Grace reached out to me with a common question, “I want to talk to my kids about food but it’s really scary with all the junk out there and my youngest doesn’t eat vegetables and my oldest is restricting; I don’t want to make things worse but I don’t know what to do.” 

Grace has two kids, and she worries about different problems with each. With her youngest, she worries about binge eating foods like chips and cookies. With her oldest, she worries about restrictive eating, skipping meals, and weight loss. She’s afraid that either or both are developing an eating disorder. And her fear leaves her paralyzed. “I don’t know what to do or say,” she says. “It seems like no matter what I say, it’s wrong for one or both of them. So I’m trying not to say anything, but that’s no good, either.”

She’s not alone in this fear, so to work through some options and ideas, I interviewed Heidi Schauster, MS, RD, CEDS-S, SEP. Heidi is a nutrition therapist and Somatic Experiencing (SE) Practitioner in the Greater Boston area who has specialized in eating and body-image concerns for nearly 30 years. Her most recent book, Nurture: How to Raise Kids Who Love Food, Their Bodies, and Themselves, addresses many of parents’ biggest concerns about raising kids with a positive relationship with food and their bodies. 

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Widespread food fear

One of the biggest challenges facing parents today is the tremendous quantity of moral judgment and fear around food. While this has been an issue for decades, the Internet and social media have amplified it. In the past, fearful food messages were limited to traditional media formats, which allowed for some gatekeeping of the message. It was imperfect at best, but there were limits on the quantity of information disseminated. 

Today, anyone can start a social media brand, blog, or Substack and share their personal and unqualified beliefs about food with millions of people. One of the best ways to go viral on these platforms is to stoke fear and confusion, then provide the illusion of certainty with a simple program or product guaranteed to bring results. Springboarding off diet culture’s proven playbook, individuals with no formal nutrition training and questionable intentions have massive audiences with whom they share alarming food messages. 

“There’s so much information out there about food and what you should eat and shouldn’t eat,” says Heidi. “We hear things like ‘This food is good and this food is bad.” There’s so much polarity. What I encourage parents to do is talk about food in a more pleasure-oriented way that centers connection. I encourage parents to make food with their kids and make mealtime pleasant because you want them to appreciate the other aspects of eating beyond nutrition.”

“In fact, I don’t think young kids need to learn much about nutrition,” says Heidi. “They have plenty of time to do that when they’re adults. More than anything, kids need to learn that food helps them get through their day and be able to focus at school. It helps them to be able to ride their bike and do all the things they like to do. And eating is a place and time where we rest, stop what we’re doing, and nourish ourselves and each other. I suggest we focus more on nourishment and less on nutrition.”

Kids learn about food by example

Diet trends go viral daily on social media, often suggesting we cut out certain nutrients or entire food groups. Parents do their best to be rational about restrictive diets. Nonetheless, children instinctually interpret food restriction as a symptom of fear. When food gets charged with fear, the risk of disordered eating, including binge eating, restriction, and purging, increases. 

“There’s so much fear around what we eat on the Internet,” says Heidi. “And there’s nothing wrong with wanting to take good care of your body and feed it well and take care of it. But fear-based messages around food for whatever reason are not helpful.”

“It’s common for parents to follow a prescribed plan or eliminate certain foods or whole food groups,” says Heidi. “Then it’s tricky to figure out how to communicate that to their kids. For example, they know their kids need carbohydrates, but the parent doesn’t want to eat them. So how do they navigate that space?”

“And my answer is you have to eat them,” says Heidi. “You do this partly for yourself because our brains and bodies need carbohydrates. But also, your kids are watching you. If you want them to eat a diverse, well-balanced diet and have an open palate, then you have to show them by example. They absolutely pick up on whether or not Mom is eating the same things as everybody else.”

Relaxing your food fear

Of course, parents don’t have absolute control over how their kids feel about food, but we are very influential. Since we are bombarded with daily messages about food fear, it’s important to model a secure, unafraid relationship with food. 

“I think being as relaxed as possible in our own relationship with food and our bodies is so helpful,” says Heidi. “As parents in this culture, we all must do our own work. We need to examine our biases around bodies and our attitudes about food so that we can be as relaxed as possible for our kids.”

“I think one of the reasons we get uptight about food is that our lives feel chaotic, and it feels good to have our ducks in a row about our food,” says Heidi. “But many times, it’s displaced control, and it’s not actually helpful. If the parent or the food environment is stressful or rigid and there’s a lot of anxiety around it, then children take that on.” 

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Managing disordered eating patterns

Parents can and should work on our own relationship with food. Meanwhile, if you’re seeing disordered eating behaviors in your child or teen, have them evaluated for an eating disorder. Beyond that, reading a book like Nurture can be very helpful. You can also work with a non-diet RD to create a meal structure and plan that works for your family. 

“I love it when families are willing to examine what they might be able to do differently in their family culture around food,” says Heidi. “I know that family culture around food isn’t the only influence on disordered eating, but it is important in the healing process to do what we can at home to create a nourishing environment.”

“This is not about saying you’re to blame if your kid has trouble with food or that it’s all about you,” says Heidi. “There are so many factors that put someone at risk for an eating problem of any type. But I think parents have influence and need support if they have a child struggling.” 

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Ginny Jones is the founder of More-Love.org, and a Parent Coach who helps parents who have kids with eating disorders.

Avoidant Restrictive Feeding Intake Disorder, called ARFID, is a type of eating disorder that’s characterized by many of the same symptoms as anorexia, but it differs in that the reason for food restriction is not driven by a desire for weight loss. People with ARFID are unable to meet their body’s nutritional and caloric requirements, which results in physical, cognitive, and emotional symptoms. They may also experience social anxiety and isolation, since eating with others can be difficult for them. 

There are three main ways a person with ARFID, a type of eating disorder, restricts food: 

• Eating enough food: someone with ARFID may be disinterested, dysregulated, or disgusted by food, which leads them to under-eat even if they know they should and/or want to eat. 
• Eating regularly: someone with ARFID may forget to eat or not notice their hunger signals, which leads them to skip meals and snacks, creating a vicious cycle of under-eating and over-hunger that sometimes but doesn’t always result in binge eating. 
• Eating a variety of food: someone with ARFID may have a very limited list of foods they are willing and/or able to eat, which can lead to missing certain nutrients and negative impacts on their ability to eat in social settings.

How do I know if my child has ARFID or another eating disorder?

Typically a person with ARFID does not have eating disorder symptoms like a drive for weight loss or body image disruptions. However, because we live in a weight-conscious society, weight changes due to ARFID can become entangled in the disorder. For example, if ARFID results in weight loss and people praise the weight loss, the person with ARFID may develop a weight-loss mentality. In this way, a drive for weight loss can become a secondary symptom of ARFID. Other times the disorder may shift to a different eating disorder like anorexia, bulimia, or binge eating disorder.

People with ARFID typically show signs early in life, and are frequently identified as “picky eaters.” The average age of diagnosis is 12 years old. But it has been documented in children as young as six years old. Unlike other eating disorders, the rate of diagnosis for ARFID is equal for boys and girls. 

Why does a child with ARFID struggle to eat?

ARFID is still a new diagnosis, meaning the research is in its early stages. There appears to be a link between ARFID and highly sensitive nervous systems. This includes the five senses (sight, sound, smell, taste, and touch), interoception (internal organ feedback), and neuroception (the sensation of how other people are feeling). ARFID may be likely to show up alongside neurodivergent conditions like autism and ADHD. People with ARFID are also likely to have anxiety and mood disorders, which are also associated with a highly sensitive nervous system. 

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People with ARFID struggle to eat because of many reasons, including:

• Extreme sensitivity to the experience of eating as it impacts smell, touch, taste, temperature, appearance, and sounds of themselves eating and other people around them eating.
• Very high sensitivity to internal cues and sensations like hunger, nausea, appetite, and fullness.
• Extreme emotional dysregulation and anxiety around mealtimes, particularly when others are feeling stressed, upset, worried, etc.
• Anxiety about having a negative outcome from eating like vomiting or choking.
• Lack of interest in eating and/or forgetting to eat.
• Chronic abdominal pain with no known cause.

