1. Art and Diseño

Inside this
issue:
Tis the Season
to Avoid Holiday
Meltdowns
3
What Are Eating
Disorders?
4
What Warning Signs
Should I Look For in
my Child/Adolescent
5
Nutrition 101
6
Parenting Perspectives
V O L U M E
2 2 ,
N O . 1
W I N T E R ,
Seeking Professional 8
Help for a Child With
an Eating Disorder
Eating Disorders and
Medical Care
12
One Parent’s
Perspective: Walking
on a Tightrope
14
Caption describing picture
or graphic.
Myths vs. Facts about
Eating Disorders
17
Are You Worried
About a Friend?
Eating Disorders in
Young Children
19
Secondary Story Headline
21
Siblings Need Support, Too!
23
Parenting
Perspectives is now
online, all the time!
24
1
2 0 1 5
Parenting Perspectives
VOLUME 22, NO.1
WINTER, 2015
On the Cover: Three year old Lilly Evanoff is the daughter of Tim and
Theresa Evanoff of Morgantown, and the granddaughter of Ken and P.J. Neer,
also of Morgantown; Roger and Linda Hedrick of East Daily, WV; and
Rebecca Hedrick of Lexington, NC.
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WV Parenting Perspectives
This newsletter is published by the West Virginia Bureau for Behavioral Health and Health Facilities
for parents of children and adolescents.
All material submitted for publication must be
signed. Parenting Perspectives reserves the right to refuse
submissions and to edit submissions selected for publication.
Editorial Board
Dianna Bailey-Miller
Bill Albert
Deana Bragg
Gloria Shaffer
Rhonda McCormick
Anne Cronin
Angela White
Parenting Perspectives
Susannah Grimm Poe, Ed.D., editor
176 Gilboa Rd.
Fairmont, West Virginia 26554
Email [email protected]
2
‘Tis the Season...
Avoiding Holiday Meltdowns!
 For those kids needing routine and who are easily overstimulated, prepare them before hand as
much as possible. “Social Stories” are a great resource. Explain the location you will be visiting,
when presents will be opened, what traditions the family will participate in, and who will be
there. Give your child a schedule of events for special activities, particularly on days with lots of
transitions. Whether it’s a written schedule or one with pictures for younger kids, your child will
feel calmer and safer knowing what is coming up. Discuss the schedule regularly and provide
info for each event. For example, let your child know which events will take place outside and
which will be loud or crowded. Sometimes just knowing what’s next can help children with behavioral and sensory issues feel less anxiety.
 If possible, teach your child a word or signal to use if he or she feels overwhelmed and needs a
break. Assure your child if he or she uses the code word, you will respond right away. Plan quiet
areas ahead of time so your child can have a sensory and demand free time out.
 Don’t forget to stay on a regular schedule. School programs, church services, late dinner can
take a toll on temperament. Try to keep the sleeping and eating schedule your child is used to,
and make sure they have time to just unwind in each day. (You, too!)
 Children with significant sensory sensitivities may require a little extra planning to enjoy holiday
festivities. For example, you may need to bring along ear plugs or headphones if you will be in a
noisy environment, or sensory fidgets if the child is expected to sit still. An iPAD or game toy
with the sound turned down might allow a short term escape and allow you to enjoy the festivities. For sensitive kids who need to wear dress clothes for events, bring along some soft clothes
for them to change into as soon as possible.
 If your children have food sensitivities or allergies that prevent them from eating holiday treats,
plan ahead to offer alternatives like all-natural candy or a gluten-free treat from home. Prepare
your host with an explanation of your child’s eating challenges, and provide food or meal options that will accommodate those needs. For example, some children can join the family with
their own food brought from home, others may need to sit a little away from the rest of the
crowd in order not to be overstimulated.
 If your child is easily over-stimulated, limit holiday decorations in your home. Too many twinkling lights combined with smells from the kitchen and other holiday distractions can cause
overload. Allow children to help you decorate for the holidays so they are involved in the
changes that take place in their comforting environment.
3
What Are Eating Disorders?
Eating disorders are a relatively common yet
widely misunderstood group of psychological disorders. Eating disorders are characterized by certain
eating behaviors and ways of thinking about one’s
body that create a great deal of distress and usually
interfere with several areas of a person’s life (like
school, work, friendships, etc.). Eating disorders can
vary greatly in the types of behaviors a child or adolescent may show, as well as the shape and size of the
child. In the following chart, we will discuss different types of eating disorders as well as “red flags” for
eating disorders in children and adolescents.
It is commonly believed that eating disorders
only occur in individuals who are clearly underweight
or malnourished; in fact, this only represents a small
Name
Anorexia Nervosa (AN)
portion of individuals with eating disorders. Although
having a significantly low weight is required for a diagnosis of Anorexia Nervosa, an individual of any
weight can have an eating disorder.
Also, many believe that only girls are affected
by eating disorders. In fact, at least 1 in 10 eating disorder cases are boys and men.
A more reliable indicator of an eating disorder
than weight is a fear of becoming fat, having a poor
body image, and placing a great deal of importance on
one’s weight and shape, even if the individual is losing
weight. Below is a table outlining the criteria of the
different eating disorders based on the criteria set for
in the DSM-5:
Weight Status
Individual has a significant weight loss
(or failure to gain weight during a
growth spurt)
Has a low weight given their height and
developmental trajectory
Behaviors
May restrict food intake
OR
May eat large amounts of food
quickly (binge) and then purge (self
-induce vomiting, excessive exercise, abusing laxatives, diuretics,
etc.)
Bulimia Nervosa (BN)
Individual is of normal weight or higher
Binges and purges
Binge Eating Disorder
(BED)
Individual is of normal weight or higher
Binges without purging
Other Specified/
Unspecified Feeding or
Eating Disorder (OSFED/
USFED)
No specific weight criteria
Individual doesn’t fit into any of the
above categories
Shows significant symptoms of an
eating disorder
4
What Warning Signs Should I Look
For in My Child/Adolescent?
Behavioral
Spending excessive amounts of
time in front of the mirror
Avoiding mirrors and scales
Wearing baggy clothing
Using scales frequently
Dieting and strict food rules (a.k.a.,
some foods may be considered
“bad” or “off limits”)
Evidence of bingeing, such as
large amount of food going
missing, spending large
amounts of money on food,
etc.
