Worried about a Teenager
What do we do - our teenager will not admit there's a problem?
The view held by the EDP team is that denial is not a trait it is a state. It is not an indication of psychological disturbance but rather a defense mechanism that exists for a reason. We assume that teens are not lying when they show their denial. We assume that at some level of their consciousness they are aware that they are troubled and that with time and the right circumstances, denial will move toward acceptance.
Parents with a teenager or young adult with an Eating Disorder will recognize three areas of denial: denial of thinness, denial of hunger and denial of consequences (physical, social & emotional). As such, when a person is in denial, it is exceedingly difficult to gather objective statements from your teen about what he/she is experiencing at a feeling level.
The rate of significant denial in the eating disorder population is higher with Anorexia Nervosa (AN) than Bulimia Nervosa (BN). An example of denial would be: 'Other people think I have an eating disorder, but I don't.' Typically, about 30% of teenagers will answer 'True' to this question.
Teens with BN will be at risk of significantly minimizing the consequences. In fact, they tend to see negative consequences in not continuing with their binge/purge cycle. For instance, the teen with BN might believe and fear that there will be unwanted weight gain and consequently experience 'normal meals' as a binge that must be purged. In fact, some might suggest that amotivation rather than denial of a problem may be at work with some of our clients, in particular with a person suffering from BN. Amotivation involves the lack of connection between one's behaviour and the outcome. Or not valuing the behaviour or the outcome.
We don't understand our teenager's eating disorder - what is she/he getting out of doing these things to herself/himself?
Sometimes a client will be asked to describe their Eating Disorder as either a friend or an enemy. The costs/benefits of the Eating Disorder may also be explored.
Commonly expressed benefits of the illness include:
- being attractive,
- feeling special,
- maintaining control,
- an experience of feeling cared for
- avoiding or escaping uncomfortable feelings.
Typical costs are frequently reported to be:
- constant thoughts and fears about food and weight,
- more difficulty remaining focused (school work),
- negative impact on relationships.
We can assess how strong the internal drive might be for a given individual and have some idea as to the degree or severity of the denial. Interacting with someone who is denying their Eating Disorder is not easy. We know some things help over time: showing support and concern, being patient, knowing not to debate or argue and telling the truth. With continuous interventions at the level of the individual, the nutritional and the family, a positive effect usually follows, sometimes sooner - sometimes later.
What causes an eating disorder?
What caused the problem? Everyone wonders but family and friends are especially concerned. The causes of most psychological problems are complex and difficult to pin down. Our best answer is that the causes of an Eating Disorder (ED) appear to be multi-factorial.
The biologic or genetic aspect of an ED
Traits such as anxiety, perfectionism, and negative/depressed mood may be passed on from one generation to the next. In other words, the person with some or all of these traits may be more vulnerable to an ED.
The culture and mass media
The media influences children fairly early on. Thin images for woman and strong images for men permeate society and are internalized to the detriment of our children. When teens try and fail to meet these 'idealized' standards of beauty/strength, as most do, some assume it is them and not the message that is flawed. Low esteem can be reinforced and radical measures can be attempted.
Parents ask why and certainly ask themselves: What did we do wrong? The accepted view today is that the cause of an ED is unknown, and as parents your possible role is at best uncertain. There are many things we might do as parents that may increase the risk to our child. None of them, for example, worry about our weight, being a vegetarian, running marathons, eating unhealthily, arguing too much or too little in the family or going through a divorce etc., appears to be specific enough to warrant being labeled a cause.
Studies have found that physical & sexual abuse is a risk factor. Trauma can heighten anxiety and, in some, magnify preexisting weight and shape issues. The majority of those with eating disorders have not experienced abuse. Yet, there is evidence that shows a larger number than expected of those who have been traumatized present with some type of ED.
What should we do to improve the prognosis for our teenage?
Find a Treatment Team that is:
- Demoting yourself to last on the list will eventually backfire
- Find support whether with 'natural supports' or with other parents experiencing a similar challenge
- Does your workplace know what you & your family are going through? Will they really 'not care less' or think 'less of you' or have 'pity on you'?
- Lack of self care will also eventually begin to effect how much you can invest in other family members - good self care tends to minimize the negative effect of the Eating Disorder on the family as a whole.
- Keep as many family routines as possible; keep all family traditions.
Forge a renewed connection with your teenage
- Connecting through communicating - learning what to say and how to say it is very important. Avoid 'speaking' at your teen about behaviours such as bathroom use; missing food, miss using food, diet pills etc is not support - support is listening and empathizing but it is also holding your teen to pre-planned expectations.
- Communicating honesty always reinforces a connection. Expecting your teen to be honest if you are not being honest will break your connection and lead to a dead end. Being honest while you are in an emotional state of unrestrained anger typically results in a 'stonewalling' or 'adverserial' outcome. Manage your temper and process the primary feelings you are experiencing - maybe then you can start a conversation with your son or daughter that will be useful in the fight for recovery.
- Responsibility-taking is probably the most difficult idea to keep straight. The work of recovery is the responsibility of the teenage or young adult. The role of parents is to recognize that denial is part of the dynamics of recovery. It is a combination of your bond and your leadership that your teenage will rely upon to keep coming to treatment when the ED tells them otherwise. You will need to set up appointments, take her to the appointments, and participate in sessions as recommended.
- It is also your job to be a role model by working on treatment with your teen. By showing openness, showing the ability to adjust and showing your teen that the family is learning too. As your teenager begins to appreciate that she/he can count on you then they are in position to use your guidance and support to turn around against the ED.
What part will we play in helping our teenage become well?
The first task for some parents is to eventually let go of the idea that they are powerless, or conversely, that if only they could find the right therapist or the right medication then this will be fixed. A critical requirement is that parents are working together against the eating disorder. This may sound simple, but our lives are complex and we are complex. A couple may start out with every intention to come together and to help their teen, especially during the early crisis phase related to seeking outside help.
The reality is that because many of the teens are in denial, amotivational or ambivalent, wanting your teen to be better will not be enough.
Parents will be required to respond rather than react to their teen's behaviors and attitudes and to follow through with pre-planned strategies. For example, deciding on what to say and do to improve the chances of your teen eating more, not binge eating or not over exercising, etc. In any typical couple relationship, there are always disagreements, some more than others. Despite these everyday conflicts, most parents are 100% in agreement that they want their child to recover. The challenge is to learn to consistently come together so that there is no room for the Eating Disorder to slip through. It is then that parents begin to report that their sense of helplessness is beginning to lift and that their confidence in truly supporting their teen's recovery is beginning to grow.
More on the Role of Parents:
- Educators: not just information, but beliefs, values and relational skills.
- Role Models: What we do is congruent with what we say. In other words, what we do reflects our 'true' values not just our stated values.
- Responsible for Guidance: we place expectations on our children that change over time and we afford them increased responsibility over time.
- Responsible for Nurturing: expressing our love for our family members and maintaining a 'home' that feels secure and warm.
- Responsible for Safety: if there is risk or danger; if there is an accident or illness, we hopefully can help with both prevention and recovery.