Importantly, someone can have any one of these, a combination, or all of them. Eating issues are complex and layered. Beyond the food itself, eating is social and emotional by design, so relationships can both impact and maintain disordered eating. One person with ARFID rarely looks like another person with ARFID—there are countless presentations of the disorder. 

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What is the impact on families when a child has ARFID?

Raising a child with ARFID makes something we tend to take for granted, feeding our child, full of stress and strain. Most parents spend years feeling frustrated. They hope their child will naturally grow out of their picky eating habits. It can take years before they realize that there’s something more serious going on. 

Here are some of the things parents who have kids with ARFID say: 

• Her doctor says I have to feed her more because she’s lost weight, but I’m at my wits’ end about how to do that.
• Weight loss and malnutrition mean that I have to get my kid to eat, but he doesn’t want to, so every meal feels like a battle of wills.
• He was always picky, but before he could eat enough to keep growing. Then he hit puberty, and his menu got even more restricted. Every meal is a battle. I thought getting a diagnosis would help, but I still feel confused by it.
• My child never eats the same things everyone else wants to eat, so I end up being a short-order cook.
• She refuses to try things that every other child in her class loves, no matter what we do.
• Our family meals are uncomfortable, sometimes even impossible, because he’s so angry and resistant.
• My child demands the exact same meal every day, and I worry that she’s not getting the nutrition she needs.
• At most meals he gets into a bad mood. He’s rude and aggressive at mealtimes, making everyone uncomfortable.
• My child won’t eat at school, family functions, events, or anywhere there are other people who might look at her or make fun of her for what she’s eating or not eating.
• It seems like we can’t go to restaurants at all anymore because they almost never have something on the menu that works for his restrictive diet.
• I feel so sad knowing that her peers don’t understand, tease, and even bully her for her food and eating choices at school.

What does ARFID treatment look like?

As with all eating disorders, the first treatment task is weight restoration if needed. Weight restoration is highly individualized and typically a trained healthcare provider should establish the goals. Professionals who typically have the most training in this are registered dietitians (RDs). They have undergone specialized eating disorder training, particularly those who have received training in family-based treatment. 

Typically but not always, weight restoration means bringing the child in line with their historical growth curve. Usually a child has steady growth along a weight trajectory before the eating disorder impacts weight and growth. For example, a child was in the 50th percentile for weight at ages 2, 4, 6, and 8. The historical weight data should drive weight restoration goals.

Beyond weight restoration, ARFID treatment focuses on: 

• Building emotional regulation skills for eating situations
• Eating regular meals and snacks with support from others 
• Normalizing eating enough food regularly
• Reducing anxiety around food and eating experiences
• Gradually increasing food variety and/or adding supplements to balance nutritional needs

Treating ARFID doesn’t end when weight is stabilized, because it’s about much more than weight. Being underweight can increase symptoms. However, gaining weight doesn’t remove the underlying sensitivities that likely drove the disorder in the first place. 

What can parents do to help kids with ARFID?

While recovery from ARFID is hard, it’s possible. And there’s a lot of evidence that family participation makes a big difference! 

The most common method for weight restoration is family-based treatment for ARFID (FBT-ARFID). This can be done with a therapist, coach, dietitian, or DIY using books and online resources like FEAST. The parent-based training program Supportive Parenting for Anxious Childhood Emotions-ARFID (SPACE-ARFID) is also effective.

While parents can certainly DIY eating disorder recovery, it’s usually best to get support and expert advice along the way. ARFID, like any eating disorder, is a difficult and frustrating condition to parent through. When parents are on the frontline, they really benefit from getting help and training.

Signs of recovery from ARFID

Recovery from ARFID, like any eating disorder, is definitely possible! Your child may always be sensitive to food and eating situations. However, they can leave disordered behavior behind and learn healthy, adaptive coping methods that help them thrive. 

Here are some of the things parents who have kids who recovered from ARFID say: 

• It took effort, and we all played a part in recovery, but today things are a lot easier for her, and she’s able to maintain her energy levels and eat socially, which is our primary goal.
• I’ve noticed so much less stress at mealtimes, and now we’re all enjoying our time together so much more. 
• Getting to that goal weight was so important, and I feel like in many ways I got my sweet boy back from the brink. His mood improved and his anxiety levels dropped with every month he stayed within his weight range, and things have been going really well!
• It feels like a chicken and an egg situation! She was so resistant to eating anything, but it took eating a little more at each meal, eating more regularly, and slowly trying new things to start being able to eat like she had before the disorder. 
• The biggest difference is that he’s so much less depressed and anxious. I thought we were looking at a lifetime of medication, but it turns out that the things we learned in recovery have turned everything around, and the future looks much brighter now. 

All types of eating disorders are hard to manage, but recovery is possible, and parents can help!

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Ginny Jones is the founder of More-Love.org, and a Parent Coach who helps parents who have kids with eating disorders.

See Our Parent’s Guide To The Different Types Of Eating Disorders

Cyrus is worried about his son Miles, who was recently diagnosed with binge eating disorder. “I honestly don’t understand what is going on, or what we are supposed to be doing at home to help,” says Cyrus. “We’ve got Miles in therapy, but other than that, we’ve received no guidance about what we should be doing. Are we supposed to keep binge foods out of the house? Should we remind him that binge eating is not healthy? Is there a cure for binge eating disorder?” 

These questions make sense, and it’s frustrating that Cyrus isn’t getting more guidance as he faces this challenge. Binge eating disorder is a very common type of eating disorder, but it’s extra tricky to handle it in our society, where binge eating and weight gain are criticized and deeply feared. The good news is that there is a lot that Cyrus can do to help Miles recover. 

What causes binge eating disorder?

All eating disorders are biopsychosocial disorders, which means they are caused by a combination of biological, psychological, and social factors. 

For example, a child may have a genetic predisposition and traits that make it more likely they will develop an eating disorder. Specifically, there are neurobiological traits that make some people more sensitive and responsive to hunger cues, the physical sensations, and emotional experience of eating. Additionally, people who have ADHD or autism are more likely to develop eating disorders than the general population.

Psychologically, a child may have traits including perfectionism, impulsivity, anxiety, and depression, which increase the likelihood of developing an eating disorder. People who have OCD, GAD, PTSD, and other common mental health issues are more likely to develop eating disorders.

Finally, our social environment encourages eating disorders. We live in a culture in which parents, teachers, doctors, and coaches all worry about children getting fat. Meanwhile, peers tease and bully fat kids. This is not only about individuals being fatphobic; it’s the result of weight stigma, which is baked into our culture.

The outcome of weight stigma is not a thinner population, but a population that is so afraid of fat that we encourage food restriction and body shame. Counter-intuitively, both these things predict weight gain and, of course, eating disorders. 

Society doesn’t cause eating disorders by itself, but if biology and psychology load the gun, our society is standing by at the trigger, just waiting to pull it.

What is the cure for binge eating disorder?

Many people assume that the problem with binge eating disorder is binge eating. However, binge eating is the very top of binge eating disorder symptomology. 

Shame triggers binge eating, and binge eating triggers shame. It’s a self-perpetuating loop, which is why it’s usually best to address the other symptoms and causes rather than the binge eating itself. Trying to stop binge eating without addressing its causes is ineffective and even harmful.

Eating disorders have both physical and emotional components. Therefore, your child needs both psychotherapy and nutritional therapy. 

A therapist can support your child in understanding their unique psychology and develop coping skills. They should also address any underlying mental health conditions, especially ADHD, autism, anxiety, OCD, and PTSD. Unless these conditions are treated, it will be very hard to recover from binge eating disorder. 

In addition to a therapist, a certified eating disorder dietitian (CEDRD) can support your child in learning how to eat in a way that will minimize binge eating episodes. The biggest physical risk factor for a binge eating episode is skipping meals and restricting food. 