Skipping meals
Frequently going to the bathroom after meals
Spending less time with friends
and family
Avoiding eating in front of others
Psychological
Depressed/irritable mood
Poor body image
Decreased self-esteem
Decreased energy
Loss of interest in usual activities
and hobbies
Preoccupation with food, calories, nutritional information,
diets, etc.
Physical
Brittle nails and/or hair
Dry skin
Major weight fluctuations
Weakness/feeling faint
Often feels cold, especially in
hands and feet
Stains on teeth from vomiting
Callouses on knuckles from inducing vomiting
Abdominal pain/constipation
5
Nutrition 101
By Brandi Sentz, MHA, RD, LD
Although we know many of the risk factors,
signs, and symptoms of eating disorders, research on
prevention of eating disorders has been limited.
What we do know is, developing a good relationship
with food and exercise is important for a healthy life
whether you have an eating disorder or not.
The following tips may be helpful in establishing a healthy connection between the body and
nutrition and lifestyle:
you have served them. Take a flexible attitude toward food. For instance, parents may say, “It’s okay
to have a piece of cake at the birthday party, but it
may leave me feeling sluggish if I eat cake for all
three of my meals today”.
Model moderation when it comes to food
choices and eating. If you start these habits early, it
is much easier to get your children on board-- but
later is better than never.
Just eat!
Exercise
with your
kids.
Our bodies like for us to
eat something every 4-5 hours we
are awake (for younger children
this would be more often). Ideally, we would eat, rest from eating, and then eat again. Likewise, the body needs a break to
allow digestion to take place, allow fullness and hunger cues to
register, and blood sugar levels
return to normal. Thus, it’s best
not to “graze” or snack constantly.
Grab the family
and go for a
walk. Shoot
baskets in the
driveway. Your
kids will love
you are spending time with
them, and won’t
realize they are
even exercising.
Most of the
time exercise is seen as a punishment, something we
have to do to burn calories and lose weight. If you
can incorporate these fun activities into your daily
routine, the activity becomes the exercise.
Start the morning with breakfast.
So many times people rush out the door without eating a healthy breakfast. Breakfast continues to
be one of the most important meals of the day. It is
literally “break”ing your “fast” from the night. It
does not have to be an elaborate meal, but you should
have a protein-carbohydrate combination.
For example, many people like yogurt with
fruit in the morning—it’s quick and easy and healthy!
By eating breakfast, you will be more clear headed
and ready to start the day.
Also, studies show that
children and teens who eat breakfast are less likely to
develop eating disorders.
Turn the screens off.
No more than 2 hours of screen time per day is
recommended for children. Screens include computers, televisions, video games, and phones. Set a
limit and stick to it. More than 2 hours of screen
time leads to more sedentary activity as well as
missed opportunities to be doing something fun outside or even playing a game as a family inside. Television and internet can also be harmful to developing
personalities—encourage them to be their own person (not their Facebook profile or their favorite actor
on television).
Be a good role model.
You can’t expect your child to eat her fruits
and vegetables if you don’t eat them. Eat with your
children and let them see you eating the healthy foods
Continued on the next page.
6
Nutrition 101
Have dinner as a family.
As children get older, the family dinner becomes more difficult to achieve due to busy sche
Have Dinner as a Family.
As children get older, the family dinner becomes more difficult to achieve due to busy schedules. Try
to make time for this one simple act. Even if you have to eat away from home—try to eat as a family. For
many families, it is a time to reflect on the day and decompress.
Family dinners are protective against eating disorders as well. Take 30 minutes and enjoy your family!
Enjoy all foods in moderation.
Go get that ice cream cone after you’ve finished mowing the lawn on a hot day, but don’t do it every
day. By showing your children we can include these foods into our diet and enjoy them as treats occasionally,
we avoid having negative feelings and guilt over eating them.
A healthy relationship with food includes being able to include the not so healthy foods into our
routine. Go to McDonald’s and get that Happy Meal, but don’t do it all the time.
Avoid “weight” talk.
With the multi-billion dollar “diet” industry it is difficult to not talk about weight or size but we want
our children to feel comfortable with their bodies. It is important for children to know everyone is made
differently and they are their own unique person. By eating healthy and exercising with your children, you are
teaching them to respect the body they have.
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7
Seeking Professional Help
For a Child with an Eating Disorder
by Jessica Suisman, MA
If an eating disorder is suspected in a child or
adolescent, it is imperative to seek professional treatment promptly. Indeed, research suggests that timely
treatment predicts a better chance of full recovery
from the eating disorder.
In this article, we discuss the types of professionals that are likely to be members of a child’s treatment
team, how to
initiate treatment, and
some of the
evidencebased psychological
interventions
for eating
disorders.
We also discuss some of
the treatment
settings that
a person with
an eating disorder may encounter (outpatient treatment, partial hospitalization, and residential treatment), and we recommend some specific resources
for identifying eating disorder treatment providers.
Physician (often a Pediatrician) – Individuals
with eating disorders need frequent monitoring by a
physician, given the high risk for deadly medical
complications of the eating disorder (see page 12).
The physician will monitor weight, vital signs, and
other indicators of nutrition and health. If a patient is
dangerously malnourished or medical complications
are severe, hospitalization may be
necessary. The physician will ordinarily work with both the patient and
his/her family.
Registered Dietitian – The dietitian
typically designs meal plans for the
person with an eating disorder, provides education about food and nutrition, and helps the patient to
achieve a healthy weight.
In some treatments, the dietitian may work directly with the patient, and in others, the dietitian may
work primarily with the parents to
aid them in feeding their child in a way that will
help him/her to become healthy.
Psychiatrist – For some individuals, psychiatric
medications, such as antidepressants, may be beneficial in reducing eating disorder behaviors. The physician on the team may prescribe these medications,
but for more specialized medication management, a
psychiatrist can be an integral member of the team.
Members of an Eating Disorder Treatment
Team
The members of your child’s treatment team may
vary depending upon your child’s specific symptoms
and the type of treatment that is being provided.
Listed below are the types of professionals that most
commonly work with a child and her family.
Patient and his/her family – Most importantly,
the patient and patient’s family are key members of
the treatment team! The hard work of overcoming an
eating disorder cannot be accomplished only in the
office, and much of the work has to be done by the
patient with the help of his/her parents at home.
Psychologist or Therapist – This team member
will typically help the person with an eating disorder
begin to eat normally again, challenge distorted beliefs about food and weight, and work toward improved body image and self-esteem. Ideally, the psychologist or therapist will also work closely with the
child’s family in order to help family members support and nurture their child.
