking to recognize that behavior holds critical clues, we can decode our kids’ emotional state and respond appropriately. Our kids’ negative, annoying, and dangerous behavior, including eating disorder behavior, tells us they need this from us. 

This approach is a critical shift from thinking our kids’ behavior is something that needs to be overcome, fixed, shut down, or controlled. Instead, we want to learn to translate behavior and use co-regulation to help them learn self-regulation. 

Often we get frustrated with our kids’ irritating behaviors. We all wish our kids would self-regulate their emotions better. But emotional regulation is a learned skill, and our own irritation is our signal that we need to tune in and help them with co-regulation. 

No matter how convenient it would be, we don’t improve nervous system regulation with cognitive skill-building. Rather, we improve nervous system self-regulation through co-regulation.

Windows of tolerance

One helpful way to visualize this is to consider our kids as having different emotional “windows.” I created a visual way of seeing these three windows, or emotional states: dysregulated, co-regulated, and disengaged. This illustration is based on materials provided by Mona Delahooke. It interprets the “Window of Tolerance” concept developed by Dr. Daniel J. Siegel, a leader in neuroscience research particularly as it relates to the parenting relationship. I also integrated concepts from the work of Dr. Stephen Porges.

GJC emotional regulation model

The behaviors and feelings are scientifically validated. However, the information for “eating disorder behaviors” is based on my professional observations, research, and lived experience. Please use this information as guidance, not fact. Every eating disorder is unique.

A child who has an eating disorder will likely have periods of emotional regulation. That is to be expected. However, the eating disorder behaviors are unlikely to be a problem while the child is in a regulated state, which is why I put “N/A” in that column. Eating disorder behaviors are most often triggered by emotional dysregulation and/or disengagement.

Co-regulating with your child through recovery

A child’s eating disorder recovery will go through many stages. The main thing to keep in mind is that when a child increases their emotional regulation, their eating disorder behaviors will almost always decrease. 

This rarely happens all at once, but rather in stages. And the goal is not to achieve a state of constant emotional regulation. Instead, we just want to shift the balance and have more periods of regulation than periods of dysregulation and disengagement. This is normal and healthy human emotional functioning.

I’ve come up with a model: Emotional Stages of Eating Disorder Recovery based on my research, observations, and lived experience. 

Emotional Stages of Eating Disorder Recovery By ginny jones

The key here is that parents can play an integral role in eating disorder recovery by focusing on co-regulating with their child, which will build the child’s ability to self-regulate and therefore not seek eating disorder behaviors as a coping mechanism.

How to co-regulate with your child

So how does a parent co-regulate with a child who has an eating disorder? Remember that the first step is to be attuned to your child’s emotional state. Keep in mind that often your first signal that your child needs co-regulation is that you’ll feel irritated or upset with them. Use that signal to determine where your child falls: are they dysregulated or disengaged? Once you know that, you can start to intuit the feelings they are experiencing.

Once you are tuned into your child’s emotional state, you can begin co-regulating by: 

  • Making gentle, non-threatening eye contact
  • Using a soothing vocal tone
  • Saying kind words of understanding and validation
  • Touching them gently and respectfully
  • Breathing deeply to keep your nervous system regulated
  • Using compassionate self-talk to keep yourself centered

The most important part of co-regulation is to keep your nervous system centered and confident. What you feel is more important than what you do or say.

Remember that you can always come back and talk about the problematic behavior that tipped you off to your child’s need for co-regulation. But you cannot have useful conversations about behavior while your child is in a state of dysregulation or disengagement.

