Category Archives: Eating Disorders

The Power of Validation: Supporting Your Child Through Eating Disorder Recovery

The Power of Validation: Supporting Your Child Through Eating Disorder Recovery

Posted on by

Is your teen struggling with an eating disorder?

As a parent, witnessing that struggle and feeling like nothing you say helps or wondering if you’re helping or are making things worse, can be one of the most difficult obstacles to navigate as a parent. And if you’ve felt this way, know that you are not alone. These aren’t experiences most of us know how to prepare for–there are no tools for caring for a loved one with an eating disorder in general parenting books. Unlike clinicians who go to school and receive on-going training to help people in recovery, parents have no such roadmap.

Witnessing your child struggling with an eating disorder can feel overwhelming, confusing, and deeply painful. As a parent, you naturally want to help, but knowing how to respond in the most effective way is not always intuitive. One key tool you can use to support your child’s recovery is validation–understanding what it is, why it matters, and how to practice it can make a world of difference for both your child and your family.

What Is Validation (And what it is not)?

Validation is the act of recognizing, understanding, and accepting someone’s feelings or experiences as real and meaningful.

Caregivers often worry that their validation will give their child permission to restrict food or purge–but that’s not the effect that validation has. Validating your child’s emotional experience doesn’t mean endorsing or encouraging damaging behaviors. What it does mean is that you are able to acknowledge their emotional reality without judgment. This practice lets your teen know that you are someone safe to turn to, because you will listen without assigning “right” or “wrong” to what they are feeling, and are instead there to try and understand their experience so you can better support them. Practicing validation can also be helpful for parents or caregivers in the moment because it often diffuses intense reactions you may be experiencing, and give you a moment to listen rather than react.

What validation is:

  • Actively listening and showing empathy.
  • Communicating that their feelings make sense, given their perspective.
  • Offering a safe space for them to share their struggles without fear of criticism.

What validation is not:

  • Agreeing with unhealthy behaviors or distorted beliefs about food, body, or worth.
  • Dismissing your own boundaries or enabling harmful actions.
  • Fixing their problems or trying to reason them out of their feelings.

Why Validation Is Crucial in Healing

Validation is a cornerstone of emotional healing because it helps your child feel heard, understood, and less alone. Eating disorders often thrive in silence and shame, and by validating the emotional experience your child is having, you help dismantle the isolation that fuels their struggle.

When your child feels validated, their nervous system can move out of a heightened state of stress or fear (often referred to as “fight, flight, or freeze”) into a calmer, more regulated state. This shift is essential because a regulated nervous system allows your child to:

  • Think more clearly and process emotions more effectively.
  • Develop healthy coping mechanisms.
  • Engage more fully in therapy and other forms of treatment.

Fears Parents May Have About Validation

Parents often worry that validation might:

  • Encourage unhealthy behaviors: It’s important to remember that validating your child’s feelings is not the same as endorsing their actions. For example, “I can imagine that it is very hard for you to complete your meal right now because it makes you anxious” is letting them know that you understand what they are struggling against, without encouraging them to restrict themselves.
  • Undermine parental authority: Validation doesn’t mean you have to compromise your boundaries or expectations. In other words, because you understand how hard it is for them to eat, that doesn’t mean you let them go unnourished.
  • Reinforce disordered thoughts: Validation focuses on emotions, not necessarily agreeing with the thoughts driving them. For example, saying, “It makes sense that you feel overwhelmed right now” doesn’t mean you agree with their belief that they “must” restrict food to feel in control.

Barriers to Validating Your Child

It’s not always easy to validate your child’s emotions, especially when:

  • Their feelings seem irrational or extreme. For example, your child may be fearful that they will gain a bunch of weight if they eat a piece of bread or that if they get a B in a class they won’t get a good job.
  • You’re feeling triggered, stressed, or unsure of how to respond.
  • You’re worried about saying the “wrong” thing and making things worse. The important thing is that you are trying and your teen will see that you are trying to understand them and what they are experiencing.
  • Your own emotions—such as frustration, fear, or sadness—are taking over in the moment. If this is the case, you may need to take a step back and come back later to your teen and validate them later. It is never too late.

Validation often doesn’t come naturally to us (I know when in my personal relationships I often find it challenging, and I am a therapist!). The good news is that validation is a skill that you can learn and practice.