Many people who have binge eating disorder eat too little and/or go too long between meals. This exacerbates the problem and increases the likelihood of binge eating. The most important physical treatment for binge eating disorder is feeding the body regular meals and snacks and eating enough food throughout the day. 

How can parents help with binge eating disorder? 

Parents alone can’t cure binge eating disorder; you’ll need professionals on board to help. But parents play an essential role in recovery. Parents can help kids recover from binge eating disorder by following these five steps:

1. Feeding structure

The biggest risk factor for a binge eating episode is not eating enough food. Skipping meals and restricting food are common, particularly for kids in larger bodies who are afraid of weight gain. However, restriction sets them up for larger and more frequent binge eating episodes. Parents should take an active role in recovery by feeding kids three meals and 2-3 snacks per day. Your child should not go more than 2-4 waking hours without eating. 

Additionally, eating should be an important aspect of family life, and family meals should happen as often as possible. Binge eating is often done in secret, so it’s important to model the social nature of eating together and sharing meals. Eating is an important social and emotional activity, so pleasant family meals should be a priority.

2. All foods fit

Many parents are worried about kids’ health and weight and restrict kids’ sugar and “junk food” intake. This is popular advice, however, the evidence shows that restricting food to only “healthy” options at home increases kids’ likelihood of binge eating. Work with a non-diet registered dietitian to build your comfort with a wide variety of food. Yes, you should serve veggies and fruit, but you should also serve snack foods and desserts. A healthy diet incorporates all sorts of food. Restriction is a major trigger for binge eating episodes, so avoiding it is key. 

3. Weight is not the same as health

It’s natural in our culture to be afraid of weight gain. Many parents believe they must keep an eye on their kids’ weight and worry about weight gain. But weight is not the same as health, and worrying about weight is associated with weight gain and eating disorders. Instead of worrying about your child’s weight, learn about a non-diet approach to health, which is shown to improve health behaviors and health outcomes. This approach focuses on healthy behaviors like eating, moving, sleeping, stress management, belonging, and human connection. Unlike weight control, these behaviors improve health with zero side effects.

4. Emotional regulation

Once you have your child in therapy to address underlying mental health conditions, you need to build their emotional regulation skills at home. Whether we mean to or not, parents teach kids how to regulate their emotions from the time they are born. It’s embedded in our DNA to learn emotional regulation from parents. Most people with eating disorders lack emotion regulation skills. Luckily, due to your role as their parent, you are by far the best person to build your child’s emotional regulation. Literally nobody else can do it as quickly and effectively as you. Get intentional about teaching and modeling emotional regulation skills and you’ll make a big difference, fast. 

5. Avoid shame

Above all, you want to avoid bringing shame to the process of eating and weight. Things like telling your child to eat less, pointing out that binge eating is leading to weight gain, and locking up food can be harmful. While doing these things might make intuitive sense to you, they are not an effective cure for binge eating disorder and can make things worse. 

Food and body shame lie at the heart of eating disorders and drive disordered behavior, so you don’t want to add to it. Work on your own issues with food and weight, and talk about your fears and worries with another adult, not your child. You should never criticize your child’s eating and weight.

If you are tempted to criticize your child’s eating or weight, shift your energy to the other four steps I’ve described. They are much more likely to help your child recover.

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Ginny Jones is the founder of More-Love.org, and a Parent Coach who helps parents who have kids with eating disorders.

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

See Our Parent’s Guide To The Different Types Of Eating Disorders

Avoidant restrictive food intake disorder (ARFID) is an eating disorder that features highly selective eating patterns. The major risk for kids with ARFID is not getting enough nutrients and becoming weight suppressed, which can interfere with growth and overall health. Getting expert advice when a child has ARFID can help parents understand what their child is going through and support recovery from this eating disorder.

ARFID is strongly associated with kids who are highly sensitive. This sensitivity often includes being sensitive to food flavor (taste and smell) or texture. But eating is a 5-senses experience, so a child may also be sensitive to the way food looks and even the way it sounds and the sounds of others eating. Beyond the 5 senses, kids who are highly sensitive may also be very tuned into the emotional experience of eating and how their parents and others around them feel when eating. 

ARFID is typically seen beginning at a young age. It is strongly associated with people who have ADHD and autism. Over time, ARFID can cascade into another eating disorder such as anorexia, bulimia, or binge eating disorder. It is typically characterized by high levels of anxiety about food and eating. Behaviorally, someone with ARFID will refuse to eat foods that make them feel anxious. Without intervention, the list of “safe foods” can dwindle to just a handful of options. 

Many parents feel overwhelmed when their child has ARFID, but there are very good treatments available, and there is a lot that parents can do to help. 

I interviewed two dietitians who specialize in treating ARFID, Rebecca H. Thomas RD, LDN, and Stefanie Ginsburg, RD, CEDS-S. They are members of the ARFID Collaborative, a group of clinicians dedicated to increasing ARFID awareness, education opportunities, training options, and treatment access. 

Here is their expert advice for parents who want to support their child’s recovery from ARFID: 

How do you explain ARFID to parents?

When we paint the picture for parents of what it is like to have ARFID, we ask them to think of some of their fears or things they dread doing. This may be flying, waiting at the DMV, a fear of heights, or maybe it’s creepy crawly things, like snakes or spiders. 

Then we ask them to imagine having to engage with that fear or disliked thing, at least 3 times a day! All the while, enduring pressure and shame from an authority figure (maybe a boss or professor) for not being able to manage this easily. 

Think about how doing this on a regular basis might affect your motivation to participate in daily activities that involve these fears. This can be what it is like for children who have ARFID.

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What is the hardest part of treating ARFID from your perspective? 

There are so many obstacles within the treatment for ARFID. We would have to say the hardest part is helping parents and clients stay motivated to continue care. Progress with food acceptance and increasing dietary variety can take a long time and requires consistency and endurance. 

Oftentimes parents are overwhelmed with their child’s struggle and with the amount of work it takes them to carry over the treatments from sessions into daily life. It can feel disheartening when you’ve spent months working on one food, and they are still only taking one bite. We try our best to let them know that things DO get better and easier and part of our role is to cheerlead even the smallest of wins and successes.

What treatment do you recommend for ARFID? 

We recommend a hybrid-individualized approach that incorporates CBT-AR, Satter’s Division of Responsibility of Feeding, FBT-AR, food chaining, and food exposure therapy. 

We have seen the most success with children when families are re-feeding from home and are being consistent providing the food we are working on at home between sessions. Parental commitment is an essential part of treatment.

How can parents be helpful in treating ARFID? 

Presence and consistency. As we mentioned before, treatment is a 50/50 effort. Providers can give you guidance, coaching and resources, but ultimately, it is the caregivers showing up everyday to say: “I know this is hard for you, but we can do hard things. Let’s figure out how to get through this meal/food together” that is going to be the most helpful.  

It can also be helpful to remind them that we do not have to “like” a food in order to eat it. We think there is a fair amount of unnecessary pressure to like all the food you eat. A lot of our normalized eating consists of eating and drinking items that can be tolerated.

How do you measure recovery/What does recovery look like?

Recovery from ARFID involves the following key elements:

1. Ability to maintain nutrition status
2. Preventing unwarranted weight fluctuations
3. Being free of nutritional deficiencies
4. Having enough energy to do daily activities
5. Staying on a regular growth trajectory
6. Managing daily eating with minimal distress
7. Dietary variety

The term recovery when it comes to ARFID is typically a life journey. It involves both acclimating to and building resilience for food-related anxieties or indifferences. One degree of change helps pave the way for ongoing progress in recovery.

Food Refusal & Picky Eating Printable Worksheets

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What resources/books do you recommend to parents who have kids with ARFID? 

