“How can I stop walking on eggshells?” - Communication with my child through the fog of an ED
The unexpected advent of an ED into a family pulls the brakes of the train of everyday life as it was known and sends everybody into an imperative re-adjustment with new rules that are not clear at all. One of the biggest challenges is communication with a child who seems distressed all the time. Parents start questioning their capacity to parent and everything that they did before this point in time. The initial attempts to “conquer” the ED often backfires and timelines as we have known them, don’t seem to help. Not knowing the landscape of an ED renders all attempts at communication a struggle. While the child is feeling squished between their anxiety and parents’ expectations, parents feel squished between their own anxiety and a child who seems to be a stranger, at times. It is helpful to not lose sight of the fact that we are still the parents and somewhere in there is the child we always knew. In the words of the attachment therapists, it is never too late to learn, repair and connect anew.
Following are a few key points to keep in mind as you go along this rocky journey.
Curiosity - The value of a curious stance cannot be overstated. As parents , we rightfully have an assumption that we know our child. Some children are easier to know than others. Small children are often easier than teenagers because they run towards us. However, the truth is that small children are trickier in that they might have feelings that we do not pause to pay attention to, as we can pick them up and move them around. Small children are physically smaller which gives us an advantage for a while. Teenage has the reputation of being a difficult time because “teenagers don’t want to be around their parents”. This is a mistaken and dangerous assumption that has become prevalent through pop psychology. Teenage is a period of exponential brain and body metamorphosis. The child is evolving into an adult , going through many gawky, awkward phases. If we pause to think about it, this is a period where the child needs more safety, guidance and mentorship than any other stage as they contemplate their gradual flight out of the home nest into the big world beyond. It is a period often fraught with anxiety and the teenager tries to do their best to look confident with no real clue about how they feel through this tremendous transition. If a parent can muster a very curious position, the teenager and the parent can gently explore the shifting landscape together, with or without an Eating Disorder.
The operationalisation of curiosity involves -
Not making assumptions
Always wondering (even if the answer seems obvious)
Teaching the child and learning ourselves to ask questions - why and why not
Being patient as the child’s brain matures
Making space for emotions and
Learning to talk as though we were talking to a stranger you just met on the train.
Curiosity is often forfeited to accommodate our fast-paced lives. This is a mistake. Make room for time spent side by side - on a walk, the drive home or a coffee break
Practice silence, active listening and small prompts like - “oh, say more” or a small question about a specific topic. Any expansion is a window into the child’s world.
2. Reciprocity - a good conversation has reciprocity, an easy give and take with mutual interest. Parents , in the rush of life, do not realize how often we talk “at” our children without pausing to notice a fleeting expression, make eye-contact or wait for an answer. As parents, we are also not often aware of the gravity of our facial expressions, tones and body language. Our children have been watching us closely since they were born and respond / react to our ways of being in their presence. Teenagers start reflecting back to us the ways in which our manner might not be inviting or the times that we did not pay attention. Teenage is a time where LOVE has to be a verb. The teenager has not evolved in a vacuum. They are a result of their reciprocity with us. It becomes more imperative than ever to pause, listen and notice. Above all , to not keep talking or instructing without waiting for the child’s response.
Taking the time to check within ourselves to find the words that convey what we are actually thinking , is a skill that has to be cultivated. While we can all talk, speaking with accurate language must be practiced. One can always start a new pathway by saying - “I know that I haven’t always paid attention or paused to think before I say something but I am going to try” or “ The landscape of this eating disorder is new to both of us and I am going to do my best to learn how to help you”. Once we learn that we can use words for almost anything, we are less afraid to make mistakes because we can always use our words to revisit a situation and work to understand it better.
3. Hierarchy - A healthy, functional relationship with our child requires us to never forget our hierarchical position. As a parent, I am the manager of this company, the architect of this family structure, the secure base, the first teacher and the role model. While it is true that we are only flawed human beings who might not have quite realized the weight of the task we signed up for, ( i.e. growing up a helpless impressionable human baby into a fully functioning adult )we have to know that we lose ground when we make concessions for ourselves. We often make the mistake of thinking that our children only know what we consciously remember them seeing or hearing. On the contrary, our children are watching not just what we do or what we say, they know how we think from years of intimate observation. And many assumptions are made on both sides. Curiosity and reciprocity help us know each other in a new and conscious way. However, on the part of the parent - a parent always aspires to be consistent and “bigger, wiser and kinder”. Trust is built in this way. A child who can trust their parent feels secure and the parent who has earned that trust has “influence”, the most effective tool in parenting.