Examples of How to Validate

Here are some ways to practice validation in everyday conversations:

  1. Listen Without Interrupting: Show you’re fully present by maintaining eye contact, nodding, and responding with short affirmations like “I’m listening” or “Tell me more.”
  2. Reflect Their Emotions: Paraphrase what they’ve shared to make sure you understand what they are saying. For example, “It sounds like you’re feeling really anxious about eating today, am I understanding that correctly?”
  3. Normalize Their Feelings: Help them see their emotions as a natural response. For instance, “I can understand why you’d feel overwhelmed; this is a big change for you.”
  4. Acknowledge Their Struggle: Recognize the difficulty of their experience. For example, “I can see how hard this is for you, and I’m here to support you.”

Ways to Practice Validation

Validation is a skill that can be developed with practice. Here are some tips:

  • Pause Before Responding: Take a deep breath to ground yourself if you’re feeling reactive. This both gives you a moment to decide how to respond, and helps to regulate your emotions so you are more able to respond intentionally.
  • Practice Empathy: Try to see the situation from your child’s perspective. Ask yourself, “How might this feel for them?” If you don’t know how they are feeling, ask.
  • Use “I” Statements: For example, “I’m here for you” or “I want to understand how you’re feeling” or “I can see why this feels overwhelming” rather than focusing on what they “should” do can help show your teen that you want to be an active support for them, and don’t want to blame them for what they are struggling with.
  • Role-Play Scenarios: If you’re working with a therapist or support group, practice validating responses to common situations.

A Path to Healing

Validation is not a magic cure, but it lays a critical foundation for healing. By helping your child feel seen and understood, you create a space where they can face their struggles without fear of judgment. Over time, this fosters the emotional resilience and trust they need to move toward recovery.

As a parent, you don’t have to be perfect—and there will be times when you stumble. 

But each effort you make to validate your child’s emotions is a step toward connection and healing. Remember, you are not alone in this journey. Reach out for support, whether from therapists, support groups, or other parents who understand the challenges of eating disorder recovery. Together, you can help your child find their way to health and hope.

As a therapist who is also a dietitian, I can help you understand what is going on from both angles. If you are in Texas and interested in working with me, click here to fill out a contact form. I would love to support you and your child on your journey to health.

Book Review: Binge Eating Disorder: The Journey to Recovery and Beyond is a Must Read

Book Review: Binge Eating Disorder: The Journey to Recovery and Beyond is a Must Read

Posted on by

Binge Eating Disorder: The Journey to Recovery and Beyond by Amy Pershing with Chevese Turner, seamlessly blends clinical knowledge with the lived experiences of those affected by BED, making it an invaluable guide for individuals experiencing BED and their families. Divided into three parts: understanding BED, addressing its root causes, and finding sustainable recovery strategies, this book is a must read for anyone looking for an insightful and compassionate resource on binge eating disorder (BED).

Understanding Binge Eating Disorder

Binge eating disorder (BED) is the most common eating disorder, it can develop at any age, often in childhood, and can impact people across diverse identities and backgrounds. It is characterized by recurrent episodes of eating unusually large amounts of food in a short period, accompanied by feelings of loss of control. 

BED affects an estimated 2.8 million individuals, making it the most prevalent eating disorder in the United States. Despite its high prevalence, BED often goes undiagnosed or misunderstood, in part due to societal weight bias and outdated treatment paradigms. 

Understanding Binge Eating Disorder Symptoms

BED is not a one size fits all diagnosis, and can often affect people in unique ways, but there are some hallmark symptoms that are commonly observed, which include:

  1. Frequent Episodes of Binge Eating:
    • Consuming more food than most people would in a similar time frame and situation.
    • Feeling unable to stop eating during a binge episode.
  2. Emotional Distress Around Eating:
    • Intense feelings of shame, guilt, or embarrassment during or after binge episodes.
    • Experiencing disgust or self-loathing related to eating habits.
  3. Behavioral Indicators:
    • Eating rapidly or at an unusually fast pace.
    • Eating until uncomfortably full.
    • Consuming large amounts of food even when not physically hungry.
    • Preferring to eat alone to hide the behavior from others.
  4. Physical Symptoms:
    • Fluctuating weight due to consistent overeating and undereating.
    • Gastrointestinal discomfort or other health issues linked to excessive eating.

If these symptoms occur at least once a week for three months, it could indicate BED, and you should talk to a trusted care provider.

Who experiences Binge Eating Disorder?

BED doesn’t discriminate—it can affect people of any age, gender, race, or socioeconomic background. Please note that people of all body sizes can experience binge eating disorders. 

Why is Binge Eating Disorder: The Journey to Recovery and Beyond by Amy Pershing with Chevese such a powerful resource?