• How to Nourish Your Child Through an Eating Disorder by Casey Crosbie RD, CSSD  Wendy Sterling MS, RD, CSSD.  
• Helping Your Child with Extremely Picky Eating by Katja Rowell, MD  Jenny McGlothlin MS, SLP  
• Avoidant Restrictive Food Intake Disorder: A Guide for Parents and Carers by Rachel Bryant-Waugh  
• Raising Adventurous Eaters: Practical Ways to Overcome Picky Eating and Food Sensory Sensitivities by Lara Dato MS OTR/L, SC-FES  
• Food Refusal and Avoidant Eating in Children, Including Those with Autism Spectrum Conditions. A Practical Guide for Parents and Professionals Book by Elizabeth Shea and Gillian Harris.  
• The Picky Eater’s Recovery Book by Dr. Jennifer Thomas (For those that have teens or young adults with ARFID)

Regardless of the type of eating disorder your child has, including ARFID, expert advice can help you support your child’s recovery.

See Our Parent’s Guide To The Different Types Of Eating Disorders

There are four red flags that a child has binge eating disorder, and some of them may surprise you. Binge eating disorder is the newest eating disorder in the DSM-5, the diagnostic manual used in the United States. Most people think of binge eating disorder as the opposite end of the spectrum from anorexia. They assume that people who have binge eating disorder love eating “too much,” lack self-control and have high body weight. 

However, these assumptions are both incorrect and dangerous. They can interfere with our ability to recognize and treat binge eating disorder. Here are the red flags parents should know about and how to respond to them when they show up in a child.

💡Remember: Binge eating disorder is a mental disorder, and therefore we want to pay attention to the state of mind that drives the behavior and the mental impact of their behavior. 

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1. Binge eating episodes

Binge eating disorder is defined by binge eating episodes. These are specific episodes during which the person consumes more than is typical, faster than usual, and gets uncomfortably full. In contrast, a person can consistently and mindfully consume large quantities of food and feel satisfied and pleasantly full afterwards. This person is not binge eating. 

A binge eating episode is typically defined as consuming an unusually large amount of food in a short period of time. This will vary from person to person. One person’s “normal portion” can be very different from another person’s. But in general we’re looking for a quantity of food that exceeds that individual person’s “normal” serving size. 

Additionally, a binge eating episode involves consuming food more rapidly than normal. You will see your child eating more quickly, and maybe more messily than is typical. A binge eating episode may involve eating food when not hungry, when the food isn’t particularly palatable, and/or to the point of being uncomfortably full. This is due to the mindless or numb state which often accompanies binge eating episodes. 

💡How to respond to binge eating episodes: Never shame or embarrass your child for binge eating episodes. They result in significant physical and mental pain and suffering. Be kind, gentle, and accepting of your child during and after a binge eating episode. Soothe their body and mind with compassion and empathy. If your child has at least one binge eating episode per week for three months in a row, they qualify for a binge eating diagnosis and should be evaluated and treated as soon as possible.

2. Sneaking, hiding, and lying about food

Binge eating disorder involves tremendous shame and embarrassment. Therefore, a key symptom of binge eating disorder is signs of shame like sneaking, hiding, and lying about food and eating. It’s very important to keep in mind that shaming or embarrassing your child for doing these things will make binge eating disorder worse, not better. Treating shame with shame only makes shame worse and, therefore, the symptoms of shame more severe. 

💡How to respond to sneaking, hiding, and lying about food: If your child is frequently eating food alone to avoid embarrassment, that may be a symptom of binge eating disorder. Many parents believe the treatment for sneaking and lying behavior is to expose the behavior and talk about it as something that needs to stop. But you want to be very careful about how you approach this to avoid triggering more shame and pain. Get your child treatment and learn how to talk about food and eat together as a family without triggering the urge to sneak and hide while eating. 

3. Shame and despair

Remember that eating disorders are mental disorders. So while there are behavioral patterns you can observe, shame and despair are most likely driving the behaviors. In binge eating episodes, your child may be coping with unconscious emotions by eating. People with binge eating disorder experience a loss of control over their eating. They feel compelled and driven to eat in ways that do not make them feel good. 

Criticizing binge eating behaviors is deeply damaging and will make your child’s disorder worse. A child who has a binge eating episode will likely feel disgusted, depressed, and guilty after eating. They are experiencing extreme distress around the most natural and necessary human behavior: eating. 

💡How to respond to binge eating shame and despair: Never forget that your child’s binge eating episodes are physically and mentally painful. Do not prohibit your child from eating, limit their access to food, or restrict their eating. Instead, support them in emotional literacy and emotional regulation. Validate their feelings to build their self-worth and make them more resilient against shame. You doing this is possibly the most important ingredient for your child’s recovery from binge eating disorder.

⭐⭐⭐⭐⭐

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4. Restricting food

Something that surprises many people is that a key sign of binge eating disorder is food restriction. Most people are so focused on the binge eating episodes that they don’t realize there is often a period of restriction preceding binge eating episodes. Most types of eating disorders have some form of restriction.

This often means skipping breakfast, or not eating all day. Physiologically, such restriction will result in a significant drive for food at the end of the day. The body will be literally starving. This drives the mind to become obsessed with food and feel compelled to eat a large quantity of food. Such cycles are very often present in people who have binge eating disorder but are rarely discussed. 

💡How to respond to restricting food: Make sure that you are doing the work to feed your child regularly throughout the day. Parents must prioritize feeding their kids’ bodies at regular intervals. During eating disorder recovery, your child should eat three full meals and 2-3 snacks every day on a regular schedule. This means eating every 2-4 hours. Just like with anorexia, parents must take responsibility to ensure their child with binge eating disorder eats regularly and adequately. When this happens, while the psychological urge to binge may continue, it will not be amplified by physiological urges. 

How to help a child with binge eating disorder

If you suspect your child might have binge eating disorder, the first thing you should do is set an appointment with an experienced eating disorder professional. Unfortunately, binge eating disorder is terribly misunderstood and well-meaning professionals can do more harm than good if they don’t have specialized training in treating kids who binge eat. Our directory has non-diet professionals who can help. 

You should ask whomever is going to meet with your child how they view binge eating disorder and whether they ever support or recommend food restriction as a path to binge eating disorder recovery. If so, you may want to reconsider their training and background. Bringing diet culture and weight stigma into binge eating disorder is extremely dangerous and should be avoided at all costs. 

Next, prepare and serve your child food regularly throughout the day. Since restriction is often the first step in a binge eating episode, you want to feed your child regularly. If your child refuses to eat, then you’ll know that the true issue is not the binge eating, but the restriction. 

Finally, work on your own issues with food, weight, and eating. Few of us are free from disordered beliefs about these complex issues. Most of us need to relearn how to approach food and eating from a non-diet perspective. This isn’t your fault, but rather a symptom of growing up in our body-negative, food-negative culture! Seek support and guidance as you work on your own relationship with food and your body from a coach, therapist, or other professional who approaches health from a non-diet perspective.

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Ginny Jones is the founder of More-Love.org, and a Parent Coach who helps parents who have kids with eating disorders.

See Our Parent’s Guide To The Different Types Of Eating Disorders

Arianna had an eating disorder for a few years before getting a diagnosis. “It’s all so obvious in hindsight,” says her mom, Renee. “She had all the classic symptoms of an eating disorder except she didn’t look like she had an eating disorder. I just didn’t know what to look for.”

Renee’s not the first parent to miss an eating disorder due to the biases and assumptions that drive our cultural understanding of eating disorders. Most people assume that an eating disorder has a “look.” But in fact, the majority of eating disorder diagnoses are not for anorexia. They’re for Other Specified Feeding and Eating Disorders (OSFED). This guide will help you understand OSFED, a serious and often-missed eating disorder.

OSFED is the most common eating disorder. The symptoms cause significant distress but do not fit into the strict criteria for anorexia, bulimia, Avoidant and Restrictive Food Intake Disorder (ARFID), or binge eating disorder.