A footnote - Hierarchy does not have to be boring. Parents can have fun with children and be silly and playful. Hierarchy is an energetic stance where the parent is always aware of their position and can revert to “bigger, wiser, kinder” when the child is looking for direction.
4. Comfort with big emotions - This is a non-negotiable and a place where many parents struggle. We are the product of our own families and what we have learned there, consciously and unconsciously. Emotions are often inconvenient - they appear at the wrong time, location or situation - and families rush along trying to avoid them as much as possible. Sometimes there is only space for one person’s big emotions in a family and if a parent takes that space , everyone else flies under the radar. Children arrive with the complete range of emotions - joy, sadness, anger, frustration, anxiety. I believe that babies arrive with an assumption - or hope - that we, their parents, know what to do with them and their emotions. When parents have not themselves cultivated the bandwidth / tolerance to stand in the presence of a big emotion with calmness and equanimity, they try very hard to not activate big emotions in the child. This is why parent-oriented methodologies like letting children “cry it out” have a place in the parenting world. The idea that parents are told to ignore a child’s expression should make us all shudder.
An Eating disorder is a teenager’s best attempt to not rock the boat or “be a burden” with their big emotions. Therefore, the young person works very hard to manage them with a tight regimen of numbers and rules. Interrupting those rules and inviting flexibility often unleashes the big emotions swirling underneath - repressed anxiety, anger or sadness. The way out of walking on eggshells is cultivating comfort, acceptance and acknowledgement of big emotions as a part of life. When a child is allowed their big emotion, it arrives like a wave and passes by. it is important for the teenager to experience their emotional wave in their body, experience their parent not shying away from their emotion and learning that emotions are manageable. It requires the parent to breathe, hold space for the emotion and knowing it will pass. There is room for constructive conversation after the emotion passes. The child might be in a “flooded” or “fight/ flight” place at the height of an emotion and this is not a good place for words and questions.
We are able to tolerate another’s big emotions when we have made peace with our own. Therapy and mindfulness can help with this. Sometimes parents are asked to feed their child without this knowledge that it is imperative to know how to “ride the wave” of big emotions in their own bodies and the child’s. And this is where things go wrong at the table. Like doing homework even when the child doesn’t like it , refeeding requires compassionate acknowledgement of how hard it is in the moment, equanimity in the parent AND expectation that the task of finishing the meal has to happen. parents also go into fight, flight and freeze and any parent who is in charge of refeeding a child will need support to reorganize themselves and practice calmness for the task.
5. The Wide View and the Long Game - The child with the ED lives in a world of immediacy. Calories are calculated and balanced hour by hour and emotions are felt minute by minute. The tighter the cocoon of the ED, the safer the person feels. The anguish of the parents and the treatment team about the long term implications on the body make little sense at all to the person who is simply trying to avoid the next meal and the next wave of anxiety. In the attempt to re-feed the child over and over, it becomes imperative that the parent is able to hold a very wide stance with their own emotions. This will allow the child to have the wave of their anxiety, notice that their parent is able to tolerate it and experience the hope that an emotion, however scary it feels in the body, will not annihilate us. By the time we are doing ED treatment, we are in “repair”. We are repairing some important things that went unnoticed with this child. A very important one among them - the tolerance of distressing emotions. Emotions come and go in a wave. The high point of the wave is dreaded by everybody. But if we can remember that a passing wave will pass and we will survive, the wave becomes a manageable event. A parent has to know this and a child has to learn this.
