You may be asking, “Why is it so hard for my child with anorexia nervosa to eat?”

When we, healthy, fully grown and fully functioning humans, think about eating- it us usually an enjoyable experience. For the most part, we find joy in food, we look forward to eating and it is all-around a positive social bonding experience. We typically notice when we’re feeling hungry or full, we might spend some time thinking about what to eat, but not much. We anticipate with excitement holidays or outings involving meals. For someone with an eating disorder, it is none of those things.

Parents and caregivers can become easily frustrated when they don’t understand what makes eating so hard for their child. Because it is so different from our own experience, it can be hard to comprehend. I am to help you better understand the psychology and biology behind difficulty with eating when battling an eating disorder.

The first factor is anxiety and fear. People with anorexia nervosa may appear to have a fear of food and eating. Underneath that fear, there is really a deep-rooted fear of gaining weight or becoming “fat”. Children have irrational thoughts that anyone food will add pounds to their body and drastically alter their shape and appearance. Your child likely has certain foods that are scarier than others such as deserts or pizza, due to Diet-Culture's messages about what these foods will do to their bodies. Your child is likely spending the entire day worried about what food they ate and didn’t eat, calculating and counting calories and planning how to “do better” or “make up for it” the next day be restricting more or exercising more. In addition to the fear Anorexia Nervosa creates, it is possible your child had pre-existing anxiety before being diagnosed with an eating disorder. It is common for adolescents diagnosed with Anorexia Nervosa to also have a depression or anxiety disorder diagnosis. The eating disorder likely exacerbates depression and anxiety.

Your child is likely hearing an internal “voice” of the eating disorder that is constantly telling your child the opposite of what you are telling them. The anorexia tells your child not to trust you, to listen to them. It constantly tells your child you are only out to make them fat and listening to the anorexia is the only way they will be popular and have friends. The anorexia persuades and berates your child so much, they are convinced the AN voice IS them and they do not like to be told differently.

I'm making a board guess that your child loves you and wants to please you. They were likely a very well-behaved and agreeable child before the AN. The AN voice puts your child in a very tough position- listening to you will make the AN voice mad and beat them up the rest of the day. Listening to the AN voice makes their parents mad and upset- it is a no-win situation for them.

Your child is likely living by a set of Anorexia-imposed rules that determine what they are and are not allowed to do and to eat. Rules help your child to feel “in control” and “safe”. The anorexia tells them that by breaking any of these rules they are at risk for harm and losing the things the Anorexia values. Though we know these rules are harmful and dangerous, the child believes they are what is keeping them safe and “healthy”. Some common examples of rules:

• I can only eat [X] amount of calories in a day

• I can’t eat before 12 PM

• I can’t eat after 7 PM

• If I eat [this], I must burn [this many] calories

• I can only have [this food] on the weekend

• I can’t eat bread because it has too many carbohydrates

• I can’t eat in front of others

• People will only like me if I’m skinny

• I will only be popular and get a significant other if I’m skinny

• I can’t drink any calories

• I can’t eat anything except fruits and vegetables

• I can’t use dips or dressings

• I have to exercise and burn [x] calories every single day

Finally and most importantly:

What makes it the most difficult for your child to eat? Their starved brain.

If your child has been restricting and losing weight, it is not only their physical appearance that has been affected. Their heart, organs and brain are all being starved as well. Just as their Heart rate may have slowed to converse energy because it is not getting enough, their brain is also running on fumes. The brain survives only on glucose, and when that is low, the brain takes it from other areas of the body since the brain is most important. When there is not enough glucose after severe and prolonged starvation, the brain will start to break down neurons for glucose, resulting in shrinkage of the brain (Ganci).

“Starvation leads to an impairment in the frontal lobes responsible for executive functioning- judgment, insight, concentration, decision making” (Ganci, 2016). This may explain why your child lacks logical thinking or insight into their irrational behaviors. The longer and more severe the starvation, the greater the effects. The good news is that most of these brain changes are reversible with refeeding and proper nutrition, though there is still a lot we don’t know about the long-term effects of starvation on a developing brain.

Other factors that may contribute to difficulty eating in anorexia nervosa in children and teens may be personality traits such as perfectionism, inflexible thinking and teenage difficulties In “Seeing the bigger picture” or “risk/reward” of behaviors.

All of this together makes it almost impossible for a child to recover from Anorexia Nervosa on their own. They need you, their parents and caregivers to step up in a big way and help lead the charge in the battle against their eating disorder. They may fight you along the way, but knowing these factors I hope helps you to understand that so much of it is out of their control. Your child needs you to help feed them, despite their insistence on the opposite and despite how difficult it may be. They won’t ask you for help, but one day they will thank you.

If you have more questions about eating disorder treatment for children and teens or want to get started, please scheduled a FREE consultation call or visit my Info page on my website, eatingdisordertherapyohio.com

References:

Ganci, M. (2016). Survive FBT: Skills Manual for Parents Undertaking family based treatment (FBT) for child and adolescent anorexia nervosa. LMD Publishing.

Lock, J., & Grange, L. D. (2015). Treatment manual for anorexia nervosa: A family-based approach. Guilford.