Category: Treatment For Eating Disorders

Gloria has been in recovery from an eating disorder for years, but she feels hopeless. “It’s just that I have all these personality traits that doom me to a life with this problem,” she says. “I don’t see how I can possibly escape from my eating disorder because I’m such a perfectionist.” 

I completely understand. Our personalities are a very important part of our identity. And it’s true that certain personality traits are associated with eating disorders. Eating disorders are “biopsychosocial,” which means they have biological, psychological, and social causes. Personality traits are some of the psychological causes of eating disorders. The stronger a trait is, the more likely it will be considered a “maintaining factor” in an eating disorder. In other words, a trait like perfectionism can drive an eating disorder to develop. And if it’s unmanaged it can also makes the eating disorder more likely to stick around. 

However, I think viewing personality traits as purely negative is both inaccurate and unhelpful. Many people like Gloria feel like being labeled “perfectionistic” is a life sentence. This does not help Gloria achieve recovery. And in fact, it keeps her focused on what she doesn’t have rather than what she does have. A strengths-based approach to eating disorder recovery is much more hopeful and helpful.

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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

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Personality traits associated with eating disorders

There are several key personality traits associated with eating disorders: perfectionism, obsessive-compulsiveness, neuroticism, negative emotionality, anxiety avoidance, low self-directedness, low cooperativeness, high impulsivity, sensation seeking, and novelty seeking.

These personality traits are commonly perceived as negative and seen as weaknesses. But every personality trait contains both strengths and weaknesses. And continuing to focus on weaknesses keeps people stuck in endless loops of self-recrimination.

NOTE: self-recrimination does not help people recover from an eating disorder. 

A strengths-based approach to eating disorder recovery

Of course the so-called negative personality traits have downsides. But that’s because great strengths cast long shadows. Research shows that focusing on weaknesses is de-motivating. Conversely, focusing and building on strengths is motivating. It’s better to focus on what’s right with someone than what’s wrong with them.

“Many health systems have traditionally adopted a view of mental disorders based on pathologies and the risk individuals have towards mental disorders,” says Huiting Xie. “However, with this approach, mental disorders continue to cost billions a year for the healthcare system.”

The deficit-based approach to recovery damages recovery because it is inherently unmotivating. If Gloria believes she has a “fatal flaw,” she’s unlikely to embrace the resources available and fully engage in the recovery process. However, if she is confident that can apply her natural and intrinsic strengths to recovery, she’s more likely to embrace recovery. 

A strengths-based approach to eating disorder recovery doesn’t pretend there aren’t difficulties to be faced, but it mobilizes a person’s strengths rather than focusing on what is wrong with them. Mental health issues like eating disorders can be seen as a normal part of human life that can be managed and overcome. This treatment approach focuses on a person’s abilities rather than their shortcomings, symptoms, and difficulties. 

Here are four personality traits and examples of how we can take a strengths-based approach to eating disorder recovery:

1. Perfectionism

Perfectionism meaningfully and consistently predicts employees who are more motivated on the job, work longer hours, and can be more engaged at work. These strengths can clearly lead to eating disorder behaviors if they are focused on eating and body weight. However, they can become a driver of eating disorder recovery, too. For example, if a person with an eating disorder focuses on their strength of being highly motivated, they can become deeply engaged in recovery. 

Typically treatment focuses on the negative fact that a person has become overly-engaged in their eating disorder behaviors. A strengths-based approach means we focus on their ability to deeply and passionately engage in things that matter to them. If they become deeply and passionately engaged in recovery, they can do anything!

2. Obsessive-compulsiveness

People with obsessive-compulsive personality traits are often confident, warm, organized, and high-achieving. They have meticulous standards of behavior and high expectations that can benefit them in every area of life. When these standards are applied to eating and body weight, they can drive eating disorder behaviors. However, this person has a strong ability to organize and make strategic decisions. When this strength is harnessed, they can become strongly motivated to recover. 

This trait likely drives the people who “spontaneously recover” from their eating disorders. This really happens! Some people wake up one day and decide they don’t want to have an eating disorder anymore. Once an eating disorder no longer fits their rules of “good behavior,” recovery can be easier for people with this trait.