Activities you can do together

The steps above are the most important part of co-regulation. But sometimes it will help to move into activity. Be thoughtful here and make sure activity is called for. Adjust your activity and expectations based on the level of dysregulation or disengagement. It’s unlikely that you will want to use the same activity all the time. These are a few go-to activities that can help your nervous system get in touch with theirs if they are resisting connection:

  • Art: color, paint, or doodle
  • Play: play a simple and non-competitive game from childhood
  • Stretch: do some gentle stretches
  • Exercise: go for a walk or run
  • Pets: talk about your pets and/or pet your pets
  • Eat/Drink: make a cup of tea or a piece of toast to share
  • Go outside: look up at the sky, look at trees or grass
  • Read: read a book out loud in a calm voice. You could choose something from childhood that holds good memories
  • Light a scented candle: smell is a powerful and underutilized way to soothe and calm the nervous system
  • Listen to music together

While you do these activities, don’t worry about what you say. Worry about how you feel. The goal is to stay in your child’s presence so that your calm, confident emotional state will automatically transmit to their dysregulated or disengaged nervous system.

emotional regulation

Be careful of the talk trap

Avoid getting stuck in the trap of thinking that co-regulation relies on talking about feelings. It does not. Your child cannot have useful, meaningful conversations with you when they are dysregulated or disengaged. Therefore, while soothing talk may be helpful, trying to talk about the behavior or even the feelings may not be helpful and can even get in the way. Focus on feeling calm and being with your child and rely on your senses rather than words. 

If your child wants to talk, validate what they say and help them clarify their feelings and thoughts. But avoid debating, offering advice, or providing guidance when you see signs of dysregulation or disengagement.

You can have longer and more meaningful conversations once they are regulated, which means they are showing signs of being calm and confident. But trying to do this when they are not emotionally regulated can backfire.

How we can do this better

As parents, our nervous system is constantly communicating with our kids’ nervous systems. This is why attending to our own emotional health will help our kids feel better. 

In fact, there are several validated interventions in which only parents are treated for childhood emotional disorders. In these cases, therapists never work directly with the child, but instead, teach the parent emotional regulation skills. And they work just as well if not better than direct intervention with the child. 

How to strengthen your emotional regulation as an adult:

  • Work with a therapist/coach to discover and address your own dysregulation and disconnection patterns
  • Practice meditation
  • Learn self-compassion 
  • Nourish your body with food you love
  • Move your body joyfully
  • Get outdoors every day
  • Learn self-acceptance
  • Find a hobby or something you do enthusiastically just because you enjoy it
  • Build/deepen your friendships and relationships with others

Supporting our kids’ eating disorder recovery

Parents can make a significant difference in kids’ recovery from eating disorders. And while feeding your child and getting them to therapy are important, your emotional growth can also make a big difference. 

Learning emotional regulation and how to co-regulate with your child may be the difference-maker you’ve been looking for! You can download my eBook: Emotional Regulation Skills for Parents Who Have Kids With Eating Disorders. In this eBook you’ll learn how to recognize the different emotional states and how to respond, plus powerful worksheets to help you get started.

This article is informed by the work of Stephen Porges, Daniel Siegel, and Mona Delahooke

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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32 worst things to say to someone with an eating disorder

worst things to say eating disorder

Most of us don’t know what to say to someone who has an eating disorder. Eating disorders are poorly understood, and most of us have never had a meaningful conversation about eating disorders.

The result is that people often say the wrong thing to people who have eating disorders. It’s not because they are trying to be hurtful, but it hurts nonetheless. I interviewed thousands of people who have/had eating disorders to find out the phrases that hurt the most.

The three most damaging eating disorder comments are:

  1. Just stop doing it: the idea that recovery is simple misses the depth and complexity of eating disorders. They are intensely personal and deeply challenging disorders that impact the mind and body. Recovery is rarely simple and requires comprehensive treatment.
  2. But you look great: while it’s true that an obsession with appearance is a symptom of an eating disorder, that is not all that an eating disorder is about. And no amount of reassurance will ever budge an eating disorder. They require specialized treatment and care.
  3. I wish I had an eating disorder: an eating disorder is a life-threatening disorder that can impact a person’s body and mind for life. Usually what people mean when they say this is that they wish they could lose weight. This is deeply damaging and hurtful for someone in the depths of a mental disorder.

