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The risks of accommodating an eating disorder

The risks of accommodating an eating disorder

Rachel was at the end of her rope. After years of trying to help her daughter Lily claw her way out of anorexia, it simply wasn’t getting any better.

Sure, there was COVID to blame. The pandemic made Lily even more socially isolated, and online treatment didn’t seem to be as effective. But overall, Rachel knew that Lily’s problem pre-dated the pandemic. And she was worried that it would extend way beyond the pandemic if something didn’t change fast. 

“The truth is that I’m completely burned out,” says Rachel. “This is my last hope. If this doesn’t work, I really don’t know what I’ll do or how I’ll keep this up. Something’s got to give.” 

Rachel has decided to try a treatment program called SPACE that focuses on changing her own behavior rather than trying to change Lily’s behavior.

“It’s just been a brick wall to try and convince Lily to recover,” says Rachel. “I know I’m not supposed to say this, but she just isn’t choosing recovery. She’s not taking any steps on her own to get better.”

Rachel is struggling under the caregiving burden. “When she was younger, she was a bit more self-sufficient, and being at school motivated her,” says Rachel. “But now she’s done with school, and she’s doing almost nothing. She lives with me, and I try to feed her six times per day like I’m supposed to. She’s nowhere close to feeding herself, and I can’t see her being able to get a job or move out.”

Rachel, like so many parents and caregivers, is terrified for her daughter. She’s also frustrated and fed up. Her diligent, valiant work feels like a drop in the bucket. The eating disorder is powerful, and she’s losing hope.

What is accommodation?

When someone is afraid of something, they naturally want to avoid it. 

Parental accommodation is a way that parents make it easier for their children to avoid doing the things that scare them. 

If your child screams when they see a spider, you whisk it away quickly and then soothe your child, trying to calm them down as soon as possible. This accommodation makes perfect sense.

But the next day, your child asks you to check under their bed for spiders before going to sleep. This, too, makes sense to you. You accommodate their wishes – it’s not a big deal! 

But the next day, your child asks you to check that their windows are locked tightly and check under the bed, scan the walls, and peer into the darkest corners of the closet with a flashlight to ensure there are no spiders. 

The accommodation snowball effect

You can see where this is going. Your child’s fear of spiders makes sense. But their avoidance of possibly encountering a spider ever again is becoming a problem. Even though you sense it’s wrong, you can’t imagine not accommodating them because they get so upset just thinking about spiders. It seems faster and easier to do what they ask than to convince them to go to sleep without it.

Sometimes you try to talk your child out of it. You prepare deeply-researched and highly-rational arguments to persuade them that spiders aren’t scary or dangerous. Sometimes you lose your temper and yell that you aren’t their personal spider valet and you won’t do this tomorrow night … this is the last time! 

But, of course, the next night, your child cries and seems so terrified that you give in one more time and look in all the nooks and crannies. Later they come into your room at midnight, wake you up, and beg you to check again.

You’re half asleep, and it seems like less trouble to just look than to try and convince your child there are no spiders, so you grudgingly get up, stomping your feet and huffing as you walk to their room and look in all the corners for spiders. 

You’re feeling angry, but you can’t see a way out of accommodating your child’s avoidance of possibly seeing a spider. You feel trapped and frustrated, stuck in a web.

How does accommodating impact eating disorders?

I started with a spider story because it feels less charged than an eating disorder. Eating disorders are complex, multi-layered mental disorders. Also, parents are not responsible for either their child’s fear of spiders or their eating disorder. It typically doesn’t work that way.

But parents may be responsible for accommodating their child’s anxiety-driven eating disorder behaviors.

Parental accommodation is called a “maintaining factor” in eating disorders. This means that it is not the cause of an eating disorder. But accommodation can make it easier for an eating disorder to dig its heels in and stick around for the long haul.

Eating disorder accommodation examples

There are many ways parents accidentally accommodate eating disorder behaviors. Let’s break down how accommodating can sneak into some of the common eating disorder recovery goals:  

  • Goal: have the child eat regular, healthy meals.
  • Accommodation: the child cries and yells at the dinner table. The parent becomes so distressed that they excuse the child before the meal is finished.
  • Goal: cut down on ingredient checking and calorie counting
  • Accommodation: the child refuses to eat until they know exactly how many calories are in the yogurt. It just seems easier and faster to tell them.
  • Goal: have the child eat various foods, not a limited menu of “safe food.”
  • Accommodation: when serving meals, the parent doesn’t offer new foods. They know their child will throw a fit or simply refuse to eat. Sometimes they try to add something new to the plate, but it goes so badly that they rarely do this.
  • Goal: have the child eat comfortably with other people.
  • Accommodation: the child becomes so upset about the idea of multiple people at the dinner table that the parents feed the child separately. Or they excuse the child from family meals because they are so distressed.
  • Goal: for the child to accept their body and not worry about its appearance.
  • Accommodation: when the child asks if they look bad, the parent freezes and ignores the question. Then, when the child doesn’t stop, the parent says in a falsely cheerful voice, “you’re just being silly – of course you’re beautiful!”
  • Goal: the child attends scheduled meetings with professionals.
  • Accommodation: the child insists that the therapist is useless. The nutritionist makes them eat unhealthy food, and the doctor is fatphobic and clueless. The parent spends hours every week convincing the child to attend just one more meeting. They use bribes and rewards, which work only some of the time.

All of these parental responses make perfect sense. If you do these things, you are not bad! Occasional accommodations make sense. But it can be a problem if parents repeat the same accommodation at every meal and/or the list of accommodations keeps growing. We want to stop accommodating eating disorder behavior even though it’s really, really uncomfortable for both the parent and the child. 


How can parents stop accommodating?

Parents can stop accommodating eating disorder behaviors, but it takes some careful thought, a solid strategy, and practice. It’s not a good idea to remove all your accommodations at once. A strategic, steady approach is best. 

First, you need to understand how you are accommodating the eating disorder behaviors and why you are accommodating. You will naturally think you are accommodating to avoid your child’s distress. But you are also accommodating to avoid your distress about your child’s distress. Make sense?

When your child yells and screams or slams their door in your face, you feel upset. You worry that your child will never get better. Of course you do!

This is what drives the accommodation. You want to avoid your child’s upsetting outburst, so you do whatever you can to avoid it. 

Start with you

Understanding your own worry is the first step to addressing and ending accommodation. Because ending accommodation is all about what you do. How your child responds must be relatively unimportant and not change your approach. 

You will take unilateral action to remove your accommodation lovingly and compassionately. And your child is going to be distressed. Both of you will be able to handle this distress. But you may need some support to prepare and get through it.

Next, you will pick a specific accommodation and make a detailed plan to stop doing it. You’ll tell your child what you’re going to do, why you’re doing it, and when you’ll begin doing it. 

Finally, you’ll follow through. You’ll stay steady even in the face of your child’s worry and anguish. This will be hard, but you know that continuing the accommodation, while possibly easier in the short term, will not help in the long term.

You’ll stay dedicated and single-minded in your commitment not to accommodate eating disorder behaviors anymore. Over time, your child will learn your boundaries. Your child will feel less anxious. You’ll interrupt the anxious cycle of an eating disorder and invite recovery to take root.

Rachel and Lily

Rachel was terrified of ending even her most minor accommodations. For example, she told Lily what was in her smoothie every day. This was happening even though it was exactly the same every day.

She made a plan and told Lily that she would not answer smoothie ingredient questions anymore. Lily asked a few times on the first day, and Rachel was near tears but held her boundary lovingly. 

The next day, Lily asked ten times and started to cry when Rachel held her compassionate boundary. She refused to drink her smoothie. Rachel worried that she was making a mistake or doing it wrong.

But on the third day, Lily asked Rachel once, then, shockingly, drank her smoothie. 


“I nearly fell out of my chair,” says Rachel. “I couldn’t believe it didn’t keep getting worse.”

Lily asked about the smoothie ingredients every few days throughout the next few weeks. And if it was an especially stressful day, she asked several times in a row. But Rachel was confident that not reviewing the ingredients was the right thing to do to help Lily recover, so she held her boundary lovingly and firmly.

Over time, Rachel removed more and more accommodations. Some were easier than others, but she could see the benefits. Mealtimes were less stressful for Rachel, which meant she could better support Lily through the stress of eating. 

“I feel more hopeful today than I’ve felt in five years,” says Rachel. “This is the biggest improvement I’ve seen in a long time. I feel like I’m really getting the hang of not accommodating her eating disorder behaviors. I’m focusing on controlling myself rather than trying to control her.”

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

She’s the founder of and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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

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

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

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

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

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

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

Parent training for eating disorder recovery

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

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

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

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

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

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

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

How SPACE works

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

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

Is anxiety a factor?

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

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

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


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

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

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

Setting goals

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

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

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

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

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

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

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

What results can I expect?

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

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

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

Facing difficulties

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

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

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

Give it time

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

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

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

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

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

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

She’s the founder of and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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

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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?”

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

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. 

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 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.”

*Names have been changed to protect privacy

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

She’s the founder of and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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Why I think eating disorder treatment often doesn’t work

Why I think eating disorder treatment often doesn’t work

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

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

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

What’s missing?

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

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

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

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

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

emotional regulation

Why an eating disorder?

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

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

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

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

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

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

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

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

A bottom-up behavior

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

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

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

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

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

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

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

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


Why the eating disorder exists

Rushing into treatment strategies without understanding the “why” of the eating disorder is typically an exercise in frustration for everyone (the child, parents, siblings, treatment providers, etc.). 

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

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

Typically we focus on making them eat, stopping the binge or purge, etc. But without understanding and addressing the “why” or the driver of the eating disorder, which typically lives in the emotional (non-cognitive) system, we will likely see very little change. 

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

Bottom-up treatment for eating disorders

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

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

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

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

Professional therapies

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

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

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

Parent treatment

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

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

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

A new way forward

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

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

She’s the founder of and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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Does intervention work for a child with an eating disorder?

Does intervention work for a child with an eating disorder?

Michelle has watched her daughter Marisa slip further and further into an eating disorder; now she wants to hold an intervention for her child. “I can’t sit by and watch this anymore,” she says. “It’s absolutely killing me to see her hurting her body so much, and I’m tired of walking on eggshells.”

I completely understand Michelle’s concerns. Eating disorders are the most deadly mental illness, and we know that early, effective treatment can really help. Michelle has tried many times to have conversations with Marissa. but she feels constantly shut-down and has no idea how best to proceed.

After doing some research and finding a treatment program that she thinks will be a good fit for Marissa. Michelle is ready to stage an intervention to make it happen.

Why people use interventions

Interventions are often used in the context of people who have drug and alcohol dependencies. Their families and friends will gather. Sometimes a facilitator will be there. They surprise the person with addiction and share why they think the person should get treatment.

