I discharged a family from FBT last week. Their daughter, who we’ll call Tina, was fully recovered from anorexia (AN), a healthy teen, after 22 sessions, and just under a year of treatment. So why write about that? Indeed, if we are using effective treatment methods, recovery in itself is not news. Well, the journey for this family didn’t always look so good, and it struck me that families in the trenches stand to learn and to feel comforted by the struggles of other families early in treatment, especially when that treatment has a good outcome.

So what did it look like at the beginning for this family? Well, their daughter was dangerously underweight, with AN having reduced her daily intake to little more than green juices. Consisting of varying combinations of “super foods” such as kale, fruits, chia seeds and health-fads-everywhere’s-new-fave, coconut water, the family described them as “pond scum”. She was weak, her skin somehow greyed, cold all the time, irritable, socially withdrawn and struggling to concentrate at school. At the start of treatment the family couldn’t see a time when their daughter and sister would be able to return to eating muesli, chicken schnitzel, chocolate, or any of her previously enjoyed foods; at that point, just returning to solids seemed like reaching for the moon.

During our 12 months working together, Tina, described by her family has formerly a happy, somewhat shy, certainly compliant young girl, sat through sessions with dread and even refused attendance on one occasion. Anorexia had her throw food out, lie about what she was eating and her weight, and cry in distress through the reintroduction initially of chicken breasts, but then a range of foods including that chicken schnitzel, pasta, red meat, ice cream and chocolate. Throughout this period her parents held fast, on what must have been a roller coaster of their own. Tina’s father broke down in a session telling me he wanted to give up, but that he loved his daughter too much to give that thought air time; her mother fought to stand tall not only above the AN, but to back her own gut feelings on when it was okay to support Tina to have more independence around food, sometimes in the face of her own family questioning her decisions.  

And despite those extremely trying experiences, 12 months on, Tina has a full circle of friends, can eat a wide range of foods, and feels confident enough in her body to tell me that if she could interview her former self at the start of treatment, she would tell herself she didn’t need to lose weight, she was strong and capable and good as she was. Her words, along with her (this time good) tears. Most humbling, Tina knew she couldn’t do it alone, and expressed relief that her parents were able to take charge, even though that didn’t stop her fighting for her freedom again when she was well enough to. Her parents on telling me about what was helpful and not about therapy have said it was one of the hardest journeys of their lives to figure out how to stay so united AN could never win, and how to flirt with wanting to give up without giving in; but that knowing there was a treatment that they could believe in and a treatment team they could trust held them steadfast to their sole goal of getting their daughter to full recovery. Once again, families’ courage humbles me, but I share this story to remind those in the trenches not to give in. As hard as the fight against AN is, if you can win it, you’ll give your daughter a gift money can’t buy.

I do a lot of work in family based treatment (also known as FBT or Maudsley), teaching parents to understand eating disorders in general, and Anorexia Nervosa in particular, so that they can stand up to these dreadful and potentially deadly illnesses. And not surprisingly, I am struck by parents’ struggles as they begin to grapple with what defeating anorexia really means. So I want to dedicate this post to those parents taking on the fight in the hope that it makes your understanding, and perhaps your task, just a little easier. Consider it a ‘FAQs’ response to those parts of the anorexia that stymie parents most.

First up is the frequently asked: Will my daughter/son hate me if I keep pushing them to eat? The answer lies in the model. Its so important that as parents, you can remember back to a time when your beautiful son/daughter would never have lied to you, yelled at you, or thrown a plate of food across a room. I have had patients put their hands through glass windows, so desperate are they to show their parents how terrifying eating feels to them. But that’s the thing: The person throwing plates, or smashing windows is not your daughter. The person yelling expletives, or secretly ordering laxatives online is not your son. This is the illness they are living with, and without your help, they simply cannot beat it.

And importantly the distress you witness is not a wilful refusal to eat. If you can see your child’s behaviour as a way of conveying how utterly terrifying meal times are, you will be better able to empathise with them; to show them you get that eating feels as terrifying to them as the thought of death to most of us. But that if eating means saving their lives, it’s something you can’t compromise on.

It’s so normal for parents to find the initial stages of re-feeding their children incredibly stressful. It brings up all sorts of conflicting emotions: your child is sick, and all you want to do is make them better. Unfortunately in the case of anorexia, if all is going smoothly at home in the first few weeks of treatment, it’s likely the anorexia is just in a comfortable groove, and your son or daughter is unlikely to recover. What that means in practical terms, is that in the short term, it’s likely your child will be more distressed if you are really taking the anorexia on. Your role as parents is to believe that food is medicine, and the distress is the anorexia’s way of showing you that you are, in fact on track. I cant say it better than the video below, made by a parent, and and based on Carrie Arnold's original blog, which can be found here. In writing this blog, I am hoping her learning can inform your path to your son/daughter’s recovery, and help you stay steadfast: Let the anorexia hate you, but hold on to the belief that you will get your loving child back. 

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