If you’re not sure what to say to someone who has an eating disorder, then stick with compassion and support. Avoid making suggestions or comments that expose your own fear of fat or belief that an eating disorder is a choice.

Here are 32 of the worst things people say to people who have eating disorders:

Just …

  • stop throwing up
  • eat
  • put the fork down
  • start eating regularly, it’ll fix itself
  • let yourself become one with God. And when you realize that you are in God’s love, your anxieties will go away

Statements that begin with the word “just” suggest that eating disorders are simple. Eating disorders are absolutely not simple. They are complex biopsychosocial mental health conditions. That means they stem from a combination of biological, psychological, and social conditions. All of these conditions combine to create a situation in which eating disorders thrive.

When people start a statement about eating disorders with the word “just” It shows a lack of understanding of the complexity of the situation. This suggests they don’t understand how serious and challenging it is to recover from an eating disorder.

But you …

  • are skinny, so you can’t be anorexic
  • aren’t skinny, so you can’t be anorexic
  • look fine
  • don’t look like you have an eating disorder
  • are so smart, why can’t you see that this is ridiculous?
  • aren’t really bulimic. You don’t throw up, do you?
  • can recover if you want it badly enough

When a comment begins with “But you” the next thing that comes out is going to hurt. This is because it suggests that a person shouldn’t have an eating disorder. The word “but” means “you shouldn’t.” Phrases that begin this way suggest that a person with an eating disorder is making an active choice to have an eating disorder rather than struggling with a mental health condition. A simplification of the problem will not make the eating disorder go away because it misses the point.

Also, the idea that eating disorders have a certain look is deeply damaging. The vast majority of eating disorders are invisible.

I wish …

  • I had anorexia! My body could lose a few pounds!
  • I had the strength to not eat! My problem is that I eat too much!
  • you would just stop doing this!
  • you could hear how ridiculous you sound

“I wish” statements are often followed by the idea that you wish you had some eating disorder symptoms. In doing this, you’re perpetuating diet culture, which is one of the contributing factors in eating disorders. These statements suggest that an eating disorder is a healthy diet with a positive outcome rather than a deadly condition. There is no upside to an eating disorder.

Another option is “I wish you would just stop!” This suggests that you think recovery is easy. As you’ve probably picked up by now, eating disorder recovery is not easy.

Making a wish will never make an eating disorder go away.

It’s not that hard …

  • focus on eating healthy and get some light exercise!
  • stop caring what people think!
  • run. If you run, you’ll be hungry. AND it cured my depression
  • it’s just about willpower!
  • just eat normally and then lightly exercise
  • if you’re unhappy with your weight just diet and lose it!
  • if you’re unhappy with how you look then eat better and workout more

It’s dismissive and hurtful to suggest that “it’s not that hard” to recover from an eating disorder. Of course it’s hard! If it weren’t, then nobody would have an eating disorder.

We live in a culture that has a poor understanding of mental health, but here’s a really simple rule of thumb. Any time you want to say it’s not hard to be mentally healthy, consider whether you would say the same thing to someone who broke a leg. Would you suggest that they could heal by simply “getting over it?” Or adding some light exercise? No!

And you definitely wouldn’t suggest that the way to heal a broken leg is to heal it by themselves. That’s essentially what happens when someone suggests that a person who has an eating disorder should eat, not eat, or exercise their way out of their eating disorder. That’s just not how it works.

But …

  • you look perfectly fine to me
  • can’t you see how bad you look right now?
  • there is nothing bad happening in your life for that you act like that
  • doesn’t everyone have an eating disorder?
  • you’d look better if you gained weight

When a response begins with “but,” this suggests that eating disorders are simple and/or ridiculous. We’ve covered the fact that eating disorders are not simple. Eating disorders are also not ridiculous. They are coping behaviors that are rooted in a web of biology, psychology, and societal forces.