First Steps in Seeking Treatment
If you suspect that your child has an eating disorder, finding a group of providers can feel overContinued on the next page.
8
Seeking Professional Help
For a Child with an Eating Disorder
whelming. Depending on where you live, there may
most effective for eating disorders. When searching
be treatment programs available that include all necfor a psychologist/therapist, we recommend that you
essary members of a treatment team, ideally with all
seek a provider that has training in and uses these
providers at the same location. In other cases, you
approaches:
may need to identify each member of the team separately, and they may be located in separate offices.
Family-Based Therapy:
If you think your child has an eating disorder, it is imFamily-based therapy (also sometimes referred to
perative to seek an assessment by an expert as soon as as the “Maudsley Approach”), is the most effective
possible (see the end of this
treatment for children and adolesarticle for information on
cents with anorexia nervosa,
finding eating disorder
with growing evidence for
treatment providers).
bulimia nervosa. This is
“Family-based therapy (also
This may mean
a family therapy where
traveling away
parents are tasked with
sometimes referred to as the
from home for an
ensuring that the child
“Maudsley
Approach”),
is
the
appointment, espereceives adequate nucially in West Virtrition and does not
most effective treatment for
ginia, where findengage in binge eating
ing a physician or
or purging behaviors.
children and adolescents with
psychologist
This is an intensive
trained in eating distreatment that may inanorexia nervosa”
orders can be difficult.
volve monitoring of the
Prior to your appointchild 24-hours a day, parment with an expert, it may
ticularly in the early phases of
also be useful to make an appointtreatment. Later in treatment, control of
ment with your family physician or pediatrician for an eating is handed back to the adolescent in a gradual
initial medical evaluation. As emphasized on page 12
fashion. Although research on this type of treatment
of this issue, the medical complications of an eating
initially focused on children and adolescents, redisorder can be deadly, and your child needs prompt
search is now being conducted on the use of familymedical attention. Your physician will evaluate your
based therapy with young adults (i.e., individuals
child for an eating disorder and may be able to refer
ages 18+). Family-based therapy typically lasts about
you to a treatment team.
1-year, although it may be longer or shorter dependWhen identifying a treatment team, it is important ing on your child’s progress.
to note that research strongly supports the involvement of family members in helping a child or adolesCognitive-Behavioral Therapy:
cent to overcome an eating disorder. Ask your potenCognitive-behavioral therapy focuses on cognitial treatment providers if they plan to incorporate the tions (thoughts) and behaviors (things a person
family into the treatment process.
does). A cognitive-behavioral therapist will work
with a patient and the family to help the patient
Evidence-Based Psychological Interventions for change his/her behaviors (e.g., binge-eating, dieting)
and thoughts about food, body, and weight. This
Eating Disorders
There are many types of psychological intervenform of therapy generally lasts for about 20-40
Continued on the next page.
tions that practitioners may use. Here, we focus on
two types of therapy that research has shown to be
9
Seeking Professional Help
For a Child with an Eating Disorder
sessions. Research studies suggest that cognitive-behavioral therapy works particularly well for bulimia
nervosa and binge eating disorder.
the physician and registered dietitian weekly, with
the frequency of these appointments decreasing as
the patient achieves a more stable medical and nutritional status.
Treatment Settings and Locating a Treatment
Team
Intensive Outpatient Program:
Individuals with eating disorders may receive
An intensive outpatient program (IOP) is a kind
treatment in several different settings, depending on
of treatment that is more intensive than traditional
the severity of the eating disorder and
outpatient treatment, but less intensive
medical complications. After
than the residential or partial
your initial evaluation,
day services described beyour physician or menlow. Often IOP protal health provider is
grams include about
likely to recom10-12 hours of ser“Treatment was very helpful. You
mend one of the
vices a week (in
below treatthe mornings or
learn what things trigger you and how
ment settings
evenings), so
to
handle
it.
Recovery
doesn’t
come
that the indifor your
vidual may
child. Before
all
at
once;
it’s
a
gradual
thing.
You
still be able to
starting any
participate in
treatment,
slip
up
several
times,
but
it
becomes
other daily
you may
activities such
need to
further and further apart. Eventually
as
school.
check with
you don’t have to think about your
your insurPartial Hospiance provider
eating
disorder
as
much,
and
you
can
talization:
to ensure they
Partial
provide coverage
just
live
your
life.”
DECC patient now in recovery
hospitalization
profor the treatment
grams are designed
you are seeking. Unfor
patients that need a
fortunately, many of the
higher level of monitoring
treatment options below are
and
care
than outpatient treatment
not covered by some insurance
can provide, but may not need residential (i.e., 24
providers (e.g., many insurance providers will not
hours/day) treatment. Partial hospitalization procover residential treatment).
grams typically involve programming daily, but the
patient returns home on his/her own in the evenings.
Outpatient Treatment:
There are no partial hospitalization programs excluOutpatient treatment is used when the person
sively for eating disorders in West Virginia, so pawith an eating disorder is medically and psychologitients may need to travel out of state for this type of
cally stable enough to be treated without daily monicare.
toring by medical or psychological staff.
Typically, patients in outpatient treatment will
meet with a psychologist or therapist one or two times
Continued on the next page
per week. Early in treatment, they may also meet with
10
Seeking Professional Help
For a Child with an Eating Disorder
Residential Treatment:
Residential treatment is recommended for patients who are severely malnourished, suffering from
other medical complications that require close monitoring, or when patients previously in outpatient or
partial hospitalization treatment are not improving.
There are no residential treatment centers for eating
disorders in West Virginia, so patients needing this
level of care need to travel out of state. Residential
treatment is 24-hours a day, and patients live at the
residential treatment center from a few weeks to a few
months. Patients receive daily therapy, medical treatment, and medication management. Often, patients
who complete residential treatment programs may be
referred to a partial hospitalization program before
returning home.
Other resources:
National Eating Disorders Association: Provides information on treatment for eating disorders:
http://www.nationaleatingdisorders.org/treatment
Academy for Eating Disorders: Search for an
eating disorder professional in your area: http://
www.aedweb.org/web/index.php
Families Empowered and Supporting Treatment of Eating Disorders (FEAST): An organization
of and for parents and caregivers to help loved ones
recover from eating disorders by providing information and mutual support, promoting evidence-based
treatment, and advocating for research and education
to reduce the suffering associated with eating disorders. http://www.feast-ed.org/
Inpatient Treatment:
Although sometimes the terms “inpatient treatment” and “residential treatment” are used interchangeably, they are actually different forms of treatment. Inpatient treatment is similar to residential
treatment in that it is a 24-hour a day treatment, but it
is short term (average stays are about 1 week) and
typically focuses on patient stabilization and medication management. These facilities are often general
psychiatric facilities, rather than specifically designed
for eating disorder treatment. Common reasons for
admission to an inpatient unit in patients with eating
disorders include acute suicidal ideation or other selfharm behaviors.
