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How to help your child with ADHD gain weight

How to help your child with ADHD gain weight

Dan reached out to me for some help with his son Braden, who has ADHD and needs to gain weight. “I’m not sure when it started, but suddenly Braden lost weight and his doctor tells us that we have to do something about it right away,” says Dan. “We’re really trying, but we feel totally stuck. Braden says he’s not hungry and rejects almost everything we offer him. We don’t know what else to do!”

I get it. Eating issues are common when you have a child with ADHD. And while it’s not easy, Dan and his partner Eric can make a big difference. They can improve Braden’s lifelong health by addressing this right away.

The link between ADHD and eating issues

People with ADHD are more likely to develop eating disorders than the general population. One study found that 31% of adults diagnosed with eating disorders also had ADHD. This is much higher than the general population, of which 3-10% of people have ADHD. About 36% of people who have bulimia and anorexia with a binging/purging subtype and 18% of people with anorexia have ADHD. Eating disorders have been described both as a symptom of and/or a coping mechanism for the emotional dysregulation that is common with ADHD.

Why it can be hard for a child with ADHD to eat

There are many reasons why eating issues are associated with ADHD. First, people with ADHD are usually highly sensitive to their five senses (smell, touch, taste, sound, and sight), all of which are involved in eating. This can lead to picky eating and a limited palate. They are also more sensitive to their interoceptive state, especially their digestive system, which can lead to disorganized hunger and fullness cues and/or feelings of nausea and other gastrointestinal distress. 

They are also highly attuned to neuroception, the sensation of other people’s emotional states, which can impact eating habits especially if family meals are stressful or chaotic. Together, these sensitivities combine to increase emotional dysregulation, making eating more difficult. A child who is both highly sensitive and has low emotional regulation skills is more likely to adopt coping behaviors like an eating disorder.

Also, a person with ADHD may not notice they are hungry or, even if they do, they may not be motivated to feed themselves. This tendency to be distracted and/or procrastinate eating can cascade into eating disorder behaviors. Most eating disorders begin with under-eating, either intentionally for weight loss or unintentionally due to distraction or avoidance. 

In cases of anorexia and ARFID, the person continues to eat too little. In cases of binge eating, the person restricts then binge eats. And in cases of bulimia, the binge eating episode is followed by purging. Either way, postponing and avoiding eating is a precursor to most eating disorder behaviors.

Finally, the medication used to treat ADHD can interfere with hunger cues, further affecting eating, weight, and digestion. This does not mean you need to discontinue medication, but it’s a good idea to check with your child’s psychiatrist to see if there are any adjustments that might help with eating.

Your child’s weight curve

A big thing to keep an eye on is your child’s weight and height curve. You should see a nice growth curve from birth through today, with your child staying approximately within their natural weight and height curve. This indicates your child is growing according to their body’s unique genetic blueprint. 

For example, if your child was born at the 95th percentile for weight and was there at age 2, 4, 6, and 8, but they have now dropped to the 65th percentile, your child may be weight suppressed. Though it surprises many parents, we don’t want a child from the 95th percentile to drop down to the 65th percentile. And if they do, you’ll likely see an increase in disruptive behaviors and a lower appetite, which leads to more weight suppression, more disordered eating, etc. 

If your child has dropped off their weight curve, they will need help eating enough food to get back to their healthy weight. The further they are from their natural weight, the harder it may be for them to eat. Nonetheless, it’s essential that you step in and intervene, as it is a serious medical and psychological issue. If your child has ADHD and needs to gain weight, please keep in close contact with your child’s doctor to monitor their health.

How to get a child with ADHD to eat

Getting a child with ADHD who has fallen off their growth curve to eat is extremely challenging. It’s also essential medical therapy. Start by seeking advice from a physician and/or registered dietitian (RD). However, beware of a professional who thinks it’s a good thing if your child has dropped off their childhood growth curve. That just means they’re stuck in outdated understanding of weight and health. Find a provider who recognizes that your child’s historical growth path should inform their weight trajectory. 

Assuming they agree that your child needs to gain weight, you can work with them on a plan for feeding. If your child is medically compromised, they may need residential treatment. But in most cases you will be told to feed your child more regular meals. You may get a meal plan with ideas for what to feed your child. But in my experience most parents already know what to feed their child. What you really need to know is how, given ADHD, you can feed your child enough food for them to gain weight. In these cases, parents need a behavioral intervention that won’t trigger their child’s oppositional tendencies or emotional dysregulation.

Here are my top four tips for feeding kids with ADHD:

1. Structure

It’s common in our culture for meals to be chaotic and grab-and-go style. Everyone eats separately and parents may be short-order cooks, feeding each child a different meal at a different time. However, a child with ADHD who needs to gain weight needs structured meals that acknowledge the ritual of eating as important and meaningful. We are social animals – we were never meant to eat alone. 

Create an eating and feeding schedule that involves you serving your child food on a plate, at the table, together with other family members as often as possible. Meals should feature high-calorie foods you know your child will accept as well as other foods they may currently avoid like fruits and vegetables. This will model for your child what a healthy meal looks like even if they are not ready to expand their palate yet. 

Keep the atmosphere at the table “light, bright, and polite.” Any criticism or negative discussions will result in emotional dysregulation and either a loss of appetite or a tendency to binge eat.

2. Fed is best 

If your child is weight-suppressed they need a lot of calories to make up the deficit and get back on their growth curve. While it’s common for parents to worry a lot about the nutritional content of their kids’ diets, at this point your main focus is on feeding a lot of calories as efficiently as possible. Worry less about the nutritional content and instead use the saying “fed is best” to remember that your primary goal is to feed your child enough food regularly so they gain weight. 

Offer fruits and vegetables and other non-preferred foods at every meal. Put them on the table so your child sees them. But your focus is high-calorie, high-fat foods that will help them gain weight. You will have a lot more flexibility and can expand their palate more as they gain weight.

As your child with ADHD achieves weight gain, you will notice that rigid or chaotic eating patterns reduce and you’ll have a lot more leeway for increasing food flexibility.

3. Validation + Expectation

Kids with ADHD are extremely sensitive to demands and criticism, and yet many adults use these techniques to try and motivate them to do things. You will have a lot more success if you change your approach and consistently use a combination of validation and expectation. Here’s how this works: 

  1. Validate that they have an opinion, complaint, or resistance
  2. State your request or expectation

Always do these two things together, not apart. And resist the temptation to add defensive arguments or compelling incentives. Keep your communication kind, short, and direct.

Here’s a good example of validation + expectation: “I understand that you’re playing a video game right now, but I’d like you to come to the table.” Or “I get it, you don’t want to eat right now, but I think you can handle it.” You may have to repeat yourself several times, varying the words a bit, but this technique is 100% more effective than arguing, negotiating, and debating with a child who doesn’t want to come to the table. 

Emotional Regulation Worksheets

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

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

4. Build emotional regulation skills

While eating and weight gain are the outcome we’re seeking, emotional regulation is the underlying skill that will keep eating and weight, and therefore health, on track for life. Building emotional regulation skills is essential for any child with ADHD, and it will make a difference in every aspect of their health, including their ability to maintain a healthy weight. Parents can do this by building kids’ emotional regulation skills, and we are actually the best people to do this since we’re biologically wired with our kids. Building emotional regulation skills includes:

  • Emotional literacy – building an emotional vocabulary so kids can label, name, and talk about their feelings. 
  • Emotional co-regulation – regulating your child’s emotional state with your calm, regulated emotional state. You may want to get some training and coaching to do this.
  • Skill-building – teaching your child the emotional regulation skills they need to process their emotions rather than coping with automatic, subconscious behaviors. My emotional regulation worksheets can help with this.

Measuring success

If your child with ADHD is weight suppressed it’s important that you restore their weight as quickly as possible. This will not be easy, but it is possible. And many times parents are the best people to help a child in this situation because you know your child best. Your aim is to achieve steady weight gain every week until weight restoration (getting back in their original growth curve) is achieved. Please remember to maintain close contact with your child’s medical and therapeutic providers and get support for yourself, too!

Checking back with Braden

Dan and his partner Eric met with me over the course of several months to optimize their meal structure, behavioral interventions, and emotional regulation skills. They put tremendous effort into Braden’s health, and it paid off. Braden slowly but steadily restored his weight and is back on his growth curve. And the family structure is now set up to support Braden’s nutritional needs.

They have noticed a big difference in Braden’s emotional regulation skills, and their own! Braden is still fairly picky, so Dan and Eric are working on food flexibility, but overall he’s doing great, and the family is closer and more connected than before. “The best part of all of this is that we’ve become much better parents to Braden and partners to each other,” says Dan. “We feel a whole lot more confident about what we’re doing now.”

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

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

See Our Parent’s Guide To Eating & Feeding A Child With An Eating Disorder

This site is designed to provide information and resources. It is not intended as, nor should it be used as medical advice pertaining to any individual person’s healthcare. People should always consult with a qualified medical professional regarding their specific health needs.

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How to help with emotional dysregulation and an eating disorder

How to help with emotional dysregulation and an eating disorder

Whether your child is refusing to eat, binge eating, purging, or using other eating disorder behaviors, emotional dysregulation may be at the heart of it. And the good news is that emotional regulation skills can be built. These skills are key to reducing stress and anxiety at the table and helping your child relax enough to eat (and hopefully enjoy!) food.

Emotional regulation is part of our neurobiology, which is the biology of the nervous system. Recent scientific advances have revealed that the nervous system is incredibly complex and influences everything we think and do. The breakthroughs we’ve made in neurobiology have been led by the invention of the functional magnetic resonance imaging (fMRI) technique in 1990, which has driven a startling amount of progress in understanding our brains and nervous systems. This technique facilitates many insights into emotional dysregulation, and helps us understand why certain eating disorder behaviors show up. 

People used to think eating disorder behavior was driven by the mind, something called top-down thinking. This is best shown by the common accusation that having an eating disorder is a vanity-driven choice – it’s not! Instead, what we’ve learned is that most disordered behavior comes from the bottom-up. It begins in the nervous system, which is constantly scanning the environment for threats and triggering emotional dysregulation when threats are detected. 

Emotional Regulation Worksheets

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

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

Emotional dysregulation and eating disorders

Emotional regulation is a state in which we feel calm, engaged, and in balance. In this state, we have a healthy appetite, are happy to eat a variety of foods, and are pleasant dinner table company. However, when our nervous system perceives a threat, all that goes out the window. Instead of being emotionally regulated, we become dysregulated, which makes us either over-active (fight/flight) or under-active (freeze/shutdown).

A person who is dysregulated may feel nauseated and have no appetite. They may be sobbing uncontrollably. They may be disassociating with food and not even notice how much and how fast they’re eating. You can try to force them to eat or tell them to stop eating, but it’s unlikely you’ll be successful. Because until your child is emotionally regulated, they’re going to have a really hard time eating well.

Emotional dysregulation is both a cause and a symptom of an eating disorder. People who are frequently emotionally dysregulated are more likely to develop an eating disorder. But also, once an eating disorder develops it becomes a way to cope with emotional dysregulation. Thus, eating disorders and emotional dysregulation can grow together in a feedback loop.

Signs of emotional dysregulation

Most people describe someone in a regulated state as calm, confident, and engaged. This is when we get along with people and feel pretty good in our bodies and about ourselves. Eating is easy and delicious in this state and we are in tune with our hunger and fullness cues. When we become emotionally dysregulated, we either go to fight/flight or freeze/shutdown state. Here’s what this looks like:


Most people describe someone in a fight/flight state as either angry or anxious. Eating is extremely hard in this state. The digestive system is shut down and all the blood is diverted to the limbs for running and fighting. Most people can’t eat. Those who do may eat very fast, but since the digestive system is shut down they will become very uncomfortable and even less regulated. Symptoms include:

  • Racing heart
  • Nausea
  • Sweating
  • Anxiety
  • Anger
  • Arguing and negotiating


Most people describe someone in a freeze/shutdown state as either depressed or zoned out. Eating is extremely hard in this state. Some people just don’t care about food, feel physically incapable, and are completely uninterested in eating. Others will eat food, sometimes a lot of it, as a way to try and get back to a regulated state. But food doesn’t work well for this purpose, and they usually end up even less regulated. Symptoms include:

  • Slow, sluggish movements
  • Dissociation 
  • Emotional withdrawal
  • Depression
  • Suicidal thoughts*

*If you or your child are feeling unsafe or in crisis, please call, text, or chat the 988 Suicide and Crisis Lifeline to communicate with a trained professional.

What causes emotional dysregulation?

Our nervous system is attuned to internal and external threats. Threats can come from inside or outside of the body. When a threat is detected, our nervous system signals the amygdala, raises cortisol levels, and triggers emotional dysregulation. This is a physiological response meant to protect us from bodily harm. 

We get activated into a fight/flight state when our nervous system drives us to run from or fight off a threat. And we go into a freeze/shutdown state when our nervous system drives us to hide to avoid a threat. This system was developed to protect us from predators, enemies, and natural disasters. However, in our modern world it’s more likely to sense threats in less-dangerous things like a food we don’t like or a situation that makes us uncomfortable.


People with highly sensitive nervous systems are more likely to be triggered into emotional dysregulation. Everyone can learn to get better at emotional regulation. However, people with a highly-sensitive nervous system who don’t intentionally build emotional regulation skills will tend to get more emotionally dysregulated over time.