3. Neuroticism

The word “neurotic” is one of the worst-sounding personality traits, but, like all personality traits, it has strengths. People who have a more “neurotic” personality tend to be intelligent and funny, have more realistic expectations, and have greater self-awareness. They are also highly creative thinkers and tend to possess more emotional depth. Their emotional depth is likely what makes people with neurotic personalities more susceptible to eating disorders. Because they are more sensitive, they are more likely to need coping strategies for their big emotions.

However, when their creativity and intelligence are applied to building healthy coping strategies to replace their eating disorder behaviors, they can find deep and meaningful recovery. Additionally, embracing their neurotic tendencies can provide tremendous freedom and allow them to embrace themselves as they truly are, rather than try to fit into a socially-acceptable version of themselves. Recovery requires a person to embrace their body as it is. And it also requires embracing their SELF as it is.

4. Negative emotionality

Most personality traits arise as a combination of nature and nurture. But negative emotionality is a personality trait that is usually hardwired in the brain. We are all born with brain structures that determine whether we have a generally negative or positive temperament. And we have no control over our natural tendency towards negativity. Assuming that a negative temperament is bad is harmful and inaccurate. Negative emotions are adaptive, normal, and necessary. They are also highly motivating. Negative emotions prompt us to take action and provide valuable information about the inner and outer environment. 

Someone with a more negative emotional state is better positioned to recognize when something is dangerous. Once danger is identified, they are motivated to build new skills and stop risking endangerment. But this is not a matter of “scaring people straight.” Adding more negativity to someone with negative emotionality will not support recovery. Rather, we need to support people in tuning into the messages their negative emotions are trying to send them. We can empower people to listen to their negative emotions with critical insight and use their intelligence and creative problem-solving abilities to embrace recovery.

Empowering recovery 

Seeing personality traits as negative when treating an eating disorder is unmotivating and unsuccessful. Instead, seeing personality traits as strengths can support recovery. They can help a person find greater motivation and success. 

That’s what happened to Gloria. “I found a new therapist who focused on my strengths and empowered me to claim recovery on my terms,” she says. “With her I found that my perfectionistic tendencies were actually exactly what I needed to recover.” She is now engaged in the process of recovering. And Gloria feels more hopeful and optimistic now that she’s using a strengths-based approach. By embracing her personality rather than rejecting it, she’s embracing recovery.

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Ginny Jones is on a mission to change the conversation about eating disorders and empower people to recover.  She’s the founder of More-Love.org, an online resource supporting parents who have kids with eating disorders, and a Parent Coach who helps parents supercharge their kid’s eating disorder recovery.

Ginny has been researching and writing about 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.

Ginny’s most recent project is Recovery, a newsletter for deeply feeling people in recovery from diet culture, negative body image, and eating disorders.

See Our Eating Disorder Treatment Guide For Parents

Gita has tried everything to help her daughter recover from an eating disorder. “I feel like there are so many options, and so little evidence of anything that is the magic bullet for eating disorders,” she says. But a few weeks ago her daughter’s therapist recommended trying EMDR, so Gita is curious about the treatment and wants to know if EMDR can work to treat an eating disorder. 

Parents like Gita feel desperate to find the treatment that will break through the eating disorder and trigger their child’s motivation to heal and recover. And while EMDR is far from a universal “magic bullet” for eating disorders, it has some evidence of being helpful for some people. 

What all of us want is clear evidence of a treatment that works for everyone. But eating disorders are complex and research on eating disorder treatment is vastly underfunded. So for now parents are left with trying multiple treatment modalities to see what works best for their situation.

What is EMDR?

Eye movement desensitization and reprocessing therapy, or EMDR, seems strange, maybe even outlandish at first. And it was considered very fringe for decades. However, it has gained popularity and is supported by scientific studies as an effective method for treating traumatic memories. The treatment seems helpful especially when traumatic memories drive coping behaviors like eating disorders. 

Emotional Regulation Worksheets

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

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

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An EMDR therapist first works with a client to build a sense of safety and security. Once a positive therapeutic relationship is established, the therapist will help the client remember a traumatic memory while simultaneously stimulating the right and left sides of the brain. This can be done using their fingers, sound, a light board, or other devices. The idea is that stimulating the right and left sides of the brain while thinking about a traumatic memory integrates and stabilizes the brain. 

