Child and Adolescent Mental Health Services
Information for family and friends
The following guidelines are for parents and carers whose son or daughter has had a recent diagnosis of Anorexia Nervosa, on how you can help with the weight restoration part of treatment in the early stages.
For most teenagers with this diagnosis, this early stage is characterised by extreme low weight, with concern about the short and long term effects of this on physical health and development. Integral to this is a distorted body image and strong urge to maintain the low weight and even a drive to continue losing weight, which is difficult to resist. We often refer to this as the ‘anorexic voice’.
You will probably have been asked by the care team to try to ensure your daughter eats all the food prescribed. The rationale for this is that responsibility for ensuring that the young person eats and puts on weight is handed over to parents in this early stage. This is because it is recognized that the lower in weight someone is, the more difficult it is to ignore the “anorexic voice”. Over time, as the young person recovers, this responsibility for eating is handed back to them.
Some ideas for supporting the young person in the early stages of the illness, keeping the nature of the illness in mind, are given below.
Early on in the treatment a meal plan will be devised following discussion between you, your daughter and the dietician or other member of the team. The meal plan is initially based on the current intake of the young person and will be gradually increased and adapted in order to provide a healthy balanced intake, which will ensure weight gain.
Your daughter/son, supported by you, may be asked to keep a record of everything that is eaten each day and this record will be useful in planning further adaptations to the meal plan.
In the early stages, making choices about food can often pose huge dilemmas for the young person. It is therefore often more supportive to the young person at this stage to minimise the need for choice. We would therefore recommend that parents/carers take charge of serving the young person’s meals without negotiation over meal size.
This may cause friction between parents and the young person. However, parents/carers following this plan have the young person’s best interests at heart. Following the diet plan is essential in order for weight restoration to take place. It is likely that by standing firm with this, the young person will feel emotionally contained and see that the parent’s/carers voice and actions are stronger than the anorexic voice. It is often very difficult to bear this friction and continue to stand firm with this, so please also refer to section “ideas for how to respond” and “support for yourself”.
Young people with eating disorders are often extremely anxious before meals. Parents can help to reduce anxiety by encouraging distraction or relaxing activities or helping to remind the young person of their goals.
Supervision during meals or breaks includes either sitting at the table with the young person or keeping a highly visible presence until the meal break is finished. We would encourage family members to eat together at meals wherever possible; however, we are aware that the young person may take a long time to finish meals and family members have other commitments. We do strongly recommend a visible presence, as it is important particularly in the early stages that the young person has eaten the prescribed diet.
Supervision is therefore an important part of the weight restoration phase. Watching to ensure the young person doesn’t hide food and that she finishes the meal may involve disagreement.
It may help, to believe that rather than the young person, being devious, it is the urge to listen to the anorexic voice and hide food that is strong. We would therefore recommend a matter of fact approach of replacing any hidden food rather than punishment.
We also encourage using incentives alongside this i.e. praise; planning something nice to do together when he/she finishes meals. This can be agreed with the young person prior to the meal.
We recommend in the early stages that parents/carers offer support for an hour after main meals and half an hour after breaks.
This is in order to ensure the meal is digested and, in some cases, to minimise the risk of vomiting.
This time may be used to spend some quality time together talking, playing a game, doing artwork, watching TV etc.
Parents and carers often ask how to respond to a young person with Anorexia Nervosa. Many find the young people feel that everyone is against them so we would suggest trying to ally with her in the battle against the anorexia saying for example. “we can beat this together’. “I” statements rather than “you” statements offer a non-blaming approach i.e.: “I get really worried for you”, “I’m rea1ly concerned about you”.
Managing disagreements and bearing friction can be very hard. We suggest that maintaining personal confidence about your own convictions and not being swayed can be quite helpful for the young person.
Parents/carers sometimes feel pressure from the young person to eat the same as them. Given that you are not on a weight restoring diet, we suggest that you continue eating normally.
Young people with anorexia nervosa often over-exercise in order to lose weight or in order to prevent weight gain. In the early stages of treatment it is essential to support your daughter in minimising exercise in order to safeguard their physical health and ensure weight gain. This may necessitate additional support between meals.
Helping someone with Anorexia Nervosa can be extremely tiring and often stressful. Making time for you every day is very important, even if it’s just for half an hour as an opportunity to unwind and look after yourself
If possible, try to share responsibility for mealtimes with another supportive adult who is aware of the need for a consistent approach.
It is important to recognise the occasions that you need extra support or practical help, and your care team can be available to you to discuss any issues in family meetings or by telephone. The Parents Support Group will provide a forum to share experiences and gain ideas and feedback from other parents in the same situation. This takes place on a monthly basis. Your care team will be able to provide you with the details of this group.
As the young person increases their weight, and their psychological and physical functioning improves, it is important to gradually hand back responsibility to the young person. This can be done in discussion with your treatment team.
The young person may also find it helpful to have individual support themselves which can be arranged through your treatment team.
Last updated: 12 March, 2019