I’m not often completely stumped by questions asked by those attending my presentations. But I was recently unsure of how to respond to a question asked about teenagers and eating disorders.
While raising a teenager can be incredibly rewarding, it can also be very challenging. A complicating factor is that normal teen behavior and eating disordered-behavior can sometimes look very similar! Because of this fact, a parent in the audience had asked me:
“How do I know whether I’m seeing normal teenage behavior or the eating disorder?”
Since I don’t have children — and I didn’t live with my parents when I sought help for my eating disorder at 22 — I reached out to my friend and colleague Courtney Morton, a primary therapist in our Austin program and a mom herself.
Courtney responded by sharing with me an exercise that she had done in one of her family groups. In this exercise, she asked parents and children to each write down five things they wish the other party knew about them.
Below, in italics, I share what our teenage patients in eating disorder treatment
wanted their parents to know. I also share Courtney’s insight for parents with teens in eating disorder recovery.
Patient Quote: “What I wear isn’t about my eating disorder. My clothes don’t define who I am.”
- Support your teenager as they search for their identity
During adolescence, the search for identity fits within the normal developmental process. For some teens, the eating disorder can be part of an “identity” that they hold very close. An eating disorder can serve as an effort to delay the complexity of adolescence or even to distance a person from their family.
As adolescents move forward in recovery and toward healthier identities, they are likely to continue to make choices their parents disagree with (e.g. clothing, hairstyles, choice of friends, music and hobbies). However, only when these choices threaten health and safety — as with an eating disorder — is it really necessary for parents to intervene.
Teenagers naturally explore values and passions. One of the most helpful things parents can do is to continue supporting their kids in connecting with their authentic self, even if it is different than what the parents might have expected or even wish for.
Criticism of a teen through this normal process of searching for identity can be highly destructive to family connection.
Patient Quote: “I’m a teenager, and sometimes, I do stupid things — just like you did at my age. Please cut me some slack.”
- Know that some rebellion is normal
It is normal for teens to “act up.” Think about it: most of us put our own parents through significant worry during our teenage years.
As parents, we can consider rebellious behaviors in terms of affordable and unaffordable mistakes.
Unaffordable mistakes —
impact health and safety (like the eating disorder); it is a parent’s job to intervene on these
Affordable mistakes —
allow our children to learn; parents can let these slide
Some children enter the eating disorder at a young age and emerge in recovery as full-blown, door-slamming adolescents. Just because your child is yelling and slamming doors doesn’t mean they are not in recovery.
Sort out which behaviors are part of adolescence and which could be warning signs for relapse
through open communication at home and in family therapy. Look at where
the rebellion is being expressed. Defiance related to food or exercise would certainly be a warning sign, whereas defiance related to identity issues (blue hair, for instance) might be less likely to be a warning sign of relapse.
Truthfulness is also incredibly important to discern the intention of certain actions, even if some of the truths are hard to say and hear. Help your child to see that you are open and willing to hear the truth, even when it is difficult.
Patient quote: “I need more sleep than you do. I’m more upset if I am tired.”
- Make sure your teen is getting enough sleep
Adolescents need sleep. Sleep helps them grow and is hugely important in mood regulation. Try to figure out if your child tends to be a night owl or a morning person. Then, work with their treatment team to make modifications in the meal plan necessary to help them get the most sleep. Also consider modifying their school and extracurricular activity schedule to be less demanding.
We don’t want to be overly permissive as parents, and following the meal plan is vital, but supporting your child in getting required sleep will help build connections, both in your relationship and within their brains and bodies!
Patient quotes: “Because I don’t like these foods, not eating them doesn’t count as restriction.” “I can’t miss a day of running because it helps my mood.”
- Keep an eye on eating and exercise behaviors.
No one likes all foods. However, for many people with an eating disorder, cutting out certain categories of food based on “preference” is part of restrictive behaviors.
An essential component of recovery is being exposed to a variety of foods in order to reconnect with taste preferences and not let the eating disorder continue to dictate what the person “likes.” Honestly, it takes a long time for most people in recovery to reconnect with their authentic tastes. Along the way, parents can honor certain disliked foods based on historical preferences and also whether the person is trying not to have to eat a certain food (e.g. mushrooms) or is trying to eliminate a full category of food (e.g. becoming a vegetarian)
. Eliminating full categories of food is only indicated as part of recovery if medically necessary, because this type of restriction can make navigating recovery very tricky.
Parents need not be short order cooks or feel like they have to shop separately for their child in recovery. It is vital that the person in recovery be re-integrated into family life, including the way the family eats.
In terms of exercise, watch for warning signs like compulsivity, restrictive eating on “rest” days, and working out more than recommended. For your child, once they are medically cleared for exercise, encourage them to reconnect with old passions or new interests. Encourage them to take the dog on a walk, hike or canoe, even as a family.
Patient quote: “If my door is closed, it doesn’t mean I’m isolating or hanging out with Ed. I just need space.”
- Give your teen some privacy
We often describe the experience of the eating disorder as being like falling into a hole, which is isolating and disconnected from others. In addition, many eating disorder behaviors are associated with shame and subsequently remain hidden, even though they significantly impact safety and health. At the same time, teenagers are desperate for privacy! It is normal for them to want to be able to shut the door of their room, use media that is all their own, and to have unmonitored conversations with friends.
Earning back trust is a huge part of the repair that is necessary in the family during recovery. As teens show that they can safely care for themselves, it is healthy to slowly provide increased privacy. Building back trust is a process of give and take that requires honesty, hard work, and time.
And finally, I wanted to share this quote from one of our patients; it’s so important for parents to keep in mind:
“I want to build our trust again, but I please need you to be more willing.”
What our parents said
You might be wondering what our parents said during our family group exercise. They said what any teenager — eating disorder or not — needs to hear.
“I don’t always know the right thing to say. Please teach me.”
“You can do it.”
“I love you.”
Courtney Morton, LCSW, is a primary therapist at Eating Recovery Center in Austin, TX and the mom of two energetic children. She loves walking with families down the road to recovery.
Jenni Schaefer is a bestselling author and popular speaker on eating disorders and related disorders, including PTSD.