EMDR shows promise as an eating disorder treatment. This is most likely because many people who have eating disorders also have PTSD and/or complex, relational trauma. Additionally, it is virtually impossible to live in our culture without encountering negative food and body experiences. Up to 90% of women have disordered thoughts about their bodies and food. Negative food and body experiences, compounded over years and even decades of a person’s life, are toxic and can contribute to disordered eating and weight behaviors. 

Food and body experiences as trauma

EMDR helps people process fear and trauma in an adaptive, helpful way. The idea is that by processing their trauma, a person will no longer use eating disorder behaviors to deal with the lingering impact of traumatic experiences.

In our culture, food and body experiences are very often traumatic. Almost everyone can think of many situations in which their body was observed and judged as either good or bad. This is particularly true for people who are on the higher end of the weight chart. And most people have heard countless statements about how eating is either good or bad, healthy or unhealthy. These normalized behaviors are extremely common in our culture, and they contribute to disordered eating behaviors.

Many eating disorder therapists try to address disordered food and body thoughts with cognitive behavioral therapy (CBT), and that can be effective. But EMDR is designed to reach beneath cognition and support subconscious processing and resolution. 

How EMDR works for eating disorder treatment

EMDR helps people identify a core fear that is driving behavior, find the touchstone memory that lies at the heart of the fear, and then process the memory in a safe, secure environment. The goal is that by processing the touchstone memory using the EMDR technique, the person will no longer feel so sensitive to the fear and may be able to cope with the urge to use eating disorder behaviors.

Core fears that may be addressed in eating disorder treatment include:

• Fear of food/eating
• Fear of not getting enough food
• Fear of eating too much/having no control
• Fear of gaining weight
• Fear of criticism for living in a larger body

A touchstone memory is an event that shapes how we see ourselves and can drive eating disorder behaviors. These may include:

• Rejection (especially based on weight and appearance)
• Microaggressions (particularly those associated with weight stigma)
• Food insecurity (strongly associated with binge eating and bulimia)
• Food restriction in the home (including restriction for “health” reasons e.g. no sugar)
• Physiological sensitivity to eating (e.g. highly sensitive gut, taste, smell, sensations etc.)
• Messages from parents (e.g. don’t eat too much or you’ll get fat, etc.)
• Negative feedback for weight gain (e.g. you need to watch your weight, I’m worried about your health, etc.)
• Positive reinforcement for weight loss (e.g. you look great! Keep it up! etc.)
• Eating food resulted in negative feedback (e.g. that’s bad for you! You eat too much junk food! etc.)
• Restricting food resulted in positive feedback (e.g. you’re so healthy! I wish I could be as good as you!)

There are countless experiences that shape how kids feel about food and their bodies. This is hard for anyone, but it is especially traumatic for kids who live in larger bodies. 

Lived experience

Many people who have recovered from an eating disorders credit their recovery in part to EMDR. For example, Shayna, a high school senior in recovery from an eating disorder, says it helped her. “When you have an eating disorder you constantly have these pressures in your head for one of the most seemingly basic needs,” she says. “But your mind is telling you that you don’t deserve to eat, you don’t deserve to exist in your body, that you won’t be accepted in this society. It’s a very difficult thing to grapple with.”

Shayna was in treatment for years, feeling stuck. In residential treatment she was exposed to the competitive nature of eating disorders. “I felt like my identity was being a person with an eating disorder,” she says. “My whole life revolved around my eating disorder. My mind was consumed by how can I lose more weight, how can I sneak around, how many calories is this, constantly feeling like I wasn’t good enough.”

After residential treatment

When she left residential treatment and went to high school, she continued working with a therapist, who introduced EMDR as a part of treatment. Shayna says EMDR has helped her in recovery. “I talk about my trauma or certain events that have happened, and she’ll ask me to think about an event and on a scale of 1-10 how disturbing it is, and connect it to how I feel in my body.” she says. “She either gives me tappers that vibrate back and forth or she’ll move her hand and I’m supposed to follow it eye to eye. It helps me get balanced and grounded. You can’t be anxious because you’re going to lose focus on the patterned practice.”

Shayna says the most valuable part of EMDR has been feeling more grounded. “I struggle with anxiety,” she says. “EMDR helps me feel grounded in the present. Instead of feeling washed away by my worries, I’m in the present with what’s happening. I feel safe and calm and present.” 