Here are the benefits of having better emotional regulation skills:

  • More balanced and calm state of mind 
  • Able to cope with worry, negative thoughts, and difficult emotions 
  • Greater self-awareness 
  • Able to think more clearly and make better decisions 
  • Greater emotional balance 
  • Able to respond rather than react in stressful situations 
  • More fulfilling relationships 
  • Greater self-acceptance and self-compassion 
  • Less embarrassment and shame

Also, when a person is emotionally regulated, they are able to eat regular, healthy meals and snacks to fuel their bodies and minds. Eating well both improves emotional regulation and is improved by emotional regulation.

Foundations of emotional regulation

Physical health is a foundational requirement of emotional regulation. Your child needs to meet their basic physical requirements to achieve emotional regulation: 

  • Enough food, regularly throughout the day (every 2-4 hours) 
  • Not weight-suppressed 
  • Enough sleep based on the guidelines for their age 
  • Emotional connections with others 
  • Not sick

Even though it is harder for someone who is emotionally dysregulated to eat, it is also part of their recovery to eat. It will be very hard for your child to be emotionally regulated if they aren’t eating enough food regularly throughout the day. 

If this is an issue, increase the number of structured meals and snacks, which will reduce massive physiological spikes and dips. If your child is currently weight suppressed, then weight restoration is a priority.

Emotional Regulation Worksheets

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

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

Improving your child’s emotional dysregulation

If your child is in therapy, their therapist will teach and model emotional regulation skills like reframing thoughts, naming feelings, having self-compassion, and more. 

Your child can also improve self regulation skills with activities like meditation, yoga, breathing exercises, and other things that connect the mind and body and develop a felt sense of safety. My emotional regulation worksheets also help your child build these skills.

Best of all, your nervous system has shaped your child’s nervous system, so you are deeply attuned and responsive to each other. If you learn skillful co-regulation, you can help your child build their emotional regulation skills. This will make mealtimes much less stressful and help your child get the healthy nutrition they need. You can learn to more effectively co-regulate with your child to support them as they build emotional regulation skills.

When we co-regulate with children, we help them to feel safe, and to tolerate and make sense of their sensations and basic feelings.

Dr. Mona Delahooke

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

See Our Guide to Emotions And Eating Disorders

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Preparing for your child’s return from residential eating disorder treatment

Preparing for your child’s return from residential eating disorder treatment

The return from residential eating disorder treatment can be a hard thing for parents. When you enrolled your child in treatment, they were probably physically and emotionally at a low point. You probably spent significant time making the decision to send them to treatment and agonized over the details. And the weeks or even months apart have probably been intensely stressful for you and your child as well. So while there is relief and hope when they come home, there’s also trepidation and worry that treatment won’t stick.

This guide is designed to help you prepare for the reality of your child’s return from residential eating disorder treatment. For most families, this stage of recovery requires a tremendous amount of effort. But the payoff can also be tremendous. 

You can approach eating disorder recovery much as you would any other serious health rehabilitation and recovery. Don’t underestimate what is involved, but also don’t be afraid. I am 100% confident that you have what it taks to support your child’s recovery from an eating disorder. Here are some ways you can prepare for your child’s return from eating disorder residential treatment.

Emotional Regulation Worksheets

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

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


Become educated about eating disorders, their causes, symptoms, and recovery. Imagine if your child had cancer. You would learn about their cancer, become informed about symptoms and treatment, and be engaged in recovery tasks. 

Your education about eating disorders is even more important than if your child had cancer because of two things. First, there is tremendous stigma and misunderstanding about eating disorders. You need to uncover your own biases and misunderstandings to support your child’s recovery. Second, treatment for cancer is based on vast evidence and clinical trials. Unfortunately, eating disorders suffer from a deep lack of funding and knowledge. This makes your education more important than for almost any other type of illness. 

Parents need a lot of knowledge and new skills to support eating disorder recovery. If your child returns to the exact same home and family dynamics in which their eating disorder developed, they are very likely to relapse right back into their eating disorder when they come home. 

Reasonable expectations

The hard truth is that your child will still need a lot of ongoing support and treatment when they return from a treatment program.

You should be prepared for a minimum recovery time of 6-12 months. Under the best circumstances, that’s how long it takes for a person to fully recover psychologically and physically from an eating disorder. This recovery period will be challenging, and your child will need your family’s support. During early recovery, it is easier to return to eating disorder behaviors than to abstain from using them. They will need your constant, confident support. 

Imagine your child had a stroke and is now living with you. They’ve returned home from hospitalization or rehab, but they still need daily support to get to and from physical therapy appointments. They need mobility aids, and you may need to learn new ways of communicating with them while they regain skills, mobility, language, and more post-stroke. 

You can’t anticipate everything about what recovery will entail, but you know that your life will continue to be disrupted. Eating disorders require a long recovery with ongoing care and new skills to support the reality that early recovery is harder than relapse. Luckily, full recovery is completely possible and gets easier over time and with the right support.

Parent Scripts For Eating Disorder Recovery

Scripts to help you figure out what to say to help your child with an eating disorder. Use these scripts:

  • At the dinner table when behavior is getting out of control
  • When you need to set boundaries – fast!
  • After something happened so you can calmly review the triggers and events


Residential treatment is highly structured. From sleeping to eating and activities, everything is planned out in advance. Even free time is scheduled. This is because any stress and chaos increase eating disorder urges and behaviors. And the return home after residential eating disorder treatment will be a major stressor. Therefore, you want to minimize stress and chaos by having a good schedule in place. 

While you may be relieved to have your child home and they may want to have freedom and little oversight, a lack of scheduled eating and activities will likely make recovery harder. It’s best if you have a firm schedule at least for the first 30 days after they return home and then taper off as long as recovery stays on track. Most people are doing some form of ongoing outpatient treatment, so this may take up several hours of their day. But avoid being too flexible with the remainder of the day.

Remember: they will not come home wholly recovered and will need your ongoing support. Structure is a big part of that. 

At a minimum, they should have structured meal times for three meals and three snacks daily. These should be planned times that your child can eat with at least one other person who will uphold the expectation that they eat. It’s best if you replicate treatment by planning, preparing, and serving all meals at a structured time and – importantly – expecting your child to eat every 2-4 hours without fail.


Eating disorder recovery is hard on everyone. It’s hard on the person going through it, and it’s hard on every family member. So it’s essential to have an intentional empathy practice. This means understanding that everyone is trying their best and is not intentionally being difficult. 

Practicing empathy is not easy in the best of times. Most of us subconsciously assume that when people frustrate or hurt us that they are doing it on purpose or have ill intentions. But most of the time when people frustrate or hurt us, it’s because they are having a hard time. And this is almost always the case with our kids.

Kids are biologically driven to seek care and attention from their parents. One of the key ways they do this is with behavior. They act out so we know they’re having a hard time within. When your child does something “bad,” they are showing you they feel really, really bad. 

Empathy means you realize this and try to respond from a place of calm curiosity rather than defensiveness and criticism. One way to do this is to remember, no matter what your child is doing at the moment, that they are “good inside” and worthy of your love and affection.

Importantly, self-criticism (a lack of empathy) is a significant cause and symptom of an eating disorder. Your ability to practice empathy with your child will model for them how to have empathy for themselves.

Parent Scripts For Eating Disorder Recovery

Scripts to help you figure out what to say to help your child with an eating disorder. Use these scripts:

  • At the dinner table when behavior is getting out of control
  • When you need to set boundaries – fast!
  • After something happened so you can calmly review the triggers and events


Eating disorders are complex because they are “biopsychosocial” disorders. This means they combine biological, psychological, and social influences. Most eating disorder treatment focuses primarily on the biological and psychological drivers. But social factors, especially your child’s relationship with you and others in your family, are critical. 

An eating disorder is not your fault. It’s not your child’s fault. But it’s also true that you have tremendous influence over your child’s psychology and environment. Parents matter a lot. Don’t lose sight of the fact that while your child has an eating disorder, everyone needs to “recover” by increasing mental health and learning new ways of communicating and relating to each other. 

Focus on building your relational skills and deepening your relationship with your child. Learn active listening skills and emotion coaching. How well you learn and grow as a parent in the next 6-12 months will impact how well your family functions far into the future. 

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

See Our Eating Disorder Treatment Guide For Parents

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Family therapy when your child has an eating disorder

Family therapy when your child has an eating disorder

Family therapy when your child has an eating disorder may be the most important and the hardest thing you’ve ever done as a parent. Family therapy can help your family build belonging and resolve conflicts more easily. It can have a lifetime of benefits, including supporting eating disorder recovery.

But while therapy is ideally a safe space, when it’s family therapy, parents rarely feel safe. In fact, they usually feel uncomfortable at first. That’s because family therapy addresses family dynamics. And because you are the parent, and thus the head of the family, your behavior and parenting choices are naturally going to be evaluated and discussed. 

In family therapy, your child will get the lion’s share of talking time, for reasons I’ll explain shortly. This may make you feel shut down, shut out, disrespected and even furious. You want to be prepared for these feelings to show up. Because while they make perfect sense, they can get in the way of making progress. Family therapy is an opportunity to deepen your relationship with your child and support their recovery. It will be hard, but it will be worth it.

Emotional Regulation Worksheets

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

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

What is family therapy?

Family therapy is when family members are guided by a trained, licensed therapist to improve communication and resolve conflicts. Family therapy is different from family-based treatment (FBT), which is used for eating disorders. While FBT is about feeding, family therapy is about family dynamics. 

Family therapy is designed to help families:

  • Increase empathy and understanding 
  • Set and hold healthy boundaries
  • Build belonging and communication
  • Develop problem-solving and conflict resolution skills

If your child’s eating disorder treatment team has suggested family therapy, it’s best if you are informed and prepared. Here are the five steps you should take to prepare for family therapy: 

1. Set your goal

You want to go into family therapy with a clear goal. And while it may seem like the obvious family therapy goal is to fix your child’s eating disorder, that will not work. This is because family therapy is about working on your family dynamics, not solving a particular problem.

Family dynamics are the patterns of interactions among family members. It involves each person’s roles and relationships. Within families people adopt roles that can become fixed and unhealthy. And there are multiple dyads, triads, and other inter-relationships. These all need to be addressed individually and collectively. 

Family dynamics can either be supportive or a significant cause of stress. When we shift family dynamics from stressful to supportive, we can supercharge recovery. Thus, your goal in family therapy is to build more supportive family dynamics.  

2. Don’t expect equality

Family therapy is nothing like any other therapy you’ve experienced. If you’ve done individual therapy, you had 100% of the time to explain yourself and process your feelings. If you’ve done couples therapy, you had about 50% of the time. But in family therapy, your child’s experience of being a child in your family takes center stage.

You need to enter family therapy with a very clear understanding that this is not an equal playing field. While you may not realize it, you spent many years in a position of power over your child. That’s simply what it means to be a parent. Even if you felt powerless at times, the very nature of the parent-child dynamic is that you held tremendous power over them when they were a vulnerable infant, toddler, and child. This early dynamic shapes how they see you and relate to you, no matter how much things have changed since then.

In family therapy you and your child are not peers with equal perspectives. You will not get equal time. The therapist will encourage your child to express themselves and how they felt in the family. And that is where the healing begins. The more open you are to learning about your child’s perspective, the greater your success will be.

3. Don’t debate the “facts”

There is a good chance that your child will bring many stories and grievances to family therapy. They will have complaints about things you did and things you did not do. It is natural and normal to want to debate the facts of the situation. 

For example, if your child says you never cared about them, you will want to tell them all the ways you did care about them. If your child says you loved their sibling more, you will want to tell them the times you prioritized their feelings. 

But the facts are not the issue. And debating the facts will derail family therapy. Work on your own emotional regulation and prepare yourself to hear facts that you don’t agree with. Because you don’t have to agree with the facts. What you need to do is see the small vulnerable child who is asking you to witness the pain they experienced in childhood. What feels like criticism of you is actually a request for care from you. 

All children experience pain in childhood. No childhood is perfect. And you didn’t have to get things right in the past to be close with your child today. You just have to listen to their grievances with compassion and empathy and love them for who they are. The more you witness their pain with compassion and acceptance, the less they will suffer.

Parent Scripts For Eating Disorder Recovery

Scripts to help you figure out what to say to help your child with an eating disorder. Use these scripts:

  • At the dinner table when behavior is getting out of control
  • When you need to set boundaries – fast!
  • After something happened so you can calmly review the triggers and events

4. Don’t get defensive

It’s OK. You’re probably going to get defensive. It’s natural and normal to feel defensive when a child says something went wrong. But your goal is a deeper and more supportive relationship with your child. So you need to manage your defensiveness and not let it get between you and the vulnerable child who is asking you for emotional care.

Defensiveness sounds like this: 

  • But I did all this for you …
  • That’s not what happened
  • But what I meant was …
  • What I was trying to do was … 
  • I can’t believe you would say that
  • You’re wrong
  • What else was I supposed to do?

These sorts of statements will want to tumble out of your mouth. But it’s best to manage your defensive impulses. Your goal in family therapy is to deepen your relationship with your child. And these defensive statements will not help and may even make things worse. Defensiveness from you will shut down the therapeutic process.

Work on your defense triggers in advance with a therapist or coach who can help you process your feelings with compassion and understanding. Practice managing your defensive impulses so you can hear about your child’s experience without getting defensive.

5. Listen & validate

Of course you want your child to understand you. But don’t start there. Healing begins when your child feels understood. When that happens, they will be able to see you in a new, softer light. But if you try to keep the focus on your feelings, a wall will remain between you. 

You’ll need to listen far more than you speak during family therapy. I don’t want you to repress your feelings. This is about managing your emotions during family therapy so that you’re able to hear what your child has to say. If sitting in family therapy is going to require strenuous repression, then it’s too soon for family therapy. Take more time with your own therapist or coach first so that your own feelings are well on their way to healing before you do family therapy with your child. 