  1. It Addresses the Root Causes:
    Authors Chevese Turner and Amy Pershing provide a thorough explanation of how the diet industry, weight bias, and weight stigma all work together to contribute to the development and persistence of eating disorders. Many individuals with BED have endured significant weight stigma and bullying, which often begin in childhood. Tragically, these experiences are pervasive in peer groups, families, and even healthcare settings. In an attempt to avoid further stigma, many people turn to dieting as a way to change their bodies, but this often worsens their relationship with food and deepens the cycle of disordered eating. It is estimated that up to 70% of those experiencing binge eating pursue weight loss services often making the eating disorder worse. They also delve into systemic oppression and its role in fostering BED.

    The book also makes it clear that effective treatment for BED lies in psychological support and nutritional rehabilitation—not weight loss interventions.

  2. It Makes Sense of Binge Eating:
    Within the chapter “How BED Happens and Why It Makes Sense” Pershing and Turner offer a groundbreaking discussion of the nervous system and its stress response. They explain how binge eating functions as a coping mechanism, helping individuals feel safe during times of stress or overwhelm, which helps to make sense of binge eating as an adaptive (though ultimately unhelpful) response, which in turn can foster self-compassion and reduce the shame often associated with this behavior.
  3. It Offers Inspiring Personal Narratives:
    Chevese Turner courageously shares her story of binge eating, starting from her childhood experiences with food. Amy Pershing complements this narrative with her years of clinical expertise, sharing lessons from her work with clients in recovery. These interwoven stories remind readers that they are not alone in their struggles. By reducing isolation and shame, the authors create a sense of solidarity and hope.
  4. It Provides A Roadmap to Recovery:

    Binge Eating Disorder: The Journey to Recovery and Beyond offers a framework for improving readers’ relationships with both food and their bodies. Rather than prescribing rigid meal plans, it focuses on reclaiming a sense of self. Chevese Turner and Amy Pershing introduce concepts from Internal Family Systems (IFS) therapy, such as “parts work,” to help readers understand their binge eating behaviors and work toward recovery. They also address body shame and body image distress, reframing the body as a home—not an object to be judged, but a vessel for experiencing life, joy, and even pain.

    The authors critique diet culture and thin privilege, empowering readers to navigate these societal pressures while staying true to themselves.

  5. It Expands Perspectives:
    One of the book’s greatest strengths is its ability to broaden readers’ understanding of binge eating. Binge Eating Disorder: The Journey to Recovery and Beyond explores how societal and systemic factors influence BED, and help to shift the focus away from individual blame and toward a more compassionate, holistic view.

I wish I had discovered it earlier—it would have allowed me to recommend it to more clients sooner. Those I’ve shared it with have found it incredibly helpful and affirming. If you are experiencing binge eating please consider reaching out for support.

Whether you’re a generalist clinician seeking to understand better binge eating disorder or an experienced eating disorder specialist, this book deserves a place in your professional library. Once you read it, you’ll feel confident recommending it to clients with BED—and they’ll thank you.

2024 Eating Disorder Recovery Resource Roundup

2024 Eating Disorder Recovery Resource Roundup

Posted on by

As we close the chapter on 2024, we have the opportunity to take a few moments to reflect on the last year of eating disorder recovery & treatment and make note of resources available to us for continuing care in 2025.

As awareness of eating disorders and recovery options continue to grow, families, clinicians, and communities are searching for tools and knowledge that prioritize compassion and effective care. Whether you’re considering levels of care for recovery or exploring family based therapy for eating disorder treatments, these conversations have helped shape a community of care we’re excited to take with us into 2025.

Whether you’re a parent, caregiver, or someone in recovery yourself, there’s so much to be aware of and as we learn more together, we strengthen our communities and our possibility for a thriving recovery.

As we move into 2025, these insights can guide us to approach eating disorder recovery with greater intention. They challenge us to prioritize early intervention, understand diverse diagnoses, and advocate for inclusive and accessible care. Whether you’re navigating recovery personally or supporting a loved one, the lessons of 2024 can serve as a foundation for a hopeful and informed new year.

Stay tuned as we build on this momentum in 2025, continuing to explore the complexities of eating disorders and the paths to healing. Let’s enter the new year with renewed purpose and compassion.

Here’s what I wrote about this year:

When Your Loved One Doesn’t Want to Get Better: Understanding Anosognosia in Anorexia Nervosa

“Anorexia nervosa is an eating disorder characterized by severe food restriction, an intense fear of weight gain, and body image disturbance. Anorexia nervosa affects many individuals of all genders, ages, and identities worldwide.

The consequences of anorexia nervosa can be devastating, both physically and psychologically. However, one of the most challenging aspects of this disorder, particularly for family members and caregivers (and even clinicians!), is the phenomenon known as anosognosia.

What is Anosognosia?

