Nothing can compare to the stress, anxiety, fear and heartbreak of having a child leave the home to go to treatment for their eating disorder. Now that they are back home, your fears may have increased, because now, you feel everything you do, or don't do, will impact their recovery.
Breathe. This isn't 100% true.
Depending on the age of your child, you may or may not have a lot of involvement with their ongoing care and monitoring now that they have returned home. I sincerely hope that your treatment team has thoroughly prepared you for how to engage with your child and the level of monitoring and supervision you are to provide them with.
With that said, here are a few common concerns parents that I work with voice frequently:
1. .My child keeps commenting on my eating habits, how do I deal with this? Do I need to change my own habits?
The short answer is no. I am assuming you are not participating in disordered eating. When individuals go to treatment one of the very difficult realities they have to face is that they are on a meal plan that is much different than someone who is not working to recover from an eating disorder. Children with anorexia often will be put on meal plans that are much much larger than a healthy adult. This can be difficult for a child when returning home. But please remember this, it is used as a bargaining chip for your child's eating disorder. Do not give into the eating disorder, you are not negotiating with this illness. Some parents may be swayed to change their eating habits to help their child, and while some basic strategies can help (everyone at the table eats the same thing, not amount) it is important to remember that modifying your own behaviors will not help your child when she or he is in the outside world, having to navigate these stressors with others.
2. My child is arguing with me over what her/his meal plan should be.
Too often there are gaps in education and support between a child leaving treatment and coming back home. I often see parents dumbfounded at their child's remarks about food, portion sizes, fats, proteins, carbs, label reading, and not knowing how to respond, or even doubting their own judgement. Meal plan specifics, and your child negotiating what should or shouldn't be on their plate, is very individualized. Some children come home from treatment on a maintenance meal plan (they do not actively need to be restoring weight) others are on very high meal plans and goals are to gain 1-3 pounds per week while at home. Generally, if there is a high level of distress and argumentativeness, the eating disorder is trying to run the show. Please consult with your care provider for help with implementing your child's meal plan, or schedule a parent coaching session here.
3. I am not sure if my child is falling back into his/her eating disorder, when is treatment necessary?
This can be a very scary realization. But an important one. All too often disordered eating behaviors get ignored and then all of a sudden a child is being rushed to the emergency room after a well visit, recognizing heart rates are low, and weight has fallen drastically.
How do you know if it is time for your child to enter treatment? The first step is consulting with your treatment team, if you do not have a team, talk with your primary care physician. If you feel your primary care doctor does not share your concerns as you see them, do not hesitate to seek out a primary care doctor who specializes in eating disorders, or to find a therapist or dietitian who can guide you on any necessary treatment/care.
There are many different 'levels of care' and your child does not always need to leave the home to enter treatment. OP, or outpatient providers, consist of a therapist (myself) dietitian (meal plan monitoring), psychiatrist (for medication), and a primary care doctor (to monitor general health and weight). Sometimes, this team is not enough to interrupt your child's eating disorder behaviors and more intensive programing is needed. This includes: IOP (Intensive Outpatient) which is usually 3 days per week, a few hours per day and includes things like dietary support, group therapy, and individual therapy. PHP (Partial Hospitalization) is sometimes 5-7 days per week, lasting all day, and includes the same types of interventions as IOP, but usually includes family sessions, and more individual therapy sessions each week. Residential care is where the child leaves the home and is under 24/7 supervision. In these cases your child is likely medically compromised, and/or cannot be left alone due to their behaviors (refusal to eat at all, constant exercising, purging behaviors).
Eating disorder treatment and recovery is a process. It is likely your child will not return from treatment 100% recovered and never look to his or her eating disorder again. Ongoing care and maintaining recovery can be difficult. If you are looking for additional support, I offer coaching sessions to parents and caregivers of those individuals struggling with and in recovery from eating disorders. Please see this page for more information. Or feel free to send me an email: MargaretStoneLPC@gmail.com