Locating Eating Disorder Treatment Providers and other Resources:
West Virginia University Disordered Eating
Center of Charleston: Outpatient treatment providers
located at the Charleston Area Medical Center hospitals in Charleston, WV. Treatment team includes a
psychologist, registered dietician, pediatrician, and
psychiatrist. For more information, visit http://
charleston.hsc.wvu.edu/DECC/Home
To set up an appointment, call 304-388-1000.
11
Jessica Suisman is a predoctoral
Psychology Intern at the WVU School of Medicine,
Charleston Division;
Charleston Area Medical Center
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Eating Disorders and Medical Care
by Dr. Stephen Sondike
As the medical consultant for the Disordered Eating Center of Charleston (DECC), my primary job is
to keep our patients safe while in treatment with the
psychologist and dietician. It is true that most individuals with eating disorders eventually do well and
recover. However this process often takes time, often
years, and during this process close monitoring is
needed to minimize negative effects on both short and
long term well-being. Statistics suggest that up to 15
percent of those suffering
from eating disorders eventually die from their disease.
The precise mortality due to
anorexia nervosa, bulimia
nervosa and other eating disorders is hard to know because these diseases take a
toll on every organ system in
the body, and the effects may
either be apparent immediately, or take their toll over
time. Therefore, an individual who has been struggling with anorexia nervosa over a long period of time
may die of heart failure, and the death may be reported as “cardiac failure” rather than “anorexia nervosa.” As those with eating disorders work towards
recovery, my main role is to anticipate, manage, and
help prevent some of these negative consequences and
promote a lifetime of good health.
Some of the most profound effects that malnutrition has on the body affect the heart. The most common cardiac disturbance seen in anorexia nervosa is a
low heart rate (less than 60 beats per minute). The
medical term for this condition is bradycardia. Bradycardia is due to both lowered metabolic rates as the
body tries to slow itself down to compensate for lowered calorie intake, a weakened heart wall, and disintegration (atrophy) of the heart cells themselves. People with bradycardia feel tired, weak and become easily fatigued. Often bradycardia due to nutritional deficit is mistakenly attributed to the low heart rates seen
in elite athletes. Whereas an “athletic heart” is
stronger and better functioning, an anorexic heart is
weaker. Athletes with low heart rates do not feel tired
12
and weak; people with eating disorders typically tell
me their athletic performance has worsened since
their heart rate went down. Since a low heart rate
indicates a weakened, susceptible heart, the person is
more susceptible to cardiac failure and death due to
arrhythmias and infection. It also makes a person
susceptible to increased heart rate and lowered blood
pressure when standing (othostasis), as the heart rate
tries to speed up to get blood to the brain when
standing. Symptoms include dizziness
on standing and passing out.
The one arrhythmia which is most devastating, and more common in eating
disorders, is known as a “prolonged
QT interval”. Prolonged QT can be
diagnosed by an electrocardiogram.
As the heart slows and weakens, certain electrical functions of the heart are
disturbed. A prolonged QT is associated with sudden cardiac death. Everybody with an eating disorder should
have an EKG, and a finding of prolonged QT requires immediate hospitalization in a telemetry ward
or intensive care unit. Other common heart conditions seen in eating disorders are mitral valve
prolapse, as decreased volume to the heart causes the
mitral valve to get pulled inward, and pericardial effusion (fluid around the heart).
The endocrine system is also strongly affected by
malnutrition, and the most concerning hormonal disturbance is the loss of menstrual cycles due to the
shutting down of pituitary hormones responsible for
normal menstrual functioning. The body does not
produce estrogen, and this has profound effect on
bone. Estrogen is required to keep bones from
breaking down. Unfortunately, the peak age of bone
deposition is also the peak age for development of
eating disorders- late teens and early 20s. Virtually
no new bone is formed after 25 years old, so this
bone loss is likely never recovered, and the development of osteoporosis at an early age follows. It used
to be thought that the estrogen in birth control pills
would prevent bone loss. Unfortunately, research has
shown this not to be the case. Those with eating dis-
Eating Disorders and Medical Care
orders who get regular periods due to birth control
pills are still at risk for osteoporosis. Low thyroid
hormone is also common in eating disorders and
many with anorexia develop symptoms of hypothyroidism, including fatigue, cold intolerance and constipation. Males with eating disorders have also been
shown to have low bone density, decreased muscle
mass and lowered libido, likely due to decreased testosterone levels.
Hair changes include losing hair in some
places and gaining in others. Hair is lost from the top
of the head, due to hormonal problems, dehydration,
and stress. Fine downy hairs then develop on the
arms, back and cheeks, as well as other sites, known
as “lanugo.” Lanugo develops to preserve warmth—
it is seen in newborns then goes away. Another thing
seen in newborns which returns during episodes of
malnutrition is acrocyanosis, bluish discolorations of
the hands and feet as the blood supply is inadequate to
warm the extremities. Other skin changes include dry,
cracked, and yellowish skin. Those who self- induce
vomiting regularly may develop a “Russell’s sign”calluses on the back of the knuckles from repeatedly
hitting the teeth. Those who vomit regularly develop
dental erosion, as the teeth are constantly bathed in
the extremely acidic stomach juices. Brushing the
teeth after vomiting is a bad idea-that will only strip
the enamel further. Using mouthwash is a better idea.
Vomiting can also harm the esophagus, leading to inflammation, throwing up blood, rupture, and
esophageal cancer. The cheeks may swell up due to
enlargement of the parotid glands. And those who
vomit large amounts of blood may have a MalloryWeiss tear, which are lesions in the stomach from
vomiting that bleed profusely.
Like previously stated, any organ in the body
can be affected, and liver and kidney failure also occur. Kidney failure, in particular, may be caused by
chronic laxative abuse. Those with severe kidney
damage may require dialysis. Electrolyte disturbance
may be a cause of sudden death, particularly potassium, phosphorus and magnesium. Those who vomit
or abuse laxatives are at a high risk for low potassium.