Anosognosia, stemming from the Greek words “nosos” (disease) and “gnosis” (knowledge), refers to a lack of awareness of one’s illness. Anosognosia often can feel and look like denial.

Denial is a defense mechanism and psychological response to avoid dealing with anxiety or other uncomfortable feelings. In contrast, anosognosia in mental health conditions is better described as a lack of awareness of their own condition.”

Understanding ARFID: More Than Picky Eating

“Avoidant/Restrictive Food Intake Disorder is not just a simple case of picky eating; it is a complex psychological condition that can cause significant nutritional and reduced quality of life, particularly if it endures into adulthood.

Unlike other eating disorders that are often driven by concerns about weight and body image, ARFID is characterized by an avoidance of food based on sensory sensitivity, lack of interest in eating, depressed appetite, and/or fear of adverse consequences such as choking, throwing-up, or an allergic reaction.

Individuals grappling with ARFID may face a persistent difficulty when it comes to eating sufficient quantities or varieties of food. This can stem from deep-seated anxiety, gastrointestinal discomfort, or past negative associations with food.”

Book Review: When Your Teen Has an Eating Disorder is a Must-Read

“If you think your child or teen has an eating disorder this is a must read.

Eating disorders can perplex many parents and clinicians alike. Your teen may not be acting like their usual self, and it’s hard to know if this is just normal teenage angst or something more serious. If your teen has an eating disorder, they may have changed greatly right before your eyes: refusing food, feeling anxious around eating, or experiencing changes in mood and energy.

You may have tried several times to talk with them about the importance of eating and try to reassure them that they are not gaining weight. (In fact, they are likely losing weight.) But, your child’s struggles seem to be getting worse not better.

If your teen has not seen a doctor yet about their eating disorder this is the first step to make sure they are medically stable.”

Levels of Care in Eating Disorder Treatment: How to Choose the Right Option

“Levels of care refer to how much support is needed to reduce eating disorder behaviors during treatment. Several levels of care may be utilized throughout treatment for an eating disorder, based on what is necessary for the person in recovery.

Treatment choices can be overwhelming if you or your teen are newly diagnosed with an eating disorder. Residential, day treatment, or outpatient care – what does this all mean?

Levels of care in eating disorder treatment are selected based on many factors including:

  • Medical: This often is the driving factor in selecting the level of care. If you or your teen are medically compromised more care may be needed.
  • Severity of malnutrition: Different levels of care offer varied amounts of support for nutrition rehabilitation.
  • Co-occurring conditions: Often those with eating disorders have other medical or psychological conditions that also need to be treated.
  • Social support: Social support improves mental and physical health. The different levels of care offer varying levels of social support.
  • “Motivation”: Most of us want to feel better and be healthy. However, change can feel scary, overwhelming and downright impossible at times. Those who feel more stuck in their eating disorder may need more support to feel like change is possible.
  • Access to care: Proximity to treatment, insurance, and specialty care are all considerations. Virtual treatment by clinicians and treatment programs are being utilized to increase access to care.”

Treating Anorexia Nervosa in Teens: The 5 Tenets of FBT

“Looking at all of the treatment options for anorexia nervosa in teens may feel daunting.

In this article, the focus is on family-based treatment (FBT), one type of treatment for eating disorders that is used for treating anorexia nervosa in teens. In particular, this article discusses the nuances of family-based treatment, which are referred to as the “Tenets of FBT”.

The focus of FBT is to empower you, the parent, to provide nutrition rehabilitation and restore your child back to health with the guidance of a treatment team. FBT is an outpatient treatment that can be used in place of residential treatment or partial hospitalization if your teen is medically stable. That means your teen can stay at home during treatment.

The tenets of Family-Based Therapy guide me as a clinician, and you as a parent, during eating disorder treatment and recovery. When working with families and teens throughout treatment I refer to these guiding principles frequently.”

Can Family-Based Treatment Help My Child Recover from an Eating Disorder?

“If you are a parent or caregiver, desperate to help your child who is struggling with an eating disorder, family-based treatment may be the solution you are searching for.

Often, families come into my office worried sick about their child.

Their child might have lost a lot of weight or been acting “sneaky” around food. Maybe their child has been over-exercising, using laxatives, or throwing up after eating.

Or, they might be worried because their child only eats a small number of foods, or eats a lot of food at once.

Or maybe your child has become an extremely “picky eater”.

On top of that, parents are often terrified because they have heard doctors mention hospitalization and many therapists have turned them away. When they do research online, things look bleak.

No matter their child’s symptoms, when families first come in they are often frantic, frustrated, and feeling powerless. They don’t know what to do.