During family therapy you mostly want to make validating statements. When your child speaks, they are opening a door to a relationship with you. They’re saying “can you see my pain?” And the correct answer to this is some version of “I believe you, and I’m sorry for your pain. I love you, and I will always love you.”

Emotional Regulation Worksheets

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

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

Practice validating your child’s feelings. As I said before, you’ll be tempted to focus on the facts and details, but instead focus on the feelings they are sharing with you. Listen for feelings like: 

  • I felt sad when …
  • I’m angry about …
  • I wish you had … 
  • I’m not sure that you love me …

Hearing your child have these feelings can be heartbreaking. Anticipate that your child has big feelings that will come out in therapy and practice responding to them with validating statements before you go.

I know that family therapy when your child has an eating disorder is hard. But there are tremendous benefits if you can do it. The best thing you can do is keep your goal in mind and be prepared. 

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

See Our Eating Disorder Treatment Guide For Parents

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Questions to ask eating disorder treatment centers

Questions to ask eating disorder treatment centers

It’s not easy making the decision to send your child to an eating disorder treatment center – you probably have a lot of questions. There are so many factors to consider and so many options out there. And right now there’s added stress because so many centers are at capacity and have waiting lists. 

I’ll review the basics of what it means to send your child to an eating disorder treatment center. Before we dive in, it’s very important to say that this decision is yours to make. Nobody should make the decision on your behalf.  My goal is to help you weigh your options. And I have confidence that you will make the best choice for your unique situation.

Sending your child to an eating disorder treatment center will be hard no matter what. But ideally, you should feel on some deep level that this is the best right decision for you, your child, and your family right now. It doesn’t have to be a perfect decision to be the best right decision right now. Just do your best – that’s all anyone can do!

To write this article I consulted with John Levitt, Ph.D., an eating disorder therapist who has been in the field for more than 40 years. “Treatment centers represent a lot of money and a lot of time, and a lot of heartache and concern for your child,” he says. “You definitely want to make sure that you understand your options.”

Emotional Regulation Worksheets

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

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

Why send your child to an eating disorder treatment center?

I’ll give you the questions to ask an eating disorder treatment center. For now, let’s start with the reasons why you might be considering an eating disorder treatment center for your child. Here are the top three reasons I hear:

1. Your child is in danger. You have the help of professional dietitians, doctors, and therapists, but there is no reduction in the behaviors. Despite your best efforts and professional care, your child is in serious physical and/or emotional danger.

2. You don’t know what to do. You feel overwhelmed by your child’s eating disorder and simply don’t know what else to do. It seems like a treatment center is the only choice. 

3. You are burnt out. You have been working hard to stabilize your child’s behaviors. You’re driving all over town to appointments, and facing endless arguments and stress over meals. At this point, you are overwhelmed and frustrated by the disorder. You have reached the end of your rope. 

I support parents who are facing one or all three of these conditions. And I see eating disorder treatment centers as one tool in the toolbox of recovery. They are definitely an option to address these issues.

The benefits of an eating disorder treatment center

“Treatment centers are places where your child can stabilize their eating disorder symptoms,” says Levitt. “Their weight will hopefully improve and likely stabilize. And their eating disorder symptoms will likely be reduced or even eliminated completely while they are staying at the treatment center.”

This is very good news! The main benefits of an eating disorder treatment center are: 

  • Medical and psychological stabilization
  • Your child will be assessed and monitored
  • They will feed your child regular meals and snacks
  • Your child will be physically safe and prevented from acting on purging and self-harm behaviors
  • They will provide activities and skills training to support recovery

A treatment center is ideally a safe place to get into remission from eating disorder behaviors. Your child will most likely be stabilized and make some progress toward recovery. 

The drawbacks of an eating disorder treatment center

One of the benefits of treatment centers is that your child is stabilized in a safe environment. But a drawback is that eating disorders develop in the outside world. So returning home after treatment can sometimes trigger a relapse. 

“Even if the eating disorder behaviors and symptoms get under control in a few weeks or months, there may be many more months, or even years, required to achieve remission and, ideally, full recovery,” says Levitt. “When they get home, they are faced with the same life stressors and conditions that were associated with the eating disorder prior to going to treatment. Home is where the true treatment begins. Your child needs to learn to live with a sense of self-worth and self-efficacy that is enduring and resilient across people, places, and situations, and they often won’t find that in a treatment center. You just can’t practice all of the requirements of life in a controlled setting. Full treatment does not happen in a program, it happens in life.”

In addition to the fact that there will still be work to do when they get home, there may be other drawbacks. I’ve interviewed many people who have spent time in treatment centers, and some of their complaints include:

  • It felt abandoned, isolated, and/or traumatized
  • Inadequate treatment and support
  • Being scared by/not liking the other residents
  • Developing unhealthy relationships and learning new behaviors from other residents
  • Feeling controlled and dominated
  • Not liking the staff and therapists

These drawbacks aren’t meant to discourage you. And many treatment centers actively try to counteract these drawbacks. But it’s important to consider them as you weigh your options.

Parent Scripts For Eating Disorder Recovery

Scripts to help you figure out what to say to help your child with an eating disorder. Use these scripts:

  • At the dinner table when behavior is getting out of control
  • When you need to set boundaries – fast!
  • After something happened so you can calmly review the triggers and events

Questions to ask an eating disorder treatment center

“Treatment centers are run by good people who are generally doing good work,” says Levitt. “That said, treatment centers are businesses, and you as parents are the consumers. Don’t be afraid to be a smart consumer. Ask a lot of questions. Ensure you understand what you are getting into. That is, make sure you know what you will be paying for and what outcomes you can expect. Parents should become the experts on what they are “buying” before taking the leap to send their child anywhere.”

It’s best to interview treatment centers before making a commitment. Here are some questions to ask:

  • What is your treatment approach? On what evidence is your treatment approach based? What is the data suggesting the effectiveness of your program?
  • Specifically, how do you treat people with my child’s type of eating disorder? What is the general treatment plan/approach?
  • How long does it usually take to stabilize a child’s eating disorder, including issues related to mood etc.
  • What is the daily schedule, and who specifically will be working with my child?
  • Can I see my child’s clinical team’s credentials and interview them?
  • In addition to the clinical team, who else will be working with my child? What are their credentials?
  • How do you control for the fact that sometimes eating disorder treatment clinics are learning opportunities for how to become better at eating disorder behavior? What control systems do you have in place to avoid this?
  • What is your success rate in terms of full recovery after a person leaves the treatment center? What are your extended outcomes? What is your relapse rate?
  • How do you involve parents in treatment? What are we to do while the child is in treatment?
  • How will you ensure that I am an essential part of the treatment, and how will you prepare my child, and the parents, for the child’s return home?
  • What will my child need following their stay at the center?
  • How will you know when what you’re doing with my child isn’t being effective? If such a situation were to arrive, what are the alternatives?
  • How do you ensure that a person who goes through your program is successful beyond the program?
  • How much does treatment typically cost? How much is usually the parent’s share of costs? What happens if we are unable to afford the treatment or continued treatment?

“You should not receive vague answers to any of these questions,” says Levitt. “Because they are critical to efforts to achieve full recovery.”

Free download Evaluation Sheet For Eating Disorder Treatment Center

Download The Questions

You can download a free PDF with these questions and other notes you can use to guide your evaluation of an eating disorder treatment center.

What about the cost of eating disorder treatment centers?

Of course your primary concern is your child’s health. And your child’s health is priceless. That said, treatment centers are very costly, which is why you want to be a smart consumer here. Not because you are nickel-and-diming your child’s health. Not at all. But because this is a major commitment and it makes sense to ask questions. 

I wish treatment centers had a 100% success rate. But the truth is that eating disorders are complex and challenging to treat. And residential treatment is typically just one step on the path to recovery. So it pays to be a thoughtful consumer.

Emotional Regulation Worksheets

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

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

“Don’t be afraid to ask about the costs involved,” says Levitt. “Many treatment centers are running 60 days. That’s a long time for your child to be away from home and away from school. It can also be about $60,000 plus. That doesn’t take into account post-center treatment. That can be equivalent to your child’s college tuition.”

The point here is to ask questions. Of course if your insurance company will cover everything that’s a different situation. But if the cost of treatment will fall on you and impact other financial goals that you have for yourself, then weigh the costs and benefits as clearly as possible. 

Making a decision

I wish there were a simple answer to whether to send your child to a residential treatment center and which one to pick. This is something many of my clients grapple with. And the truth is that it’s a difficult decision to make. In the end, the best you can do is do your research and make the best choice you can right now. 

Remember: it doesn’t need to be a perfect decision to be the right decision for you at this moment. Your best decision may be to send your child to residential treatment. And also, it’s OK if that doesn’t feel right for you right now.

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

The quotes from John Levitt, Ph.D. are from a series of articles published in 2017 including this one.

See Our Eating Disorder Treatment Guide For Parents

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Is it sugar addiction, an eating disorder, or something else?

Is it sugar addiction, an eating disorder, or something else?

Brandon has been worried about his son Michael for a few years. “He’s always been really into sugar, sweets, and junk food,” says Brandon. “I’ve tried to tell him he needs to avoid sugar. Telling him it’s bad for him doesn’t change anything. I’ve tried hiding the sweets, not buying sweets at all, and even punishing him for eating too many sweets. It seems like sugar addiction, or is it an eating disorder?”

I can understand where Brandon is coming from. There’s a lot of fear about sugar right now. In fact, there’s a lot of common knowledge saying that sugar is a direct cause of disease and weight gain. But the first thing to know is that scientifically sugar is a causal factor in tooth decay, but it is only correlated with other health issues. The truth about sugar is complex and nuanced. 

But the media hates nuance and loves a bad guy, and sugar is it right now. Most of us parents were raised to fear fat, but sugar has taken over as the new nutritional evil. Imagine if we’d heard about a butter board in 1998! The horror! Meanwhile, our “healthy” Snackwells fat-free cookies were loaded with sugar. Nutrition is subject to trends, so it’s a good idea to keep this in mind every time we meet a new nutritional bad guy.

Emotional Regulation Worksheets

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

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

It’s a matter of degree

Look, nobody’s saying we want our kids to eat only sugar all the time. That doesn’t make any sense. But there’s a huge distance between banning sugar and eating only sugar all the time. And that’s what I want to explore with Brandon. Just how often is Michael eating sugar? What’s happening when he eats sugar? Let’s tease this apart a little bit.

“I guess he eats sugar a few times a week,” says Brandon. “Since I rarely have sweets, cookies, and candy in the house now, it’s definitely a special occasion thing. For example, after baseball practice they always get a snack, and it’s often cookies or something like that. And of course there are birthday parties and family events. Stuff like that.” 

Brandon has banned sugary foods from the house. It sounds like he’s concerned about how Michael responds when he gets access to it out of the house.

“He goes crazy for the cookies,” says Brandon. “I see him taking more than his share and it’s embarrassing. And at family parties when there’s a cake, he’ll have two or three slices if I don’t stop him.” 

Got it. So the big question for Brandon is whether this is a sugar addiction or an eating disorder or something else. 

Is sugar addiction real?

I checked in with registered dietitian Marci Evans to find out more about sugar addiction. “I’ve been carefully watching the science of food addiction for years,” she says. “And aside from the fact that the “news” about sugar as an addictive substance sounds a lot like fear-mongering to me, it also doesn’t square with my clinical experience as a dietitian. My quick answer is that I don’t believe that sugar is addictive in the same way as caffeine, alcohol, tobacco, cocaine, and other substances.”

Many dietitians, especially those who work with eating disorder populations, are deeply uncomfortable with the vilification of sugar in our culture. They don’t agree with the idea of sugar addiction. And they worry that fear of sugar can lead to an eating disorder.

“I think that the biggest issue with sugar is that, like everything, once a human is told that something is “off limits,” our brain kicks into deprivation mode,” says Marci. “I frequently hear people talking about food, including sugar, and telling me they feel as if they are addicted, by which they mean they feel they cannot stop themselves, and they would really like to stop. It’s important to note here that someone feeling as if they are addicted to something is not the same as being physically addicted to something.”

The body’s need for food is a biological necessity. The drive for food – including sugary food – is not the same as a drive for optional substances like alcohol, tobacco, and cocaine. Putting sugar in the same category as these substances is chemically inaccurate.

A behavioral addiction

But it’s also true that food can feel addictive. Behavioral addictions are an obsession with and compulsion to do a certain behavior. And eating can certainly become a behavioral addiction. But it’s important to separate behavioral addictions from substance addictions. This is because the treatment for substance addictions usually involves not taking the substance anymore. But most behavioral addictions require at least some continuation of the behavior. 

For example, an eating disorder may be viewed as a behavioral addiction. But recovery is not about never eating or always eating. It’s about finding balance in your approach to the behavior of eating. Recovery from a behavioral addiction is not about abstinence, but acceptance and modulation of urges and desires.

“So far, there is absolutely no scientific evidence that any food is addictive,” says Marci. “Humans must eat food to survive. No specific compounds have been found in food that are like the compounds found in drugs and alcohol. The human drive for food is considered adaptive, while the drive for addictive substances is considered maladaptive.”

What about the rat studies?

“But what about the research showing that rats get addicted to sugar?” asks Brandon. 

“There has been research showing that rodents consume sugar in an “addictive-like” way,” says Marci. “But this only occurs in settings that involve sugar restriction. This is critical because it is the reason I don’t promote restricting any food items, including sugar. When rats are kept in captivity and offered sugar on an intermittent basis, they exhibit binge-like eating, which researchers identify as addictive behavior. However, when the rats are offered sugar constantly, they do not exhibit this behavior, nor do they eat excessive amounts of sugar.”