Interventions have been made very visible through popular television shows. Notably, A&E’s Intervention, which has aired for 20 seasons. “It follows one/two participant(s), who are dependent or are addicted, documented in anticipation of an intervention by family and/or friends. During the intervention, each participant is given an ultimatum. Go into rehabilitation immediately, or risk losing contact, income, or other privileges from the loved ones.” (Wikipedia

An intervention is a structured conversation between loved ones and a person with addiction. The intention is for loved ones to tell the person how their actions impact them. They also state why they believe recovery is important. The goal is to inspire the person with addiction to accept treatment as the best next step.

Parenting for positive food and body

The challenge with using interventions with eating disorders

Eating disorders are deeply complex mental disorders. While substance addiction is based on a substance that can be removed from the person’s life, eating disorders are not something that can be solved with abstinence. People cannot be abstinent with food, and asking a person who is deep in an eating disorder to abstain from their behaviors can have serious repercussions. The eating disorder is a coping mechanism for emotional despair. Abrupt abstinence can leave the person without a safety net.

And while loved ones certainly can and should talk to someone who has an eating disorder, they need to be very careful about dangerous assumptions and misunderstandings about eating disorders. This is especially true of parents, who hold tremendous power in the relationship with their child. Parents and loved ones can accidentally encourage the eating disorder behaviors. In fact, eating disorder interventions can exacerbate and reinforce some of the very conditions in which eating disorders thrive.

An eating disorder intervention goes sideways

This is what happened when Michelle brought her husband and other kids together to intervene in Marissa’s eating disorder. While she had all the best intentions, the intervention quickly went awry. “Almost immediately things went wrong,” says Michelle. “I thought that starting by talking about her weight and disordered eating behaviors was the way to begin, but Marissa instantly shut down. It was as if I could see the shades go down over her eyes, and she just tuned us out.”

Michelle and the family doggedly pursued the intervention, reading letters imploring Marissa to go into treatment. But Marissa just sat silently, not engaging at all. “She sat back against the sofa and crossed her arms,” Michelle said. “She pretty much just ignored us. And when we finished what we had planned, she just asked if she could be excused and left the room.”

Michelle was devastated. All her careful planning had done nothing to change Marissa’s behavior. And now Marissa was spending even less time with the family. “She now refuses to eat any meals with us because she says we’re all watching her,” says Michelle, in tears. “I just don’t know what to do.”

What went wrong

While interventions may work for some people who have a child who has an eating disorder, they can also backfire like Michelle’s. Michelle did everything right according to common beliefs about interventions, but the problem is that the very premise of an intervention for a child who has an eating disorder is problematic.

Unlike substance addiction, eating disorders don’t have a “villain.” If someone is dependent on alcohol, an intervention makes the alcohol the villain. In this way, it’s not that the person themself is flawed, but that the alcohol is an evil outsider that needs to be tamed and eradicated.

But eating disorders are not substances – they are behaviors. The person who uses the behaviors has a mental illness. This means that the only possible “villain” in eating disorders can be interpreted as the person themself. In other words, rather than telling someone to stop using alcohol, you’re telling someone to stop a behavior that to them is essential to who they are.

While it is popular to separate the eating disorder from the person, the fact is that eating disorder behaviors are inside of the self. The “drug” is their own beliefs, fears, cravings, and behavior with food and exercise. With eating disorders we cannot separate the “drug” from the person like we can with substance addictions.

Questions to ask yourself if you’re thinking about staging an intervention for a child who has an eating disorder

If you are thinking about staging an intervention for your child’s eating disorder, consider these questions first.

1. Do I believe (on any level) that eating disorders are a personal choice?

This is a core belief about eating disorders that is false. It’s often hidden, so really sit with this question for a while to uncover whether this belief exists anywhere in your subconscious. Eating disorders are mental disorders with serious causes and health impacts. A person with an eating disorder is in tremendous psychological and physical pain. They are not choosing their disorder. It is the only way they can tolerate living right now. Interventions frame addiction as something over which the individual has power and control. A person who has an eating disorder does not have power and control over their eating disorder.

2. Am I using words like stubborn, controlling, and manipulative when I describe my child?

These are words that are commonly used by people when they talk about people with eating disorders. But they are misguided. Again, eating disorders are mental illnesses. They are not a choice, and they are not something your child is doing to you. They are something that your child is experiencing. And it is awful to live with an eating disorder.

An intervention is a well-meaning attempt to get the person who has an addiction to see their behavior from their loved ones’ perspective. But this is in fact an emotional manipulation tactic. The purpose of an intervention is to carefully control the meeting so that the person goes into treatment as a result. I encourage you to look carefully at how interventions can be seen as manipulative and controlling.

3. Is this intervention based on television shows I’ve watched?

Remember that Intervention is a television show. It is the product of a company (A&E). The company and everyone involved in its production make money from the product. A&E produces and markets a family’s pain in exchange for profit. A television show is not a good guide for managing your family. It cannot replicate the complexities of your family dynamics any more than a holiday special captures your family’s unique experience of the holidays.

4. What is my goal of the intervention?

This is an important question in any eating disorder situation. What is the goal? When you stage an intervention, your goal is to get the person into a specific treatment that you believe is best for them. But the underlying goal is for your child to recover from their eating disorder. Next, broaden the scope of your goal even further. This is a mental illness, which means your child is in pain and your goal is for your child to feel better. With the goal of “feeling better” in mind, consider that you have many options beyond a single treatment approach.

The fact is that eating disorders are poorly understood, poorly researched, and thus have many treatment options that may or may not work. Going into an intervention with your child assumes that you know what’s best for their eating disorder, but nobody actually knows what’s best. We simply don’t have enough data to say with clarity what is the best treatment for your child’s distress. The more you can engage them in treatment, the more likely you are to find a path that works for them.


Reassuring Michelle

Now that the intervention is over, Michelle is even more worried about Marissa. Mainly because she worries that the eating disorder is getting worse and she has run out of ideas about how to help. The intervention was her best attempt to help Marissa, and it didn’t work.

But there is a huge gap between “I tried something and it didn’t work” and “I can’t do anything.” In fact, there are many things parents can do to help their child feel better. You are not limited to formal eating disorder treatment, and a conversation about mental health isn’t a one-time event.

So first Michelle needs to know that she didn’t do anything wrong in attempting the eating disorder intervention. She made the best choice she could at the time. The next thing she needs to know is that the intervention wasn’t her last chance to help Marissa. The TV show suggests that the intervention is the last step, and that the family has now done everything possible to help. But the truth is that there are many other steps towards healing from an eating disorder.

What parents can do instead of an intervention

There are many things parents can do instead of staging an intervention for a child who has an eating disorder. Here are some recommendations.

1. Talk about feelings (often)

Most parents are understandably alarmed by the food and exercise behaviors of an eating disorder. This makes total sense. And they are dangerous and should be monitored and treated by a professional if at all possible. But if your child refuses treatment, you can still help.

Remember that an eating disorder is a mental illness that causes physical symptoms, not the other way around. This means that treatment is about learning to feel and process feelings more effectively. This can start at home. Begin by talking to your child often about their feelings. Find ways to frequently check in with them about how they are feeling. Build their (and your whole family’s) emotional literacy by making conversations about feelings completely normal.

2. Spend more time with them

They may reject your overtures, but find ways to spend more time with your child anyway. A person who has an eating disorder is very lonely and feels both a deep desire to be seen and a fear of being seen. Take short walks together, run errands, cook, garden, read, color, play games, do puzzles, or just sit together. Normalize spending time together, and make it low-key and not stressful. If they’re interested and willing, consider journaling together, which will bring together spending time and talking about feelings.

3. Take them to get regular check-ups to monitor their health

Your child may be resistant to treatment, but it will be harder for them to refuse to visit a doctor regularly for a health check up. In fact, they may even offer to do this instead of getting treatment for their eating disorder. Of course your long-term goal is for them into treatment for their eating disorder. But getting regular health check ups can help you feel more secure if your child absolutely refuses treatment.

Important note: weight is a huge trigger for anyone who has an eating disorder. Ask the doctor to do “blind weight” so that your child cannot see and does not have to experience the number on the scale. Also tell your doctor to only talk to your child about their weight with your express permission.

4. Encourage them to see a therapist or dietitian

Of course you really want them to seek full treatment for their eating disorder. But lots of people with eating disorders struggle to see themselves as “sick enough” for treatment. However, they may recognize that they struggle with anxiety or depression. In this case, find a therapist who can talk to them about anxiety and depression but who is also trained in eating disorders. Asking your child to see someone once per week may be an easier route to treatment than enrolling them in a full program.

Similarly, even if your child refuses psychotherapy, they may be interested in seeing a dietitian to help them with their nutrition. Most people who have eating disorders are deeply interested in nutrition, and will be willing to talk to someone about that. One caveat: make sure the RD you select is trained in eating disorders. You don’t want to see someone who could exacerbate the problem. We have a directory of eating disorder therapists and dietitians who can help.

5. Pursue therapy or coaching for yourself

There are a lot of things that parents can do instead of an intervention to help a child with an eating disorder. So if your child completely refuses any form of treatment, you can still make a difference. Therapy or coaching can help you start to see the conditions that might be causing the eating disorder. It can also help you change your own behavior in important ways.

For example, parents can learn to support their child without accommodating the eating disorder. They can also work towards achieving any of the other four recommendations here. A therapist or coach can help you talk about feelings and spend more (and less stressful) time together. They can also help you try different approaches to get your child in for regular check ups, psychological, and nutritional counseling.

There’s so much you can do!

Michelle worked with a coach to help her learn more about eating disorders and open conversations with Marissa. Over time, she was able to help Marissa enter treatment for her eating disorder. Michelle thought an intervention was the only way to help her child with an eating disorder. And while the initial intervention did not work, Michelle didn’t give up. Michelle’s approach after the intervention created significant improvements for her whole family, including herself.

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

She’s the founder of and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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Clinical hypnotherapy for eating disorder recovery

3 Ways Clinical Hypnotherapy Can Help in Eating Disorder Recovery

by Bonnie Killip, Master Clinical & Medical Hypnotherapist 

Have you ever wondered if hypnotherapy can help with eating disorder recovery? If traditional eating disorder recovery is not progressing, it may be worthwhile considering hypnotherapy as a treatment option.

As a Dietitian and clinical and medical hypnotherapist, often my consults start with addressing people’s questions, concerns, and often skepticism around what hypnosis is. Let’s start by clearing up the common misconceptions. 

Hypnotherapy is not a trick nor is it mind control and it is also much more than meditation or relaxation.

Full disclosure: I’ve been one of the skeptics 

Until a few years ago hypnosis was not a part of my life. It wasn’t even on my radar. A no-nonsense biomedical scientist, I was only interested in evidence and randomized controlled trials (RCTs). 