If you find yourself in a similar boat today, you’re not alone. I have worked with countless families who walk into my office feeling this way. Sadly, there’s a lot of blame put on the parents. All they want for their child is to get better and live a happy life without the constant obsession with food.”

I’ll be back in 2025, writing more about eating disorder recovery, food peace, and weight bias. If there are any topics you want me to cover next year, let me know. You can send me a message here, and you can also follow me on Facebook. Every week, I share resources from myself + other eating disorder experts, so follow if you’re looking for more information.

Text in the bottom left corner reads "Treating Anorexia Nervosa in Teens: The 5 Tenets of FBT" and the rest of the graphic shows a stock photo of a white woman hugging a teenage girl on a couch.

Treating Anorexia Nervosa in Teens: The 5 Tenets of FBT

Posted on by

You may feel confused, scared, frustrated, and maybe even hopeless if your teen has an eating disorder like anorexia nervosa. You have seen your fun-loving and bright teen change drastically, becoming a shell of their usual self. 

There are many types of treatments for eating disorders that work for teens and their families. Cognitive behavior therapy (CBT), dialectical behavioral therapy (DBT), Family-Based Treatment  (FBT), and Acceptance and Commitment Therapy (ACT) are a few of the common treatment modalities that are used in eating disorder recovery. Additionally, there are different levels of care available for those with eating disorders, such as hospitalization, residential, partial hospitalization, or outpatient treatment.

Looking at all of the treatment options for anorexia nervosa in teens may feel daunting.

In this article, the focus is on family-based treatment (FBT), one type of treatment for eating disorders that is used for treating anorexia nervosa in teens. In particular, this article discusses the nuances of family-based treatment, which are referred to as the “Tenets of FBT”. 

The focus of FBT is to empower you, the parent, to provide nutrition rehabilitation and restore your child back to health with the guidance of a treatment team. FBT is an outpatient treatment that can be used in place of residential treatment or partial hospitalization if your teen is medically stable. That means your teen can stay at home during treatment. 

The tenets of Family-Based Therapy guide me as a clinician, and you as a parent, during eating disorder treatment and recovery. When working with families and teens throughout treatment I refer to these guiding principles frequently.

5 Tenets of Family-Based Treatment for Anorexia Nervosa in teens

Agnostic view of the eating disorder

In FBT, the focus shifts from why your teen developed the eating disorder to treating the eating disorder.

Eating disorders are complex disorders and can develop for a myriad of psychological, biological, social, and medical reasons, and beyond. The parents and the teen are not to blame for the eating disorder. I know it may feel like your teen is choosing their eating disorder because they are restricting food or purging, but they are not.

Additionally, parents don’t cause eating disorders-so let yourself off the hook.

How this is helpful:

It reduces blame, guilt, and shame for the teen, as well as their parents. It focuses on stopping the eating disorder in its tracks, restoring your teen’s health, shortening the length of illness, and preventing the eating disorder from becoming chronic. 

This is similar to if you found out you had cancer. You or your doctor initially wouldn’t spend a lot of time figuring out why you have cancer but rather focus on how to treat the cancer. Treatment for an eating disorder is similar, including for anorexia nervosa in teens.

Externalization of the illness

Externalization of the illness is a tool to understand that the eating disorder is separate from your teen. Although it may appear on the surface that your teen is refusing food, it is the anorexia that causes the food refusal. 

Externalization is commonly utilized in the treatment of OCD, schizophrenia, and other mental health conditions. 

How this is helpful:

This helps families understand how to separate their loved one from their eating disorder which can reduce blame and shame. The spirit of treatment feels more like us (family and teen) vs. the eating disorder, in contrast to parents vs. the teen. FBT helps you call on your years of parental experience and wisdom to help heal your child.  This can often increase parental empowerment leading to more successful nutrition rehabilitation.

An increase in connection between parents and teen is what I have observed when working with families during eating disorder treatment. Increased connection can contribute to improved physical and mental health for the whole family.

The therapist takes a non-authoritarian stance

In traditional adolescent-focused therapy, the therapist works predominantly with the teen, and the therapist is leading the treatment. In contrast, in FBT, the therapist acts more like a coach.

“The therapists are experts on eating disorders and parents are experts on their family and teen,” is something I learned during my training in FBT.  This lends itself to high amounts of collaboration between the therapist and family. Additionally, FBT utilizes the strengths of the teen to help aid in the healing process.

How this helps:

FBT is “not a one size fits all approach” to treating anorexia nervosa in teens. In Family-Based Treatment, the therapist activates the problem-solving skills of the family.

In other words, the therapist is there to help guide you and your child through recovery – but you know your child best and what has helped them with other struggles in the past. This knowledge is essential as you work together toward recovery.