You need to …

  • stop being so selfish and take care of yourself so you don’t make your mother worry. Why do you keep making things so difficult for her?
  • eat normally. You don’t have to eat pizza everyday but just eat something
  • go eat a hamburger
  • pray and Jesus will make it go away

It’s almost never helpful to tell someone who has an eating disorder what they need to do. Leave that up to the professionals who are working with the person who has the eating disorder. They alone are qualified to provide any guidance on this topic.

What to say instead

This doesn’t mean you can’t say anything! Just say words of compassion rather than advice. Compassionate statements recognize that the person is doing their very best. They also demonstrate that you trust the person to make the right choices for their recovery. Here are some ideas:

  • I’m so sorry that you’re hurting right now
  • It sounds as if you’re working really hard
  • I’m here to support you
  • It sounds like this is really challenging
  • I love you

I know it’s hard to learn these guidelines. Most people genuinely want to be helpful, they just don’t know enough to avoid causing harm. Hopefully, this has given you some ideas about why these statements can be hurtful and what to say instead.

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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Afraid, angry, and tired. Parents are at risk of traumatic stress when a child has an eating disorder

Eating disorders are terrifying for parents for many reasons. Not only are they physically and emotionally harmful for the child, but they also carry tremendous stigma and misunderstanding for parents.

Parents who have children who have eating disorders may feel angry, stressed, tired, and obsessed with their child’s recovery. These are signs of traumatic stress that can lead to significant behavioral and emotional impacts. The tension you carry as the parent of a child who has an eating disorder is serious, and it must be addressed.

Numerous studies have shown that parents who have seriously ill children often suffer significant distress, and many experience clinically significant levels of post-traumatic stress symptoms. These symptoms can impact a parent’s long-term mental health, family functioning and the child’s recovery. (NIH, 2015)

Signs of traumatic stress

Some signs that you may be developing trauma in response to your child’s eating disorder include:

1. You feel personally attacked and vulnerable when you see care providers and feel that they are judging and blaming you for your child’s condition.

2. You hide your child’s condition from certain close friends and family members because you can’t talk about it without becoming emotional.

3. You find yourself obsessing about your child’s prognosis are constantly trying to guide and control your child’s behavior to drive recovery.

4. You consider yourself responsible for your child’s recovery from an eating disorder.

5. If someone makes a comment or asks a question that implies to you that you are responsible for your child’s eating disorder, you fly into a defensive rage or abruptly stonewall them.

6. You find yourself worn out and unable to function as you used to. For example you may make more mistakes at work, be late to and forget about important meetings, and forget to pay bills.

7. You may not attend to personal hygiene and personal care as you used to.

8. You may turn to maladaptive coping mechanisms such as drinking, eating too much or too little, taking sleeping pills, and compulsive shopping.

9. You find yourself withdrawing from people with whom you used to be close.

10. You experience mood swings from extreme “doing” and action, to extreme withdrawal and depression.

11. You are sleeping more or sleeping less than you used to.

12. You sometimes feel rage and anger while participating in your child’s eating disorder recovery, for example, while driving them to and from appointments, participating in family therapy, monitoring their behavior, etc. You may feel ashamed of this anger and judge yourself for feeling it.

Parents need oxygen, too

These are signs that you may be suffering trauma in response to your child’s eating disorder diagnosis. Parents can and should be involved in their child’s recovery from an eating disorder, however, if the recovery process is bringing out these symptoms for you, then you should immediately seek counseling and support for your own feelings and experience.

Just like on the airplane, we must put on our own oxygen masks before we attend to other people. This is because we can help more people more effectively if we help ourselves first. If a parent is experiencing trauma during their child’s eating disorder treatment, they are in personal danger and are also not as effective as they could be. Seeking help for yourself is critical.