I did not believe in using personal stories or anecdotal evidence. I believed in nothing that lacked piles of peer-reviewed literature and meta-analyses. 

In fact, if I’d even heard the word hypnosis, I’d have most likely tuned it out. Now, I cannot imagine my life without what hypnosis has brought and continues to bring to my world both personally and professionally. Actually, I can, but I’d rather not!

After 15 years of living with anorexia nervosa, clinical hypnotherapy not only saved my life – it gave me a life. 

And that’s no longer the most interesting part of my story. Because I now work daily with others who have fallen out of touch with their inner guidance. These people are in positions where all else has failed and they’ve all but resigned themselves to their eating disorders. To live a life of attempting to maintain pseudo-physical health while never being entirely well. 

Parenting for positive food and body

Hypnotherapy for eating disorder recovery

I now have the daily privilege of facilitating people of all ages and life circumstances. I work with all types, from anxious and confused 10-year-olds to perfectionist and overachieving 16-year-olds, to successful 65 year CEOs and 87-year-olds. All of them want to begin the part of their lives where they are finally free to be themselves. 

I have both personally experienced and seen first-hand how hypnotherapy can help with eating disorder recovery.

Clinical and medical hypnotherapy offers a direct means by which we can bring about change in an area a person could not change through education, willpower, threats, or motivation alone. The profoundness of what this means in terms of someone’s day-to-day experience of life is high. Because information and knowledge is only part of the picture. It is not until we can put this into practice that we can experience the true benefits. 

Clinical and medical hypnotherapy is an effective eating disorder treatment because it:

  1. Treats the non-logical brain. Eating disorders are non-logical, so it can help to treat them on that level.
  2. Rewires neural pathways. Eating disorders can create rigid neural pathways that need to be loosened in order to recover.
  3. Feel good now. Recovery typically feels like chaos, so any method of feeling good during the process helps.

How does hypnotherapy work for an eating disorder?

Hypnotherapy is individually tailored to each person. It can be a powerful way to change beliefs and disruptive behaviors. The focus is on building the skills people need to function at their best versus rehashing past trauma or searching for a cause.

In hypnotherapy, a person is empowered to work on an unconscious and conscious level to change beliefs and behaviors that are interfering with their life. For example, if a person is afraid of food, we would work on decreasing the fear response both subconsciously and consciously. By experiencing the fear and moving through it in the safety of hypnotherapy, the person acquires confidence and fear patterns are reduced or eliminated over time. 

This works because the brain cannot tell the difference between an imagined scenario and a scenario that is taking place in the physical world. While it could take months of careful psychotherapy to get a person to face a fear food at the dinner table, we can face the imagined fear food in hypnotherapy rather quickly.

If a person is struggling with binge eating and/or purging behaviors, we could explore the unconscious fears underlying those behaviors. We would practice facing them in a safe, secure environment. 

The actual practice of hypnotherapy may include: 

  • Trance induction (direct or indirect)
  • Suggestion
  • Metaphor
  • Conversational hypnosis
  • Neurolinguistic programming

Hypnotherapy is specifically outcome-focused. We precisely target exactly what it is a person wants to change and then go about bringing about that change.  

Here is some more detailed information about the benefits of hypnotherapy:

1. Treating the non-logical brain

An eating disorder is not a logical problem.

Ask anyone with an eating disorder if they are choosing to feel those feelings or do those behaviours. I can guarantee they’re not. There are powerful emotions driving them to not eat, to binge, to over-exercise or whatever it is for them.

If the eating disorder was something you could fix through logic, information and understanding you’d have done so.

Clinical hypnotherapy offers a means by which we can re-establish rapport with the unconscious mind. In more science-y terms, we work with our autonomic nervous system. The goal is to restore back to what your body has known how to do all along before the outside world made you question the innate wisdom of your body. 

We’ve all had the experience of being children, and as children, we had no problem connecting to our bodies’ messages. And we have no problem communicating this. As a baby, we don’t think “I’m hungry but I can see mum is tired and busy at the moment, so I’ll just wait”. Nope, we scream and yell until we get that need met! 

Reconnecting with our bodies

If we want to be a successful adult, we have to at some point move on and meet those fundamental human needs for ourselves. If we do not, we become disconnected from the signals our body is sending. The body may even stop sending signals. Because, after all, “what is the point of telling her to eat if she will not do it, anyway?”

When we get out of the way, our body is free to do what it has evolved to do. It will steer us towards health naturally and without our micromanagement. You don’t have to think about when and how quickly you want your heart to beat or your lungs to breathe, do you? There are things your unconscious knows how to do much better and with much more ease than your conscious mind. 

2. Rewiring neural pathways

Hypnosis offers a direct means of altering neural networks and neural rewiring.  

When it comes down to it, this is the crux of eating disorder recovery, and it’s why hypnotherapy can help. 

At some point, recovery becomes recovered. And recovered is an entirely fresh way of not just behaving but also, crucially, of thinking and feeling.

The behaviors of an eating disorder often begin as a coping strategy. They are compensation or an attempt to meet a need (to be healthy, good, more confident, or better liked. But with time it turns from conscious choices into unconscious patterns. Hence why it is a disorder. Because the thoughts, feelings, and behaviors are no longer under the conscious volition of the person. 

The eating disorder then persists at an unconscious or habit level because neurons that fire together wire together. 

In recovery we change the structure, not just the function, of the mind. And there are many ways in which we can do this. Exposure therapy and cognitive behavioral therapy are the most well-known treatments. But hypnosis often offers a means of changing the structure more quickly and safely than either of these. 

Bypassing the habits of an eating disorder

Hypnotherapy bypasses the need for the involvement of the conscious mind. It goes right to where the issue is being maintained: the unconscious mind. The eating disorder thrives not in our prefrontal cortex but in our lower brain areas such as the amygdala. 

When I was sick I’d been told by so many therapists and doctors that my brain had changed because of the illness. That I’d been sick so long it most likely wasn’t possible that I could ever fix the damage or recover. What I know now is that the very fact that my mind changed to accommodate the illness meant it was more than possible for it to change back. It could even improve and rewire in all the ways it needed to to be not just free of the illness, but healthier than ever before.

 I just needed the means by which to do this. It turned out clinical hypnotherapy helped me recover from my eating disorder. 

3. Feel good now

Take a moment to answer this question:

If your child could feel great or good about eating, would they have a problem eating?   

The answer is always a resounding yes. And this is why recovery can be so hard for loved ones to understand. It may be hard to imagine, but choosing recovery from an eating disorder is choosing chaos and pain. 

To everyone outside of the disorder, recovery is short-term chaos with long-term rewards. But the person in the disorder doesn’t feel like the chaos will ever end. It feels like you are choosing indeterminate chaos and pain with no guarantee that it will have been worth it. 

The resistance to the chaos and pain is why recovery can go on and on and on for many people. I know this was my experience until I did eventually find the help that could help. And a lot of this has to do with the fact that it never feels good. If there are no wins, we lose heart, back down, and find ourselves back in old behaviors.  

How motivated, inspired, and excited are you to jump into shark-infested water just because someone tells you the island on the other side is incredible? Not much, I imagine. And that’s what it feels like for someone with an eating disorder. Eating feels unsafe, and we are asking them to do it 6 times a day as though it is nothing. Therefore, the way to truly help someone is not by focusing on all that is wrong. Instead, we must increasingly allow them to experience wins that show how recovery is worth it.

Achieve a relaxed, calm state

In hypnosis, we experience eating in a relaxed and calm state. We support the circumstances and situations which in their everyday eating disorder state of consciousness produce extreme anxiety and panic. This teaches the nervous system that they can get through these things safely and feel less panic when eating.

The power of hypnosis is that our minds produce exactly the same response whether we are in a dangerous situation in real life or we imagine being in a dangerous situation on the inside of our minds. Take a moment to imagine biting into a juicy lemon to get a sense of what I mean here. If you really imagine it, you will salivate and maybe make a scrunched-up face.    

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Take-home message

We don’t know all there is to know about the intricacies of eating disorders. But we know enough to know that education, shame, and blame do not heal. 

We know that eating disorders are on the rise. And even our gold-standard treatments often fail those who seek to recover. 

If you’ve tried one treatment path and it hasn’t worked, it may be time to expand and experiment with other options. Keep in mind that clinical hypnotherapy is an option. It’s a viable tool that I believe will only become more widely used as we improve our understanding of the human mind and what truly drives our behaviors. 

Thanks, Mom!

I could never capture in words just how thankful I am that my mum looked outside the box of what was offered to us for years and years and booked me into that first hypnotherapy session. 

Kids are great hypnotic subjects because they enter a hypnotic trance easily. They go farther and get a lot done when they get to be the creators of their destiny. I truly believe that building rapport with our unconscious mind is one of the greatest determining factors in how far we go in life. To re-establish this at a young age if it is lost or teetering on the verge of being swamped from ever-increasing messages from the outside world over what to eat, how to look, think, feel, and do, is inconceivably valuable.

Clinical hypnotherapy with a licensed professional offers a safe and controlled environment in which your child or yourself can try out fresh ways of being, something we often don’t otherwise get in the day-to-day rush of life.   

Eating disorders are complex, but please do not let complexity lead to undertreatment.

Bonnie Killip Fuelling Success

Bonnie Killip is an Accredited Practising Dietitian (APD), Master Clinical and Medical Hypnotherapist, and Master Neurolinguistic Programming Practitioner. She offers practical and usable nutrition education for those in recovery from eating issues. As a clinical and medical hypnotherapist, she can help kids reconnect with their inner guidance and develop the internal skills and resources to set them up for a life of emotional regulation, self-love, resilience, and happiness. Website: Fuelling Success

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7 steps to find a great therapist for your child who has a mental health condition

If your child is facing a mental health condition like an eating disorder, suicidality, self-harm, substance abuse, anxiety or depression, it’s easy to feel overwhelmed. And while your child’s pediatrician may help you get an initial diagnosis and point you in the direction of therapists and/or treatment programs, it’s still up to you, the parent, to make the right choice for your child.

First, consider how you will approach finding a therapist for your child. To do this, gather your insurance details and find out how many sessions are included, what is your deductible, what therapists are included in your policy?

Before interviewing a therapist, consider getting the following details up-front:

  • Where is the therapist’s office? Is it reasonable for you to get your child there at least once per week?
  • How many times per week does the therapist want to see your child, and what time slots do they have available? Will this schedule be feasible for you?
  • Will there be a co-pay or are you paying out of pocket? If so, can you afford this therapist?

We recommend identifying at least three different therapists to interview for your child. To find these therapists, you may have to call around from the list your insurance provider gave you, and be prepared for therapists who are not currently taking new clients, who don’t have time slots that work for you, or who do not work with children who have your child’s condition. This can be frustrating work, so be prepared.