“From my perspective, the study of the rats actually supports not vilifying sugar, since doing so can lead to binge behaviors that may look and feel like an addiction,” says Marci. “Again, there is no proof that this behavior is based on the substance itself, but rather the restriction of the substance.”

Ah! That is the key here. 

Sugar is compelling

Sugary foods are delicious and compelling for most people, especially children. But there are plenty of children and adults who eat sugar regularly without any signs of addiction or disordered eating. And the secret is that these people are allowed to eat sugar regularly. Without restriction, sugar is delicious, but it’s not compelling. It’s not an obsession or compulsion. We’ve seen this with rats. And dietitians who practice the Ellyn Satter method and/or Intuitive Eating see it every day, too. 

We’ve all seen the kids who dive for the cookies or brownies at the party. What makes them different from the kids who could take it or leave it? Usually it’s the amount of sugar restriction they’re experiencing at home. Because kids who have access to cookies regularly are not likely to feel obsessive, compulsive, or addicted to cookies. 

“Higher weight and binge eating disorder, both of which are frequently associated with “sugar addiction” are far more complex than any single food item,” says Marci. “What I see clinically is that food restriction is a more significant problem and a precursor to weight gain and eating disorders than sugar.”

Advice for Brandon

I can understand why Brandon is concerned about sugar addiction and the potential for an eating disorder. But Michael’s excited behavior around sugary foods is most likely being driven by restriction. We can’t rule out an eating disorder. But we do know that restricting foods at home is a risk factor for eating disorders. So I have some advice for Brandon: 

1. Relax the rules

First, relax your at-home rules around sugar. Remember there is a huge space between no sugar and only sugar. Introduce dessert occasionally or even every day and start normalizing sugary foods as part of a balanced diet. That’s right: sugar can be part of a very healthy diet. Incorporate sugar into your regular diet. This will remove the sense of restriction that may be driving the addicted-like behavior you’re seeing in Michael. 

2. Add in more nutrients, structure, and pleasure

Next, focus more on what you add than what you take away. I’ve said to incorporate sugary foods, but also seek ways to add in more nutritious foods. Expand your family’s daily intake of whole grains, nuts, seeds, fruits, and vegetables. Now, add in is more structure around food and eating. Many families lack feeding structure. But structure has been shown to have a much greater impact on lifelong health than any diet. Do you have at least one family meal per day? If not, add that in! Finally, add in more pleasure! Eating is a social behavior in human beings. Enjoy food, enjoy eating, and enjoy each other.

Emotional Regulation Worksheets

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

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

3. Talk about balance

Once you’ve had sugar incorporated in your diet for a while, if Michael is still acting like he’s “addicted” to sugar, talk about specific behaviors you’re seeing. Make sure you’re coming from a neutral, non-judgmental standpoint. Michael may need help noticing that he is taking more than his share at practice. And maybe one piece of cake at the party is totally OK. But then he could add in something with greater nutritional value and then re-evaluate whether he wants a second slice. These conversations will go much better if you’re already modeling this behavior with sweets at home.

4. Stop food shaming

Finally, stop food shaming and any negative talk about food. All foods fit in a healthy diet. Brandon loves Michael and wants what’s best for him, but badmouthing food and calling it junk makes it feel restricted. We crave foods when they are restricted. When all foods are allowed, they are no longer worthy of obsession and compulsion. And never punish a child for eating. When you punish a child for seeking comfort and joy in food you support a disordered relationship with food that can have a lifetime impact on health.

Up for the challenge

It’s a lot to take in, but Brandon seems up for the challenge. “I can relate most of all to the kids who don’t get sugar at home grabbing all the cookies when they have a chance,” he says. “I remember kids like that when I was growing up. This one kid was on a really strict diet at home and he was seriously crazy about food. Give him access to pizza or M&Ms and he was all over it. The rest of us knew it was because he didn’t get it at home. I guess I’d forgotten about that until right now.”

Brandon’s going to give this advice a try and watch carefully for a reduction in the symptoms of sugar addiction and an eating disorder. Then we’ll re-evaluate whether there’s something more serious going on for Michael. Feeding a child can be complicated in our culture!

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

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

See Our Parent’s Guide To Eating & Feeding A Child With An Eating Disorder

This is an update to an article published March 13, 2018 called “But, seriously, my kid is addicted to sugar. A discussion about sugar addiction with dietitian Marci Evans”

Marci Evans, MS, CEDRD, LDN, has dedicated her career to counseling, supervising, and teaching in the field of eating disorders. She is a Certified Eating Disorder Registered Dietitian and Supervisor, certified Intuitive Eating Counselor and Certified ACSM personal trainer. In addition to her private practice and three adjunct teaching positions, Marci launched an online eating disorders training for dietitians in 2015 and is co-developing a specialized eating disorder internship at Simmons College.

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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.

Emotional Regulation Worksheets

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

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

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. 

Emotional Regulation Worksheets

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

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

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. 

Emotional Regulation Worksheets

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

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

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

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

See Our Guide to Emotions And Eating Disorders

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Reasons why a child might be emotional eating

Reasons why a child might be emotional eating

When you think your child is “emotional eating,” it typically raises red flags. Most parents worry that emotional eating will lead to weight gain and long-term health complications. Some parents worry that emotional eating is an early sign of an eating disorder. So let’s find out what emotional eating is, why it might be happening, and what you can do to help your child. 

What is emotional eating?

Typically when parents worry their child is emotional eating, they report these signs: 

  • Weight gain
  • Eating more than the parent thinks the child should need
  • Snacking a lot
  • The child craves carbs and sugar
  • Conversations in which the child says they can’t stop thinking about food or can’t stop eating
  • Post-eating bellyaches and bloating

If these are your concerns, I understand. Parenting around food and weight is tricky. But also, please be careful! Because if you label your child as an “emotional eater” you risk pathologizing hunger and not supporting your child’s lifelong health.

Emotional eating is considered a bad thing. Parents who say their kids are emotional eaters are worried about their physical and mental health. In our culture having “too much” hunger is greedy and enjoying “too much” food is pathological.

But all eating is emotional because physiological sensations, including hunger, trigger emotions. A lack of food creates an emotional state, most often irritation, anger and a drive to eat. This is biologically adaptive and not unique to your child. All mammals are wired to respond to the physical sensation of hunger with a craving for food and emotions like aggression or anger to help them acquire it. 

Think back to when your child was an infant. Your baby’s first demand was most likely for food. I would guess your baby felt hunger and displayed an emotional response like crying and looking mad to get your attention. When a baby feels hungry, they scrunch their face in anger and cry loudly to attract their parents’ attention and meet their needs. 

Now consider your infant’s emotional response to being fed breast milk or formula. You probably noticed a look of contentment, peace, even joy on your baby’s face when being fed. Eating is inherently emotionally pleasing – it’s meant to be! All mammals have an emotional response when they are hungry an an emotional response when they are fed.

Thus, feeding kids is inherently emotional, and we should avoid pathologizing a natural instinct or suggesting a mental health condition when there is none.

How you address your child’s emotional eating can make a huge difference. Your response may help them learn self-care and intuitive eating. Or it could lead them to adopt maladaptive behaviors like binge eating and restriction. This matters, so I’m glad you’re thinking about it!

Emotional Regulation Worksheets

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

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

The reasons your child is emotional eating

The usual reaction when a child is emotionally eating is to assume something is wrong with the child’s mental health. But often, the solution is far simpler than psychology. It’s most often structural and, therefore, within your control. Here are the main reasons your child may use emotional eating: 

1. Hunger

Hunger is a physiological symptom that triggers an emotional reaction. Think of the term “hangry,” which perfectly demonstrates what happens when a person is hungry. They get grumpy, angry, and have trouble concentrating. They will start to crave highly palatable foods like carbs and sugars because their blood sugar is dipping dangerously low. The first question to ask if your child is using emotional eating is whether they are getting enough food on a regular basis. If you’re unsure, please talk to a non-diet dietitian who can help you figure out how much food your child needs at this stage in their development. Most parents are surprised to find that it’s far more than they thought.

2. Lack of feeding structure

Emotional or chaotic eating is often due to a lack of feeding structure. When there is an inadequate feeding structure, the child’s hunger is out of balance, and they find themselves frequently hungry and dysregulated. Parents should serve kids food every 3-4 hours. This typically includes 3 meals and 2-3 snacks. Having a feeding structure eliminates almost all feeding issues and is the primary treatment for any type of eating disorder. Unless you begin with a solid structure, your child will continue exhibiting signs of emotional eating. 

3. Poor sleep hygiene

Sleep is essential for many reasons, including appetite regulation, digestion, and emotional regulation. Before you worry that your child has any sort of mental health issue or diagnose them with emotional eating, ensure that they have good sleep hygiene. Therapy and nutritional advice will not help a sleep-deprived child. Like a feeding structure, sleep is essential to physical and mental health. 

4. Emotional dysregulation

If all of the above conditions are met but your child is still emotionally eating, your child likely needs help with emotional regulation. It’s our job as parents to help our kids develop emotional regulation by co-regulating with them and building their emotional literacy throughout their lives. We can learn this skill and teach it to our kids. So once all the above conditions are met, emotional regulation is the next area to focus on. 

What can parents do to stop a child from emotional eating?

Most of the time, the best thing a parent can do to stop a child from emotional eating is to attend to our parental responsibilities. Make sure your child is getting enough food on a consistent schedule. Ensure they get the sleep they need with a stable bedtime. And finally, work with them on emotional regulation to help them label emotions and work through emotional dysregulation. 

Once that is covered, learn how to talk about food neutrally. This means not labeling food as good or bad. Instead, talk to your child about how to balance food to feel satisfied and avoid getting too hungry. For example, a meal should ideally include fat, carbs, protein, and fruit/vegetables. A snack should ideally include at least two of those elements. This simple model can help children learn to feed themselves in a way that keeps them satisfied for several hours and will reduce chaotic eating driven by hunger and the associated emotions.

Avoid cutting out food groups unless your child has a medically diagnosed allergy. It is common to restrict foods like wheat and sugar based on non-medical diagnosis, but this can lead to disordered eating for many children. The best diets are balanced and incorporate a variety of food from all food groups. They also include highly-palatable foods like cookies and chips as part of the variety.

This is the prescription for raising healthy children who can regulate their emotions and eat healthfully. It also prevents and treats most eating disorders.

What not to do if your child is emotional eating

Most parents address emotional eating in the wrong direction. They assume the problem lies in the child. Parents believe they should tell the child to eat less or educate them about nutrition and the dangers of weight gain. This is understandable, but it’s also not the right approach. 

Most children who are treated this way will feel shame about their bodies, their hunger, and their character. This could lead to restricting food, which exacerbates emotional eating, binge eating, and a cascade of disordered eating patterns that may develop into a full-blown eating disorder. 

Restricting food and intentional weight loss are culturally normalized behaviors. However, they do not result in improved health. 95% of people who intentionally lose weight gain it back, often plus more. The No. 1 predictor of weight gain is not how much food a person eats but how many times they have intentionally lost weight (i.e., dieted and weight cycled). Additionally, teens who diet have up to 18x greater chance of developing an eating disorder.

Frequently asked questions about emotional eating

I know this is a fraught topic. It’s very hard to parent around food and body issues in our culture, which is toxic to both. Societal beliefs about eating and weight can get between you and raising a healthy child. So here are some answers to frequently asked questions about emotional eating:

1. But what about weight gain?

Children need to gain weight to grow and should continuously gain weight throughout their childhood and adolescence. If you are feeding your child regularly and serving them enough food, and they have good sleep hygiene and emotional regulation, their weight will sort itself out according to their genetic and environmental conditions. Any attempt to intentionally manipulate weight predicts weight gain and eating disorders.

2. But my child is already eating too much food

I encourage you to consult with a non-diet dietitian who can talk to you about the quantity and variety of food your child requires to be healthy. They can help you determine what to serve your child, how often, and when. This structural support will give you the confidence that your child is eating appropriately for their unique body.

3. My kid snacks on chips and cookies all the time but doesn’t eat meals

This is most likely a structural issue. The evidence-based feeding system called Division of Responsibility, developed by Ellyn Satter, lays out exactly how parents can set boundaries around meals and snacks. This includes a feeding schedule and providing adequate eating opportunities and a variety of food in a pleasant atmosphere. If you follow the Division of Responsibility, you will likely no longer have this problem.

4. My child only wants to eat carbs and sugar

See numbers 2 & 3 above. This problem will be resolved once you have the right structure in place.

5. My child says they can’t stop thinking about food or can’t stop eating

This indicates a preoccupation with food. The most likely culprit is a lack of feeding structure and hunger. Once you have addressed the structural issues, work on emotional regulation skills and emotional literacy. Is your child physiologically hungry or hungry for emotional care? Don’t ask them – just tune in and determine whether they need more emotional care from you. Make sure they are getting enough food on a regular schedule. If you’re sure it’s not physical hunger, then fulfill the emotional need. Our children are usually hungry for attention, affection, and acceptance. So give them more of that! 

6. My child eats to the point of having a bellyache or bloating

When a child gets too hungry, they will most likely feel discomfort after eating. So the first thing to address is the feeding schedule and ensuring that your child is eating enough food regularly throughout the day. If the structural issues are addressed, and your child is still eating beyond comfortable fullness, then examine what emotional need they are trying to fill with food. Are they lonely, tired, or sad? Give them more affection, attention, and acceptance throughout the day and particularly before and during meals so they are not trying to fill an emotional void with food. Get some parent coaching and support if you’re trying to do this and it’s not working.

7. What if it’s an eating disorder?

If you are concerned or suspect that your child’s emotional eating is an eating disorder, then please reach out for a diagnosis by a trained health professional, ideally who has extensive experience with eating disorders.

