Eating Disorders
Survival Guide for Parents
with Eating Disordered Children
online conference transcript

Cris Haltom, PhD., who has treated many adolescents and adults with eating disorders, is the guest speaker.

David is the HealthyPlace.com moderator.

The people in green are audience members.

BEGINNING:

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our conference tonight is entitled: "A Survival Guide for Parents with Eating Disordered Children". This will cover children will suffer from anorexia nervosa and bulimia nervosa.

Our guest is Dr. Cris Haltom, PhD. Dr. Haltom has treated many adolescents and adults with eating disorders (anorexia and bulimia), has trained mental health clinic staff in eating disorders treatment and is a guest lecturer on the topic of eating disorders at Cornell University. She also works with parents to help them cope with the emotional stresses of having eating disordered children.

Good evening Dr. Haltom and welcome to the HealthyPlace.com site. I received about 20 emails today from parents who are not only concerned about their eating disordered children, but also explaining the impact that this has had on their lives and other members of their families. In your experience, what is the toughest part of surviving this ordeal for the parents?

Dr Haltom: Coping with the frustration of an eating disordered child who is resistant to treatment and the long-term nature of treatment.

David: And that's part of the disease. Many times, the sufferer doesn't realize or doesn't want to acknowledge that anything is wrong. How is a parent to deal with that?

Dr Haltom: Parents need to recognize, first, that they have a right to express their worries and concerns to their children. An open and honest approach to gently confronting a child is important. Parents need to use "I" statements when they confront a resistant child and to site some of the behaviors and signs that they have observed which suggest there is a problem.

Parents should approach an eating disorder like any other illness. It is a serious matter and they can communicate that to their children. They can also point out that there are professionals who will be gentle and supportive with them in proposed treatment.

David: I know that's easy to say. But many parents are faced with children who are openly combative and insist that nothing is wrong. Parents tell the child she/he needs help and the child says "no way." Then what?

Dr Haltom: Great question. Parents can expect resistance and anger. As you said, it is often part of the disorder. Taking a child to a physician can often be helpful. Because eating disorders also have a medical component, there are often telltale signs that will be picked up in a doctor's office. It is difficult for a child to refute medical evidence. In the case of a child's safety being jeopardized, a child may need to be escorted to the emergency room of a hospital where both a mental health and medical professional can assess the situation for safety.

Also, I would like to point out that there is nothing wrong with anger. Underneath a child's anger is some important communication about why they are having problems. And underneath anger is usually hurt and/or fear.

David: Dr. Haltom, here are a few audience questions:

PattyJo: Since a lot of eating disorder sufferers have a 'guilt complex' anyway, how can a parent express concern without triggering the eating disorder? I found that the eating disorder 'spoke' for my daughter about 80% of the time at her lowest weight. I found that even at 62 lbs., we had to "Force" our daughter into an inpatient treatment facility.

Dr Haltom: Since the eating disorder is often the primary way a child copes, it is often difficult to avoid triggering eating disorder symptoms. In general, it is best not to walk on eggshells with your child even if you are concerned about causing guilt.

Emerald Angel: What if you (the child or the parent) cannot afford to get help?

Dr Haltom: One important step for parents is to educate yourself about eating disorders. There is now excellent on-line information on a number of websites (including this one) about eating disorders. There are also a number of national organizations (e.g. National Association of Anorexia and Related Eating Disorders or ANAD) which act as referral sources to low cost treatment. These organizations all have websites.

Also, your local mental health clinic and pediatrician will most likely be able to help you. Recent studies have shown that primary care physicians, when educated about eating disorders, are key treatment team members.

David: If you haven't been on the main HealthyPlace.com site yet, I invite you to take a look. There's over 9000 pages of content. Check out the Eating Disorders Community.

Here's a question I've received from several parents: Is there really any such thing as "true recovery". Or is it like alcoholism, where, in a sense, you are always in recovery?

Dr Haltom: It depends on which school of treatment specialists you are talking to. The addiction camp suggests that once you have an eating disorder, you remain recovering. However, there are many who believe that people with eating disorders can and do recover. About 50% of people with eating disorders, after recovering, report being "cured."

David: Many, though, go on to have relapses. That, too, can be very stressful and also wearing, I'm sure.

Dr Haltom: Yes, many people do relapse. Many times that is because of incomplete treatment. After intensive treatment, people who have reached normal weight and/or are free of debilitating symptoms leave treatment in what I call "hover mode." They are hovering between still having disordered eating and being healthy with eating and body image issues.

Treatment for eating disorders may last from six months or so to two years. Sometimes, as with chronic anorexia, the treatment may go on long-term. During recovery, there may be a period of good health only to be followed by temporary relapse. This uneven progress is to be expected in treatment. And the uneven recovery process can be frustrating to expectant and hopeful parents who desperately want to see their child recover.

David: So, for parents, one important thing to keep in mind is, even after being in extended treatment, whether in- or out-patient, it's important to receive follow-up treatment and monitoring. Just because your child says she/he is better, it doesn't mean that's so.

Here are some audience questions:

camkai: I have a 10 year old that is 8 months into her eating disorder. Are you seeing younger children with this problem?