Additionally, FBT appreciates the uniqueness of each family and their teen including culture, gender, abilities, exceptionalities, neurodiversity, religion, and family values to name a few.

Parental empowerment

Simply put, parental empowerment means that parents feel confident about taking care of their children. Some parents have some experience with feeling empowered with things like setting a curfew, boundaries around school work, and expectations around chores, while others might second-guess their parenting choices. FBT is an opportunity for growth in this area.

One of the tasks of the FBT therapist is to help you harness the skills and confidence that you already have as a parent, and apply them to renourishing your teen. 

How this helps:

Empowered parents can be more effective at renourishing their teen. Since you, as the parent, are in charge of feeding your teen, it reduces distress and second-guessing about what and how much to feed your teen. 

Furthermore, empowered parents provide structure, consistency and boundaries that help children and teens thrive. 

Pragmatic approach

The initial focus of FBT is symptom reduction rather than focusing on why the eating disorder developed. In the case of anorexia nervosa in teens, parents are tasked with the nutrition rehabilitation of their child, similar to the staff at a residential treatment center. This allows the family to stay together during treatment.

How this is helpful:

This approach stops the eating disorder from getting worse, which can lead to medical complications or potentially death. Stopping the eating disorder behaviors will help keep them from becoming habitual for your teen.

One hypothesis for why eating disorders develop is that eating disorders have a function. That is, they are helpful in some way, despite causing physical harm. For example, if someone smokes a cigarette, although the cigarette is physically harmful, it reduces stress for the smoker in the short term. Eating disorders are thought to function in the same way.

In my work, I have witnessed families rally around their teens, and through connection and compassion help their teen develop new skills to manage life stressors so the eating disorder is no longer needed.

Do you have a teen who is struggling with anorexia nervosa? Working with a therapist who is experienced in Family-Based Treatment can help. If you are in Texas and interested in working with me, click here to fill out a contact form.

Understanding ARFID: More Than Picky Eating

Understanding ARFID: More Than Picky Eating

Posted on by

Avoidant/Restrictive Food Intake Disorder (ARFID) often remains underrecognized and misunderstood.

Adults who have struggled with Avoidant/Restrictive Food Intake Disorder for most of their life may feel it is impossible for things to be different. Parents who have a child struggling with ARFID have, more often than not, literally tried everything to help their kiddo eat, but nothing seems to be working. ARFID is often equated with picky eating, but it’s actually much more complex than that.

Although ARFID is a newer diagnosis, there is really nothing new about it.

Prior to being added to the DSM-5, it was included in a broader category called “Feeding Disorder.” It was added to the DSM-5 in order to develop better ways to treat it.

Parenting a Child with ARFID

If you are a parent, well meaning doctors may have minimized your child’s selective eating. This can be particularly true if your child is on track with growth. This can be frustrating for a number of reasons. You spend significant time to figure out how to feed your child – and it takes a lot of mental energy and often can feel very limiting to keep dealing with this challenge day after day.

If it’s left unaddressed, ARFID can lead to nutritional deficits, which can impact both physical health and emotional well-being. Early detection of ARFID is important so it doesn’t turn into a life-long struggle. Understanding ARFID is crucial for effective intervention, and a comprehensive treatment strategy tailored to the individual’s specific needs is necessary.

Understanding ARFID

Avoidant/Restrictive Food Intake Disorder is not just a simple case of picky eating; it is a complex psychological condition that can cause significant nutritional and reduced quality of life, particularly if it endures into adulthood.

Unlike other eating disorders that are often driven by concerns about weight and body image, ARFID is characterized by an avoidance of food based on sensory sensitivity, lack of interest in eating, depressed appetite, and/or fear of adverse consequences such as choking, throwing-up, or an allergic reaction.

Individuals grappling with ARFID may face a persistent difficulty when it comes to eating sufficient quantities or varieties of food. This can stem from deep-seated anxiety, gastrointestinal discomfort, or past negative associations with food.

Recognizing Avoidant/Restrictive Food Intake Disorder Symptoms

Persistent avoidance of specific foods or food groups or low food intake are characteristic of ARFID. Physical responses such as gagging may coincide with this avoidance of certain foods.

The eating patterns of individuals with ARFID reveal a restrictive intake that fails to meet their physiological needs. Without treatment, ARFID can lead to potential nutritional deficiencies, weight loss, or developmental delays, irrespective of age, gender, or body weight.