The advantage of a catchall OSFED category is that people can get a diagnosis for an eating disorder even if they don’t meet the narrow criteria for other disorders. The drawback is that even though it’s very common, few people outside of the eating disorder community know what it is. It also means that people who have very different symptoms get grouped together in a category despite needing very different care.

Exploring weight bias in eating disorder treatment

Among other things, OSFED is used to categorize people who meet all the criteria for anorexia except low body weight. Anorexia is the only mental disorder that carries BMI criteria. To get diagnosed with anorexia you must have a “significantly low BMI.” But BMI is a population tool that was never meant to be used to determine individual health. 

BMI (body mass index), which is based on the height and weight of a person, is an inaccurate measure of body fat content and does not take into account muscle mass, bone density, overall body composition, and racial and sex differences.

Medical News Today

The problem with BMI as a diagnostic for an eating disorder is that if someone was born and has lived their life in the 100th percentile for weight and drops to the 50th percentile, they are very ill, but they don’t technically have a “significantly low BMI.” 

Assumptions about weight and eating disorders can slow down diagnosis. That’s what happened to Renee. “I saw all the signs of an eating disorder,” she says. “She was restricting her food, and definitely over-exercising. I could tell she had a negative body image, though she didn’t talk about it with me very often. But when I tried to talk to her pediatrician about it, the doctor was so pleased about Arianna’s weight loss and fitness routine that he brushed me off.”

Renee is not alone. Many parents who talk to doctors find themselves frustrated and feeling dismissed because their child doesn’t fit the criteria for anorexia or bulimia. Nonetheless, they know that something is wrong. They suspect an eating disorder, but the fact that few people know about OSFED gets in the way of diagnosis.

OSFED: a misunderstood eating disorder

OSFED is poorly understood and recognized in our culture, yet it constitutes the majority of eating disorder diagnoses. When it was called by its previous name, EDNOS, more than half of all patients seen at eating disorder treatment centers were in this catchall category. 

Since OSFED is a broad category, it is often misinterpreted as being less serious. But studies have shown that people with OSFED experience eating pathology and medical consequences that are just as severe, often even more severe than those who are diagnosed with anorexia or bulimia. 

In fact, one study found that 75% of people who were diagnosed with EDNOS (now called OSFED) had comorbid psychiatric disorders and 25% had suicidal thoughts. Professionals say that people who are diagnosed with OSFED need the same level of treatment and support as those with anorexia or bulimia. And untreated OSFED often leads to a future diagnosis of anorexia, bulimia nervosa, or binge eating disorder. 

A lack of understanding

Renee kept pushing for answers, and Arianna was diagnosed with OSFED about a year ago. Aside from the delay in treatment, Renee is frustrated by friends and family who don’t understand. “It’s really invalidating when my friends assume that because she doesn’t have anorexia or bulimia it’s somehow not serious,” she says. “And if I feel invalidated, I can only imagine how she feels!” 

Most people assume that when someone has an eating disorder it must be anorexia. But less than 6% of people with eating disorders are medically diagnosed as “underweight.” If parents and loved ones only think of eating disorders as having the look of emaciation, we risk under-diagnosing and under-treating the majority of eating disorders.

Weight is a very tricky element of eating disorder diagnosis and treatment. Parents can’t assume that a child’s weight alone is a sign of health or illness without careful evaluation of emotional and behavioral symptoms that will more reliably indicate an eating disorder. That’s why I created this guide to OSFED, a poorly-understood eating disorder.

One key is to recognize the behavioral and emotional signs that typify most eating disorders.

Behavioral symptoms of eating disorders

Here are the behavioral symptoms that commonly cross across all eating disorders: 

• Different eating behavior, particularly skipping meals, eating less in public, sneaking food, lying about food, etc.
• More emotional outbursts like yelling or crying, or emotional withdrawal
• Marked changes in social behavior like being more or less socially active, getting a dramatically different friend group, etc.
• Body checking and monitoring with a scale, mirror, reflective surfaces, etc.
• Wearing tighter or looser clothing and/or changing outfits frequently because nothing seems right
• Talking about their body and other people’s bodies, what they’re eating, what they weigh, etc.
• Sudden interest in “health” foods, nutrients, carbs, sugar, and fat
• Increased exercise and a lack of flexibility about exercising (e.g. I have to exercise to feel OK)
• More interpersonal conflicts and social isolation

Emotional symptoms of eating disorders

Here are the emotional symptoms of most eating disorders:

• A tendency towards perfectionism and/or binary (black and white) thinking patterns
• History of trauma
• Anxiety and/or depression
• Lack of emotional regulation skills to manage feelings of stress and anxiety
• A sense of being different or “other” 
• People-pleasing
• Low self-worth
• Strong desire to be “good” as defined by society
• Defensiveness, particularly when confronted about unusual eating behaviors
• Irritability and moodiness

Even if your child never meets the diagnostic criteria for an eating disorder, these behavioral and emotional signs are enough to warrant therapy. This can help prevent a future eating disorder.

What to do if you suspect OSFED

This guide will help you spot whether your child has an eating disorder and understand OSFED in particular. If you suspect your child has an eating disorder, please follow these steps: 

1. Take a deep breath, and remind yourself that this is hard, but you can handle it. Your emotional reaction is understandable, but you’re going to need a lot of self-compassion to get through this.
2. Contact your child’s physician and have them physically evaluated to check for any physical symptoms of an eating disorder.
3. Schedule an appointment with a therapist and/or dietitian who specializes in eating disorders. These are people who are trained specifically to diagnose and treat eating disorders. Particularly with OSFED, you want an eating disorder specialist, not a general therapist or dietitian.
4. Educate yourself by learning as much as you can about eating disorders in general and your child’s specific symptoms.
5. Find out how you can change your own home environment to support your child’s recovery. Eating disorders are highly responsive to social environments, so you will need to make changes to foster change.

Catching up with Renee

Renee says that Arianna is doing well with treatment. “I wish we had started earlier, but I’m also glad I pushed so hard for the diagnosis,” she says. “She’s actually been doing really great, and our whole family has adjusted to support her mental health. It’s made a difference for all of us. We’re all feeling better these days!”

I know that having a child with any type of eating disorder is hard, and I hope this guide to OSFED is helpful.

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Ginny Jones is the founder of More-Love.org, and a Parent Coach who helps parents who have kids with eating disorders.

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

See Our Parent’s Guide To The Different Types Of Eating Disorders

Eating disorders are so challenging, and one of the reasons is that what causes eating disorders is complicated. Eating disorders are complex and multi-layered. The people who develop eating disorders are worthy of so much compassion and love. I hope this article brings some color to the conversation and helps you understand eating disorders more clearly.

I’m sharing all my knowledge of decades living with an eating disorder and several years in full recovery. I’ve built on my own experience with many years spent researching and studying eating disorders. And I’ve also interviewed hundreds of professionals who treat eating disorders, people who have eating disorders, and parents who have kids with eating disorders.

From my perspective, the information currently available about eating disorders is clinical, dispassionate, and biased. These rigid clinical diagnoses and behavioral descriptions of eating disorders keep us locked in place. We miss the larger truth of why eating disorders occur and what comprehensive treatment looks like.

What follows is a wholehearted description of how I see eating disorders right now. This is personal but also factual. I’m not going to give you a boring, dispassionate account of the technicalities of eating disorders. Rather, this is an attempt to share the human reasons we suffer. And, hopefully, how we can find our way to recovery.

Remember that each eating disorder is unique. Therefore, this article is just one lens through which to view eating disorders.

What causes eating disorders?

A combination of biological, psychological, and social factors contribute to eating disorder development. 

Biological:

• Genes appear to play a role in eating disorder development. There is not a single gene recognized as the cause of eating disorders. But there are numerous genes that researchers have identified as common among people who develop mental disorders. This may explain why eating disorders typically show up alongside other disorders like anxiety, depression, substance abuse, etc.