Low phosphorus can be caused by the refeeding syndrome, which occurs when a chronically undernour13
ished individual increases intake too quickly, so
treatment should be supervised by a medical provider
to watch for this.
You may have noticed that I always say malnourished- never underweight or too thin. Though many
people with these symptoms are underweight, you do
not need to be underweight to be malnourished. In
fact, I have seen all of the above in people at
“normal” weights. At DECC, we do not believe in
the concept of an ideal weight. If your child is restricting calories, and/or performing unhealthy behavior to control weight, and has some of the symptoms above, your child is malnourished, regardless of
the number on the scale. The ideal weight is whatever your child’s weight is when eating regularly and
enough, not excessively exercising or purging, and
feeling well. My goal as a physician specializing in
eating disorders is to help you help your child get
there and stay there.
Dr. Stephen Sondike is a professor
at the WVU School of Medicine –
Charleston Division Department of Pediatrics;
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One Parent’s Perspective
Walking on a Tightrope
From the last issue of Parenting Perspectives…
Megan’s parents know something is terribly
Megan is 16, an aspiring artist, active in her
wrong but they aren’t sure what to do. Off their rachurch, an honors student in school, and learning to
dar screen is the possibility that Megan has develdrive. Her parents have the normal worries of anyone oped an eating disorder. It just doesn’t seem possitrying to parent a teenager—how to help her navigate ble—isn’t that a problem faced by dysfunctional
drugs, alcohol, peer pressure and new and more com- families, Hollywood stars, and runway models—not
plex relationships.
a highly motivated well-adjusted teenager from a
Megan has developed a new interest in running good home with loving, involved parents?
and expressed an interest in eating more healthy foods.
Megan has anorexia nervosa and her proAt first her parents are delighted, helping her sign up gression into the disorder and resulting consefor the cross country team and reinforcing her efforts quences are eerily similar to others with the same
to eat better. Megan puts her full effort into running
disease regardless of race, culture, socioeconomic
and eliminates desserts and “junk” food from her diet. factors or family issues. Highly heritable and affectHer running times improve and much to her
ing approximately 0.5 to 1 percent of the population,
delight, she loses a little weight. Over time, Megan
anorexia nervosa is deadly, killing up to 20 percent
adds more mileage to her already intense workouts on of individuals with the disease, more than any other
the team by lifting weights and running before she
psychiatric disorder.
goes to school. She’s so dedicated she runs regardless
of the weather, how fatigued she is, and even pushes
How does Megan’s Story End?
through a hamstring injury. Her parents are thrilled—
That depends…
she seems so dedicated; her coach has commented on
It depends on how quickly her parents and
physician recognize her symptoms and how quickly
how well she’s doing on the team.
they intervene. It depends on access to professionals
As Megan increases her workouts and starts
who use research-based treatment in their practice. It
eliminating even more food from her diet, her weight
depends on how persistent her parents are in advostarts to plummet.
cating for her care and on how involved they become
Her parents express concern but Megan says
in her treatment. The disheartening truth is that
she’s fine and when they sit down to dinner each eveMegan’s access to care and potential for lasting rening she seems to have a ready excuse as to why she’s covery may be based on where she lives and how
not eating—“I’m full,” “I already ate,” “I’m going to cooperative her insurance company is in paying for
treatment.
eat later.”
Ideally, if Megan has a knowledgeable physiHer parents’ concern grows as they notice
cian who understands the symptoms and medical
their normally cheerful daughter seems more withcomplications of eating disorders, she and her family
will quickly be referred to a specialist, who will prodrawn and sullen; her collar bones, ribs and cheekvide them with information about their daughter’s
bones seem more prominent; her hair is falling out and
eating disorder. If Megan is medically stable, her
her eyes are sunken. She’s not longer menstruating, is
parents will be encouraged to begin the process of recold all the time, and isn’t sleeping well.
feeding their daughter at home using Family-Based
Continued on the next page
14
Walking on a Tightrope
Therapy (FBT) or Maudsley, an evidence-based approach considered to be the gold standard in the treatment of eating disorders in adolescents and young
adults. The process won’t be easy—there will be pitfalls and bumps along the road, and Megan and her
family will need a tremendous amount of support.
With continued care and support from her parents and
treatment team, Megan’s symptoms will improve with
normalized nutrition, giving her a good chance of
making a full recovery.
Unfortunately, many do not live near specialist
services and sometimes don’t have a knowledgeable
physician or other supports in their area. In addition,
many parents or loved ones will be encouraged by
well-meaning professionals to take a back seat in their
child’s treatment rather than being fully involved.
While fictitious, Megan could easily be my
daughter. Change the name and alter some of the details, and you have our story—seven years ago our
family was completely blindsided when our daughter
developed an eating disorder.
Similar to Megan’s parents we knew something
was wrong but didn’t know what to do.
We were scared, and didn’t want to make the
situation worse. We visited the pediatrician several
times which resulted in temporary relief—we were
told it was a “diet gone bad,” not an eating disorder.
We were told that things would get better on their
own, but as we continued to wait, our daughter became more ill.
When we were finally told our daughter had an
eating disorder, we were given nutritional information
but no practical advice on what to do at home.
Not ones to stand back and watch our daughter’s
eating disorder spiral out of control, my husband and I
began scouring the internet for information on treatment, coming across research on FBT and a small
group of parents who had created an informational
support forum.
Encouraged by initial research showing the success of FBT and by other parent stories, we began
searching for effective treatment. Despite numerous
calls to various local psychologists, we found no one
who had information or experience with FBT; however, we did find a local dietician with extensive ex15
perience in treating eating disorders in an inpatient
setting who was willing to support us as much as she
could. Finding that services were limited in WV and
following the advice of other parents, we called some
of the major eating disorder treatment centers across
the country who used FBT as a treatment approach.
Realizing our daughter was only getting worse—the
eating disorder was progressing faster than we could
assemble a treatment team- we decided to begin the
intervention process at home despite the lack of resources. We felt very alone in our daughter’s treatment as her anxiety and fear of eating and gaining
weight was debilitating. However, we felt empowered; we were changing the course of the illness.
Within a few weeks of better nutrition, our real
daughter, who had been so engulfed by the eating
disorder, started to emerge– a little smile here, a
laugh there- things she hadn’t done for several
months.
It took some time but we finally found a treatment center which had just started a parent training
program on FBT for out of state families. Our whole
family, including our younger daughter, traveled
across the country, spending a full week immersed in
training to help solidify our attempts of supporting
our daughter in her recovery. Once we were home
staff continued to provide phone support in order to
help us successfully implement the skills we had acquired.