Once you begin interviewing therapists, stay organized! Keep detailed notes of the therapist’s name, rate/co-pay, recommended treatment plan, and any thoughts and details you get out of your interview. You will think you’ll be able to remember which therapist you like without notes, but it’s really much better if you document your interaction. Also, if the therapist you choose ends up not being a good fit after a few months’ treatment, you may want to revisit your notes.

Here are seven steps to help you find a great therapist for your child who has a mental health condition:

1. Check their credentials

There are many types of therapists, so it’s important to start by understanding what the different credentials mean. There are two main types of licensed therapists: Licensed Clinical Social Worker (LCSW) and Licensed Marriage and Family Therapist (LMFT). Both have a master’s-level degree and at least to years of supervised clinical practice. Both are qualified to assess, diagnose, and treat the full range of mental and emotional disorders in the Diagnostic and Statistical Manual through the use of psychotherapy. The difference between these two licenses is blurry, so it’s best to ask your prospective therapist why they pursued their particular license.

You may encounter professionals who are in pursuit of their licenses, which means they can charge less. The trade-off is less experience. If you work with a professional who is not yet licensed, you want to be very clear about their level of training and understanding, particularly as it relates to your child’s current status.

There are professional certifications for specific challenges such as eating disorders and substance abuse. If your child has a specific diagnosis, you can ask your prospective therapist whether they have any certifications or specific training in that area.

NOTE: if disordered eating and/or body image is part of your child’s condition, it is important to find a therapist who follows a non-diet approach/weight-neutral approach. Ask specifically whether the therapist is familiar with these approaches. The therapist should be aware of the dangers of a weight-based paradigm. Do not work with a therapist who promotes weight loss as an outcome, regardless of the eating disorder type (e.g. binge eating disorder). This is an outdated approach to eating disorder treatment and can be very harmful.

2. Ask them questions

The single best thing you can do when evaluating a potential therapist for your child is to ask a lot of questions. Choosing a therapist is not like choosing a car to buy – it’s not just about lining up cost and features and selecting based on rational criteria. Therapy is a relationship, not a transaction so it’s important for you to understand your therapist’s motivations, approach, and philosophy.

One of the best ways to evaluate how your child’s therapist will treat your child is to evaluate how they treat you when you ask questions. If they seem disturbed, bothered, or put out by your questions, that may be a sign of impatience. On the other hand, if they treat you with compassion and respect, while still maintaining professional boundaries, you can make an educated guess that they will treat your child in the same way.

3. Talk about expectations

It is perfectly reasonable for parents to ask a prospective therapist about what can be expected from the therapy process. There’s a good chance that the therapist’s answers will be somewhat vague since every therapeutic intervention is unique in its own way. Nonetheless, you should feel reassured that your child’s therapist has expectations for recovery and will follow a path that they believe will achieve certain milestones along the way.

4. Find out how you’ll be involved

The old model of childhood therapy was to keep the parents at a distance. The concept was that if a child was in therapy then their parents had done enough damage and needed to stay away so the child can heal. This approach is generally not recommended anymore since parents can be an essential component of healing from and managing a mental condition.

Your child’s therapist should be able to give you an idea of how often they will communicate with you and whether there will be any family sessions incorporated into the treatment plan. You should also find out how the therapist wants you to communicate with them if you observe any dangerous or concerning behavior at home.

5. Ask for a treatment plan

It doesn’t need to be typed up as a proposal, but your child’s therapist should be able to communicate with you what their treatment plan is based on your child’s condition. The treatment plan is designed to guide your child towards reaching recovery goals. It will also help your child’s therapist measure progress and make treatment adjustments along the way. A therapy treatment plan is not a rigid model, but it is a map to help the therapist, child, and parent all get on the same page about treatment.

6. Listen to your gut

Remember that therapy is a relationship, not a transaction, so one of the most important things, when you select a therapist for your child, is to listen to your gut. If you have an uneasy feeling or are unsure whether the therapist is a good fit for your child and your family, it’s OK to keep asking questions and interview some other professionals to test the waters.

It’s also OK if you engage a therapist and disengage later due to a lack of fit. Remember that the therapist’s work is likely going to disrupt some established patterns for you and your whole family, so when you’re evaluating a therapist, it can help to look closely at whether you really don’t like the therapist or if it’s just that you and your child are uncomfortable with the necessary changes that take place during recovery.

7. Listen to your child

Your child is the one who is working with the therapist the most, so it’s important to listen to your child. Of course, some children are very resistant to therapy in the first place, so you have to listen very carefully to try and tease apart their resistance to recovery vs. their resistance to the therapist.

If your child is complaining about the therapist, that’s not always a sign that there’s a poor fit, but it’s definitely worth letting the therapist know what’s happening at home, and what the child is saying about therapy.

A child may seem engaged during therapy and be making progress, but then they speak poorly of the therapist to others. This is tricky, but don’t shy away from having open-ended conversations with your child about their experience with therapy and the therapist so you can help guide them towards health and healing.

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

She’s the founder of and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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Get answers to your questions about eating disorder treatment

We held a Q&A webinar with eating disorder therapist John Levitt, Ph.D. on May 5, 2019. Here are some important questions he answered for us.

1. Do you have any advice about FBT for eating disorders?

Answer recap: FBT (family therapy) is one of the evidence-based therapies available for eating disorders. It’s effective for a certain group of patients. Its primary outcome is to cause weight gain.

2. Should I send my child to residential treatment for an eating disorder?

Answer recap: The purpose of a program is to stabilize and refeed to manage the critical side effects of an eating disorder. I’m concerned about sending a child away from their family and recommend asking: how is the family involved, and how does the family sustain recovery when they return home? Often a local treatment program can achieve the same goals.

3. What should I do if my child is in treatment for an eating disorder and the behaviors aren’t stopping?

Answer recap: If your child is in a treatment center and their behaviors aren’t stopping, it’s important to understand why that is. Ask questions, and understand the goals and treatment plan.

4. Parents are doing their best, why isn’t child recovering from their eating disorder?

Answer recap: Your child not recovering doesn’t mean you’re doing anything wrong. Most people recover from an eating disorder, but it can take time. Recovery depends on many factors, including how long they have had the eating disorder. It’s OK to sit down with the therapist and ask how treatment is going. You should have some sort of treatment plan to guide the process.

5. What is evidence based treatment for an eating disorder?

Answer recap: Evidence-based treatments have been tested with group studies in which there have been random assignments to different treatment types. Certain therapies have been statistically proven to be more effective. It’s important to ask the therapist or treatment center what it means to use “evidence-based” treatment and how do they use it?

6. Why, if the eating disorder behaviors are under control, does my child still need therapy?

Answer recap: When someone recovers from an eating disorder, they may still have trauma symptoms, anxiety, depression, self-harm, and other residual symptoms that existed in addition to the eating disorder. These conditions and symptoms can be a good reason to continue therapy beyond eating disorder treatment.

7. If my child has trauma and an eating disorder, will an eating disorder treatment center treat both?

Answer recap: If possible, find an integrated treatment approach that addresses eating disorders and other challenges like trauma, self-harm, etc. Be sure to ask your treatment team or therapist whether they are using an integrated approach.

8. How do I find a good therapist for my child who has an eating disorder?

Answer recap: Ask a lot of questions! The therapist is a guide, and it’s their job to facilitate recovery with the child and the parents. We should be available to answer parents’ questions. If your child is not responding to treatment, it’s not always because the therapist isn’t “good,” but it is important to talk to the therapist about the treatment plan and that they can communicate with you and your child.

9. Our therapist told me to be patient with my child who has an eating disorder – what does that mean?

Answer recap: I’d ask “what does ‘patient’ mean?” and try to find out what the therapist is asking for. Yes, treatment takes time, but you should see some results. If your child is medically compromised, you don’t have time to be patient. But if you’re talking about therapy, it’s a process. It does take time. Ask what you should be doing while you’re “being patient.”

10. My child’s in treatment for an eating disorder, what should I be doing?

Answer recap: Ask your child’s therapist! You should receive suggestions from the program or therapist regarding what they think will be helpful. Your outpatient therapist should regularly give you recommendations about what to do. I suggest parents provide support, love the child, supervise the food, weight, eating, and be mindful of purging. If the child is at a more acute stage of eating disorder behavior, parents may need to be more active in preventing the behaviors.

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

She’s the founder of and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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A mother’s perspective: insights and experience gained in supporting my daughter in her recovery

Eating disorders are not well understood, isolating, frustrating, and painful. And that goes for the person who has it as well as the people who love and support that person. When a child develops an eating disorder, parents can easily become overwhelmed by treatment, fear, and frustration. It can help to hear stories from other parents who have gone through the recovery process.

This eBook was written to provide a mother’s perspective of her daughter’s eating disorder recovery. This eBook is provided courtesy of Recovered Living, a recovery coaching service that, from this mother’s perspective, was a critical element of her daughter’s recovery from an eating disorder.

A mother's perspective - insights and experience gained in supporting my daughter in her recovery

Following are a few excerpts from the book, but it’s well worth reading in its entirety for more details and perspective.

What I learned about recovery

“(To me) owning recovery involves eating, feeling emotions, building relationships and participating in life – everything an ED denies.”

“My daughter was told that recovery is harder than she could imagine … and supporting her in her recovery has been so much harder than I imagined, too. I can see why those who recover can accomplish anything they choose in life because I think I could tackle most things now and I’m only the support person.”

“My daughter initially struggled until she found a recovery coach who stated outright that becoming fully recovered was possible. For her, the knowledge of being able to recover was the foundation to her decision to commit fully to recovery, but even then the pull of the ED was still very, very strong.”

“Learning to own recovery includes allowing feelings to be felt; good and bad.”

“Real recovery comes from being able to emotionally step back in life; a life the ED is accustomed to numbing them from.”

My own relationship with food & weight

“I previously thought I had a good relationship with food, but I was silently a watcher of my weight and a dieter, although I never openly dieted or talked about my weight. I hadn’t realized that my own self-esteem was tied to the size of my clothing.”

“… for me, addressing my own issues around food, body image, and weight has been crucial.”

“Eating what I want, doing what I want, and being me, without judgment based food eaten and what the bathroom scales say, is freedom – just like I want for my daughter.”

“I could never imagine going back to how I was before, which is how so many other mothers I know live. The sense of freedom is very liberating.”

Walking on eggshells

“I have never walked on so many eggshells in my life since an ED took up residence in our home!”

“… no one told me we did not need to walk on eggshells. Only after we found her recovery coach did I learn that this behavior was actually the ED exerting control over the whole family …”

“If an ED had its way, it would zip everyone’s lips. Talking can help draw my daughter our and temporarily away from her ED because she can’t withdraw and be present in a conversation at the same time.”

Siblings and friends

“It has been tough on (her brother) and early in her recovery he did ask a few times if he was ever going to get his sister back.”