• Epigenetics is a sort of code that triggers genetic activity. A person may have the genes that underlie mental disorders. But researchers agree that genes alone don’t cause mental disorders. Epigenetic triggers come from environmental conditions beginning in utero. They can even pass through generations in a family. It appears that epigenetics can be shaped by trauma, abuse, and neglect (physical and emotional).

• Neuroception is a body-based sensation of being either safe or unsafe. Developed by Dr. Stephen Porges, neuroception means that neural circuits in the body distinguish safety or threat and cue the body to respond physiologically, emotionally, and cognitively. When neuroception senses emotional and physical threats, the body responds with a state of fight, flight, freeze, or shutdown. This impacts every aspect of the physical and emotional experience of being alive. A person who has an eating disorder is often living in a heightened state of threat, sensing danger in their body and mind and seeking comfort and safety in their eating disorder behaviors.

Psychological:

• Anxiety is a common partner to eating disorders. Since it can be hard to spot, it may be helpful to know what anxiety looks like. In its more active form it looks like perfectionism, people-pleasing, and codependency. In its less active form it may look like procrastination, avoidance, and withdrawal. Other signs include chronic shame, stress, and worry.

• Emotional regulation skills are likely protective against eating disorders. Emotional regulation is something children learn from parents beginning in infancy and extending through early adulthood. When adequately developed over time, a person becomes able to self-regulate. Sometimes we miss emotional developmental milestones. When this happens, a person will have trouble self-soothing and responding appropriately to everyday stress and disruption.

• A person who has an eating disorder may believe that their identity – who they are – is based primarily on what they look like and what they do. This belief can lead a person to try and “perform goodness.” When this happens, a false self takes over and the true self is hidden in shame and unworthiness. This can happen when a family and/or society teaches a person that they need to change who they are and how they behave to be loved. Healing takes place when the true self is allowed to emerge and be loved as-is.

• Mental disorders often appear in clusters, and eating disorders are part of a larger psychological ecosystem. Disorders that commonly show up with eating disorders are autism, attention deficit hyperactivity disorder, anxiety, depression, suicidality, self-harm, substance abuse, and obsessive compulsive disorder. These disorders should be addressed holistically. Otherwise, an eating disorder may fail to recede, morph into something else, or return after treatment.

Social: 

• Families are a child’s first social group. And family norms and structure shape how a child feels about themselves and the world. Families don’t cause eating disorders. However, family beliefs and behaviors about emotions and bodies can contribute to an eating disorder. For example, many parents are not aware of the role of emotional co-regulation. Therefore their kids may miss emotional developmental milestones. Additionally, many families accidentally enforce and encourage disordered eating. Therefore they may pass along harmful messages about food and bodies based on their own cultural training.

• There is a strong connection between diet culture and weight stigma and eating disorders. These two conditions lay the groundwork for the thoughts and behaviors that comprise an eating disorder. Diet culture is founded in the belief that bodies can and should be weight-controlled using food restriction and exercise. Weight stigma is discriminatory acts and beliefs against people who live in larger bodies. Diet culture and weight stigma are pervasive in our culture. And they are likely the driver behind increasing rates of eating issues in the United States. Since the BMI levels were arbitrarily lowered in 1998, the weight loss industry has grown dramatically. In 1985 the U.S. weight loss industry was valued at $10 billion in annual revenue, but today it is worth at least $72 billion.

As a culture we assume weight loss is a personal goal, but it is in fact a money-making industry.

• Cultural group oppression:
  • There is evidence that people who are not heterosexual and/or cis-gender are at higher risk of eating disorders. LGBTQ+ people are chronically oppressed in our culture. And self-repression is often required to maintain physical and emotional safety in a hostile culture.
  • While they can impact anyone, females are at higher risk than males. The most likely reason for this is the cultural oppression of females in a patriarchal, male-dominated culture. The chronic objectification of the female body leads women to self-objectify. Then they naturally fall into unhealthy pursuit of the “thin ideal” or “wellness culture.”
  • People of color are much less likely to receive a diagnosis for an eating disorder. But they are at least as likely (if not more likely) to have symptoms. The trauma of living as a person of color in a white-dominant culture likely contributes to eating disorders.

Why do people get them?

There are so many factors that contribute to eating disorders. One way to view them is as coping mechanisms. I believe they develop in response to unmanaged stress and emotional dysregulation. In our culture, stress is chronic, and many people are raised without adequate emotional regulation development. Thus, coping behaviors become essential to function within our high-pressure society. Eating disorders join shopping, gambling, gaming, sex, using drugs and alcohol, and other addictions, compulsions, and obsessions as a way to cope with life. 

An eating disorder is just another way to numb a person from the pain of being human in our society. Dieting* is constantly prescribed and weight loss is celebrated. Thus, an eating disorder often begins with a well-intentioned plan to feel better and meet societal goals. There are many false and misleading health claims associated with diet plans and weight loss. And these actively promote eating disorder beliefs and behaviors. 

While not everyone who diets will develop an eating disorder, almost all eating disorders** begin with a diet. 

*defined as any effort to lose/control weight using food and/or exercise 

**with the exception of ARFID 

What are the most common types of eating disorders?

According to research published by Hay et. al. in 2017, the rates of eating disorders are as follows:

47% OSFED. The most common eating disorder is a catch-all category called other specified feeding or eating disorder (OSFED). This category includes a mix of eating disorder behaviors.

22% BED. The second most common eating disorder is binge eating disorder. This often involves a restrict-binge cycle in which a person restricts food and then binge eats. 

19% Bulimia. This often involves a restrict-binge-purge cycle. A person restricts consuming calories for an extended period of time. Next, they eat and then seek to purge the calories consumed with vomiting, laxative use, and/or over-exercise.

8% Anorexia. This is characterized primarily by restriction and being medically underweight. It is the only mental disorder that has a BMI requirement for diagnosis.

5% ARFID. The only eating disorder that is not technically associated with a desire to lose weight. ARFID typically involves restricting food and appears to be due to sensory and emotional drivers.

While these categories may be helpful, it’s important to remember that all eating disorders are mental disorders. This means that regardless of the specific behaviors, effective treatment must get beneath the behaviors to address the underlying thoughts, beliefs, and emotional dysregulation that drives them.

A path forward

This description of eating disorders hopefully adds some flavor and nuance to what you’ve seen elsewhere. But of course each eating disorder is unique. And I can’t possibly capture the vast nature of these complex mental disorders in a single article. I hope that if you have an eating disorder, you get help and find your path to healing.

And if you love someone who has an eating disorder, please remember that there is a lot you can do to help recovery. Eating disorders are so much more than a personal problem, which means loved ones can make a significant impact.

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Ginny Jones is the founder of More-Love.org, and a Parent Coach who helps parents who have kids with eating disorders.

See Our Parent’s Guide To The Different Types Of Eating Disorders

When you have a child with anorexia, it may be necessary to teach family members about the eating disorder and explain what to say and what not to say, and a letter can work well for this. This is especially true if your child’s eating disorder is visible. While there are many eating disorders that are invisible, low-weight anorexia can be surprising and even distressing for loved ones to see. This can lead to unhelpful and even harmful comments.

One problem with eating disorders is that people think they understand them. After all, eating disorders appear simple: a person doesn’t want to eat because they want to be thin. But this definition misses the vast experience of having anorexia, its physical consequences, and the depth of its mental distortions. 

Anorexia, like all eating disorders, is a health condition, not a choice. It’s not something that even the most well-meaning and loving family member can talk your child out of. This is not a situation in which a TV-style intervention will likely be helpful.

In fact, often well-meaning family members accidentally make things worse, not better. Of course, all they want is for your child to feel better, but they are operating out of instinct, not knowledge. And unfortunately, instinct doesn’t typically serve us well when we’re dealing with an eating disorder.

What to tell family members about anorexia

If your child is visibly ill with anorexia, then it may be helpful to provide family members with some guidance about the illness, what to say, and what not to say. However, this should be done carefully and thoughtfully. Anorexia is a personal health condition, and you should respect your child’s right to privacy as much as possible.

