Basic Intervention Skills for Parents

By Sandra Friedman, MA

For a parent, seeing your daughter struggle with body image and weight issues can be scary. It's even scarier to think that she might have an eating disorder. Visions of starving girls dance around in your head. You become afraid that anything you say is going to make it worse. You try to stop the behaviors by trying to reason with her. You say things such as, "You know, Katie, you can get sick doing this." You try to bargain with her with offers like, "If you eat, you can go shopping/go away for the weekend/get your own phone" etc. You resort to guilt in the form of, "If you really loved me, you would..." When these things don't work, you become angry and afraid because nothing you do seems to make things better. If you're a mother, you might blame yourself, even if you know intellectually that it's not your fault. If you're a father, you feel powerless. Your job is to take care of and protect your child and to fix things. This is one thing that you cannot fix.

There is no one single factor, experience, or moment in time that causes somebody to develop an eating disorder. They occur because of a complex combination of factors, which include biological predisposition to anxiety or obsessive-compulsive disorder, genetics, stage of development, societal factors, family dynamics, and personality structure. For many girls, food and disordered eating behaviors develop as a coping mechanism that becomes a way for them to deal with painful, scary or "inappropriate" feelings, tension and anxiety, emotional conflict, and unresolved issues. While you can't change her biology or genetics it helps to understand the impact that societal and personal pressures have on her.

Girls are relational, and their connections with others make up a large part of their sense of well-being and also influence how they navigate in the world. Until girls are between the ages of 8 and 10 they tend to be confident, strong, outspoken, and bold. As they approach puberty, however, they fall prey to the forces of socialization that tell them to be "nice," and please others at the expense of themselves, and to the media that encourages them to define themselves by how they look. Many girls take their feelings and insights underground—lest they hurt or upset someone else and are then rejected. Girls "lose their voice"—that is, their ability to express their feelings, opinions, and thoughts directly and, instead, express them indirectly though a negative voice. Because fat has become the bogeyman in our society, girls (and especially girls with a tendency toward anxiety) redirect their feelings and concerns into the fear of being fat. Worrying about fat, "feeling fat" and speaking in "fat talk" become a way of turning something real on the inside into something artificial on the outside. In other words, girls deal with the discomfort of their psychological fat by trying to change what they perceive as body fat in the belief that this will change their lives and, thus, how they feel about themselves.

What You Can Do

Work with your family doctor to find out where your daughter is on a continuum that includes girls with disordered eating patterns, girls just beginning to use eating disorder behaviors, girls whose behaviors are more entrenched, and girls whose behaviors are making them sick. Knowing where she is on the continuum will help you assess the kind of intervention she needs.

Remember Golden Rule of Parenting: You didn't break it. It's not your fault. You are not a plumber. You can't fix it.

Understand that eating disorders are coping mechanisms that develop over time. As long as you don't encourage weight loss or make her feel guilty for not getting better, there is little you can say or do that will make it worse.

Share your concerns about her behaviors. Use "I statements" to describe the specific things that you see. "I see that you are not eating breakfast or lunch. This makes me worried about you." "I heard you throwing up yesterday, and that worries me." If she doesn't want to listen to you or becomes angry with you for calling attention to her behavior, just keep telling her that you are concerned. Remember that this is not about you. She won't change her behaviors because you tell her you love her or how hard it is on you.

Help her become a detective. Take the focus off the food and the fat talk. Encourage her curiosity about her behaviors, her thoughts, and what she tells herself. Ask her to remember the specific day and time of day when she felt fat or wanted to really exercise or restrict what she was eating. What was she was doing and thinking about? Did she have any "forbidden" thoughts such as being annoyed at someone, or did she feel jealous or insecure? Have her tell her story again focusing on real feelings and issues. Instead of giving her advice, let her know that you understand how and why she feels the way she does in that situation.

Encourage her to be specific. Girls with disordered eating or eating disorders tend to have "black and white" or "all or nothing" thinking. They tend to use global language instead of being specific about right now. Keep asking her to give you a "for instance" and help her focus on just one thing.

Help her expand her range of feelings. Feelings such as anger, disappointment, jealousy, loneliness, and feeling criticized are seldom part of a girl's emotional vocabulary and are often seen as "bad." Incorporate descriptions of these emotions into your own language when appropriate so that you can model, diffuse, and normalize them. Let her know that just because she has a feeling doesn't mean she has to do something about it.

Encourage her to speak in a BIG VOICE. When girls can't speak out or set boundaries they often feel insignificant and powerless and express themselves in a tiny, soft, little voice. Talk about how the different voices make her feel. Encourage her to stand up and speak in a BIG VOICE when she is telling you how she feels.

Help her accept her body at whatever size it is. Help her counter societal messages around fat by teaching her that beautiful bodies come in all sizes and shapes. Also, educate her that weight does not create health risks; poor nutrition and lack of exercise do.

Examine your own issues around food and weight. If you are dieting, relating to food in terms of calories and fat, and/or making comments about your body or your partner's body, you are passing your attitudes onto your daughter.

Remember that the greatest gift you can give her is to love and be real with her. Instead of trying to fix her or her disorder, build and nourish a healthy foundation so that no matter what happens you can maintain your connection with her.