Get help

The first step in helping yourself during your child’s recovery from an eating disorder is to accept that your situation sucks and get help for yourself. This is not to take away your child’s experience or your involvement in their treatment – this is merely to make sure that you are being treated for your own trauma.

Most parents who have children who have eating disorders cycle through the five stages of grief: Denial; Anger; Bargaining; Depression; and Acceptance. These stages are natural and normal for parents who have a child who has any critical illness, including an eating disorder. It is perfectly healthy for you to go through these stages. Get support so that you can recognize which stage you are in and accept yourself at every stage.

With support, you will hopefully achieve acceptance of your child’s eating disorder. This does not mean approval or resignation. It simply means you are able to accept the fact that you have feelings about your child’s eating disorder. When we process feelings with acceptance, they pass with less pain and suffering and are less likely to lead to trauma symptoms.

Make some personal goals

This may surprise you, especially if you have put all of your own goals on hold until your child is recovered. However, you must maintain your sense of self and personal freedom even as you help your child. The martyr approach to parenting is just like trying to put on everyone’s oxygen masks before you put on your own. You are less effective and lose your own ability to function and help them. We must help ourselves in order to help others.

First, notice whether your goals include “make sure that my child recovers from their eating disorder,” and take that off the list. You are not responsible for your child’s recovery. Of course, you are a critical part of recovery, but no parent can force a child’s recovery – it must come from within. You can show up and facilitate the recovery process, but you cannot make yourself responsible for recovery itself. That must remain in your child’s control.

Avoid tunnel vision

To avoid the tunnel vision that can happen to a parent facing a child in crisis, make some short and long-term goals for yourself. Short term goals may include your self-care and hygiene activities. This should include rest and relaxation, and time spent doing things that make you feel energized and happy. You do not need to remain in a prison of unhappiness as long as your child is in recovery. You are allowed to have fun and enjoy your life.

Longer-term goals may include planning for a vacation, learning a new skill, or working with a therapist on your own childhood trauma, addictions, depression, anxiety, or other emotional conditions. You may feel guilty about doing these things, but rest assured that it is absolutely necessary for you to invest in yourself at the same time as you invest in your child’s recovery.

If you like podcasts, listen to the ED Parenting podcast episode 25: Mom’s burned out

Give it time

When our child faces a health crisis, it’s natural to go into fight or flight mode – in other words, we panic. This is completely normal, but since eating disorders can take time to resolve, we cannot remain in a state of panic throughout recovery. It’s simply not sustainable.

You should know that most people can and do recover from their eating disorders. Many even recover “spontaneously” without direct treatment. Yes, eating disorders are very serious, and we must take recovery seriously, but also keep things in perspective as much as possible.

If possible, enroll your child in an appropriate care program. And do everything you can to learn about eating disorders and to create an environment of healing for your child. But you also need to have some patience with the process and give your child the time and space to heal. Eating disorders are complex and layered disorders, which means it usually takes time to unpack and treat the underlying conditions. Recovery is usually a marathon (with a lot of detours), not a race. Prepare accordingly.

Practice mindfulness

This is an excellent time to learn and practice mindfulness. A mindfulness practice can help parents gain perspective even during very difficult times. Mindfulness is the practice of being in the present moment only. This means that our thoughts are not flying behind us, analyzing what we have done right or wrong, and our thoughts are not flying ahead of us, anticipating what might go right or wrong. Instead, we are simply in the moment.

We almost never need to panic in the present moment. Unless we are actively in a life-or-death health crisis, our panic is typically caused by past and future rumination and is thus unhelpful in the present. Mindfulness can help us calm our nervous system and reduce our reactions to past and future obsessions.

If you have a child who has an eating disorder and you are experiencing high levels of stress and suspect you may be experiencing trauma, please seek counseling from a professional therapist, coach, clergy member, or other trusted (and, ideally, trained) person who can help you get the help you need.

Your pain is valid and serious. I’m sending you so much love and support as you do this important work.

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.