I recommend you talk to your child about whether and how to talk about their condition with family members. You may want to bring in their therapist to help you address this. When an eating disorder is visible, it can be very helpful to educate family members so they don’t say the wrong thing. But we must be very aware of privacy when doing it.

There are no hard and fast rules about whether and how to do this, but it’s important to think carefully and consciously about how to proceed.

Following is an email/letter you could provide to family members if your child has agreed to this language. Of course, there are hundreds of ways to write this letter – this is just one option.

Family letter: about anorexia

Dear Family,

It’s been another crazy year, and we’re looking forward to seeing you at Marcy’s wedding this summer! Before we get together I wanted to share some information with you about Ellen’s health. I’m sharing this information with Ellen’s permission because we know you will have questions and want to do our best to address them before the wedding.

Ellen has anorexia nervosa. This is an eating disorder that we’re working hard to address with the appropriate professionals. When you see her, you may be surprised by Ellen’s appearance, and we’d like you to consider the best response when you see her since I know how much you love her and want her to be safe and healthy. 

Here’s what we’d like you to know:

Eating disorders are an illness, not a choice

It looks like there’s a simple choice to eat or not eat. But eating disorders are complex medical and psychological conditions that do not respond to simple encouragement or willpower. Treatment relies on highly-trained specialists.

When loved ones assume that eating disorders are a choice, their well-meaning comments can actually make things worse (not better). Please believe us when we say that we have explored the necessary options for Ellen’s care and that it’s more complex than most people realize. That’s why I’m sharing this letter with the family about anorexia. I know most people don’t know much about it, and I hope this guidance is helpful.

What to say when you greet a person who has an eating disorder

When you see Ellen, you may be tempted to say something about her appearance. But focusing on her appearance, positive or negative, can be harmful. So instead, say things like:

• I’m so happy to see you!
• It’s wonderful to catch up with you!
• I’ve missed you! 
• How are you?

What not to say: “You’re so small/thin/tiny/like a skeleton.” While you may think the person needs to “wake up” and see that they have a problem, comments about their appearance do nothing to reverse the trajectory of the eating disorder. In fact, they actually give the eating disorder a dopamine hit. This sort of comment will not “wake her up,” but it will “wake up” the eating disorder and give it more power (not less).

What else not to say: After getting this letter, you may find that Ellen’s appearance is healthier than you assumed it would be. You may be tempted to praise her for that. But it’s actually just as harmful to comment on her appearance positively as it is to comment on it negatively. Just stay away from appearance-based comments including: 

• You look so healthy! 
• You look radiant!
• You’re glowing!
• That dress fits you like a glove!

The bottom line is to please focus on Ellen as a person, not her body.

What to say when a person with an eating disorder doesn’t eat

Now that you know about her eating disorder, you may feel as if you need to encourage her to eat. Please don’t do this! If you find yourself distressed by her eating habits, you can say things like:

• So what’s been going on with you lately?
• How are you?
• Can I share something that happened to me recently? (this should not be about food, eating, weight, or health)

What not to say: “Just eat” (or any variation). This assumes that eating is a simple choice for Ellen. It’s not. This is like telling a cancer patient that they just need to stop growing tumor cells. An eating disorder is a health problem that needs to be treated by trained health professionals. Your care and love are so helpful, but please don’t try to treat the eating disorder by convincing her to eat. 

Avoid comments like:

• Try the cake, it’s delicious!
• Come on, you’ve got to try this amazing hamburger!
• Wouldn’t you like just one bite of my salad? You always liked it when you were younger!
• You look hungry! Have a bite!
• Let’s put some meat on those bones!

As with appearance, it’s best to focus on Ellen the person, not what she’s eating.

What to say when a person with an eating disorder is upset

At times Ellen may look sad or distressed to you. Please consider whether this is something that demands a response. While I’m sure you want to cheer her up and make her feel better, just like convincing her to eat, it’s rarely helpful. But if she is clearly upset and you believe the time is right, you could say things like:

• Would you like to talk?
• Weddings can be pretty stressful, huh?
• Is there anything I can do to support you right now?

What not to say: “Come on, why are you so upset? Cheer up!” Any version of “snap out of it” is like telling her to “just eat.” It’s not going to be helpful and may be harmful. Ellen, like all people, has feelings and emotional experiences. And sometimes she may be resting her face or relaxing – just because she’s not smiling doesn’t mean she’s sad. And if she is sad, we’re working on validating and supporting her rather than asking her to suppress her feelings and move on.

What to say to me

Yes, this has been a real challenge for our family, and I appreciate the concern that I anticipate you have. Sometimes I may want to talk about it, and sometimes I won’t want to. I would really appreciate it if you would treat me fairly normally by asking the usual questions like “how are you,” without asking for details about Ellen’s health. Many times I won’t be able to answer your questions. I hope you can understand this. The greatest support you can give me is compassion without questions. 

What not to say: “Have you tried acupuncture/natural medicine/hypnosis” (or any other treatment you have in mind). Please trust that we have her professional treatment team lined up and are addressing this. I’ll ask for advice if I want it, but unsolicited advice, no matter how well-meaning it is, can be really hurtful to me right now. Some other things I’d rather you not say include:

• Why is she doing this?
• How long will she have this?
• Where did this come from?
• What’s wrong with her?
• She looks so thin! 
• She looks terrible!
• Don’t all girls today have some type of eating disorder?
• My friend’s daughter had anorexia and she …

The bottom line is that I’m a lot more sensitive than usual right now.

We want to talk about other things

We are working hard to address this, and sometimes it’s nice to have a break. So what we would like most of all is to enjoy the wedding. For Marcy’s sake and for ours, we’d appreciate it if Ellen’s health isn’t a topic of conversation. I know you love Ellen and are concerned, but unless one of us seeks you out to talk about it, let’s just enjoy each other and the wedding itself.

Thank you so much for making it through this letter. I’m sure you can imagine it was hard for me to write. I hope it’s been helpful, and we look forward to seeing you in June!

Love, Jordan

How to send a letter to family about anorexia

If you decide that a letter is the best way to educate your family about anorexia, then you should first consider what should and should not be included. Every family is different, and every case of anorexia is unique. So you should create a letter that fits your family and unique circumstances.

Once you’ve settled on the letter’s content, you can either email it or mail it. Of course, email is much easier, and you have the added benefit of being able to send it to everyone at the same time. You may want to use the BCC field of emails, which will avoid having a long email chain of responses. While some families might want to include everyone and begin a big “Reply-all” email exchange, if you want to avoid that, you can use BCC.

Once you have sent the email, you should expect to hear back from people in some way. Depending on your family, these responses may be supportive and thoughtful. Some responses may not respect the boundaries you set out in the letter. This is fairly normal and to be expected. Remember that you are not obligated to answer questions about your child’s health or treatment.

A good response for overly-nosey emails is “Thank you so much for checking in. I know you are concerned and appreciate that. To respect Ellen’s privacy, I can’t share any details beyond what I included in the letter. Thanks for understanding!” Boundaries don’t have to be rude to be effective.

Another thing that might happen is that people might feel hurt that you didn’t tell them earlier or reach out for help from them. While understandable, this response also requires you to hold a boundary. You can say something like “I really appreciate your concern and know that you would have helped if you could. For now, we’re handling it the best we can. Thank you for your support!”

How your family responds to your letter about anorexia may be wonderful or make you feel bad. But either way, you should know that holding your and your child’s boundaries is valid and important. While of course people like to be informed, we don’t owe our family our children’s private health information. And remember: you are doing the best you can when you can. Thank you for caring for your child’s health and privacy.eating disorde

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Ginny Jones is the founder of More-Love.org, and a Parent Coach who helps parents who have kids with eating disorders.

See Our Parent’s Guide To The Different Types Of Eating Disorders

Watching your daughter struggle with bulimia can feel heartbreaking, overwhelming, and at times, helpless. You may be desperate to say the right thing, do the right thing, or simply understand what she’s going through. This guide is here to help you move from panic to purpose, with clear, compassionate steps you can take right now to support your daughter’s healing. You are not alone, and your support can make a powerful difference.