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

See Our Parent’s Guide To Eating & Feeding A Child With An Eating Disorder

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Family Based Treatment (FBT) for eating disorder

FBT for eating disorder recovery

Erin was terrified when her 13-year-old daughter was diagnosed with anorexia. She spent a few months just trying to get her feet under her as she navigated the care system and tried to figure out what she was supposed to do to help her daughter get better.

“I felt like I was running through quicksand,” she says. “It was awful. Professional advice ranged from ‘wait and see’ to residential treatment, and neither option felt like the right one for us.”

Eventually, she was relieved when she was referred to a practice providing family-based treatment (FBT) for anorexia. “When I found FBT I just knew that was what we needed,” she says. “Our therapist helped us get our arms around the disorder and treat our child with respect and firmness. It made a world of difference, and she started to get better faster than I thought was possible.”

Erin’s experience with FBT is what every parent who has a child with an eating disorder wishes for: efficient recovery at home. And while FBT isn’t a fit for every child who has an eating disorder, it has been very effective for many families facing anorexia.

FBT parent coaching

Eating disorder recovery

Approximately 13% of adolescents will develop an eating disorder by the age of 20. Eating disorders have been reported to be the third-most common chronic condition among adolescents. Despite this, research into the best treatment for eating disorders has been chronically underfunded. Therefore, evidence-based treatment trials for adolescents with anorexia nervosa are few, and study sizes tend to be small. As a result, many parents facing an eating disorder feel isolated and frustrated with the system of care.

Because it is one of the few anorexia treatments with scientific validation, FBT is considered by many to be the first-line treatment for adolescents with anorexia. There is also some evidence for its use with adolescents with bulimia.  In this article, I’ll review:

  • The evidence for FBT for eating disorders
  • How FBT can be used to treat eating disorders
  • What you should know if you’re thinking about FBT for your child’s eating disorder

What is FBT?

Family-based treatment (FBT) is also sometimes known as the Maudsley method or Maudsley approach. It is considered by many to be the first treatment of choice for adolescents with anorexia. FBT is a manualized outpatient therapy designed to restore adolescents to health with the support of their parents. The primary focus of FBT is weight gain and it is seen as a viable alternative to residential treatment for that outcome.

Who does FBT work best for?

Family-based treatment (FBT) is an effective intervention for adolescents with anorexia nervosa. Also, preliminary evidence suggests that it may be effective in treating adolescents with bulimia nervosa.

Qualified therapists use FBT with all sorts of eating disorder populations. As of 2018, eight scientific studies have evaluated FBT in 657 patients with anorexia. And while it has been tested in multiple demographics, the majority of scientific evidence so far indicates positive outcomes for people who fit these criteria:

  • Adolescents <18
  • Female
  • Anorexia
  • Illness duration <3 years
  • Medically stable and fit for outpatient treatment

FBT has also been evaluated for bulimia. As of 2018, three randomized controlled studies have evaluated 295 patients. These studies have indicated positive outcomes compared to individual therapy, though the results are less dramatic than those for anorexia.

How to provide Family-Based Treatment

Many parents will cobble together an FBT-like treatment for their child with an eating disorder. However, true FBT is a detailed program based on a manual. Therefore, it contains specific elements in an outpatient setting and requires sessions with a trained therapist. Studies have evaluated short-term FBT (10 sessions over 6 months) and long-term FBT (20 sessions over 12 months). FBT is delivered in 3 stages with decreasing levels of parental control over feeding.

The second session of treatment includes a family meal. During this meal the therapist can observe the child’s eating patterns and family behaviors. At each session, the therapist will weigh the person who has an eating disorder. Following that, they meet with the family to discuss progress, including a review of weight gain. These meetings begin on a weekly schedule and decrease over time. 

The central premise of FBT is that families can be central to eating disorder recovery. And while it is not a fit for every family, many find it very helpful.

Stage 1 of FBT is designed to replace inpatient treatment for an eating disorder. Eating and weight gain are the priority, similar to how they form the foundation of inpatient treatment. Typically the person with the eating disorder is able to continue attending school and participating in activities as long as they are eating and gaining weight.

Food Refusal & Picky Eating Printable Worksheets

Give your child the best tools to grow into a confident, calm, resilient eater!

Principles of FBT

Family-based treatment for eating disorders is organized around a few basic principles:

1. Agnostic view of the illness

FBT makes no assumptions about the cause of the illness. Previously, families were blamed for eating disorders. To counteract this, FBT takes a strong position that families are not to blame. Rather, FBT focuses entirely on resolving the primary symptom of not eating. FBT is not concerned with identifying the underlying factors. Instead, it aims to get adolescents to gain weight and stop using their eating disorder behaviors.

2. Externalize the illness from the patient

FBT emphasizes that the eating disorder and the child are not one and the same. The idea is that the eating disorder has “taken over” the child and is driving their thoughts, feelings, and behaviors. Parents are asked not to blame their child or believe that the eating disorder is the child’s choice. The goal of externalizing the illness is to reduce parental criticism, which has been shown to harm treatment outcomes.

3. The therapist takes a nonauthoritarian stance

The role of the FBT therapist is to take an active role in guiding the family through the recovery process. However, an FBT therapist does not tell the family exactly how to go about helping their child recover. The therapist partners with the family to help them figure out how best to refeed their child. The therapist models an uncritical, supportive, and compassionate stance toward the patient. Meanwhile, they take a firm, zero-tolerance approach toward eating disorder behaviors. 

4. Parents are empowered

In FBT, parents are empowered as the best resource for their child’s recovery. Essentially, they are seen as the main agents of change in their child’s therapeutic process. Therefore, FBT success rests in the parents’ confidence that they can handle the eating disorder. The therapist works to put the parents in charge and communicate confidence in their ability to beat the eating disorder.

5. Unwavering focus

FBT has a pragmatic, unwavering focus on symptom reduction. It is designed to quickly and single-mindedly focus on weight gain. And, in the case of bulimia, ending binging and purging. Therefore, problems associated with the eating disorder like depression, anxiety, irritability, body image issues, trauma, loneliness, and more are not addressed in the first phase of FBT. The belief is that many of these secondary problems will lessen with the return to physical health.

What are the three phases of family-based treatment?

The FBT treatment for anorexia consists of three phases.

Phase 1

Phase 1 focuses on rapid weight gain. In cases of bulimia, the focus is on ending binge and purge behaviors. Parents are told that the disorder makes it hard for the child to make healthy decisions about food and eating. They are empowered to take over decisions about eating, much as would be done in inpatient care. Parents are responsible for deciding what their child eats, when, and how much is eaten. They typically also curtail any physical activity, much as would take place in residential treatment.

In the second session of FBT, the therapist will coordinate a family meal. During this meal, they will instruct the family on how to be more effective with the eating disorder. The goal of this meal is to give parents the confidence that they can encourage their child to eat more than they intended.

Phase 1 continues until the following conditions are met:

  • Steady weight gain
  • Eating disorder symptoms have begun to recede
  • The child is eating without significant resistance

Phase 2

During the second phase, parents will gradually give eating decisions back to the adolescent based on what is age-appropriate. This phase is introduced gradually and managed carefully.

FBT parent coaching

Phase 3

During the third phase, the therapist reviews the adolescent’s progress and ensures the family is on track to get back to normal family life. The therapist offers skills to support ongoing development. Additionally, they will help the child navigate change without reverting to eating disorder behaviors to cope.

Is FBT right for your family?

Family-based treatment can be more effective than other treatments for anorexia, especially in cases where it’s caught early. However, if it’s not a good fit for you and your child is not gaining weight, you should know within four weeks. If that is the case, you may want to try other treatment options. It’s not a failure on your part, it just means FBT is not the right treatment for your family. FBT is great when it works, but it’s not the only path to recovery. There are alternatives, and you should not feel ashamed if FBT is not the right fit for you.

What do parents say about FBT?

When it is a good fit, FBT is very effective, and parents rave about it. Parents who succeed with FBT say recovery is faster and more effective than alternative treatments. But even parents who found FBT efficacious say it is time-consuming and emotionally challenging. Implementing Phase 1 of FBT can be a full-time job for parents, and it can last up to 3 months or even longer. Therefore, in some families, one partner will take a leave of absence from work to administer the treatment.

The risk of parental burnout with FBT is high. Burnout is a major risk for any parent who has a child with an eating disorder. Also, it’s serious because parental burnout has negative consequences for eating disorder treatment outcomes, whatever the modality. Therefore, parents report that having support makes the job easier.

That’s what Erin found helpful. “We had a great therapist, and I was active on parent message boards,” she says. “But I found that parent coaching was the real game-changer for me personally. Having a coach helped me work on my side of the equation and learn better communication skills. It made me much more influential over the eating disorder.”

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

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

See Our Eating Disorder Treatment Guide For Parents

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Emotion coaching when your child has an eating disorder

Emotion coaching when your child has an eating disorder

Emotion coaching is a 5-step method developed for parents by John Gottman, PhD that can be applied to eating disorder recovery. The emotion coaching method builds emotional intelligence and creates positive, long-lasting effects for children, from toddlers to teens and young adults. It’s evidence-based, easy to learn, and regularly used by parents, educators, therapists, and caregivers in many different settings.

When parents learn the emotion coaching method, they identify how best to respond when a child is sad, angry, scared, or emotionally dysregulated and having big emotions. Once parents understand emotion coaching, they recognize that emotions, even the big, scary ones, are opportunities to build connection and emotional resilience. 

Parents also learn that emotion coaching doesn’t let the child “off the hook” when they have big emotions, but rather that the child gets to have big emotions, and the parent also gets to set clear, consistent limits on behavior.

The five steps of emotion coaching are: 

  1. Be aware of your child’s emotions
  2. Recognize your child’s expression of emotions as a perfect moment for intimacy and teaching
  3. Listen with empathy and validate your child’s feelings
  4. Help your child learn to label their emotions with words
  5. Set limits and problem-solve

Emotional Regulation Worksheets

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

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

Emotional literacy is critical in eating disorder recovery

Often eating disorder behaviors are a way for a person to cope with difficult and uncomfortable emotions. Thus, eating disorder recovery necessarily involves learning how to feel big and uncomfortable emotions without using eating disorder behaviors. 

This is why parental emotion coaching is so helpful for recovery. You are spending far more time with your child and seeing a greater range of emotions than their therapist. Therefore, if you can help your child learn to tolerate and process difficult emotions, you can help them recover from their eating disorder

But tolerating and processing emotions is not something that most of us do naturally. In fact, many parents do the exact opposite. For many parents, when a child has uncomfortable emotions, the goal is to settle the emotions and move on as quickly as possible. 

Here are the three most common techniques parents use to settle emotions quickly:

  • Accommodating: Your child is afraid of heights, so you avoid heights
  • Authoritarian: Your child gets angry when you ask them to take out the trash, and you yell back that they are ungrateful and need just to do the job without complaint
  • Reassurance/Facts: Your child doesn’t want to do something, so you provide them with facts and reassurance that it’s a good thing to do and that everything will be OK

These are just three ways that parents try to avoid emotions. Most parents who do this believe they are making the only rational choice. They believe that the rational way to handle emotions is to settle and/or avoid them. However, we know that the opposite is true. Repressed and avoided emotions tend to get bigger and more disruptive over time, not smaller. 

That’s why emotional regulation is a core element of eating disorder recovery. To recover from an eating disorder, your child must cope with big and disruptive emotions without their eating disorder behaviors. The only way to do this is to build emotional resilience, which can be achieved with emotion coaching. 

Emotion coaching when parenting a child with an eating disorder

Parents can support recovery by working with their kids’ emotions rather than denying, avoiding, or accommodating them.

1. Be aware of your child’s emotions

The first step in providing emotion coaching for a child who has an eating disorder is to recognize when your child is having emotions. This may seem obvious, but it is both essential and easy to miss. 

You need to tune into your child’s emotional state to do this. Consider these questions: 

  1. Do you know when your child is angry, sad, scared, or feeling another emotion?
  2. If so, how do you know? What are the signs of the different emotions your child feels? (hint: don’t focus on words alone. Emotional expression is much deeper than language, so look for physical signs like eyes, facial expression, posture, vocal tone, gestures, etc.)
  3. Do you understand that often there is a presenting emotion (e.g., anger, stubbornness) that is covering a primary emotion like fear, worry, and shame?

It helps to build your emotional literacy, or ability to recognize and label emotions. There are several tools to help identify feelings: 

Print out one of these tools and use it to help you recognize your child’s different emotional states. Look for opportunities to use more emotional language with your child. Show your child how often we have more than one emotion at the same time. For example, it’s normal to feel both nervous and excited at the same time. We may also have a presenting feeling like anger that’s hiding a core feeling like sadness. 


2. Recognize your child’s expression of emotion as a perfect moment for intimacy and teaching 

Most parents become alarmed and maybe defensive when a child has big emotions. But emotions are a perfectly natural and normal part of being human. There are a few different theories, but a common one developed by Paul Ekman, suggests we have six basic emotions. They are: 

  • Sadness
  • Happiness
  • Fear
  • Anger
  • Surprise 
  • Disgust

If you consider that there is also a state of neutral emotion, it’s safe to assume that most humans spend less time being happy than they do the many other emotions. Having a child who is not always happy is not a problem: it’s normal.

Uncomfortable emotions like sadness and anger are natural and normal. And your child needs you most when they are sad, angry, afraid, or experiencing other “negative” emotions. It’s not that your child needs to stop having the emotion. It’s that they need to have it safely, ideally with you until they learn to handle it by themselves without their eating disorder behaviors.