Dr Haltom: Yes. About 10% of young people diagnosed with an eating disorder report the onset of their illness at age ten or younger.

JEN 1: My daughter is in treatment now. When she comes home, how much of a role should I play to insure she stays on the right track? Should I be involved in monitoring? She is 19 and living at home.

Dr Haltom: It sounds as if your child is in an inpatient or day treatment program away from home. My guess is that the staff that are working with her are experts in the treatment of eating disorders. They will direct you with regard to monitoring.

David: One of the questions I received was that, of course, eating disorders are a "physical thing", but can a person ever recover from the "mental aspects" that led to it?

Dr Haltom: Yes. People can recover from the behaviors, emotional issues, poor body image, distorted beliefs and attitudes that led to and maintained the eating disorder.

lyn: Can you give any advice concerning prevention for those of us who still have younger children ?

Dr Haltom: A top piece of advice is the following: Teach children to "listen to their bodies" when it comes to eating habits, hunger, etc. In general, we want to teach children to pay attention to internal cues about eating and hunger.

chloe: Do you believe that hospitalization is necessary? Can an adolescent be treated successfully at home?

Dr Haltom: In this era of minimal insurance benefits available for expensive treatments (often about $1000 per day for good inpatient treatment), there are increasing numbers of people who are using intensive outpatient services to treat eating disorders. Of course, when there is a medical emergency, such as heart arrhythmia, esophageal tears, and other medical problems, hospitalization may be absolutely necessary.

Luvem: Why do therapists & nutritionists recommend that parents not discuss food issues?

Dr Haltom: Many young people in recovery need to learn to listen to internal cues and make autonomous decisions about food choices. It is part of the recovery process in many cases. Also, focusing on food is often not focusing on the most important issues - those underlying issues such as identity confusion and a myriad of other concerns are more important to focus on.

On the other hand, most of them are interested in promoting healthy eating habits in a child's home. That may require some talk about food. For example, a common recommendation is to make sure their is a family habit of eating three times a day and eating at least one meal together. Also, a common recommendation is to have a healthy variety of foods available in the home. There may be some "food talk" about what food choices different family members want in the home.

David: In your web site www.anorexiasuvivalguide.com, you have a program which you call an "anorexia survival guide for parents". Can you explain that in more detail?

Dr Haltom: This is a program which utilizes virtual modalities - computer, phone and fax - to connect parents for psychological and educational learning about their children's eating disorder. I have a free monthly newsletter which can be subscribed to at my website. And I have started offering tele-classes for parents which run for 4 to 6 weeks, one hour per week. Parents are connected by a telephone bridge line and I teach the class. Parents can both learn and support each other.

The idea is to support parents while their child is in treatment. The classes and newsletter are a supplement, not a substitute for treatment by a team of professionals.

Jackie: What is identity confusion?

Dr Haltom: Young people are often in the throws of developing their identities. That is, they are in the process of figuring out what their personal values are, what their chosen peer group is (who they identify with, e.g., athletes), what their sexual orientation is, what their career aspirations are, etc.

Children are picking their values, career aspirations, chosen interest areas, and educational goals. All this can be very overwhelming. As a result, there is sometimes a need to feel special or in control of their lives when everything around them seems to be one large question question and difficult set of decisions. One way to be in control is to control one's body and eating. Or one way to feel special is to be the thinnest at school.

Luvem: How can a parent show their concern and support for their child without sounding "controlling"?

Dr Haltom: Be a good listener. Be available to talk. Don't be too probing or judgmental. Many young people with eating disorders want to be "understood" by their families. Showing empathy is also a good way to draw out a child and show support. A parent can use reflective listening and they can ask about how a child might be feeling. They might say, for example, "That must have hurt your feelings."

David: An audience comment on point:

lyn: Not too easy to not be probing these days with young people.

PattyJo: What about medications, what is effective for anorexia? And should a parent be receptive to medication treatment for their child?

Dr Haltom: Because absorption of medications is sometimes affected by eating disorder behaviors, e.g., starvation and poor nutrition or vomiting near the time medication is taken, a physician will determine when the appropriate time to give medication occurs. And the physician prescribing, often listen to the mental health professional (unless it is a psychiatrist who is both prescribing and treating) about what mental health conditions may be underlying an eating disorder.

chloe: My daughter was put on the antidepressant, Zoloft, and we have seen tremendous progress in the depression that accompanied her eating disorder.

Dr Haltom: For example, it is very common for young people with eating disorders to suffer from depression. Also, social anxiety and obsessive compulsive disorder (OCD) are often part of the clinical picture. And substance abuse is a consideration. The medication chosen will address the clinical psychiatric problems. There is some evidence that certain anti-depressant medications will curb appetite for those who binge. Also, sometimes medicine is given for gastrointestinal problems that arise with eating disorders.

In short, parents should be prepared to deal with the question of medication when their child is in treatment for an eating disorder.

David: It's getting late. I want to thank Dr. Haltom for being here tonight. Again, her website address is: www.anorexiasurvivalguide.com. There was a lot of good information and I appreciate the audience participation. Our homepage is: www.healthyplace.com. I invite everyone to take a look around. Thank you again, Dr. Haltom, for coming tonight. Good night everyone.

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