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Tuesday 10 January 2012


So I have covered the "What to do" and the "When to do it" (Now!) and we come to "How to do it", the tricky one.

Sadly, it is not a case of preparing some food, putting down in front of the eating disordered patient and asking them to "Please, nicely, finish it up" or "Please, try and eat something, darling" or "Do you think you could manage this bowl of cereals/glass of milk/apple?"

How it helped me was to reframe it from the patient's point of view. (Caveat, not all patients are the same and this is our experience).  What I was doing was putting down a plate of hissing cobras and asking if my daughter would like to try and eat them.  Her brain was in full "fight or flight" mode, her andrenaline was pumping, her heart was racing, she was ready to run and I was asking her if she could "manage" to eat a bit of a hissing cobra.  Er...No!  Her whole brain was telling her that this was an extremely dangerous and life-threatening action and to run, run, run.  Her dear old mother had morphed into some evil bitch queen and was asking/telling/yelling to eat?  No wonder she thought I was mad.

It came as a complete shock to us to see her distress.  It wasn't willful, oppositional or defiant or teenage moodiness or her being stubborn, or angry or upset.  It was deep deep fear.  As with all animals backed into a corner, she came out fighting.

Our problem was how to overcome this fear, how to feed her her medicine and how to rebuild the trust that had been smashed almost beyond repair.  Calm, kind and supportive confidence during and after mealtimes (for the most part) but an absolute requirement to eat whatever what put in front of her, whoever is in charge, however long it takes.

We found Janet Treasure's animal models extremely helpful and C&M produced a few short films here to model effective parenting in the face of extreme resistance.


  1. So true... It IS deep, deep fear and not wilful child 'trying to get her own way and control her over-controlling parents'.

    I really wish doctors had realised this when I was a teen with AN. Instead they got angry with me and threatened me in all sorts of ways. I regarded them, and my parents with fear.

    It is REALLY important to recognise that the behaviours of AN are borne out of fear.

    Thanks Charlotte :) xxx

  2. Wow Charlotte - Wow, wow, wow...

    If ONLY everyone thought like you and had this approach. And If ONLY the Maudsley was available and easily accessible to everyone. My dietician was bloody awful - and I told her so.

    And if ONLY my parents understood it all - we dont talk about what happened in 2010 - they were keen to move on and have things return to "Normal" faster than anyone (including me) could keep up with..

    Lucky, lucky G.....

    all love xxxx

  3. I really like your post, Charlotte. I wish my husband and I had known what you describe above and the information available from FEAST and Around the Dinner Table when my daughter first became ill so many years ago. Each person who ends up with an eating disorder has different mental/psychological issues both before and after, and they can be quite complex.

    My daughter manifested anorexia (AN) at age 11 and had lots of mental health issues going on even before AN - highly anxious, harm avoidant, hypersensitive to sensory things, many irrational fears, OCD tendencies and more. And she had the added complication of having always, even pre-AN, had the twisted neurological circuitry that made her feel bad after eating. By bad, I mean that she felt even more anxious and in kind of a brain fog. We did not know this back then. She thought everyone felt that way and did not know she was different. That continues to today as a young adult, as she is working on recovery from various EDs and comorbids.

    Here's what she says about how AN "helped" her. "I discovered by total accident that restriction did away with the horrific anxiety I suffered from 24/7. Instead of being cloudy, nervous, panicked, and terrified all the time, I was clear-headed, focused, calm, and felt in control of something. Miracle cure? I think not...I almost died! Dieting is the norm, feeling awesome as you starve yourself to death IS NOT."

    My daughter's "how to do it" as a young adult who wants to get better is using her therapist as the guide and helper. She is making herself eat through her fears, and has had to give up feeling focused and calm, and is trying hard to deal with how bad she feels after eating. She hopes that one day she'll start feeling better with the full nutrition that she has been receiving for quite some time now, but given how she was pre-AN, she doesn't know if that's possible. She still feels awful after eating (and she eats 7 times a day!) and is unable to focus very well - is unable to resume her college coursework because of it.

    I wish her Dad and I had known that it is necessary to bring child sufferers all the way to their unique full healthy weight keep feeding for growth. The clinicians we had for her either thought her suboptimal weight was ok or didn't know how to help us push her weight up to where it needed to be.

    Anyway, posts and blogs like yours, Charlotte, are helping to point the way for parents of those with EDs today!