Since that point, our daughter has hit bumps in
the road but we are confident in our skills to help
her. I often imagine our daughter walking on a tight
rope. Sometimes she manages very well but sometimes she slips. We are standing by, cheering her on
and holding the safety net to catch her and help her
back on her feet. With each slip, she becomes
stronger and more determined to achieve recovery,
and while we’ll never let go of the safety net, we
know she’ll make it to the other side on her own.
Postscript… I’ll admit it. When asked to write
this article and participate in developing this edition
of the newsletter, I was nervous. I wasn’t sure I
wanted to use my real name. It would be easier to
hide behind a pseudonym. Ironically, I’ve been in
Continued on the next page
Walking on a Tightrope
volved in advocating for families of children with
eating disorders for several years on a national level
and I’ve always used my real name. But this was so
much closer to home.
When our daughter was diagnosed, we were incredibly and, perhaps naively, open about her struggle with anorexia; however, we quickly learned we
couldn’t predict the other person’s response and
sometimes, but not always, it was less than ideal – it
was as if we had grown horns and were spreading the
plague. Usually in these situations, the other person
becomes silent and acts as though they are ready to
end the conversation quickly and run as far away as
possible –surely we as parents must have done something terribly wrong to cause our daughter to develop
anorexia and they wanted no part of that. Although it
makes me feel terrible, I know their response is
based on misinformation and misunderstanding.
And, then there are the other responses which led
me to finally decide to use my real name for this article. Sometimes, we are caught off guard when we
reveal our situation and find the other person on the
verge of tears as they tell us about their daughter,
their brother, their wife, their cousin. There’s real
pain and desperation in their story. The terrible
heartbreak in watching a loved one – a loved one
who is incredibly talented and intelligent- struggle
with a terrible disease for which there is no cure and
there is woefully little know about causes and effective treatment.
There’s real pain and desperation in their story.
The terrible heartbreak in watching a loved one – a
loved one who is incredibly talented and intelligent—struggle with a terrible disease for which there
is no cure and there is woefully little known about
causes and effective treatment
I’m speaking up for all of those individuals
afraid to speak up because of the stigma associated
with an eating disorder but mostly I’m speaking up
for my daughter. I want her to stand proud of who
she is and live the life she is fully capable of having
in spite of her eating disorder.
How can families help their child recover from
an eating disorder?
Read. Obtain as much knowledge about your
child’s eating disorder and treatment as possible.
Read respected resources and information based on
science rather than opinion or a sales pitch.
Act quickly. If caught and treated early, people
with eating disorders can recover and lead full, productive lives. If left untreated, eating disorders often
become chronic and disabling. It’s important to seek
specialist care as quickly as possible.
Be involved. Research indicates parents and caregivers are the most important resource for the
treatment of their child’s eating disorder and
should be involved in all aspects of treatment. Initially, the person with an eating disorder may not have
the capacity or ability to make treatment decisions so
loved ones may need to do that for them until they are
able to better manage decisions.
Seek quality treatment. Treatment providers
should be up-to-date on the latest research on treatment approaches. Seek the best available care for
your child even if it requires traveling some distance
from home. Don’t be afraid to ask questions and advocate for yourself and your child. If treatment is not
working, bring this to the attention of treatment providers and be involved in problem solving efforts. In
some cases, it may be necessary to change treatment
providers and/or the treatment approach.
Have hope. Have hope for a positive outcome.
You may need to continue to have hope even if your
child loses faith in their ability to recover. Hold hope
in your hands until they can do so…
Jennifer Whisman is an
Assistant Professor at Marshall University,
Board Certified Behavior Analyst and a volunteer
parent advocate for the Disordered Eating Clinic of
Charleston. She lives in the Huntington area with her husband, 3 dogs, 2 cats and assorted stray creatures
which seem to show up in their backyard.
Her daughters are both grown and she enjoys
their frequent visits. If you have questions
about eating disorders or would like more information,
you can reach her at [email protected].
16
Myths vs. Facts About Eating Disorders
About 50 percent of all people in the U.S. either
know someone with an eating disorder or have been
personally affected by one. Despite that, major misconceptions about eating disorders are widespread. These myths can lead to stigma, making it
difficult for some individuals to seek treatment and
often making it less likely that medical professionals
will identify or diagnose eating disorders when they
occur outside of the stereotypes.
Below are some of the most common myths about
eating disorders and the facts to counter them. It’s important that we continue to provide education and increase awareness about eating disorders to help dispel
these myths.
centage of them actually develop eating disorders.
Eating Disorders are serious illnesses that have biological, genetic and psychological underpinnings. Sociocultural messages about weight and
beauty (including photoshopped images) can certainly impact a person’s body image and stimulate
pressures to look a certain way, but they cannot
cause an eating disorder.
Myth: Men don’t get eating disorders.
Fact: At least 1 out of every 10 people with an
eating disorder is male. In fact, within certain diagnostic categories like Binge Eating Disorder, men
represent as many as 40 percent of those affected. In
a recently released report from the
American Academy of Pediatrics,
boys and men were cited as one of the
“...boys and men
groups seeing the fastest rise in eating
over the past 10 years along
were cited as one of disorders
with 8-12 year olds and ethnic minorities. It’s equally important to screen
the groups seeing
for eating disorders among females
and males.
the fastest rise in
Myth: You can tell if
someone has an eating disorder simply by looking at them.
Fact: Individuals with
eating disorders come in all
shapes and sizes. Many times,
the media and other public
discussions about eating disorders focus solely on individueating disorders
als with a diagnosis of anoMyth: Only people of high socioecorexia who are severely emacinomic status get eating disorders.
over
the
past
10
ated. In reality, many indiFact: People in all socioeconomic
viduals with anorexia may not
have eating disorders. The disyears, along with 8- levels
ever appear so drastically unorders have been identified across all
derweight. Furthermore,
socioeconomic groups, age groups,
12 year olds and
many individuals with severe
both sexes, and in many countries in
ethnic minorities.”
disorders including bulimia,
Europe, Asia, Africa, and North and
binge eating, and OSFED/
South America. (source: NEDA)
USFED can be underweight,
normal weight, overweight or
Myth: Eating Disorders are a lifeobese and often fluctuate in weight. Even athletes
style choice; someone can choose to stop having an
who appear to be incredibly fit might be struggling
eating disorder.
with an eating disorder. The bottom line is that you
Fact: Eating disorders are serious illnesses with
cannot define someone’s health by how much they
mental and physical consequences that often involve
weigh and you cannot determine whether they have
a great deal of suffering. Someone can make the
an eating disorder just by looking at them.
choice to pursue recovery, but the act of recovery
itself is a lot of hard work and involves more than
simply deciding to not act on symptoms. Sometimes,
Myth: Eating Disorders are caused by Photothe eating disorder has become a person’s primary
shopped images in the media.
