In Family-Based Treatment (FBT), figuring out how to get your starving child to eat and gain weight is a daunting task. Parents often feel overwhelmed and helpless when starting out on a re-feeding program. It is important to remember that your child is literally more afraid of the food than of dying of starvation. But food is the medicine, and it is your job to save her (or his) life.
Anorexia makes children do things they would never normally do and an escalation of behavior is common when parents start to stand up to the anorexia. In fact, an escalation during the first week, although unpleasant and often scary, is usually a good sign that parents are not giving in to the anorexia. Consistent confrontation of the anorexia ultimately brings greater compliance as well as weight gain. It is imperative that parents work together and are well aligned; otherwise the anorexia can split them and gain strength.
Below are excerpts of emails from a family that used FBT:
I will not be able to attend the afternoon seminar. Daughter refused to eat the breakfast and just stormed to her room. As a result, she will not be able to attend her weekend volunteer activity (she volunteers at the Children’s hospital). I feel bad as it is a positive activity for the community. That said, it is the point that it is something that she wants to do. I cannot leave the house as I cannot predict her behavior. Husband will not be able to manage as effectively as I will and plus there will be 4 of sister’s friends over getting ready for a party. Husband and I had plans for a wine tasting tonight and daughter was supposed to babysit younger sister. I know that this will not happen given the rageful reaction.
I am holding strong. Was able to even ignore and work through last night’s outburst of “go f— yourself.” It is like you said yesterday -all of this is so incongruent with daughter’s previous behavior and overall disposition.
After about one week:
Let me first say that I am sold on FBT. I am amazed at just the difference a few days make. Her anger has decreased and she is beginning to manage previously uncomfortable levels of food. I am gradually increasing amounts as well as beginning to include her few taboo items. There is a fine balance to be struck with regard to flooding vs drowning. Husband or I have been going to school for lunch this week. The first time she was utterly pissed – the second time, she accepted. The comments are still there, but a bit decreased and even she has noticed that her anxiety has lessened. In one particularly rational moment, she commented that she wished that we would have done this sooner. I’ll be pleased when this type of thinking is the norm rather than the exception.
It is common for the anorexia, once threatened, to cause children to become angry, hostile, and threatening, and even to blame YOU for ruining their life (by requiring that they eat!). Remember: it is the anorexia that is threatening to kill them and ruin their life, not the food. Do not believe for a moment that you are doing anything awful to your child by helping her to do a basic task that she cannot do for herself. You are taking on the anorexia and that is making the anorexia angry.