“… there aren’t many teenage girls who have the fortitude, maturity or innate wisdom to stand by a friend when an ED is pushing them away.”

“… for my daughter, a big part of her second half of recovery has been about building new friendships and connecting with people who contribute to her growth and joy.”

What I learned about treatment

“Recovery involves learning and learning leads to growth. (This is) why having a recovery coach specialized in ED recovery has been vital for my daughter, as no one else could provide this type of expertise.”

“My experience shows a person in ED support needs to be specialized in the area, not dabble in it as part of their job description, because ED work is a career path that has chosen them and not the other way around. Having a recovery coach or therapist who has recovered themselves is also a prerequisite in my opinion …”

“I joined a Facebook group set up to help mothers navigate recovery, but within a couple of months I realized it was more harmful than helpful because the group embraced a victim and sympathy mentality which I likened to a “stagnant pond” environment where nothing positive could grow from.”

“Fortunately my daughter’s recovery coach offers her own online support group and this makes a real difference. It is free to attend and has been gold.”

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Best care package ideas for a person who has an eating disorder

care package ideas for eating disorder recovery

Do you know someone who is being treated for an eating disorder? Do you want to show them that you care? A care package is a great way to connect with someone who has an eating disorder. It’s a wonderful reminder that people who love them are cheering them on. Top ideas for care packages include:

  1. Art/craft supplies
  2. Boredom/anxiety management items
  3. Comfort items
  4. Writing supplies
  5. Personal notes and mementos

Why send a care package to someone who has an eating disorder?

An eating disorder is a serious illness. However, unlike other illnesses like a broken arm or even cancer, most people don’t really understand eating disorders. Like all mental illnesses, eating disorders carry an unnecessary stigma, which can make it hard for friends, family, and loved ones to know how to respond.

People who have eating disorders can feel lonely and isolated. They may feel ashamed or guilty about their illness. But just like anyone who is facing a medical challenge, friends, family, and loved ones can really help by showing up, talking, and helping to care for someone who has an eating disorder.

Sending a care package is a great way to show support for someone who has an eating disorder. Whether the person is in treatment at a care facility or at home, it’s a loving, wonderful way to show that you care.

Sending a care package to an eating disorder treatment center

Eating disorder treatment facilities are a place where eating disorder recovery takes place in a managed care setting. These facilities make an effort to make the living conditions home-like. But just like any situation when you’re away from home, it can feel a bit institutional, and it’s nice to receive packages.

If you’re thinking of sending a care package to a person in an eating disorder treatment facility, it’s a good idea to call the facility and ask about their policies first. Unfortunately, not all facilities accept care packages, and many will check the package before it is given to the person in care. It’s best to know what you can and cannot do before you start putting a care package together.

But if you can send a care package, then I recommend that you do. Everyone I’ve spoken to who received a care package during eating disorder treatment was grateful and appreciated the thought and care. A care package is a great way for family members, loved ones, and friends to connect with a person while they are recovering from an eating disorder. They are a great way to remind someone that you are thinking about them, love them, and support their recovery.


Great care package ideas for eating disorder recovery

I asked people who have been in eating disorder treatment what they want. Here’s what they said:

Art/Craft Supplies

  • Sketchbook/Pads of art paper
  • Gel pens
  • Markers
  • Watercolors
  • Colored pencils
  • Coloring books
  • Macrame yarn/thread/string
  • Knitting/crochet/embroidery supplies

Boredom/Anxiety Management

  • Word searches/Crossword puzzles
  • Puzzles
  • Fidget spinners
  • Silly putty/slime/play dough
  • Stress ball
  • Slinky
  • Rubik cube


Just like home


  • Journal
  • Gel pens
  • Stationery and stamps
  • Stickers


  • Letters, postcards, and cards
    • Avoid requests to “hurry home” or “get better soon.” Instead focus on messages like “I’m proud of you,” “I’m rooting for you,” etc. Funny and corny are good choices, too!
    • Avoid images of food or bodies, which may be triggering.
  • Photos of loved ones, pets, and favorite places
    • Avoid images of the person in recovery. Remember that they may be sensitive to their appearance.
  • Personalized pillow or blanket. For example, add a custom quote or favorite pet’s face.
  • Paint/design a personalized inspirational message
  • A souvenir from a favorite place you have traveled together. For example, a miniature Eiffel Tower, London Bridge, snowglobe, etc.

Restricted Items

  • Food and drink items are typically restricted.
  • Each treatment center may have items that they do not allow residents to receive. It’s a good idea to check with the treatment center before sending a care package to ensure delivery.


The BuddyBox, developed by the Blurt Foundation, is a care package designed to make the recipient feel good. The contents are carefully selected to avoid psychological triggers. Blurt is an organization dedicated to helping people who have depression. But the BuddyBox is gender-neutral and applicable for many types of mental health conditions. BuddyBoxes are available as a monthly subscription or a single box.

Wrapping and delivery

One of the best parts of getting a package in the mail is unwrapping it! It’s so exciting to get a gift! Therefore, here are some ideas for getting creative:

  • Wrap the gift in gift wrap with a bow
  • Add confetti or glitter to an envelope
  • Add stickers on the outside of the envelope or package
  • Find a pop-up card, card with googly-eyes, or a singing card
  • Use a map of a favorite place, like Disneyland, London, or your home neighborhood, as wrapping paper
  • Use sheet music of a favorite song as wrapping paper
  • Enclose a personal voice recording or recording of a favorite song
  • Have a cousin, niece or nephew draw a picture on the wrapping paper

What to write in a card to someone who has an eating disorder

Once you have planned everything for the gift or care package, the final touch is a card or note. But what can you say to a person who has an eating disorder? And are there things you should not say? Here are some ideas for what to write in a card:

  • I’m thinking of you and can’t wait to see you again!
  • I’ll always remember when you/we …
  • We’re all behind you and support you
  • I believe in you
  • This is hard, and I’m so sorry
  • I’m here for you
  • Call or write to me anytime
  • I’m so proud of you
  • We’re looking forward to having you back home when you’re ready
  • Can’t wait to watch Riverdale with you for the thousandth time!

These may be obvious, but here are a few things not to say in a card to a person who has an eating disorder:

  • Can’t wait to eat cake with you again!
  • I wish you weren’t there
  • It’s ridiculous that you’re there
  • Hope they aren’t being too mean – haha
  • We’re having tons of fun without you
  • I found someone else to do things with
  • I started a new diet and lost a ton of weight
  • So much has happened since you left

Understanding eating disorders

A care package is a wonderful way to show someone that you care. But the greatest gift you can give a person in recovery is your understanding and acceptance. Our society is very uncomfortable with eating disorders. It can feel very lonely to have an eating disorder even though they are fairly common.

Disordered eating is common

Recent estimates say eating disorders impact about 10% of the population. But disordered eating, which is a milder but still serious form, is very common. Estimates put it at up to 80% of the population. Above all, knowing that disordered eating is common can help you be more understanding of your loved one.

Disordered eating is societally-driven

There are many factors that contribute to an eating disorder. But we cannot ignore the fact that our diet culture drives many of the behaviors and drivers of eating disorders. Therefore, understanding the societal drivers of eating disorders can help you be more compassionate towards your loved one.

Eating disorders heal in community

While eating disorders are often treated privately and in treatment centers, the healing takes place in the community. Every person needs to eat, and eating is a part of our social fabric. When neighbors, friends, and loved ones understand eating disorders, they are less likely to make unintentionally hurtful comments. In other words, when communities commit to understanding eating disorders, they are healthier for everyone.

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

She’s the founder of and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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What’s new in eating disorder treatment? An interview with Jennifer Rollin, MSW, LCSW-C

We sat down with Jennifer Rollin, an eating disorder therapist and founder of The Eating Disorder Center based in Maryland, to find learn what’s new in the treatment of eating disorders.

1. What do you think has changed about the way we treat eating disorders in the past 10 years?

I think there have been a lot of changes in eating disorder treatment, and we still have a ways to go. One of the big things is a shift towards more evidence-based treatments. We now have a higher emphasis on treatments that have been demonstrated by research to be effective. This will hopefully lead to improved care.

We have also seen the incorporation of Health at Every SizeⓇ (HAESⓇ) principles into eating disorder treatment. We’re experiencing a push towards more weight-neutral care, and are reducing the fat phobia that has been deeply steeped into so many treatments in the past. Providers are finally recognizing is that eating disorders impact people of all body sizes. We’re working hard to eradicate fat phobia in the eating disorder treatment space because it is incredibly harmful.

I think some residential treatment centers are lagging behind, especially in terms of supporting males who have eating disorders. We have two local treatment centers, and only one of them accepts males. Residential treatment has a long way to go in terms of equalizing eating disorders in terms of gender, race, size, and abilities. We are seeing a shift in terms of providers being more welcoming to people of all shapes and sizes, but we still need a lot more education that people who have eating disorders can be any body size, race, class, and gender.

We still need a lot more progress in terms of being welcoming to people in all types of bodies. A lot of people who have eating disorders don’t ever seek treatment because they don’t fit the stereotype and don’t seek treatment or when they do, they are not treated appropriately. Diet culture has completely normalized disordered eating so people don’t even realize they have a problem. Larger people who have eating disorders are often seen as someone who’s trying to “be healthy” and “lose weight.”

2. How do you work with adolescents who have eating disorders?

The first thing that’s most important when working with anyone, but especially teenagers, is building a relationship. It can be hard to earn teens’ trust, especially if they don’t feel a connection with their therapist or healthcare provider. We can have all the best clinical skills in the world, but if we can’t connect with a teen, we won’t get buy-in or trust, and then we won’t be effective. Personally, I think it helps that I’m younger, and I work to keep in touch with teen trends so that they feel I can relate to their world and, therefore, their deepest struggles.

When we’re working with a teenager, we have the benefit of being able to work with the family, which can really help treatment. I will utilize the family in the treatment process as much as makes sense. We have to look closely at the family dynamic and determine the best way to work in partnership for optimal treatment.

Sometimes I will use modified Family Based Therapy (FBT), especially if I’m working with a younger child and it’s a purely restrictive eating disorder. I find it’s most helpful to modify treatment for each child and each family system. Anybody who says that any one treatment is a panacea for eating disorders is problematic – we must look at each case individually. Not everything is appropriate for everyone, and not every family can or should take on FBT.

3. How do you involve parents in a child’s eating disorder treatment?

This totally depends on the person and the situation. I always share with parents that they can be involved as much or as little as they want. Sometimes I need to push for more involvement if I feel it will serve the child’s recovery. I am the child’s therapist, but I will send weekly email updates to parents, and I encourage parents to email updates to me so that I can be aware of what’s going on at home. I will invite parents into sessions and sometimes do family sessions, depending on what makes the most sense. But I always remain aware that my client is the child.