Emotional Regulation Worksheets

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

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

Learn More

Checking in with Gita

Gita’s daughter is medically stable, which is a prerequisite for EMDR. Gita’s main hesitation is that she’s worried the treatment may re-traumatize her daughter at a time when recovery is still very early and unsure. This makes sense, and it’s good to be cautious. It’s important to find a therapist who has training in EMDR and is trained in eating disorders. It’s a lot to ask for, but it’s more likely today than it was five years ago. 

Gita found a provider who fit the bill and her daughter has attended four EMDR sessions so far. “I think it’s helpful for her so far,” says Gita. “The eating disorder is still there. We’re still working on it. But I’ve noticed that she’s much calmer now, and it seems like the negative food and body thoughts aren’t quite so loud anymore. I can see this possibly helping her feel better.” 

Guidelines for using EMDR with eating disorders

If you are considering EMDR for your child who has an eating disorder, please keep in mind the following guidelines:

1. Your child should be medically stable, not weight-suppressed, and eating regular meals and snacks.
2. The therapist should have specific training in both EMDR and eating disorders. They should follow the EMDR protocol and practice from a non-diet perspective.
3. The therapist should invest in building a therapeutic relationship that is safe and secure for your child. They should not rush too fast into traumatic memories without building a solid relationship first.
4. You should be able to support your child’s emotional wellbeing and emotional regulation after and in between sessions. (Get help with this)

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Ginny Jones is on a mission to change the conversation about eating disorders and empower people to recover.  She’s the founder of More-Love.org, an online resource supporting parents who have kids with eating disorders, and a Parent Coach who helps parents supercharge their kid’s eating disorder recovery.

Ginny has been researching and writing about 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.

Ginny’s most recent project is Recovery, a newsletter for deeply feeling people in recovery from diet culture, negative body image, and eating disorders.

See Our Eating Disorder Treatment Guide For Parents

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

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Education

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.

Structure

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.

Empathy

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

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

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Relationships

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. 

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Ginny Jones is on a mission to change the conversation about eating disorders and empower people to recover.  She’s the founder of More-Love.org, an online resource supporting parents who have kids with eating disorders, and a Parent Coach who helps parents supercharge their kid’s eating disorder recovery.

Ginny has been researching and writing about 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.

Ginny’s most recent project is Recovery, a newsletter for deeply feeling people in recovery from diet culture, negative body image, and eating disorders.

See Our Eating Disorder Treatment Guide For Parents

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

Learn More

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.

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

Learn More

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. 

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Ginny Jones is on a mission to change the conversation about eating disorders and empower people to recover.  She’s the founder of More-Love.org, an online resource supporting parents who have kids with eating disorders, and a Parent Coach who helps parents supercharge their kid’s eating disorder recovery.

Ginny has been researching and writing about 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.

Ginny’s most recent project is Recovery, a newsletter for deeply feeling people in recovery from diet culture, negative body image, and eating disorders.

See Our Eating Disorder Treatment Guide For Parents

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

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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.

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.”

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

Learn More

“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.

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Ginny Jones is on a mission to change the conversation about eating disorders and empower people to recover.  She’s the founder of More-Love.org, an online resource supporting parents who have kids with eating disorders, and a Parent Coach who helps parents supercharge their kid’s eating disorder recovery.

Ginny has been researching and writing about 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.

Ginny’s most recent project is Recovery, a newsletter for deeply feeling people in recovery from diet culture, negative body image, and eating disorders.

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

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.

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!

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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.

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.”

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Ginny Jones is on a mission to change the conversation about eating disorders and empower people to recover.  She’s the founder of More-Love.org, an online resource supporting parents who have kids with eating disorders, and a Parent Coach who helps parents supercharge their kid’s eating disorder recovery.

Ginny has been researching and writing about 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.

Ginny’s most recent project is Recovery, a newsletter for deeply feeling people in recovery from diet culture, negative body image, and eating disorders.

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

See Our Eating Disorder Treatment Guide For Parents

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

Learn More

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. 

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. 

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?

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

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Ginny Jones is on a mission to change the conversation about eating disorders and empower people to recover.  She’s the founder of More-Love.org, an online resource supporting parents who have kids with eating disorders, and a Parent Coach who helps parents supercharge their kid’s eating disorder recovery.

Ginny has been researching and writing about 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.

Ginny’s most recent project is Recovery, a newsletter for deeply feeling people in recovery from diet culture, negative body image, and eating disorders.

See Our Eating Disorder Treatment Guide For Parents