Recovery from an eating disorder is a confusing process. Some improvements happen quickly, and others take much longer. And unfortunately, while you are waiting for those improvements that take longer, conflict around food continues in your home. That conflict is hard for you and your child with an ED, and it is also hard for your other kids. One of the things I monitor as families provide treatment at home is when siblings are starting to be overly impacted by the conflict, or by the ED itself. It can feel like everything evolves around food and the ED, and there's some truth to that. The ED is so loud and overwhelming in your child's head that of course it kinda leaks out everywhere, over all of you.
Let's start with the things that can improve quickly. Fortunately, many medical concerns can resolve quite quickly with improved intake of food and water. Orthostatic hypotension, blood pressure, heart rate, and lab values can all correct quickly, and most often do. (That is most true for patients who are not purging in any way. If intake improves, but purging continues, these values can remain unpredictable, and ongoing weekly monitoring is needed until purging ends. Fortunately, purging is not as common in teens as it is in adults.) For reference, teenagers that are hospitalized for issues related to vitals and labs often find all the issues corrected in just a few days; food and water is an amazing healer! Patient will also report improved thinking processes and energy with just a week of sufficient intake, and overall, they seem to be happier, though they tend to be very hesitant to admit any of these things. Medical risk decreases significantly, as long as ED behaviors do not continue.
However, as all of this medical progress is being made, the anxiety around food increases. The best way to think of it is to look at fear in general. Imagine something you are afraid of, and how you respond to it. Most likely, you avoid it. However, avoiding it only serves to continue, and potentially increase, your fear of it. So, for your child, he/she is fearful of food, and has avoided it. Now we are shutting down that option, and as you can imagine, fear shoots up. Without fail, those with EDs become convinced they will rapidly gain weight as a result of what we have them eat. They won't, but we cannot easily convince them of that, so don't even try to do so very hard. We just have to wait. And, what I have noticed over all these years, is that it takes about two weeks, on average, for that fear to peak and decrease. In two weeks time, we are able to prove that they can eat way more than they thought and barely gain any weight. We were not able to talk them out of their fear, but their body proves the fear to be wrong. Now, if only EDs were so easily convinced, right?? Treatment could then just be done. But, nope; they are very annoying disorders and they hang on as long as they can. The EDs "job" is to convince its host that we are all lying, and only it is telling the truth; it's truth is that food is bad and your child will gain lots of weight, among other things. And the only thing that can disprove that....is time.
So, your job is to outlast that obnoxious ED. While your child is screaming at you about what you are serving for dinner, you want to try to remember it is the ED screaming, not your child. And so you do your best to get mad at the ED for them, because they are not ready to be mad at it yet. You will want to closely watch your phrasing and express anger at the ED, not your child. Your child is frightened, though is not acting like the scared kid you might be used to. No, the fear is coming out as aggression and cruelty at times. But, it is not your child; it is the ED. And, of course, sometimes you just want to back down and serve something easier, or otherwise negotiate with the ED. But in those moments, if you have the resources within you (you won't always; we all have bad days), you want to stand up to that ED and make it clear it will not get to win, in that moment, or in the future.
But what do you do if the disorder has become too aggressive for you to stand, or is impacting siblings too much? First, you want to make sure the other kids are getting attention too. I know, I just told you you have to work EVEN HARDER. Believe me, I know this is not fair. At all. But your best protection against your other kids potentially learning that the way to get more attention is to be sick, is to make sure they get attention for being well. This makes your job even harder as I know you are tired. So, it doesn't have to be big stuff. Just little moments to show that you have not forgotten about them in the mess of the ED. And, if this level of ED chaos continues, we then start to look at whether a higher level of care is necessary. And that's not because you or your child failed; we just know there are some EDs that are really nasty, or maybe you are a single parent, and the expectation of managing the ED at home becomes too much. For many teens, once they realize their parents actually will send them to treatment, they are able to rein in some of the ED acting out a bit more, and it becomes more manageable at home. But for others, there are excellent treatment centers that can step in and help out until the brain is more healed.
I know this might sound more pessimistic, but I want to make sure you realize you are not alone in this battle and in how difficult it is. It is very difficult. But stay the course. Follow what the treatment team recommends, and recognize that it is unfortunately a bit of a waiting game. But recognizing that it just takes time can also be empowering. I know it's a cliche, but you do have to look at recovery as a marathon, not a sprint. There's a sprint off the starting line, just to get all the medical stuff managed, and the treatment team put together, but from there, it's about persistence...just putting one foot in front of the other until you reach the end. And the end does exist. I promise. Otherwise, I could never do this job.
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