The Wide View allows us to tolerate the repetitive waves / outbursts that occur at every meal and remember that they will diminish in time. The Long Game is knowing that through this process we call “treatment”, the child is learning to not micromanage their food and body, to deal with emotions separate from food, to deactivate their fight/ flight response and finally to find an easy and harmonious relationship with their evolving body. A very active working relationship with a good therapist and dietitian is imperative to get through the roller-coaster of this stage. Many families initially start the journey determined to “wrap up” treatment in a few months. It is helpful to realize that we are actually working with the child’s anxiety about this big transition of teenage and it is a case of “slow and steady winning the race”. Learning that sustainable change can only be achieved by pacing with the child’s anxiety is important. Change that is made, weight that is gained under duress without emotional / mental collaboration on the child’s part is often ground gained that is soon lost. The individual will take the body back to the place they can tolerate. Numbers pertaining to weight are a marker of progress when a person is moving out of a medically unstable place. Once at a stable weight, numbers stop being reliable markers. It is important that everybody’s attention moves to a normalized relationship with food and body and life.
6. The parents’ own relationship with food and body - Diet culture - i.e. the culture of normalizing control over the body and food as a good thing, talking about the body and food in fear-based terms of good and bad and equating restriction with control and success - has been around for at least three generations at this point. Which means it is not uncommon for a teenager to have a grandmother who had an eating disorder/ disordered eating that was called “dieting”. Teenagers grow up in homes where parents and grandparents have habitually talked about sugar and carbohydrates as “bad” and attended Weight Watchers and Jenny Craig, often ashamed of their own bodies and their love of food. disordered eating is not called “dieting” anymore, it is just “eating healthy”. In sports like gymnastics, swimming, figure skating and in ballet , girls at the cross-roads of their bodies growing are openly told to stay small. It is my experience that in many families , weight loss is appreciated till an ED is diagnosed. It is many a young girl’s experience that the family abruptly swings into treatment mode and the young person has to eat everything that they were told was not good for them. This is shocking to the young person’s system. When the young person remembers and questions this later in recovery, I find many a mother saying it did not happen, it is not true or “we don’t do that anymore”. It is very important to acknowledge what the child remembers as true and to really change our ways. It is extremely hard for a therapist to convince a young person that it is alright to eat to the wisdom of your body when the child’s parent continues to normalize diet-culture. It will contribute to the endurance of the ED in the home.
The lessons we learn in our families are deeply imprinted and ingrained. We trust our parents before we know what trust is because they loom large in our tiny lives. Anything a therapist says is secondary to what the child knows from home. It is important for parents to acquire a deep understanding of the anxiety that underlies an ED in the context of their child’s life. Talking about the ED in a compartmentalized way - as something only Allison ( fictitious name) is struggling with for reasons we cannot understand - only makes Allison more ashamed and anxious about her struggles. Often the arrival of an ED invites the whole family to turn inwards, take stock and reorganize in a way that benefits all members. The ED loses its function in the child’s life and the child gradually allows the transition to adulthood to happen. The ED disappears. Sometimes this takes a few years.
“Liking” and “Fearing” foods - Mild, moderate and severe diets and eating disorders include a fear-based languaging of food. People learn to fear sugar , carbohydrates , fats and if we further it - red meat and dairy. Emotions live as physical feelings in the body. Anxiety is felt in the shoulders , chest, stomach and back. Because people often do not think about feelings in the stomach as having emotional causes, it has become quite common to quickly assume that a person has issues with gluten and dairy. I am not advocating that we should all eat red meat or be overweight. I am suggesting that learning to live in harmony with food and our subjective bodies without fear and control , is becoming more and more difficult when every day presents us with new waves of information about what is “good” for you and what is “BAD”. The hallmark of an ED is the fear surrounding food and body. ALL my anxieties have been consolidated into the one anxiety about body - “I will get fat!”. This is the code statement repeated constantly. It is a code. As we redirect the client to explore what lies beneath , it is important that the family examine any fear-based language that has been practised in the home. It is my experience that clients as well as family members who practice restriction will substitute the word “like” for “fear” - “ I like soy milk. I don’t like butter. I like rice cakes and vegetables. I don’t like cakes , ice creams, pizzas or burgers”. It is hard to argue with a person’s “likes”. However, it stops being a coincidence when the things that a person likes falls into the category of “good” or “ healthy” foods excluding everything that is ‘bad’. Whether something is an issue or not can be identified by how much the person ( parent or child) “freaks out” when change is proposed. I call this the “freak-out factor”. The freak-out helps us identify where the anxiety is connected to a behaviour.
Recovery from an ED is not eating a muffin. It is coming to ease with the fluid nature of life and food and the body……….. and the emotions that move within.