Behavioral signs and changes in eating that may indicate ARFID include:

  • Poor appetite
  • Getting full quickly
  • Avoiding eating due to fear of choking
  • Picky eating that often gets worse over time

Avoidant Restrictive Food Intake Disorder (ARFID) is often misinterpreted as a phase among children or as mere pickiness in adults; however, it represents a significant feeding or eating disorder that hinders one’s capacity to consume an adequate variety and volume of food.

Impact of ARFID on Everyday Life

ARFID’s restrictive eating patterns in children can lead to low energy, isolation, and anxiety around meal times. For caregivers, it can be a struggle to know how to feed your child, or  it can take lots of effort to prepare foods that you know they will eat in order to support growth.

For older children and adolescents, ARFID can make socializing, which often happens around food (such as parties, sleep overs, family events or team dinners), anxiety provoking for both the child and parents. The disorder’s consequences radiate outward, often simmering into familial tensions and social rifts, as loved ones grapple with the complexities of ARFID.

Adults with ARFID tend to have a decrease in quality of life. Moreover, the fear of eating outside one’s comfort zone can hinder personal and professional growth, particularly when mealtime activities are involved.

Ultimately, the disorder’s grasp can dampen overall quality of life, exerting a significant emotional toll.

Approaches to Treating ARFID

The main goal of treatment for ARFID is supporting the sufferer with eating enough (and enough variety) to keep their body nourished. For children, treatment works to support growth. Treatment for children, adolescents, and adults can help to improve overall quality of life.

Improved quality of life looks different depending on the individual with ARFID. For some, that may mean eating most food. For others, it may mean expanding the variety of food in order to support quality of life and being nourished.

Avoidant/Restrictive Food Intake Disorder treatment usually focuses on making eating or feeding a priority.

That is, for most folks, increasing the number of times each day they eat meals and snacks. Due to the nature of ARFID, eating often gets put off because it is uncomfortable for the person to eat, or they simply aren’t hungry.

Structured meal planning can be an effective strategy for managing ARFID, as it introduces routine and predictability into the dining experience. By brainstorming menus in advance, individuals and families gain clarity and a sense of control over their food choices.

Having structure and making eating a priority can help make sure people are getting adequate nutrition and reduce meal time stress.

In addressing the dietary concerns that stem from Avoidant/Restrictive Food Intake Disorder, we take a gradual approach to food exposure. Food exposures are designed in collaboration with the client and/or the family in order to personalize care.

Incremental exposure to food means starting with foods that are less anxiety-provoking, building up to a more diverse diet over time. Food-related anxieties are meticulously deconstructed, facilitating the individual’s encounters with previously feared foods in a safe and controlled environment.

Efforts are channeled into ensuring balanced nutritional intake while concurrently addressing emotional and cognitive barriers. Over time, the individual learns to associate eating with safety rather than distress, thus gradually dismantling the cycle of avoidance that characterizes ARFID.

My Approach to ARFID Treatment

When I am working with children with ARFID I work closely with their caregivers. I have learned from my training in Cognitive-Behavioral Therapy for ARFID that I can bring the expertise in eating disorders, and the parents & kiddo bring the expertise on their family, food beliefs, culture, and abilities (to name a few).

With adults with ARFID I use a similar mindset. I bring skills to the table to treat the eating disorder and they bring their expert knowledge of themselves.

Are you concerned that you or your child are dealing with Avoidant/Restrictive Food Intake Disorder? Sign up for a free consultation to learn more about how I can help you and your family.

"When Your Loved One Doesn’t Want to Get Better Understanding Anosognosia in Anorexia Nervosa" in white text on a light purple background in the bottom left corner of the graphic. The rest is a stock photo of a white woman sitting on a couch next to a teenage girl, looking concerned. White text in the top left corner reads "www.alisonpelz.com Helping people make peace with food & their bodies."

When Your Loved One Doesn’t Want to Get Better: Understanding Anosognosia in Anorexia Nervosa

Posted on by

Anorexia nervosa is an eating disorder characterized by severe food restriction, an intense fear of weight gain, and body image disturbance. Anorexia nervosa affects many individuals of all genders, ages, and identities worldwide. 

The consequences of anorexia nervosa can be devastating, both physically and psychologically. However, one of the most challenging aspects of this disorder, particularly for family members and caregivers (and even clinicians!), is the phenomenon known as anosognosia.

What is Anosognosia?

Anosognosia, stemming from the Greek words “nosos” (disease) and “gnosis” (knowledge), refers to a lack of awareness of one’s illness. Anosognosia often can feel and look like denial. 

Denial is a defense mechanism and psychological response to avoid dealing with anxiety or other uncomfortable feelings. In contrast, anosognosia in mental health conditions is better described as a lack of awareness of their own condition.

Anosognosia can affect individuals struggling with bipolar, schizophrenia, eating disorders, and other psychological disorders. 