Fact: Many people are exposed to the media and
way of coping with intense emotions and difficult
Continued on the next page
altered images on a daily basis but only a small per17
Myths vs. Facts About Eating Disorders
life events. In order to heal from the eating disorder,
a person needs appropriate treatment and support regarding medical monitoring, nutritional rehabilitation
as well as learning and practicing healthier ways to
manage stress.
Myth: Anorexia is the only life threatening eating disorder.
Fact: Eating Disorders in general have the highest mortality rate of any mental illness. Recent research has expanded our knowledge about the risks
associated with each of the specific diagnoses.
The research (Crow, S., et al. 2009) showed mortalMyth: Purging is an effective way to lose
ity rates for bulimia and OSFED/USFED that were
weight.
similar to, and higher, than those for anoFact: Purging does not
rexia.
result in ridding the body
“Eating Disorders
Bulimia had a 3.9 percent mortality
of ingested food.
rate
and
OSFED/USFED had a 5.2 percent
At least half of what is
in general have the
mortality rate while anorexia had a 4.0 perconsumed during a binge
cent rate. These numbers were based on a
highest
mortality
typically remains in the
study of individuals seeking outpatient serbody even after selfrate of any mental
vices. Without treatment, it’s suspected
induced vomiting.
that as many as 20 percent of individuals
It’s important to know
illness
.“
will die as a result of their illness. Even for
that laxatives do not prepatients whose eating disorders don't prove
vent the body from abfatal, there are often severe medical complisorbing calories either becations
associated
with starvation and purging, incause they impact the large intestine and most calories
cluding bone disease, cardiac complications, gastroare absorbed in the small intestine. Laxatives may
provide an illusion of weight loss because they stimu- intestinal distress, and infertility.
late a temporary loss of fluids from the body which
can lead to dehydration.
Purging does not cause weight loss, nor does it
prevent weight gain. In fact, over time, the binge/
purge cycle can actually contribute to increased or
accelerated weight gain as it affects the body’s metabolic rate. For these reasons, many people with bulimia are average or above-average weight.
Myth: Recovery from eating disorders
is rare.
Fact: Recovery, though challenging, is absolutely
possible. Recovery can take months or years, but
with treatment, many people do eventually recover
and go on to live a life free from their eating disorder.
Myth: Eating Disorders are a result of over controlling parents and dysfunctional families.
Fact: In the past, parents were often blamed for an
individual’s eating disorder but new research and conventional wisdom have helped to dispel this
myth. Families affected by eating disorders are very
diverse. We now know that between 50-80% of a
person’s risk for developing an eating disorder is due
to genetic factors. We also know that parents and
families can play an integral role in helping a loved
one recover. For this reason family-based therapy is a
primary therapeutic modality used for adolescents and
is also strongly encouraged for adults.
18
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[email protected]
About Mental Health
Are You Worried About a Friend?
Here are some guidelines to approaching a friend who may be struggling with a mental health problem.
Pick a Setting
Talking about your concerns can be uncomfortable for both people.
Pick a place where you both feel safe, but emphasize your friend's comfort. It should be a place where
they feel on equal footing with you. Privacy is essential.
Pick a time with flexibility. The conversation may be short, but just in case, make sure neither of you
have anywhere to be immediately. You don't want to have to stop the conversation.
You and several other people may be concerned about your friend, but approaching them one-on-one
is the best practice. It prevents the friend from feeling overwhelmed and attacked. Don't be afraid to involve a
friend's parent (if they're on good terms) or a professional. Your friend may be angry, but sometimes you need
back-up.
Be prepared
Whether it's the first conversation or the fifth, be prepared to give your friend some resources to check out.
Always carry the National Suicide Prevention Lifeline number: 1-800-273-TALK (8255).
Know how to contact and utilize the counseling center or local mental health services. Once you've had
the conversation, your friend may want you to go with them when they call or go to their first appointment.
Take care
Your friends are lucky to have you looking out for them. But sometimes distress keeps them from appreciating you. Be prepared to be met with anger, denial and/or rejection.
Know that you're doing the right thing, and their reaction isn't about you.
Have your own support network. Helping a friend through a tough time can be hard on the helpers, too.
Make sure you are looking after your own physical and mental health.
Still not sure how to approach your friend?
Here are some questions you could ask them that might help get you started. These examples can get you
thinking about things to say and how to word the 'tough stuff'.
 I've noticed that you haven't been acting like yourself lately. I'm worried about you,








is something going on?
What can I do to help?
How can I help you?
How long have you been feeling this way?
Have you spoken with anyone else about all of this?
Do you want me to walk with you to the counseling center?
Can I help you find someone to see about your concerns?
Are you getting the care you need?
It makes me afraid to hear you talking about dying; there is hope for feeling better, can
we talk to someone about this?
Continued on the next page
19
About Mental Health
Are You Worried About a Friend?




What do you feel like? What are you experiencing?
Do you think you might be in immediate danger?
Have you been having thoughts about trying to kill yourself?
Have you ever had thoughts about hurting yourself?
Formulating "I" statements
"I" statements are a critical tool when broaching any delicate topic with a friend. These statements help
you express your concern without seeming judgmental and encourage conversation and problem-solving.
Start with
Continue with
For example
I feel...
Emotion
I feel concerned
When...
Situation
when you can't get out of bed
Because...
Why
because I care about you.
I'm wondering...
Suggestion
I'm wondering if it would help to talk to a
counselor.
There are many more detailed resources about how to help a friend. For more information, please see:
SAMHSA - Treatment & Resources
DBSA - Helping a Friend or Family Member
Mayo Clinic - Supporting a Family Member or Friend
20
Eating Disorders in Young Children
exhibiting picky eating behavior usually overcome
their aversion to other food relatively quickly before
any nutritional threat is imminent. Those with selective eating disorder only eat foods from very narrow
categories, often those high in simple carbohydrates.