When parents learn how to help their bulimic daughter, everyone benefits. Bulimia can be a scary diagnosis. And like all eating disorders, it needs specialized and intensive care. But the good news is that parents can make a significant impact on recovery. Your daughter needs you. You can help.

How to help your bulimic daughter

Managing an eating disorder diagnosis isn’t easy. But parents can help by accepting and supporting their child. Your love and acceptance can make a huge impact on her ability to recover. Here are the five things you can do to help your bulimic daughter:

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Free Guide: How Parents Can Help A Child With An Eating Disorder

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1. Accept your child’s diagnosis

It’s very common for parents to resist an eating disorder diagnosis. That’s because it’s scary to hear that your daughter has a problem. Hardly anyone talks about eating disorders, especially bulimia. Bulimia often carries the most shame among eating disorders.

At the same time, it’s very likely that your daughter will assure you she is fine and doesn’t need treatment. It’s very likely that she will tell you she doesn’t need help. This is actually part of the disorder and is to be expected.

But if she has been binge eating and purging, she does need help, and a few weeks of therapy is not enough. Therefore, accepting your daughter’s bulimia is key to helping her recover.

2. Understand that this is a serious problem that needs to be addressed thoroughly

Bulimia is extremely complex and persistent. Your daughter’s bulimia is likely more serious than you think it is because bulimia tends to live in the shadows. It is a powerful coping mechanism that provides your daughter with soothing endorphins. She is reliant on her bulimia to feel OK in her life. As a result, treatment is deep and intense.

Letting go of bulimia in exchange for healthy coping skills will take time and persistence. But the consequences of a lifetime of bulimia are far more serious. There are serious physical, mental, and emotional health impacts of the disorder. Rest assured that living with bulimia doesn’t have to be your daughter’s fate. It will take time and energy to recover. But it is very possible.

3. Recognize that bulimia requires specialized treatment and recovery

Eating disorders are poorly understood and under-treated. Of all the eating disorders, anorexia has received the most attention and funding for treatment. As I already said, bulimia is often avoided because it can seem distasteful and many people do not appear sick even when they are.

Therefore, finding help for your bulimic daughter can be a challenge. But you need specialized care from someone who is qualified to treat bulimia. This is not a condition that should be treated by a general therapist or dietitian. Please be sure to seek a specialist who was trained in and gets supervision for eating disorder treatment specifically.

4. Respect your child’s process and body throughout recovery

Recovery is hard for everyone. Bulimia provides a protective numbing layer that your child relies on. As a result, recovery requires her to remove her numbing layer and show her parents, loved ones, and friends her true self. Recovery empowers her to recognize her unique wants and desires. It also empowers her to say “no” to things she doesn’t want.

This can be incredibly hard for parents to tolerate. Therefore, it helps if you prepare yourself for conflict and challenging conversations as she recovers.

At the same time, your daughter may gain weight during recovery. It’s best if you avoid any mention of weight gain. However, if she mentions it to you, consider your response very carefully. Parents who respect their daughter’s full recovery process make a huge impact on the strength of her recovery.

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Free Guide: How Parents Can Help A Child With An Eating Disorder

Master the secrets to supporting a child with an eating disorder. Thousands of families like yours are stronger today because of these six vital lessons drawn from lived experience, best practices, and extensive study.

Get Your Free Cheat Sheet

5. Get help for yourself so that you can manage the stress of having a bulimic daughter

Your daughter’s bulimia is going to be hard on you. This is not parenting 101. You’ll be asked to learn new things and stretch yourself. Remember that your child must change to recover. Therefore, you’ll need to support her as she changes, grows, and expands.

The most successful parents find support for themselves. When parents learn and grow, their kids feel better. Ideally, it would be great if you could get some therapy and/or coaching to understand your complex feelings about your daughter. Professionals can provide you with education, ideas, and an outlet for your frustration during the process.

Understanding bulimia

Bulimia nervosa is an eating disorder that involves restriction, binge eating, and purging. In this way, it combines the behavioral aspects of anorexia and binge eating disorder, while adding a third behavior: purging.

Many people misunderstand bulimia and focus only on purge behaviors. But it’s important to recognize that purging is often the last step in the cycle of bulimia. First comes negative body thoughts, which often lead to food restriction. Most people respond to food restriction with binge eating. Finally, a person with bulimia will use purging as a way to feel better after binge eating. The entire cycle needs to be addressed in treatment and recovery.

A person who has bulimia often begins with food restriction or anorexic behaviors. While a small population of people will continue with anorexia and become medically underweight, the majority of people do not. The most common response to restriction is binge eating. Most people find themselves driven to eat large quantities of food to make up for the deficit created by dieting and restriction. Therefore, binge eating is often driven by the biological response to hunger.

An obsession with maintaining a low weight makes binge eating feel both scary and unacceptable. Therefore, a sense of being broken and “addicted to food” is common. Binge eating episodes are followed by tremendous shame. Some people will deal with this shame by purging. These are the people who, with repetition, develop bulimia nervosa.

Why your daughter has bulimia

There is no single reason why a person develops an eating disorder. Because there is a complex interaction between genes, inborn temperament, life experience, and the society in which we live. Here are some of the factors that appear to contribute to the development of bulimia nervosa:

• Highly sensitive temperament
• Highly conscientious, with a tendency towards perfectionism
• Conditions including anxiety, depression, obsessive compulsive disorder, attention deficit disorder, and autism
• Sexual abuse/harassment/assault
• PTSD/C-PTSD
• Adverse Childhood Experiences (ACEs)
• Family fatphobia and focus on body weight
• Family history of food restriction and dieting
• History of dieting and weight cycling
• History of food insecurity
• Racism
• Poor body image
• History of self-harm, antisocial behavior, and suicidality
• Living in a society that believes thinness equals health, beauty, morality, and wellness
• Being female in a patriarchal society

These conditions combine to create an environment that supports eating disorder development. Not every person who develops an eating disorder has all of these conditions, but most have several.

Treatment for bulimia

Treatment for bulimia typically begins with nutritional counseling to try and get the body in a medically secure place. But it’s also important to work on the underlying conditions that fostered the disorder. As a result, treatment almost always includes psychotherapy and possibly group therapy.

The eating disorder has become a powerful coping mechanism for your daughter. It is how she survives in her life right now. Therefore, in treatment, she needs to gradually learn to replace her eating disorder behaviors with adaptive coping tools.

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Free Guide: How Parents Can Help A Child With An Eating Disorder

Master the secrets to supporting a child with an eating disorder. Thousands of families like yours are stronger today because of these six vital lessons drawn from lived experience, best practices, and extensive study.

Get Your Free Cheat Sheet

Remember that bulimia is not just purging. It is also negative body image, restricting, and binge eating. And all of these behaviors are driven by emotional dysregulation. Stopping the purging behavior may seem like the most important first step. But treatment is much more complex and nuanced.

While your daughter is in treatment for bulimia, she may still engage in purge behaviors. Most parents find this very frustrating. However, your child’s provider may be trying to create the conditions for recovery rather than attacking the eating disorder head-on. Head-on attacks can create resistance and rebellion. They can be counterproductive in bulimia recovery.

Can she recover from bulimia?

Yes. It is possible to recover from bulimia. Many people recover from bulimia and go on to live healthy, fulfilling lives. The recovery process for bulimia, like all types of eating disorders, involves learning self-care and emotional management.

Many people who recover from bulimia are often better off than they were before. The process of recovery gives them an advantage over people who never went through an eating disorder and its recovery. Self-awareness can help them better handle life’s ups and downs.

Full recovery requires time to establish amazing tools. The result can be a fabulous life.

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Ginny Jones is the founder of More-Love.org, and a Parent Coach who helps parents who have kids with eating disorders.

See Our Parent’s Guide To The Different Types Of Eating Disorders