When your child has big emotions in your presence, it’s best if you acknowledge the emotions and see them as an opportunity to build your connection with your child. Don’t push the feelings away or avoid them, but rather to step into your role as an emotional caregiver and soothe your child’s emotions.

Soothing does not occur when you accommodate, make demands, bribe, or convince your child not to have their emotions. It takes place when you acknowledge their feelings and respond to them. Soothing can be both verbal and physical. For example, you can begin with labeling the feelings, but you can also start by reaching out to them, hugging them, and giving them gentle eye contact to let them know you are there with them in their pain.

When parents soothe their kids’ emotions, kids learn over time to soothe themselves. And this is the true growth opportunity of emotion coaching and why it’s so important in eating disorder recovery. When you coach your child, they learn to do it for themselves.

3. Listen with empathy and validate your child’s feelings 

Emotion coaching is a highly attuned, challenging task. Parents who want to emotion coach their kids through eating disorder recovery need to practice listening and validating. Here are some tips for this: 


  • Make sure you are listening to understand, not listening to respond.
  • Relax your desire to give solutions or convince your child of anything.
  • Breathe deeply and calmly while you listen to your child. 
  • Remain emotionally regulated.
  • Mindfully “listen” to your child’s body language, not just their words.

Emotional Regulation Worksheets

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

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


  • Mirror what your child said by repeating a few of their words or summarizing what you heard without judging, editorializing, problem-solving, or debating the “facts.” Say things like “It sounds like …” and “Let me know if I’m understanding how you feel, you’re …”
  • Say things like “I get it” and “that makes sense.”
  • Don’t discount feelings, tell them how they should feel, use logic, or try to fix anything.
  • Attend to your body language: have soft eyes, a relaxed but firm posture, and an engaged and open facial expression.
  • Avoid “why” questions, which will put your child on the defensive. 

You need to validate your child’s emotions, not their behaviors. There’s a big difference. For example, you don’t need to say, “I can understand why you didn’t eat today.” Instead, say, “It sounds like you felt overwhelmed by everything you had to do today (and didn’t eat).”

4. Help your child learn to label their emotions with words 

Consistently work with your child to label their emotions with words. This powerful way to integrate the mind is essential to mental health. Use the feelings tools from earlier and keep steering conversations with your child towards feelings. 

You can ask questions like: 

  • Tell me more
  • What was/is that like for you?
  • What did that make you think? 
  • How did/does that make you feel? 
  • How did/does that affect you? 
  • What did/does that mean to you?

When your child gives you an answer, try to pick out the feeling words or add some of your own to make sure the conversation is emotion-focused.

Most of us want to focus on “facts” and details. But with emotion coaching, you’re working to help your child identify their feelings, which will help them deal with distress without their eating disorder behaviors in the long term.


5. Set limits and problem solve 

Emotion coaching is not permissive. In other words, while you are validating and accepting all of your child’s emotions, that does not mean that all behaviors are acceptable. 

For example, your child with an eating disorder might prefer to eat alone in their room. You can validate that they prefer to do that, but in your home, you insist on eating at the table as a family. Just because your child has feelings does not mean feelings should dictate behavior. This is very important when a child is dealing with dangerous behaviors like restricting, binge eating, and purging.

You can set clear boundaries and expectations that may include things like: 

  • Family meals
  • Not going in the bathroom after eating
  • Therapy appointments
  • No swearing at people or calling people names
  • Not hitting things or people

When things get hard, you can validate the feelings for why your child doesn’t want to or can’t meet the boundary but still uphold the boundary you have set. This is what parents learn to do in the highly effective and evidence-based SPACE Training

If your child has expressed their emotions and feels validated, you may move into problem-solving. But be careful about problem-solving, as most adolescents and young adults do not actually want you to problem-solve. Most of the time they want to express themselves and then solve their problems by themselves. 

Surprisingly, the more room you give your adolescent/young adult to solve their own problems, the more likely they will seek your advice. So hold back unless it’s specifically requested.

If you are sure that your child really wants you to problem-solve with them, here are the steps: 

  1. Identify goals
    • What is the problem we are trying to fix? 
  1. Think of possible solutions
    • Brainstorm – no idea is too silly or stupid to consider 
    • Write them all down 
    • Remind your adolescent/young adult of past success and how he/she handled it 
  1. Evaluate proposed solutions based on family values
    • Is the solution fair? 
    • Will it work? 
    • Is it safe? 
    • How am I likely to feel? 
    • How will other people feel? 
  1. Help your adolescent/young adult choose a solution if they want help doing so.

Helping your child with their emotions during eating disorder recovery can help them find healing.

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

See Our Guide to Emotions And Eating Disorders

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A log parents can use to track eating disorder symptoms and treatment

Keep a log of eating disorder symptoms and treatment

If your child has an eating disorder, then it may help you to keep a log of eating disorder symptoms and treatment. This is a useful tool to support you in seeking treatment, recognizing progress, and, when necessary, making decisions to switch to new or different treatment. A mental health log can help parents keep track of their kids’ mental health and support them in making strategic decisions to support recovery. 

There are many benefits to keeping a mental health log of eating disorder behaviors and treatment. The three most important reasons are so you can: 

  • Maintain your focus and know what’s working and what’s not working
  • Share your notes with treatment providers to keep treatment on-track
  • Recognize when things are getting better or worse

An eating disorder is a constantly moving target, and getting from day to day can be a major undertaking. But if you don’t have a tool to pull yourself up from the weeds and see the big picture, you can’t make strategic decisions. And impulsive decisions based on your feelings alone are often much less effective than decisions that are made in a more strategic manner. A log that tracks symptoms and eating disorder treatment will help you keep everything straight.

Emotional Regulation Worksheets

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

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

Why keep an eating disorder treatment log?

Managing a child’s eating disorder is a big undertaking. There is so much information and many details to keep track of. Since you have other things on your plate and you’re more likely to forget details in stressful situations, it helps to write down what is going on. Doing this will help you keep track of medications, rules, and expectations so that you aren’t wasting time trying to remember what was said or tracking down different pieces of paper, medication bottles, and other things to help jog your memory. 

In times of stress, it can be dangerous to rely on memory, since facts become distorted with pressure and time. Keeping a detailed log of eating disorder symptoms and treatment means you have the information you need at your fingertips.

What is an eating disorder tracking log?

A log for eating disorder symptoms and treatment can help parents keep track of all the little and big things that take place during the various stages of having an eating disorder. Whether your child is in a very active eating disorder or in early, mid, or full recovery from an eating disorder, a log can be helpful. 

An eating disorder symptom log should track the following:

  • Eating: for example, what and when did you serve food, and what was eaten. You may also include how it was eaten (e.g. easily, slowly, fast, reluctantly, etc.)
  • Other behaviors: for example, track whether your child is purging and, if so, how often. Same with over-exercise. You can also observe whether body image issues are becoming more or less frequent. 
  • Conversations you have with professionals: this should include notes from your meetings with therapists, doctors, dietitians, etc. This should include information about the treatment they recommend and suggest and why you did or did not follow it.
  • Distressing events: you should take note of major events such as self-harming, anxiety attacks, and aggressive behavior. Describe what happened and approximately how long it lasted and its intensity.
  • Conversations with important adults: note things that people like coaches, teachers, family members, etc. have said to you about your child’s behavior. Sometimes it’s hard for us to see what’s going on, and these comments, when written down, give us insight.
  • Appointment notes: if your child is being monitored by a medical doctor you can keep track of vital signs like weight, heart rate, etc. Also, take note of any recommendations and suggestions. If you chose not to follow the doctor’s advice, state why.
  • Medications recommended and/or prescribed: keep track of what was prescribed, when, why, by whom, and at what dosage. Also track when providers adjust medication or if they make a recommendation that you disagreed with. Note any positive impact of medication and possible side effects.

In addition, you should have a quick-reference sheet showing you the providers’ names and phone numbers and any medications your child is on. 

How to keep a quality log

You already have a lot on your plate. A parent who has a child with an eating disorder is facing tremendous work in terms of treatment and care. You’re already doing the planning, scheduling, coordinating, budgeting, and decision-making. This is a lot of work. 

So you don’t have to turn keeping a mental health log into another tedious job for yourself. But you should have a system for jotting down your notes at the end of every day. As things improve, you can reduce this to every other day, then once per week, and so on. Remember that eating disorders can be effectively treated and you probably won’t have to do this forever. But it will be a tremendous help to you if you keep track of what’s going on. Aside from anything else, a good mental health log will give you the peace of mind that you are on top of your child’s care. 

log eating disorder symptoms

What format to use

Start by thinking through the format you will use for your log.

Some people really like paper and a pen for keeping notes. If so, get yourself a dedicated notebook and a pen and put them in a place where your child will not find them. Unless you are approaching the log as a group effort, you might want to hide it so your child cannot stumble across it. For some kids, a treatment and symptom log will bring on feelings of being vulnerable, observed, and exposed. 

If you prefer a digital record, then you have several options. You can set up a spreadsheet or a document, or even just use your note-taking app on your smartphone. Whatever you use, keep in mind privacy concerns, and password-protect your devices so your child doesn’t accidentally see your log if you don’t want them to. 

Once you know whether you’re going paper or digital, consider a standardized format. Not everyone likes this, but many people find it helpful to have a list of what they should be logging. To help, I’ve created a document with everything you need to get started. 

log eating disorder symptoms

Getting in the habit

In the beginning, make it a habit to jot down a few notes every day. New habits are hard to start, but once you get going, they get easier. Here are some tips for starting a new habit: 

  1. Get ready: gather the supplies you need and set up your worksheet, cheat sheet, or whatever you’re using to keep your log
  2. Set a goal: it’s very hard to build a habit if your goal is undefined. Commit to daily notes or, if that’s not possible, a note every time you do something like visiting the pediatrician or dietitian. 
  3. Set up a cue: if your goal is to make a note every day, set up the specific time and location. Many people will set a reminder on their smartphones to make sure this happens. Another option is to make the cue something like when your child goes to their therapy session, after dinner, or something else that reliably happens.
  4. Set up a reward: it’s best if you feel successful when you complete your habit each day. This could be something simple like giving yourself a quick hand or temple massage, scrolling through your phone for 5 minutes, or getting a hug from your partner. 
  5. Have a plan B: while you really want to stick to a regular plan to create a habit, it can be helpful to build in your plan B. This is what you will do if you don’t meet your goal. For example, can you set a second reminder on your phone? If you forget to do it after dinner, can you do it before you go to bed? Establish this in advance so it feels like a more formal and thus acceptable backup plan.

The log is not a journal for your feelings

Journaling your feelings about the eating disorder might be very helpful for you. A journal can help you process your difficult emotions and thoughts about your child’s disorder. However, this mental health log is not the same thing as a journal. I suggest you keep the two concepts separate. Remember that a good log might be helpful for you to show to your child’s treatment providers. So you want to limit your personal thoughts and feelings.

Keep the log factual, and process your feelings elsewhere. Use a reporting approach: stick to the facts! You can even use a reporter’s prompts to structure your notes: 

  • What happened?
  • Where did it happen?
  • How did it happen?
  • Who was involved?
  • Why did it happen?

Parent Scripts For Eating Disorder Recovery

Scripts to help you figure out what to say to help your child with an eating disorder. Use these scripts:

  • At the dinner table when behavior is getting out of control
  • When you need to set boundaries – fast!
  • After something happened so you can calmly review the triggers and events

Privacy considerations

Your child’s private health information is sacred. I already mentioned this, but carefully consider whether you plan to share your log with your kid. And, if not, make sure they have no way to accidentally stumble upon it. I really can’t overstate this. What you are doing is not wrong. However, it could be hurtful for your child to discover your log without adequate preparation. Here are a few options for thinking about how you set this up: 

Keeping an open log

You may choose to make the log open and accessible to your child. This means you share with them that you are keeping the log and are willing to show it to them upon request. However, it does not mean your child is keeping the log for themselves. If their therapist suggests they journal or maintain their own notes, that’s separate from what you are doing. Even if you are providing your child with access to the log, make sure that it is your responsibility to record your observations and notes. 

Keeping a private log

A more common approach is to keep a private log. In this case, you keep your log private and in a secure location that your child cannot access. You are gathering very personal information, so it is essential that you take this very seriously. There are ways in which an eating disorder symptoms log can go awry, including: 

  • The child with the eating disorder finds it and feels criticized, triggering a relapse or new symptoms
  • Siblings find the log and make fun of the child or become worried about the child’s health
  • Other people, from nosy neighbors to extended family members find the log and catastrophize the situation, possibly even accusing you of wrongdoing if they don’t understand what’s going on

This is why it cannot be overstated: if you keep a handwritten log, make sure that it is hidden securely in a place that nobody will find. If you keep your log on digital devices, make sure they are password-protected to make sure nobody can access them except for you. Don’t fall into the trap of relying on weak passwords that your children are likely to guess! Do not use anyone’s birthday, name, or classic combinations like 12345, abcdef, or the all-too-common mistake of using the word “password” as your password.🤣

Get started!

Keeping a mental health log of eating disorder symptoms and treatment can really help you uncover patterns of behavior. It will also help you recall facts and information that you’ve received in the past and jog your memory about why you have made the decisions you have made. Finally, it can be very helpful when you’re talking to new treatment providers who need a history of what has taken place so far.

You can get started here

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

See Our Eating Disorder Treatment Guide For Parents

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SMART goals parents can set in eating disorder recovery

SMART goals parents can set when kids return to college after an eating disorder

Vicky is feeling really nervous because her 19-year-old Alex (they/them) wants to go back to college after eating disorder treatment. Alex is highly motivated to get back to school and manage their own life, but Vicky feels deeply unsure about exactly how that will work. 

