People can develop difficulties with food for a number of reasons, but it is clear that some young people with severe attachment difficulties cope with self and interpersonal difficulties by employing a range of self-destructive behaviours, including disordered eating. Working with this group is difficult and requires some specialist intervention, but there are also a few basic principles that can help.
• No one chooses to have disordered eating, although the child can seem very attached to theirs. Usually an individual would want to give up their disordered eating if they knew how. Attempts to help can be frightening, because the disordered eating has some advantages
• The disordered eating serves a purpose. Resistance to change and resistance to help are part of the condition, and do not mean that your child is being deliberately difficult, rather it reflects their fears of giving up something that helps with other problematic areas of life.
• Poor self-esteem can be a crucial underlying issue
• There is no quick and easy solution
Fundamentals of management
• Try not to blame the child for her disordered eating
• Accept the child is in distress
• There is no single correct way of helping, but the whole team around the child need to identify and support strategies for working with the disordered eating, and all need to consistently apply them. Finding everyone working together in harmony can provide the child the confidence she needs to overcome her disorder
• The things you do to help need time to work. Be consistent, persistent and repetitive
• Try not to lose sight of the healthy and good things about the child. Get a full and complete picture of her strengths. Try to do the normal things the child enjoys
• Try to separate the disordered eating from the person. This difficulty does not make them a bad person. It’s a bad thing that is happening to a good person
• Away from meals, try to focus on your child’s feelings. Show her that you can acknowledge and accept them. Offer warmth, comfort and reassurance
In cases of anorexia
In cases of anorexia and similar conditions, it’s as if the child has two inner voices. The “anorexic” voice telling her that she is “fat, ugly and stupid” and the “healthy voice” telling her she is “ill, thin and should eat” The first voice is experienced by everyone as louder and more insistent. Try to focus on the healthy voice along the following lines:
I know how strong the voice is that tells you, you are fat and shouldn’t eat; how sometimes it torments you and at others it seems to be your friend. It must be confusing and frightening for you. But I want to speak to the healthy part of you, so I’m not going to talk to the part of you that torments you in that way