It can be very tricky to navigate fat phobia and diet culture. Parents are so well-intentioned and love their kids, but I can still see that they are trapped in our societal expectations regarding weight. A HAES-informed recovery process involves accepting the body as it is, but I still have great parents asking whether they can help the child lose weight in a healthy way. This is where we still have a lot of catching up to do in terms of educating people about the futility and dangers of intentional weight loss.

When treating a child who has an eating disorder, I become very aware of parents’ thoughts about weight. I take a gentle educational approach and tell parents that in my professional opinion, any focus on weight loss is not helpful for anyone, especially someone who is in recovery for an eating disorder. I know parents want what’s best for their kids, and diet culture has convinced them that certain foods are bad or higher weights are bad. Parents just want to do the right thing, but unfortunately, even though they are trying to help, they don’t understand that it can hurt.

I sometimes recommend that parents meet with a HAES-informed dietician who can help them understand these concepts. The analogy is that having diet foods in the house, talking about dieting, and focusing on weight loss is like going on an alcohol bender while living with someone who is in recovery for alcoholism. We have to be mindful of what we do when we live with someone who is in recovery.

4. What do you think parents most commonly misunderstand about a child’s eating disorder?

I think the most common misunderstanding is that an eating disorder is a choice. Even if parents have been told that it’s not a choice, it’s hard to accept that. We naturally want to understand responsibility and want kids to recover. Well-intentioned parents may feel upset when a child doesn’t follow a recovery plan exactly, they will say things like “you have all these skills, why aren’t you using them?” But this is where it gets tricky. An eating disorder is not a choice, but recovery is. This means that the eating disorder can slip in at any time and take over, and a person who is in recovery has to exert tremendous effort to constantly make the choice to recover. It’s so helpful to know that recovery is a process, not an event. And recovery looks different for every single person.

Of course you’re concerned about your child, and of course you’re disappointed when you see them struggling. But parents need to understand that they are going to have these feelings, but they don’t always need to say them out loud, especially with their child. Disappointment is normal, but parents can unintentionally make kids feel they are disappointed in them for struggling.

I have some clients who feel very guilty for making their parents’ life complicated and scaring them. And it’s true that parents do have to work harder when a kid has an eating disorder, but if the child had cancer, the parent would do it and recognize it wasn’t the child’s fault that they have cancer. That’s what I’d love to see when a child has an eating disorder.

I see some parents who are resigned to the idea that their child will always be sick. Then I have parents who think that if the weight is fine, the child is fine. We have to find a balance and recognize that you can’t judge an eating disorder based on someone’s physicality. Ultimately it’s a mental illness, and we can’t tell how healthy someone is based on how they look or their behaviors.

5. What is advice would you give a parent who has a child who has an eating disorder?

First, have compassion for yourself. A lot of parents blame themselves for a child getting sick. It’s natural to think about what could have been done differently, but ultimately parents have to move forward. Make time for your own self-care. Helping someone in recovery can be emotionally draining.

Second, have compassion for your child, and have compassion for the eating disorder behaviors. Sometimes eating disorder behaviors are the best way your kid can cope in the moment. The eating disorder is serving a purpose for them, otherwise they wouldn’t’ have it. Your child is trying to help themselves – they’re just going about it in a way that is not helpful.

Clearly, I’m passionate about helping people to recover from eating disorders, but I also believe in starting with radical acceptance, which is a concept in Dialectical Behavior Therapy (DBT). Acceptance doesn’t mean you like it, it just means you acknowledge it’s there and you don’t have to make it the enemy. The eating disorder is currently a part of your child. When we make it the enemy, it can feel disapproving or critical to the person. Instead, seek ways to reduce anxiety and help your child meet the needs that their eating disorder is currently meeting, in other more life-affirming ways.

jennifer rollin eating disorders

Jennifer Rollin, MSW, LGSW is a Psychotherapist specializing in eating disorders and body image. In addition to her psychotherapy practice, she also offers recovery coaching via phone or Skype. She has published numerous articles regarding children, adolescents and eating disorders. Website

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Understanding therapy for eating disorders – an interview with Colleen Reichmann, Psy.D.

We interviewed Dr. Colleen Reichmann to find out more about what it’s like to be a therapist who specializes in eating disorders. 

Q: Why did you become a therapist?

I became a therapist because, quite simply, I wanted to give back! I have struggled with my own mental health issues, and have seen first hand the healing power of therapy, which inspired me to pursue a career in psychology.

Q: What made you decide to go into eating disorder treatment as your specialty?

I mainly made this decision because of my own past history-I struggled with an eating disorder for around a decade. I was told that I would be a “chronic” patient and felt so hopeless at times. When I finally began to really recover, I realized that I wanted to use this journey to help others who are struggling with eating disorders. This is not to say that I understand your eating disorder, because everyone is different. My past history simple gives me what I like to call an “empathy chip” for this particular illness and journey.

Q: What training have you received to be an eating disorder specialist?

Unfortunately, I did not receive much specialized training in the core parts of my graduate program, as it was a generalist program. I sought out research experiences (assistantships and my masters thesis and dissertation) that focused on eating disorders. I also attended conferences and trainings outside of school as much as I could. I completed my predoctoral and postdoctoral internships at inpatient eating disorders units, which were huge training experiences. Currently, I am pursuing my CEDS specialist, and expect to be finished within a year or so!

Q: How do you pursue ongoing education as an eating disorder specialist?

I attend conferences. Specialized eating disorder conferences are absolutely crucial. I make it a point to find training opportunities that offer an inclusive, Health At Every Size perspective on issues within the ED community.

Q: How do you typically approach treating a child (up to age 18) for an eating disorder?

Typically I utilize family based therapy (FBT) if at all possible. (I have received some specialized training in FBT). If parents are invested, involved, and ready to learn, I find it is ALWAYS best to include them in the treatment process. After all, you know your child far better than I do! If this is not possible, I offer interpersonal/feminist-relational therapy, with cognitive behavioral therapy techniques threaded throughout. I believe that insight-focused work AND behavior/action-focused work is necessary when it comes to recovery from an eating disorder.

Q: What treatment format do you typically recommend for a child (up to age 18)? For example, how often do you like to meet, for how long, and do you involve family members? Do you involve other caregivers like doctors and nutritionists?

I recommend at least weekly individual session, (50 minutes each), and every other session would ideally involve parents. I also recommend monthly (or more if needed) meetings with an eating disorder-informed MD, and weekly meeting with a dietitian (pediatric dietitians are very helpful for children under 12/13), and non-diet, fat-positive dietitians for everyone else!

Q: What would you like parents to know about having a child who has an eating disorder?

I would like parents to know that this is not your fault. This is a serious mental illness with research-proven genetic underpinning. You cannot “give” your child an eating disorder. You can, however, be a powerful piece of their recovery. I would also like to remind parents who feel helpless/powerless that you likely fed your child successfully for many years. You have the power and the knowledge to help your child-all you need now is guidance and support in how to apply that power now that your child is struggling with an ED.

Q: What mistake(s) do you think parents make when parenting a child who has an eating disorder?

I commonly see parents trying to “appease” their child when it comes to recovery. This is understandable-if your child is begging you not to eat something, to make something different, or to eat less, it is so common and human to want to comfort your child by giving in. To this I say, much like other aspects of parenting, the most comforting action for your child is not what will be best for him/her/them in the long term. Empathic firmness works best here.

I also see parents trying very hard to understand the eating disorder or rationalize what is happening to their child. Often times, it is impossible to find the rationality in someone who is struggling with an eating disorder. Please know that this is an illness with a largely fear-based brain component. Meaning that, neurochemically, your child’s brain is likely reacting similarly around food to someone who struggles with an extreme phobia and is being asked to confront it. So please do not feel hopeless if explaining the rational need for food/eating does not get through to your child.

Q: Do you see any promising new research or techniques that you think will make an impact on the future treatment of eating disorders?

I have recently seen some research that involves “bridging the gap” between research and field work when it comes to family based therapy. (This “gap” refers to the difference between the great outcomes that we have seen in controlled studies, versus the less-powerful outcomes that we see when this research is applied to real-life clients). I think this idea of focusing on the gap and how to close it will be very helpful to the field.

Additionally, we are seeing more and more providers discussing the role of intersectionality, identity, oppression, and marginalization when it comes to eating disorders. This is helpful because it allows us to begin addressing and confronting the environment that leaves some people vulnerable to eating disorders.  (Versus acting as if recovery happens in a vacuum).

colleen Reichmann psyd

Colleen Reichmann, Psy.D. is a licensed clinical psychologist who specializes in the treatment of individuals with eating disorders and body image issues. She has worked at various inpatient eating disorder treatment facilities and is the blog manager for Project HEAL. She lives in Virginia Beach with her husband and golden doodle and currently works at a group practice.

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How to pay for your child’s eating disorder treatment

Eating disorders are chronically underfunded, both from a research and a treatment standpoint. Many healthcare providers are ill-equipped to diagnose and treat eating disorders, and many insurance companies will severely limit treatment or deny treatment altogether. This is seriously depressing, especially since we know that eating disorders that are caught and treated early are less likely to turn into more serious forms that can require even more extensive (and expensive!) care.

There are several organizations that are working to address the inadequacy of eating disorder treatment and payment. But, meanwhile, if you have a child who has an eating disorder, you have to figure out how to pay for it.

Insurance coverage

Your first step is to get a formal diagnosis and find out what your insurance provider offers in terms of treatment. Depending on the diagnosis, your insurance provider, and various other factors, your child’s eating disorder treatment may be covered up to a certain point. But it is unlikely that the ongoing treatment required to maintain recovery will be covered. So, unfortunately, parents are in the uncomfortable position of figuring out how to pay for at least some of their child’s treatment for an eating disorder.

Grants for eating disorder treatment

There are two organizations that offer grants to help pay for eating disorder treatment. Project Heal is a major US-based organization that administers several grants, which you can check out here. The Manna fund offers scholarships for inpatient treatment programs in Atlanta, which you can check out here. Unfortunately, those are the only two organizations that we can currently identify as actively providing help with eating disorder treatment, but ask your treatment program or provider whether they have any grants or scholarships available.

Low/No Cost eating disorder treatment

If your child is currently enrolled in K-12 school, you should check with the school psychologist and/or counselor to find out how they may be able to help. Some schools have the resources to provide free counseling for students who have eating disorders.

If your child is currently enrolled in college, you should check with the school health center and psychology department. Often students can receive free counseling and therapy for a period of time.

Sometimes universities and research hospitals offer eating disorder treatment programs as part of their research. For example,  the Columbia University Department of Psychiatry has linked to RecruitMe, a recruitment tool meant to connect those who want to participate in clinical trials or research studies to the researchers that are conducting them, to help you find one. You can also check the national list of ongoing clinical trials here.