“I can’t get over the memory of having to hospitalize them and put them in inpatient treatment last year,” says Vicky. “It was traumatic for all of us, and right now I can’t even imagine feeling good enough to send them back to school even though they say that’s what’s motivating them to recover right now.”

Vicky struggles to balance being a responsible mom with the freedom Alex wants. She wants to get clear about what Alex needs to do to show her that they are ready to go back to college.

I suggested coming up with some goals that will help Vicky feel better about sending Alex so far away again. I recommend using SMART goals for eating disorder recovery, since they are specific and attainable, and there can be no doubt as to whether they are achieved. They’re also motivating because Alex will be able to see a pathway to freedom from parental oversight.

Emotional Regulation Worksheets

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

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

What are SMART goals? 

SMART goals are often used in business and education settings to help employees and students set and achieve measurable goals. The key to SMART goals is that they are very specific and work well when you have large goals that you want to break down into smaller steps. 

SMART is an acronym that stands for “specific,” “measurable,” “attainable,” “relevant,” and “time-bound.” Every SMART goal features these essential elements to ensure the goal can be reached to satisfy both the child who will take action towards the goal and the parent who wants to see the goal achieved.

Specific: What is the goal? 

The goal should be well-defined, clear, and unambiguous. For example, it’s not enough to say “eat enough.” If the goal is to eat, get specific, like “eat 3 meals and 2 snacks every day.”

Measurable: How will I measure progress?

The goal should have specific criteria that measure progress. For example, if the goal is 3 meals and 2 snacks daily, the child could text a photo of each to their parent or dietitian.

Attainable: Do I have the resources & skills for it? 

The goal should be something that is attainable and not impossible. It should be within the child’s capacity to do. In the eating example, the child needs access to food and a smartphone.

Relevant: Why is this goal important? 

The goal should be an important step toward self-management. It should matter to you and your child. In the eating example, maintaining regular meals and snacks is a major part of being a competent eater, and thus makes sense as a relevant goal.

Time-Bound: When will I achieve the goal I’ve set?

The goal should have a clearly defined timeline, including a start date and a target date. For example, if they send photos of all three meals and snacks every day for eight weeks, you may set a new SMART goal that gives them less oversight in the next stage.

Why are SMART goals important? 

SMART goals are important because they help parents:

  • Set clear intentions, not broad or vague goals
  • Feel confident about the child’s path to self-management
  • Focus on the specific behaviors that support recovery
  • Measure progress with specific benchmarks
  • Provide sensible objectives that are realistic and achievable
  • Avoid the distraction of a long list of goals that is hard to manage
  • Be clear about the timeline and next steps if goals are met

SMART goals increase your child’s pursuit of self-management by making your expectations really clear and unambiguous. Your college-age child wants to get out from under parental control, so setting SMART goals gives them a clear path to doing that. These goals communicate that you believe your child can succeed but also gives you the confidence to let them go away to college.

How can SMART goals help with eating disorder recovery?

SMART goals can help with eating disorder recovery, especially for college students, because they help both the child and the parents get what they need. The child wants autonomy and to return to their life back at college. But the parents want assurance that the eating disorder is not active and putting their child in danger.

Vicky was really excited about using SMART goals for Alex. “I feel like this is going to really help us put together a plan that feels good for all of us,” she says. “Alex would much prefer zero controls, and I get that, but I need something to make sure I’m not being reckless or thoughtless when sending them back to school.”

Working on SMART goals

Vicky worked on three SMART goals that she felt were important. Since they are in family therapy and Vicky was unsure how Alex would respond, she brought up the idea during a family therapy session. The therapist was encouraging and supportive of the idea, and Alex didn’t hate it. So the next week Vicky brought in the SMART goals worksheet. Together they worked with the therapist and Alex to make adjustments that felt good for everyone. 

“A big deal for Alex was the time-bound aspect, of course,” says Vicky. “Alex just wants to see a path out of being monitored all the time, and I feel like these SMART goals give us all the confidence to move forward. I want Alex to feel independent and free … and I want to be free of the eating disorder, too! This has absolutely taken over our lives, and I can’t wait to move into the next stage and reduce our monitoring.” 

This steady and clear approach to eating disorder recovery adds a lot of confidence and security for parents while also showing kids the steps they need to take to reclaim the independence they crave.

SMART goals eating disorder

SMART goal template & examples

SMART goals for recovery example: eating

SMART goals eating disorder

PLEASE NOTE: this is not intended as or delivered as medical advice. Please don’t make choices about your child’s recovery without consulting their treatment team. Make sure your SMART goals are appropriate and make sense in the context of your child’s eating disorder recovery.

SMART goals for recovery example: therapy

SMART goals eating disorder

How to make a SMART goal

Like Vicky, you may be excited about SMART goals and want to dive right in. I get it! I love SMART goals! Please just remember that while Vicky drafted some SMART goals, she checked with her family therapist before introducing them to her child. Depending on your child’s eating disorder recovery status, SMART goals may not be the right approach right now. Check with your child’s eating disorder treatment team before presenting your child with SMART goals.

To make a SMART goal, begin by thinking of your big goal, then breaking it down into behaviors that will get you closer to the goal. With eating disorders, the big goal is “recovery,” but that’s hard to measure and it’s a state of being, not a behavior with measurable steps. If we make recovery the goal, we will struggle to measure and monitor it. Instead, break it down into attainable, measurable, and observable behaviors like:

  • Eating regular meals and snacks
  • Checking vital signs of health such as heart rate, blood pressure, etc.
  • Going to therapy and nutrition appointments
  • Getting blind-weighed if appropriate/necessary

Next, write down a few SMART goals that are “specific,” “measurable,” “attainable,” “relevant,” and “time-bound.” If the goal is eating regular meals and snacks, detail how many meals and snacks, and how the goal will be measured. The most common mistake is not being very specific about the goal. The more specific and measurable the goal, the greater your chances of success.

Vague GoalsSpecific Goals
Eat regularlyText photos of 3 meals and 2 snacks every day
Don’t lose weightGet blind-weighed once every two weeks*
Stay healthyGet your vital signs checked once every two weeks*
Take care of yourselfAttend weekly therapy and nutrition sessions

*the frequency will vary based on your child’s current medical status and is here as an example only. Please consult your child’s treatment team to set goals that make sense for their individual recovery path.

Measuring success

The most motivating eating disorder goals are those that provide a pathway out of being monitored. Show your child the path to self-management by setting multi-stage SMART goals. 

For example, if the first goal is for them to attend therapy weekly for 8 weeks, that doesn’t mean you stop all therapy if they reach that goal. Maybe the next goal is that they switch to every 2 weeks for 8 weeks after that, then monthly. A stepped approach will provide the safest structure for recovery

SMART goals should never feel punitive or shameful. The value of providing time-bound goals is so your child knows what will happen when they meet the goal. But you should not say you are disappointed if your child does not achieve the goal by a certain date. That’s why I suggest using consecutive weeks rather than a specific date. Just count the weeks that they do accomplish the goal. If they skip a week, then you start again at 0. Once they do it every week in a row for the number of weeks specified you can celebrate and set a new goal. 


Setting the clock

For example, Alex might text photos of their meals every day for two weeks in a row, then skip a few days during the third week. Alex is not bad for doing this. It’s understandable. However, that resets the clock back to 0. Once Alex texts all meals/snacks for 7 days, that puts the clock at 1. If the goal is 8 weeks, then Alex must text all meals/snacks for 7 days in a row for 8 weeks in a row to meet the goal. 

Avoid being flexible or changing the goal, because it will show your child that the goals are open for negotiation and debate. This is a slippery slope that eating disorders love to take advantage of. Instead, maintain clear, compassionate boundaries. It sucks for all of you to start at 0 again. But that’s how you make sure you aren’t accidentally accommodating the eating disorder.

Celebrating success

I checked in with Vicky after Alex had been back at college for a semester. She had been both hopeful and terrified of the return to college. And I’m pretty sure Alex felt many of the same feelings! 

Alex struggled a little bit with the transition back to school, which we expected and had prepared for. But after 4 weeks of being inconsistent with their progress, Alex stayed on track and they are almost ready to set new SMART goals that give Alex more freedom and autonomy. 

Vicky says that having SMART goals is a huge relief for her. “I just feel like I have some level of insight into what’s going on for them at college. Now I can keep an eye on their health and safety when they’re so far away from me.”

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

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

See Our Eating Disorder Treatment Guide For Parents

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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.

Emotional Regulation Worksheets

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

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

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 through eating disorder treatment.”

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

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

See Our Eating Disorder Treatment Guide For Parents

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When your child gets violent during eating disorder recovery

When your child uses violence during eating disorder recovery

Sometimes when a child has an eating disorder they may get aggressive and even violent with family members. This is a deeply upsetting situation for parents. It’s especially hard when parents are already worn out from months or even years of caring for a child who has an eating disorder.

The first thing to know is that getting angry, aggressive, and even physically violent are known symptoms that can accompany an eating disorder. They have been studied and observed in anorexia and bulimia. The most common symptoms are verbal and physical aggression against relatives and others who are close.

The most likely reason for the aggression is that it is a natural response to fear and anxiety. The two most common responses to fear are fight and flight. Fight typically looks like aggression and violence. It is often a signal that a person is experiencing extreme fear and anxiety.

Getting violent during eating disorder recovery can make sense through this lens. Anxiety often underlies and drives maladaptive coping behaviors. It makes sense, and it needs to stop. 

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What it feels like

When a child gets physically violent during eating disorder recovery, parents can feel shocked, overwhelmed, and afraid. There’s so much shame and stigma around kids hurting their parents, and it’s rarely spoken about. 

Violent behavior can happen during eating disorder recovery, but it’s also not acceptable. And there are no conditions under which a parent should accept violence. Additionally, your child’s violence is a symptom of extreme emotional distress. This means that ignoring it or pretending it’s not happening is dangerous for both your child and you.

Often it feels like the only possible responses to violence are to fight back, endure/ignore the violence, or call the police. Fighting back rarely ends well for anyone. And it can add to the shame involved for both parent and the child. And enduring or ignoring violence is unacceptable and, like fighting back, is dangerous for both the child and the parent.

The other response, calling the police, is something you may need to do at some point in the future. But most parents want to avoid that. And there are some steps between doing what you’re doing right now and calling the police.

How to prevent and handle violence

Here are some steps you can take to help prevent and respond to violent behavior during eating disorder recovery and keep yourself and your child safe:

1. How you respond

The most common response to violent outbursts is to fight back with some form of physical or verbal wrestling. However, this rarely defuses the emotional tension that drives a person to a violent outburst. Fighting back is ineffective and often makes the outburst worse.

Violent outbursts are usually the result of extreme emotional disruption. And while it may feel as if it comes out of nowhere, there are usually patterns and signs that a violent outburst is coming. 

Before a violent outburst, your child will show symptoms of emotional dysregulation. These may include shifty eyes, tense body posture, pacing, or loud voice. Some kids will signal their dysregulation by swearing or name-calling.

Parents should be aware of the signs of patterns that signal a violent outburst is building and take steps to try and soothe their child’s nervous system as soon as possible. Here are some ways to avoid and/or get through aggressive and violent behavior when your child has an eating disorder:

Manage your own emotional dysregulation

Possibly the hardest thing to do when your child is getting aggressive and violent is to maintain your own emotional regulation. But if you are not emotionally regulated then your child will have a very hard time becoming regulated in your presence.

Work with a professional coach, therapist, or guide who can help you identify your common forms of emotional dysregulation and learn to regulate yourself with self-compassion and mindfulness.

If at any point during an aggressive confrontation you notice yourself becoming dysregulated, try to calm yourself. But if you can’t, take a break. Don’t blame your child for this by saying something like “You’re out of control so I’m leaving!” Instead, tell your child “I’m very upset right now so I’m going to take a break.” Then leave. Give yourself at least 20 minutes, which is how long it typically takes to soothe your nervous system.

Always come back to your child and talk about what happened. Leaving is not a problem, but if you leave without talking about it later, that will put your relationship at risk.


Label and mirror their feelings

An essential emotional regulation skill is to label and mirror your child’s feelings. This is a way of soothing your child. This is because it shows that you are attuned to them and accept their feelings as valid and real. This step alone can transform your relationship with your child. This may not work if your child is already at the point of violence. But it can be used very effectively in the moments leading up to violence and may even prevent it.

Labeling is when you name your child’s feelings. You could say something like “I can see how angry you feel right now. You’re pacing and look agitated.” This video about the concept “name it to tame it” might be helpful:

Mirroring is when you repeat about three of your child’s words back to them. For example, if your child says “you never listen to me and you’re always telling me what to do!” You could mirror back something like “it feels like I don’t listen to you.” If your child says “you can’t make me do it if I don’t want to!” You could mirror back “you don’t want to.”

When mirroring your tone of voice matters just as much, and maybe more, than the words you say. Use what Chris Voss in his book Never Split the Difference: Negotiating As If Your Life Depended On It calls the “late-night DJ voice.” Imitate the voice of a late-night DJ: slow, steady, and soothing. With this voice, you comfort both your child’s and your own nervous system. It taps into your shared neurobiology to soothe and reassure. It communicates: we can handle this.


If your child does not calm down and moves aggressively towards you, calmly narrate what is happening in a supportive and non-judgmental manner. You could say things like:

  • I sense how furious you feel, but it’s not OK to push me. I’m confident we can get through this without pushing.
  • I can see that you are very angry, but I will not allow you to hit me, so I’m going to leave now. I’ll come back in about 20 minutes and we can try again.
  • I understand that this is making you feel very upset, and you get to feel that way, but I’m not OK with you threatening me. Let’s sit here together and I know we can get through it.

