The following guidance presumes that the situation is not immediately life-threatening. If you are unsure, seek immediate emergency medical care or dial 911.
Eating disorders can be fraught with secrecy and shame for sufferer and family alike. Many with eating disorders will deny they have a problem. Sometimes they are embarrassed and ashamed of their behaviors. Other people are afraid that if they admit they have a problem, they will have to stop their eating disorder behaviors, which can be extremely frightening and anxiety-provoking. Still other sufferers truly do not believe they have a problem and can be extremely reluctant to seek treatment.
Despite this, many sufferers later say that they were ultimately glad when someone stepped in and encouraged them to seek treatment. Often sufferers desperately want to get well, even as they are ambivalent about giving up eating disorder behaviors.
As a parent, it can be tempting to believe your child when they insist that they are fine. But when it comes to an eating disorder, your child may not always be the best judge of their physical and mental state. By insisting on a thorough evaluation by an eating disorder expert, the worst thing that can happen is you find out you made a big deal out of nothing.
Clear both of your schedules and set up a quiet place to talk.
The goal of this discussion should be to express your concerns to your loved one and to explain any steps you might be taking (e.g. setting up a doctor’s appointment or requesting they get evaluated for a possible eating disorder). Don’t worry about convincing them they have a problem. What you need to do as a parent won’t necessarily depend on their ability to believe there is something wrong.
Be calm, caring, and non-judgmental. Express your observations with minimal emotion and use specifics. Try using a formula like “I am concerned when I see you running to the bathroom after dinner.” Share your concerns about other changes you may have noticed, such as an increase in depression, anxiety, or isolation.
Be prepared for denial and anger.
Many eating disorder sufferers feel threatened or exposed when someone confronts them about their behavior. Not infrequently, they react with denial and anger. Don’t take this personally. It isn’t because you didn’t do a good job talking to them, but because they are likely very afraid and uncertain. Try to stay off of their emotional wave as best you can. Your ability to stay calm and tolerate their distress is one of the most powerful tools you can muster against their eating disorder.
Don’t expect insight or buy-in.
Your child may be one of those with an eating disorder who can recognize that something is wrong and expresses a willingness to participate in treatment. If so, great! If not, don’t worry. It’s normal for a young person with an eating disorder to have limited insight into the seriousness of their illness. It doesn’t mean they won’t get better. Sometimes insight doesn’t happen until long into recovery.
Stay focused on what you need to do.
One of the biggest gifts you can give your child is to stay focused on their long-term needs and their health. Even if they don’t think it’s necessary, insist on a medical check-up and evaluation by an eating disorder expert. Go to the appointment with your child if you can. If not, make sure the physician knows ahead of time about your concerns and potential tests to run. Also require that your child sign all waivers and forms so that you can speak directly to their medical providers. The age at which this happens varies by state: in some places, the age is 18, but it can be as young as 13.
Seek a second opinion.
Not all eating disorder treatment providers are created equal. There are no rules as to who can call themselves an expert at treating eating disorders. Talk to several therapists and physicians until you find one you can feel confident will treat your child well. Get several ideas about treatment options and determine which one will work best for your child and family.
Remind your child that life will be there after recovery.
Taking time off of school or college can seem like a deal-breaker to many young people. What can be hard to realize in the moment is that school and life will still be waiting after they are more stable in their recovery. Plenty of people can seek treatment for their eating disorder with minimal disruption in their life, but others need more intensive support. When making your decisions about treatment, remember that recovery comes first. Everything else can wait.
If your child is over 18, you may be more limited in what you can legally require your child to do. However, don’t despair. You have love on your side, and that really helps. Here are some other things that also might help:
Use whatever leverage you have.
Even some of the most successful young adults aren’t completely financially independent, especially while at college or if they have recently graduated. Require them to seek an eating disorder evaluation and seek appropriate treatment (including signing any waivers). Make these actions contingent on your providing any financial or practical assistance, such as paying for college, car, cell phones, etc. It sounds cruel on the surface, but you are really prioritizing their health and their life above anything else.
Set your own boundaries.
Know what behaviors you will and won’t tolerate in your home. Every family will draw the lines somewhat differently. Try framing it like drug abuse. You probably wouldn’t allow your child to do heroin in their bedroom if you could stop it. Make it clear to your loved one what behaviors are out of bounds and what the consequences are, and then calmly, clearly, and consistently follow through. This will help reinforce in their minds what is and isn’t okay, and will hopefully help to encourage them to seek treatment.
Seek to be involved with their treatment.
Yes, they’re over 18 and they’re legally adults. But an eating disorder often causes a regression in maturity, so although they might be 25 in years, they may only be able to function at the level of a 14-year-old. Add to that the fact that the eating disorder is a master manipulator and feels threatened when others are involved in treatment. Regardless of how your child feels about you being involved in their treatment, you can provide valuable insights to clinicians that your child might miss.
Keep lines of communication open.
If your child initially rejects your pleas that they seek help, don’t give up. If they are financially independent, you may have less leverage to encourage them to seek care, but you can still play an important role in their life. It may take time for the message that you love them and you want them to live a full and complete life without an eating disorder in the way to sink in. Hopefully, with time and love and lots of open communication, they will receive your message.