The non-profit organization Open Path Psychotherapy Collective is a network of mental health professionals dedicated to providing in-office mental health care to individuals, couples, children, and families in need. Open Path therapists provide in-office sessions ranging from $30-60 for an individual and $30-80 for couples and families.

Budgeting for eating disorder treatment

Unfortunately, like insurance coverage, both of these options are limited in scope and time. While they typically cover inpatient treatment, they may not cover ongoing treatment that is often necessary to maintain recovery. Eating disorders are complex and multi-faceted disorders that typically require ongoing treatment for underlying conditions such as anxiety and depression.

This means that parents are in the unenviable position of needing to fund their child’s recovery treatment out-of-pocket. If you are struggling to pay for your child’s treatment, please know that it’s absolutely not fair that we live in a society that grossly under-treats this serious condition. This totally sucks. Many parents go into debt, deplete retirement savings, and resort to other desperate measures to save their child.

Here are some basic budgeting concepts to help you plan for treatment.

1. Avoid expensive solutions

Many parents don’t realize that they don’t have to send their child to inpatient treatment for an eating disorder. Residential treatment programs cost an average of $30,000, but many times less expensive treatment is an excellent option.

In cases in which your child is not in immediate medical danger, you may be able to utilize outpatient treatment centers or even a less structured solution utilizing regular sessions with therapists and nutritionists. Remember that eating disorder treatment is a marathon, not a sprint. Very few of us will become instantly cured, and parents need to have the finances and energy for ongoing treatment for the foreseeable future.

Do your research. It’s hard to make big decisions when we’re really stressed, but as long as your child is medically stable, take some time to think through your options. Learn about eating disorders and treatment options, and don’t just blindly follow a treatment center’s recommendation. Remember that no matter how nice and authoritative they seem, treatment centers are running a business and need to recruit customers. That doesn’t mean they’re bad people, but we must always take their advice with this in mind.

It is better to hire one excellent and highly-qualified therapists than to work with a low-cost, poorly-qualified team. Ideally, we recommend finding a weight-neutral therapist who has been certified by the IAEDP and has at least 5 years of clinical experience working specifically with eating disorders.

READ MORE: What I want parents to think about before sending their child to an Eating Disorder Treatment Center, by John Levitt, PhD

2. Create a budget

The biggest mistake people make when budgeting is not writing down the expected costs. Most of us just think about money one day at a time, but it will really help you avoid financial ruin if you can look at the costs of your child’s treatment clearly and in writing.

Whatever treatment you decide upon, you should ask your providers to give you a budget for at least six months of treatment. For example, if your child seems like a candidate for a lower-cost treatment program, you may get the following fee estimates:

  • Therapy for your child: $150 per session, with twice-weekly sessions for four weeks, and once-weekly sessions for the following five months.
  • Nutrition therapy for your child: $100 per session, with four sessions spread over four weeks, with follow up once-monthly sessions for the following five months.
  • Family therapy: $150 per session, with twice-monthly sessions for six months.

This means you can budget as follows:

TherapistNutritionistFamily TherapyMonthly Total
Month 1$1,200$400$300$1,900
Month 2$600$100$300$1,000
Month 3$600$100$300$1,000
Month 4$600$100$300$1,000
Month 5$600$100$300$1,000
Month 6$600$100$300$1,000
6-Month Total$4,200$900$1,800$6,900

Once you have estimated your monthly costs and the total cost for six months of treatment, you can begin to think about how you are going to afford treatment.

3. Create a savings plan

Before you start considering dipping into savings and using credit cards to pay for treatment, create a savings plan – you may be surprised by how little changes can make a big impact on your ability to pay for treatment. Think of every way you can reduce existing expenses first because this is going to help you avoid going into debt. Most of us have at least some non-essential expenses that can be cut to afford major expenses like eating disorder treatment. The key with a savings plan is to write it down and commit to your savings plan in writing.

Some impressive savings that can add up include:

Savings PlanMaximum Annual Savings
If you buy coffee at a cafe, you spend between $5-$25 a week, which equals between $240-$1,200 per year.$1,200
If you buy lunch at work, you spend between $10-$15 each day, which equals between $2,500-$3,750 per year. If you make your own lunch you’ll spend just $3-$6 per day. The savings is between $1,750-$2,250 per year.$2,250
If you eat dinner out each week, you spend between $15 and $35 per person. For a family of four, that means you’re spending $60-$140 each week, or $3,120-$7,280. That could pay for the eating disorder treatment all by itself! Since most of us eat out more than once per week, cutting out one restaurant dinner per week could make a huge difference financially without too much burden.$7,280
If you tend to over-spend and don’t know where your money goes, you could be wasting hundreds of dollars each month. Institute a 30-day wait rule, which means that any purchase that is not absolutely essential (i.e. food or other essential requirements) must be put on a waiting list and stay there for 30 days. If after 30 days you still want and need the item, you can buy it. With this program, we usually find that we do not actually “need” many of the things we think we do.$1,200+
If you are planning a vacation in the next 12 months and can cancel it, do that. The average vacation costs $1,145 per person or $4,580 for a family of four. Don’t give up on the idea of the vacation – just the expenses. Plan a fun staycation with daily family activities. Even if you budget half of what you planned for the vacation, you’ll still save almost $3,000$3,000
Total Possible Savings $14,930

Reducing expenses is surprisingly easy since small expenses add up. In this example, we could pay for more than 12 months of the prescribed treatment with very little impact on our quality of life. If you are worried about sticking to a savings plan, remember to write it down and keep track of your savings so you can stay motivated.

4. Finance if necessary

Whenever possible, it is better for your long-term financial prospects if you can pay for treatment by saving money rather than going into debt. But this requires you to have room in your budget to cut back, and it takes discipline and time. If necessary, consider these payment options:

  • Borrow from investments and retirement savings – be really careful about this unless you are absolutely sure you will be able to pay yourself back any money you borrow.
  • Borrow from friends and family members – consider using a site like or to ask friends and family members for help.
  • Borrow against your home equity – if you own your home and it has equity, you could take out a line of credit against your home’s value. Be very careful to avoid getting “underwater,” and don’t over-borrow or you could end up owing more than you can get if you sell your home in the future.
  • Use credit offers – these typically have a 6-12-month no-finance charge period, but you will still pay a fee up-front. Be very careful with these, and avoid them if you don’t think you will be able to pay the entire balance at the end of the 0% period. The best way to use these is to write yourself a check and pay it off with equal monthly payments over the remaining months. While you will pay the up-front fee, you will not pay finance charges as long as you zero out the balance in the grace period.

Paying for your child’s eating disorder treatment is an unfortunate side effect of living in a society that undervalues and under-treats mental illness. Be careful about over-investing without thinking through the actual costs and creating a financial plan to make sure you don’t end up in an unsustainable situation.

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

She’s the founder of and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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Our family’s story of our 13-year-old daughter’s recovery from anorexia with Family Based Treatment (FBT)

family based treatment for anorexia

Many families who have a child with anorexia nervosa will hear about Family Based Treatment, or FBT. It is an evidence-based treatment and for anorexia. Here’s one family’s story:

By Anonymous

My daughter had a brain tumor at age two. It caused morning vomiting through age 6.* She survived due to early intervention. This included craniotomies and physical therapy.

She was diagnosed with social anxiety at age 6. She refused to drink water at school because she did not want to use the bathroom at school. I remember her telling me about a teacher who commented negatively on her snack of a cupcake. She also had a paraeducator telling her that sugar is as addictive as cocaine.

These are some of the memories I have that help me make sense of the anorexia. It seemed to develop in a matter of weeks.

We compiled a list for the doctor:

  • Changes in diet (won’t eat whipped cream, butter, regular cheese, ham)
  • Cooks, but doesn’t eat what she makes
  • Eats really slowly and seems to play with food more than eat. After she eats, it looks like a mess (food all over the place)
  • Eats really small portions
  • Feels guilty after eating (cries)
  • Fascinated by cooking shows and recipes, but doesn’t eat
  • Does jumping jacks after eating
  • Smells like fingernail polish remover
  • Moody and Emotional
  • Seems cold and wears big jackets all the time
  • Sleeps a lot
  • Wants me to take her to the gym all the time
  • When she takes off her big sweatshirt, I’m shocked because she’s very thin

My husband and I met with the doctor first. He asked us if we have a scale in the house. We do. He told us to take it out of the house. Once it’s gone, she notices it is missing and I say it’s broken. It has been “broken” ever since.

Visiting the doctor

That night, I tell my daughter that we are going to see the doctor. When I check her phone I find that she has visited a website that tells her how to “cheat the doctor.” I’m devastated. I’m angry. She just got the phone a few weeks ago, and this is what she’s looking up? This is the moment I am certain that my daughter has an eating disorder.

The doctor meets with my daughter and evaluates her. He tells her she needs to gain weight. At home, she spends hours crying. He calls later and says she needs blood work and an EKG. He gets her admitted to the hospital. We feel relief. The children’s hospital doctors tell me that my daughter is very ill. She must be hospitalized for at least 5 days, but maybe a few weeks. She is told she must eat or she will get an NG tube. There is no negotiating or pleading, this is just the way it is.

Family based treatment for anorexia

Anorexia nervosa is a monster and it has a stronghold on my daughter. It also has a 20% mortality rate (often suicide). This is the highest for any mental illness, so I’m scared to death of it taking my daughter’s life.

She’s 13. The best chance of recovery from anorexia is Family Based Treatment, or FBT. This includes intensive meal support, and we parents oversee three meals and three snacks daily. I check for hidden food (sleeves, cheeks, pockets, trash can, etc). I check that food is eaten and swallowed (mouth check before leaving the table).

After leaving the table, she has to sit with the family and play a game, watch TV or do homework. She is not allowed to use the bathroom (for fear of purging or flushing food she somehow hid). We can’t let her go to her room, because she does jumping jacks to compensate for the meal she just ate.

So much sadness

Our daughter is suffering and there is a lot of crying and sadness.

We have to encourage her to eat at a decent pace (ideally less than 30 minutes). She wants to cut her food in tiny pieces. She’ll move it around her plate and let it fall to the floor. We make her eat it at a swift pace. She is not allowed to plate her food and must eat everything on her plate. In fact, everyone at the table has to clean their plate.

We band together as a family, my husband, myself and my 10 year old. We fight the monster (anorexia) that wants to starve my child. My child who has anorexia can not help with grocery shopping or food preparation. I black out the calorie content of any prepared package food I serve to her.

She tells me about low fat alternatives and wants to eat vegan. We do not allow this, but we allow her to choose 3 foods that she can refuse to eat. The food she chooses to reject are tomatoes, bananas and eggs.

Pulling together as a family

Every week, we attend family based therapy. At the beginning of each session my daughter is weighed. If she puts on 1-2 pounds, we parents are applauded, and my daughter cries the rest of the session. If she does not put on weight, she smiles and we work with the counselor to develop new strategies.