These statements do the same thing:

  • Label the child’s feelings and name the inappropriate behavior
  • Set a clear boundary
  • Show confidence that you can handle it

Your child may not like it when you do this, but that doesn’t mean you’re doing it wrong.

Keep your narration short, simple, and factual. Don’t editorialize or debate what you’re saying with your child. Use the “late-night DJ voice” and keep your voice calm and regulated.

Emotional Regulation Worksheets

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

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

Don’t debate

One key in responding to anger is to not engage in debates with it. You will never win a debate when a person is in extreme emotional dysregulation. Most parents believe there must be a perfect verbal response to violence that will stop it. They think that other parents have figured it out and are doing better than them. But that’s simply not the case. 

Eli Lebowitz, author of Treating Childhood and Adolescent Anxiety suggests you focus not on debating but on simply getting through or getting out of the moment.

“Parents are not expected to be able to manage the disruptive situation, and instead focus on getting through it. Their only role while the child is acting in the disruptive manner is to ensure physical safety and resist being drawn into the interaction.”  – Eli Lebowitz & Haim Ober, Treating Childhood and Adolescent Anxiety

The passage continues with this advice: “remain silent, or state in a quiet way that the behavior is unacceptable. If necessary, parents should attempt to distance themselves from the child in order to minimize the potential for escalation.”

Follow up

Once everyone has calmed down, talk about what happened. Begin by telling your child that you know they are a good kid who was having a hard time. Tell them you are going to work with them on this because even though you know how angry they get, you know that they can handle their anger without getting violent.

Violence must be named clearly and in a detailed but non-emotional manner. Avoid pointing fingers, blaming, or criticizing. Think of yourself as a dispassionate reporter. State what you observed during the violent episode. 

Don’t ask questions like “What were you thinking?” or say things like “How dare you!” Because these will shut the conversation down or escalate another outburst. They will not be useful in preventing future violence. Maintain your own emotional regulation.

Talk through what you did in response to their outburst, and why. For example, if you narrated what was going on, tell them you did that because it’s important to name feelings and behaviors. If you left the room, tell them you needed to do that because violence is not acceptable.

If you did something that you regret, like wrestle with them verbally or physically, take responsibility for that and apologize for it without defending yourself. “When you approached me with your fist raised, I pushed you away. I’m sorry for doing that, as I have no intention of wrestling with you.” Or “When you called me that name, I cursed at you. I’m sorry for doing that, as I have no intention of swearing at you.”

You will likely need to follow all of these steps consistently a few times before you see a change in behavior.  

2. Write a letter

A written letter is a way to make clear your beliefs and what you intend to do in response to violence. It is a way to formally escalate your attempt to solve this problem and make it clear to your child that you take it seriously.

The letter I’m describing here and the next section about calling in supporters is largely based on a treatment called SPACE developed and scientifically tested by Eli Lebowitz and his colleagues. The process is much more extensive than what I’ve written in this article. If this sounds like something that may help you, please consider reading his books, Breaking Free of Childhood Anxiety and Treating Childhood and Adolescent Anxiety.

I have a treatment program for parents that teaches SPACE.

Lebowitz suggests printing this letter and giving it to your child, then reading it aloud. He also says that even if your child’s response is to put their fingers in their ears and rip the letter into pieces, it has still sent a meaningful signal to your child that you are serious about ending the violence. 

The goals of the letter are to clearly define the specific problem of physical violence and say exactly what will happen in response. This makes clear exactly what is happening and escalates the situation in your child’s mind.

One of the biggest problems with physical violence and intimidation is that families don’t talk about it. This letter states clearly what the behavior is and how the parents are going to respond from now on. 

There is a very important thing that the letter does not do. It does not tell the child what they need to do differently. This is strategic and by design. Lebowitz says that the parents need to take responsibility for what the parent will do and how they will respond, but they should not tell the child what they should do, as this will be perceived as criticism and blaming, no matter how carefully done.

3. Bring in supporters

If your child continues to physically threaten and attack you, then it’s time to enlist help from your community. This may feel like an extreme response, but it’s much less extreme and often more effective than calling the police. 

This is based on the strength of our social and community relationships. We are social beings, and the thought of someone outside the family witnessing the child’s violence can help end unacceptable patterns of violence. When done with support and love, bringing in supporters can make a huge difference.

“The role of supporters is not to shame children or embarrass them but rather to rally round the children, giving them the message ‘We all care about you, believe in you, and are going to help you.’” – Eli Lebowitz & Haim Ober, Treating Childhood and Adolescent Anxiety

Make a list of people in your family and community who might be able to help you. You are looking for people who have high levels of compassion and a good relationship with your child. Possible options include grandparents, uncles, aunts, friends and family, sports coaches, teachers, school psychologists, guidance counselors, your child’s eating disorder treatment team, and others. 

Lebowitz suggests a list of 5-10 supporters, at least some of whom are in your physical community. Then reach out to them and explain the reason for your request.

Telling your child about supporters

Once you have contacted your supporters, tell your child what you have done. You can say something like “August, your violent behavior has been escalating, so we have decided to get some community support. We have contacted [list the names] and told them about what’s going on. They’re going to contact you in the next few days, and we will also tell them each time you get violent with us.”

Your child will not like that you have told outsiders about their violent behavior. Be unwavering in your belief that this is the best approach, as your next option is calling the police, which is really a last resort. Don’t debate why you did this, who you chose, or whether it’s a terrible idea. Stay firm in your conviction that this is the right thing to do.

Emotional Regulation Worksheets

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

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

“Any objection on the part of the child to this step should be met with a simple statement: ‘When you act in a violent way, we will not keep that a secret.’ Parents should adamantly avoid any further discussion of this point.” – Eli Lebowitz & Haim Ober, Treating Childhood and Adolescent Anxiety

When things get violent during eating disorder recovery

This article is designed to give you ideas about how to handle violent and aggressive behavior during eating disorder recovery. If your child is struggling with emotions in eating disorder recovery, then I encourage you to seek professional support for yourself as you navigate this difficult situation. You will likely need it, and you definitely deserve support. You will also be more effective if you have someone who can help you weather this storm.

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

See Our Guide to Emotions And Eating Disorders

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When your child is dropped by their eating disorder dietitian

When your child is dropped by their eating disorder dietitian

Sometimes a person who has an eating disorder is dropped or discharged from the care of a Registered Dietitian (RD). Parents may wonder why this happens and whether such behavior is ethical given how fragile their child is.

It’s undoubtedly hard for parents to hear their child has been discharged. If your child is under 18, you may be the one who the dietitian informs that they are terminating treatment. In this case, you will likely get the reasoning directly from them. But if your child is over 18, there’s a good chance that you will get the news second-hand. Your child will tell you their version of why they’ve been dropped or discharged by their eating disorder dietitian.

In either case, the news can be shocking, bewildering, and painful.

Grace’s story

That’s what happened to Grace*, a client of mine whose daughter Casey* is 19 years old and has bulimia. “We’ve had a terrible week because on Monday Casey’s dietitian dropped her,” she said, shaking her head in dismay. “Why would a person do that? Casey is getting worse – she’s in terrible danger. So why would her dietitian, who has been working with her for over a year, drop her right now?”

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

  • Self-Esteem
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  • Mindfulness
  • Calming strategies

Grace was in tremendous pain. Casey had spent the week raging against her dietitian and her whole care team. Casey’s eating disorder symptoms, which were already getting worse, ramped up to levels Grace hadn’t seen before. Her daughter was medically in danger, but because she is over 18, Grace had limited options. 

Things had been getting worse for Casey for a while. But knowing she was seeing a dietitian in person every week helped Grace feel a bit more secure. “I admit that those weekly sessions gave me hope,” she said. “At least I knew that Casey was being monitored and talking to someone who could help her.” 

“I don’t know what we’re going to do now,” she said. “I’m really at the end of my rope. And I’m so angry with the dietitian for putting us in this situation.” 

I completely understand Grace’s feelings. As we talked, we tried to understand what being dropped by the dietitian during eating disorder recovery meant for them.

Trying to find out what’s going on

I had a pretty good idea that what was going on is that Grace’s daughter’s dietitian had hit a point in treatment at which it felt medically and ethically unsafe to continue treating Grace in outpatient treatment. 

There had been months of weekly dietitian meetings and continued signs of medical instability. It sounded as if the dietitian had hit the point at which her training and expertise were at their limit. But it’s never simple, so I reached out to Leslie Schilling, MA, RDN, CEDS-S. Schilling runs a private nutrition therapy and wellness coaching business. She is also a supervisor for other dietitians working with eating disorders. 

“Ending treatment with a client is such a nuanced situation,” says Schilling. “I work really hard to avoid discharging a person from my care. Because I know how difficult it is, and it may feel like abandonment.”

“That said, there are times, particularly in a situation in which the person clearly needs a higher level of care, that I may have them sign a form or agreement acknowledging that I have recommended a higher level of care and they are choosing to continue working at this level of care instead,” she says.

“Many people don’t realize that dietitians provide a service called medical nutrition therapy. This includes some medical components like reviewing lab values, food-drug interactions, and systems assessments,” says Schilling. “And, if we see someone who is extremely medically compromised and needs to be in inpatient care, we could be at risk if we continue to treat them.”

Emotional Regulation Worksheets

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

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

Why does it happen?

There can be many reasons a person may be dropped by their eating disorder dietitian. Here are the most common reasons: 

1. Lack of specialty

Sometimes a dietitian will start working with someone without realizing how serious their eating disorder is. Maybe when they started the eating disorder was not recognized or disclosed. But then the RD realizes the person has an eating disorder. If the RD is not an eating disorder specialist, then they would probably refer the client to someone who is qualified to treat them. 

2. No team

If a dietitian is working with someone who has an eating disorder alone, they may decide that they cannot continue without the addition of a team. This is typically a medical doctor, therapist, and possibly a psychiatrist. If a client refuses to work with a team, the dietitian may need to make some difficult decisions about the ethics of continuing care alone.

“In most cases when supporting someone with an eating disorder, I do not recommend that a dietitian work alone – you really need a complete care team,” says Schilling. “I am not a therapist, and I can’t work on certain aspects of the eating disorder the way a therapist can. I also can’t admit someone to a hospital with a low glucose level, although I can read that in their lab work. Working without a team is not a good idea when we’re dealing with an active eating disorder.”

3. Personal reasons

Sometimes a professional will begin working with someone and then need to disengage for personal reasons. This could be for family reasons like pregnancy or elder care, moving to a new practice or out of state, retiring, or a number of other situations. 

In these cases, the dietitian rarely leaves their client hanging and will typically give their client plenty of notice and provide them with referrals to other professionals. Sometimes emergencies or illnesses mean a dietitian must end treatment abruptly. While not ideal, these situations are sometimes unavoidable. This is one of the reasons why eating disorder dietitians prefer to work with a team.

4. Ethical issues

There are cases in which a dietitian must make an ethical determination about care. “At a certain point, a dietitian may need to evaluate whether their client needs a higher level of care, particularly if they are medically compromised,” says Schilling.

“Sometimes there are other things that take priority over seeing the dietitian, like acute mental health concerns or stabilizing someone medically. I’ve often stepped back while other members offer more support until the client becomes stable enough to resume nutrition therapy,” she says. 

Schilling says this situation usually begins with the dietitian exploring the issue with the patient’s treatment team, and then talking to the client about recommending a higher level of care. “If the client really wants to keep working with me, or doesn’t feel safe entering a higher level of care, then I’ll use a form or waiver that clearly states my recommendation and the client’s preference to continue working together despite my recommendation,” she says. 

Emotional Regulation Worksheets

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

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

She says this is important since dietitians provide medical nutrition therapy and may be at risk of liability. “If we recommend a higher level of care and the client refuses to sign the waiver, then we will still give options and referrals. This is a tricky situation that would need to be discussed with the dietitian’s professional supervisor if they have one and the patient’s treatment before discharging from care. This isn’t a decision a dietitian would make hastily.”

Thinking it through

Schilling, who supervises eating disorder dietitians in addition to treating eating disorder clients in her practice, says that it’s rare that a client would be let go without extensive conversations, attempts to make progress, and referrals to other professionals or a higher level of care.

When Grace started to think about it, we were able to deduce that this is likely what happened with her daughter Casey. Casey’s entire team has been recommending a higher level of care for months, in fact almost since they started working together. Casey’s dietitian introduced a treatment contract over six months ago, which is a way that a dietitian tries to establish treatment milestones and move a client forward in their recovery.

Grace told me that Casey complained bitterly about the contract. And while we don’t know if Casey was offered a waiver to continue care under the dietitian, it’s very likely that the dietitian hit an ethical issue in treating Casey.

Grace says Casey complains that her team is pressuring her into a higher level of care, and Grace herself has been desperately trying to get Casey to enter inpatient treatment.

In fact, that’s a big part of the work we’re doing together. I’ve been coaching Grace to build influence in their relationship and have more effective conversations about Casey’s eating disorder and treatment.

Next steps

With a bit of clarity, Grace understands the dietitian’s choice. “I still hate it,” Grace says. “It puts me in a really bad place.” 

Grace is going to have some tough conversations with Casey. Based on our understanding of why the RD released Casey from her care, we can guess that Casey is severely medically compromised. 

Grace needs to get really clear with Casey about how eating disorder treatment needs to proceed. There is no easy solution here because of Casey’s age. But Grace is not willing to give up. “I’m fighting for my daughter’s life right now,” she says courageously. “I’m going to figure out how to get her the help she needs.”

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

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

See Our Eating Disorder Treatment Guide For Parents