Recognizing the symptoms of selective eating
and taking steps to mitigate negative nutritional and
psychological consequences can stop the child from
developing a full-blown disorder that threatens
health and well-being. Children with true selective
eating disorder have an
aversion to certain food
textures and smells.
They associate the texture, odor, or both with a
traumatic incident,
which they now associate with food. When
coaxed to try the food
group associated with
the event, they often
gag, cough, or choke.
This disorder is often
associated with an underlying psychological
condition involving
anxiety or autism.
Eating disorders occur most often in young adolescents and teens; however, young children can develop eating disorders as well.
Healthcare professionals are seeing a disturbing trend of children as young as age 5 developing
eating disorders. While these eating disturbances often seem similar to the anorexia nervosa and bulimia,
most commonly found in young teen girls, those occurring at a very young age often have other causes.
Food Refusal
With this disorder, children use food
refusal as a means of
manipulation. The
behavior is often erratic and inconsistent.
While this tactic is
certainly frustrating
for parents, it is
sometimes associated
with a recent source
of stress or sadness
and is not usually
thought of as a threat
to health.
Restrictive Eating
Food Avoidance
Emotional Disorder
With restrictive eating, very young children eat a
variety of foods, but clearly restrict portions. The underlying causes of this disorder remain unclear and
although children exhibiting restrictive eating habits
may have low weight or growth for their age, they
generally eat a balanced diet, albeit portion restricted,
causing medical staff to consider them healthy in
most cases. As with most eating disturbances in very
young children, restrictive eating seems to have no
basis in a preoccupation with body image and weight.
Children can exhibit symptoms of food avoidance emotional disorder (FAED) very early in life.
With this disorder, children can be as thin or thinner
than those with untreated anorexia nervosa. The difference being that these children often feel shame at
their thin bodies and know that their eating habits are
irrational. Symptoms are closely related to obsessivecompulsive disorder. Many times, children with this
disorder do not know exactly why they cannot overcome their eating issues, but desperately want to eat
like their peers. They are often plagued with intense
worry, sadness, and anxiety. Untreated, atypical eating disorders, such as FAED, can result in profound
health and social issues for the child.
Selective Eating
Selective eating disorder syndrome can begin as
early as infancy and can mimic the common for picky
eating habits of many infants and toddlers. Children
Continued on the next page
21
Eating Disorders in Young Children
thought to cause the child difficulty. Both individual
and family therapy may benefit the family unit and
the child specifically.
Causes
Eating disorders in very young children can
often mirror those of
adolescents and teens
with anorexia nervosa or bulimia, but
generally manifest
themselves much differently in the mind
of the child patient.
Anorexics and bulimics usually have profound body image
and self-esteem issues because of their
emotional stresses.
Very young children
with eating disorders do not have body image concerns. They exhibit no fear of becoming overweight.
These children often have a first or second degree
relative with an eating disorder, which indicates a genetic factor in the disease. Many have anxiety disorders and fear of separation from their primary parent
(usually their mother). Other contributing factors include perfectionism, inability to effectively cope with
daily stresses, and depression marked by tearfulness.
http://www.activeminds.org/
issues-a-resources/
get-help/how-to-help-afriend
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Treatments
Eating disorders in pre-pubescent children are
new to prominence in the medical community. Consequently, specific treatments have not been established,
but possible treatment options can be administered by
a pediatric physician or psychiatrist. Concerned parents can stay informed and involved by keeping regular appointments with their child’s pediatrician. Those
who strongly suspect the onset of an eating disorder in
their prepubescent child should bring the child in for
evaluation by a pediatric psychiatrist. The psychiatric
physician may prescribe medication to attenuate the
underlying anxiety or obsessive-compulsive condition
22
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when new issues are
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Siblings Need Support, Too!
Siblings of individuals with eating disorders
may be greatly affected by their sibling’s illness, yet
little research exists on the effects of eating disorders
on siblings and approaches to support them. Research
on siblings of children with other chronic illnesses
suggests that siblings may experience a variety of
emotions.
Siblings may feel anger or resentment because
their ill sibling takes so much of their parents’ time,
energy, concern and support. Siblings may experience feelings of loss and loneliness as their typical
relationship with an ill sibling changes and may be
limited by the eating disorder.
Siblings also may experience fear that they
will end up with an eating disorder too.
On the positive side, siblings may feel empathetic toward their ill sister or brother and may have a
desire to help; however, often siblings may not be
sure how to help.
Following are some suggestions on how to
support siblings of individuals with eating disorders:
Provide siblings with information about the
eating disorder, what is happening within the family
and how treatment will proceed. Information should
be provided based on the age and maturity of the sibling with the level of detail increasing the older the
sibling is.
Let siblings know how they can support the ill
child. Some siblings provide support to the ill child by
engaging in activities with the ill child (e.g., watching
movies, completing a puzzle, scrapbooking, etc.) between meals. Others might give encouragement and
sympathy to the ill child during meals and still others
may be active participants of Family Based Therapy
(FBT) sessions.
Reassure siblings that you, as caregivers, will do everything you can to help their sister or brother with an
eating disorder get better and keep them safe.
23
Try not to put siblings in the role of policing their ill
sister or brother by telling parents about purging,
binging or restricting.
Provide opportunities for siblings to talk with you
about their experiences.
Because extreme behavior is common, siblings need a plan for what they should do during
these times. For example, you might tell siblings
they do not need to help during the situation and suggest siblings go to their rooms, listen to music, watch
tv, etc. Again, reassure the siblings that the eating
disorder causes a lot of anxiety, this is temporary,
will get better and you will help the ill sibling stay
safe.
Help siblings understand that anything the ill
child says or does should not be taken personally.
These behaviors are not a reflection of the sibling
and the ill child does not mean to say or do them.
They are responding to their own fear and anxiety.
Ask siblings to participate in family meals during
most days of the week. This may mean making some
compromises on typical activities, at least at first.
As much as possible try to carve out time, even if it
is briefly, for siblings to spend time with parents
alone and engage in fun activities.
Ask friends, neighbors and/or family members to help take siblings to their activities and keep
the sibling occupied (e.g., by asking the sibling to a
sleepover, movie, trip to the mall, church, sports,
etc.).To the extent possible, assist siblings in maintaining healthy relationships with peers and other
family members.
If you find that siblings are really struggling
to make sense of the eating disorder and what they
have been through, consider individual therapy for
them too.
*Reprinted and revised with permission from
www.feast-ed.org
Parenting Perspectives
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