I learn that is difficult for an adolescent to put on weight. So I buy high calorie snacks and nutritional drinks to help with the weight gain. The counselor tells us that we cannot only serve “safe” foods (pop-chips, salad, whole wheat pasta with lean chicken). We must also serve “fear” foods (caramel, chocolate, soda pop and pizza). We give her fear foods when we are feeling strong enough to take on the monster. Sometimes I trembled after those meals.


The impact of family based treatment for anorexia

My younger daughter misses eating pizza and ice cream with her older sister. She seems sad as her older sister’s personality changes for the worse. At one time, my younger child told me she wished she could die. I realize it is really important to get her out of the house away from the disease. Trouble is, she doesn’t want to leave. Perhaps she is scared of losing her sister?

Personal fallout

The stress gets to me and I see a counselor for anxiety. I see a medical doctor for anxiety medication and an occupational therapist. I developed Irritable Bowel Syndrome and suffer from frequent back aches.

The only part of my life that is a break from the disease, my job, is something I felt forced to resign from. There were so many appointments (individual counseling, nutrition therapy, family counseling and medical). And my manager felt I wasn’t pulling my share of the weight at work. FMLA would have protected my job during this period of intense caregiving. But before I knew of the illness, I switched jobs. I was still on probation when she was diagnosed.

After eight months of FBT, the family counselor thought it best for the me to send my daughter away for therapy full time. I felt some relief at the thought of a break, but my daughter started gaining weight after we talked about “sending her away”.

Sometimes I find moldy food hidden in slippers or spit in trash cans and I cry. Will the anorexia take my child’s life?

We share very little about the disease with friends, for fear of adding to my daughter’s stress. Our goal is to avoid exposing her to the potential stigma associated with mental illness. We feel very isolated.

The recovery from anorexia with family based treatment

We sign up to be volunteers at the local food bank. She enjoys volunteering and we make it a routine. She wants to play volleyball, go to the gym, or play softball. As she gains weight, she is allowed to practice softball for an hour a week. Hours are added back based on her recovery.

Eventually, 13 months in, she hits her fear weight and she doesn’t cry. She asks us to buy her candy. The monster seems to be gone.

At a healthy weight

Now it is 17 months later and my daughter is much better. At her last medical visit she was a very healthy weight. Her fear foods are no longer and we don’t supervise every meal. She can play softball everyday after school and she can participate in PE class.

She still has problems making and keeping friends. Recently, when she broke with a good friend, we caught her drinking from our hard alcohol. Now we lock our alcohol in a safe. We have made contact with a counselor at school who would love to help her. She is refusing further counseling, so we decide to limit her freedoms instead.

I cringe at every mention of “clean” or “healthy” food or trendy diets. I just wish we, as a society,  could focus on teaching our children to enjoy food and love their bodies. I’m tired of this anti-obesity campaign. It could kill my child.

* A recent study conducted by USC found that pediatric brain tumor patients face increased risk of interpersonal and emotional distress.

  • 25% of respondents reported that the patient had trouble making and keeping friends
  • 20% reported that the patient feels isolated and alone.

Interpersonal and emotional distress has been correlated with eating disorders. So while this child’s childhood illness is not a stand-alone “cause,” it is an important part of this family’s anorexia story.

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When your child refuses to get treatment for an eating disorder

refuses treatment eating disorder

Lots of parents get understandably frustrated with a child who resists or refuses eating disorder treatment. Sadly, trying to force your child can spark a dangerous power struggle. It’s tempting to invest a lot of energy and money trying to force kids into recovery. But it’s expensive, exhausting, and often ineffective. So what can parents do when a child refuses treatment for an eating disorder? Here are some tips:

  1. Don’t engage in debates and power plays: this can (paradoxically) only strengthen the eating disorder
  2. Get help for yourself: so you can learn how to be more influential and connected
  3. Repair your relationship with your child: relational repair is how we get closer to our kids
  4. Attend family therapy: invest in time to understand your family dynamics and areas for improvement
  5. Enjoy the child you have: your child is more than their eating disorder

Why people refuse treatment for eating disorders

There are many reasons why people refuse treatment for eating disorders. First, many people who have eating disorders don’t think it’s a serious problem. In fact, part of the disorder is a distorted view of what “healthy” is. Therefore, it can be hard for them to actually see that what they are doing is a problem.

Next, eating disorders are coping mechanisms that your child has discovered make them feel better. Even though they seem terrible to you, eating disorder behaviors are serving a purpose in your child’s life, and they may not be able to tolerate living without them right now.

Finally, you may not have done a very good job of approaching your child about their eating disorder in the past. This is really common. Few parents have knowledge of eating disorders, let alone know how to handle them. Your past approach may be making it hard for your child to talk to you about their eating disorder or accept treatment or help from you.

I’m not saying this from a point of blame. I know you have done your best. But if you want to influence your child’s recovery, then we have to look at things as realistically as possible.

Here are five things parents can do when a child refuses treatment for their eating disorder:

1. Don’t engage in debates or power plays

Try not to turn recovery into a battle of wills, a debate, or a power play. Try to focus your energy on the things you can control (e.g. your beliefs and behavior), rather than the things you can’t (e.g. your child’s will).

It’s natural to want to debate the value of treatment when your child refuses treatment for an eating disorder. But you want to avoid turning your child’s eating disorder into a power struggle. The more they defend and protect their eating disorder, the harder it will be to get them into treatment. Avoid turning eating disorder treatment into a power struggle at all costs.

This doesn’t mean you can’t do anything (see below!) But it does mean that digging your heels in, making ultimatums, and otherwise trying to control your child’s willingness to get treatment will usually backfire.

It makes sense if you feel a strong urge to force your child into treatment. And the fact is that sometimes, if your child is a minor, you may need to and be able to do so. But in most cases, things will go better if you can encourage your child to enter treatment willingly. This is not easy. But an eating disorder can be a signal that the family dynamics need healing. And that’s usually where parents can begin if a child refuses treatment for their eating disorder.


2. Get help for yourself

You may find this strange, but you will be amazed by how much more you can accomplish when you get professional support for how you parent through your child’s eating disorder. Remember that we can’t change other people, but changing our own beliefs and behavior will often get things moving in the right direction.

While your child is the one who has an eating disorder, you can make a significant impact on their recovery. This is because parents and families are often part of the eating disorder formation. Find a qualified therapist or coach who works with parents. Parents can also work with a dietitian who can help you with food and weight beliefs and meal behaviors.

Ideally, seek someone who is familiar with Health at Every SizeⓇ (HAESⓇ) and will not mistakenly discuss your child’s body as a problem. We have a directory of professionals who can help.

In therapy/coaching, you can work on your beliefs, assumptions, and parenting skills. You’ll also get someone who has compassion for your experience. Parenting through an eating disorder is not easy, and you deserve support.

Q: Which should I try, therapy or coaching?

A: Both are an excellent way to get in touch with your parenting style and help you navigate eating disorder recovery. A therapist is a licensed professional who helps people develop better cognitive and emotional skills and cope with life. A coach helps people identify and achieve life goals. The difference is mainly style, and therapists and coaches vary greatly. So the best thing is to find someone who feels like a good fit for your needs. You need someone who you can trust to help you get through this and grow in the process.

3. Repair your relationship with your child

Surprisingly, relationships are built not in the good times, but when someone takes action to repair mistakes. And every parent makes mistakes. When we repair the parent-child relationship, our relationship will strengthen and we’re more likely to have a positive impact. This doesn’t mean that it’s your fault, but it does mean that you can make a difference.

You have probably been experiencing increasing arguments, slammed doors, and cold shoulders from your child for months. It’s likely that your child denies they have an eating disorder. They may completely refuse treatment or attend treatment but do not fully participate.

While you may be dismissing your child’s volatile behavior as “normal” teenage or young adult behavior, when it is combined with eating disorder symptoms, it is not healthy. In addition to your child’s health, your lifetime relationship with them is at risk.

Your child may say they do not have an eating disorder and call you ridiculous for thinking they do. They may yell at you and tell you that it’s all your fault they have an eating disorder. These statements may make you want to pull away, but they are actually a sign that your relationship needs repair.

Many of us mistakenly believe that our kids want to be completely self-sufficient. But they desperately crave their parents’ caregiving, love, and unconditional acceptance. Even the most well-intentioned parents make mistakes that need to be repaired. In fact, rupture and repair is how relationships grow and become strong.

Your child’s recovery will be supported if you repair your relationship with them. Your therapist or coach should be able to help you get this process started. Once you have made some changes to the way you are parenting, you should gain your child’s confidence and be able to take the next step: family therapy.

4. Attend family therapy

An eating disorder exists in an individual, but it’s also often a symptom of family dynamics. It can help to expand your view of the problem. Rather than focusing all your effort on your child’s behavior as the issue, seek support in working together to improve attachment, communication and safety in your family as a whole.

This is where family therapy comes in. Once you have made some progress on your relationship with your child, you should be able to ask them to join you for family therapy. You can do this even if your child is still refusing treatment for the eating disorder. Take your time setting this up, and get help from your therapist or coach to optimize your chances of success.

Interview different therapists to find someone who will help, not hurt the process. You are looking for someone who has experience with parent-child relationships and is aligned with you on healing the relationship and encouraging your child to explore the option of eating disorder treatment.

Your child may refuse family therapy. They will likely assume you’re attending family therapy to “fix” them. Help them understand that family therapy is about repairing your family dynamic. Make sure you believe it will help all of you. It will.

If your child believes the family therapy is because they are a bad child, they will refuse to go. If the child believes the family therapy is meant to “fix” their eating disorder, they will refuse to go. So be very clear that family therapy is about healing your family dynamics.

The purpose of family therapy is for you to build a stronger connection with your child, to gain some parenting skills, and to help them express themselves fully to you in a safe space. You will learn some communication skills and work on expressing yourself authoritatively and compassionately while unconditionally accepting your child exactly as they are.

5. Enjoy your child

Your child’s eating disorder may feel like the worst thing to ever happen to you. You may think that enjoying time with your child while they refuse to get eating disorder treatment is enabling the eating disorder. But eating disorders are complex, and they take time and patience to treat. Ultimatums rarely help and can be harmful.

It’s OK, even advisable, to enjoy time with your child. Don’t treat them as if they are only their eating disorder. They are still your child, and they still need you to love them and accept them. In fact, loving and accepting them while making improvements to your parenting practices may be the best way to encourage your child into eating disorder treatment.

Most people who have eating disorders can and do recover. Taking the steps outlined above, embracing your potential to change, and improving your parenting techniques will help make that happen. The happy side effect of all of these steps is that your family will become more bonded and stronger in every way. And hopefully, your improved relationship will help your child accept support and seek eating disorder recovery.

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

She’s the founder of and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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