In anorexia nervosa, individuals may minimize the severity of their condition. They may adamantly believe they are not sick, or that their behaviors are justified, making it incredibly difficult for them to recognize the need for treatment. It can feel like your loved one is being “difficult” and in teenagers it can be especially confusing because during adolescence it is normal for teens to be contrary or contradictory. 

Anosognosia causes a person to be unable to achieve one or more of the following:

  • Accept that they have an illness or disorder.
  • See the signs and symptoms of their condition.
  • Connect their feelings and personal experiences back to that condition. 
  • Understand and agree that the condition is serious and needs treatment.

One of the most dangerous aspects of anosognosia in anorexia nervosa is the individual struggling with insight when the condition becomes life-threatening.

This lack of awareness around a loved one’s illness can further complicate the treatment plan and, many times, prevent treatment from occurring altogether. 

Parents frequently ask me if they should wait for their child to want to recover.

My answer is always no, because I know that anosognosia is most likely operating, and because the devastating effects eating disorders have.

Let’s face it – no teen really wants the devastating effects of an eating disorder. Contrary to popular belief, no one chooses to have an eating disorder.

How Anosognosia May be Affecting You

It’s already difficult enough to observe as a family member or loved one suffers from Anorexia nervosa, but anosognosia can make it incredibly distressing and frustrating. Despite your pleas, watching as your loved one deteriorates physically and emotionally, while they remain unaware of the severity of their condition, can evoke feelings of helplessness and despair.

To best help your loved one, you must recognize that anosognosia is not a choice but rather a symptom of the disorder. 

It is deeply rooted in neurological and psychological mechanisms impairing the individual’s ability to perceive reality accurately. This is completely out of their control, and without professional help,they may be unable to leave behind their problematic and highly dangerous behaviors.

The Role of Brain Connection in Anosognosia

Research suggests that anosognosia in anorexia nervosa may have an anatomical basis. 

Brain imaging studies indicate abnormalities in brain structure and function. According to a study published in the European Eating Disorder Review, up to 80% of individuals with anorexia exhibit some degree of anosognosia.

Malnutrition, a hallmark of anorexia, can lead to significant changes in brain chemistry and structure. This potentially contributes to the development of anosognosia. These neurological alterations can impair the individual’s ability to recognize their illness and hinder their motivation to seek help. This perpetuates the cycle of disordered eating behaviors.

The good news is with nutrition rehabilitation, anosognosia diminishes. 

Navigating Treatment and Recovery

Supporting a loved one with anorexia nervosa requires patience, empathy, and a comprehensive understanding of the disorder. Here are some ways you can help your loved one on their journey to recovery:

Show Compassion and Understanding

When you are speaking to your loved one about their eating disorder, it’s important to approach the conversation with compassion. You want to validate their experiences and avoid judgments, criticism, and shaming.

Encourage Professional Help

Although it may be difficult for someone with an eating disorder to want to receive treatment, it is still important for you to encourage it. Most success is found in early intervention. When the illness is treated, early on, there are often better outcomes than for those struggling without help for years.

Educate Yourself

One of the best things you can do to support your loved one if they are struggling with anorexia and/or anosognosia is to educate yourself on the facts. This should include the common signs and symptoms, possible treatment options, and debunked myths. This information is powerful in helping you better advocate for your loved one and their well-being.

Foster Open Communication

Create a safe and supportive environment where your loved one feels comfortable discussing their thoughts and feelings. Encourage open communication and active listening, allowing them to express themselves without fear of judgment or criticism.

Practice Self-Care

Supporting a loved one with an eating disorder can be emotionally and physically draining. Take care of yourself and prioritize your own well-being, seeking support from friends, family, or mental health professionals if needed.

Be Aware of Triggers

One of the most important things to keep in mind is that even those deep into recovery can and will experience triggers. You can avoid adding to these by educating yourself on avoiding phrases and conversations, such as calorie counts or weight loss.

Expert Eating Disorder Treatment

If you think that a family member, child, or friend of yours is struggling with an eating disorder, it is important to consult a professional. With proper treatment, individuals can overcome their eating disorder and live a healthier life, both physically and mentally.

I am Alison Pelz, a psychotherapist and registered dietitian with over 16 years of experience. I specialize in treating eating disorders in Austin, TX. 

If you or someone you care about is struggling with an eating disorder, don’t hesitate to reach out for help. To learn more about expert eating disorder treatment and schedule a consultation with me today. I am here to help you and your loved ones reclaim their lives and break through the chains of disordered eating.

Are you a clinician? Sign up for my mailing list and CE course!

Sources: