Supporting Your Child’s Eating Disorder Recovery with Exposures

TLDR

During eating disorder recovery, children need high-calorie, fear-challenging foods for their bodies and brains to heal. Eating these foods is a form of exposure therapy. Parents play a crucial role by supporting their children with co-regulation and by eating the same foods to model safety.

Eating for Re-nourishment in Recovery

Many parents who prioritize nutritious or minimally processed foods feel confused when their child’s treatment includes foods like desserts, fast food, or packaged snacks. You likely did your research when they were infants, reading books on how to raise a healthy eater. If you are like me, you may have made your child’s baby food from scratch and felt a sense of pride when they happily ate veggies and fruits without complaint. Perhaps you have avoided purchasing chips, candy, and cookies, choosing to serve these things only on special occasions.  And now suddenly you are being told to feed them things with added sugar, cholesterol, and lots of fat to support your child's eating disorder recovery. For many parents, this advice is confusing and scary. You know that “food is medicine”. You realize that your child desperately needs to gain weight. But surely there’s a way to achieve this with healthy fats, right? Why is it necessary to give your child the foods you have raised them to avoid or to eat “in moderation”? 

There are a few reasons why we must prioritize nutritionally dense foods during eating disorder recovery. Firstly, eating highly caloric foods allows a child with an eating disorder to gain weight quickly (after the child has been medically assessed for risk of refeeding syndrome). The faster we can help them put weight on, the faster we can restore their physical and emotional health. Research has consistently shown that prioritizing early weight gain in treatment is highly correlated with long-term recovery. 

A child who has been restricting calories for some time will likely feel some physical and emotional discomfort when charged with eating large amounts of food. Therefore, we want to pack as many calories as possible into each meal and snack. They might beg to simply eat more of the foods they feel are “safe”. Many parents are tempted to acquiesce to minimize their child’s intense anxiety. However, it is impossible to restore weight with “safe” foods. And even if they could gain enough weight eating only the foods their eating disorder approves of, avoiding the foods they are afraid of means the eating disorder is still in charge. 

Confronting Fear Foods Through Exposures

Another reason why it is important to incorporate nutritionally dense “feared” foods is because the idea of eating these foods has become terrifying to the child with the eating disorder. Eating disorders are sneaky, insidious diseases that create a tremendous amount of anxiety in the person suffering. The disorder has created an irrational fear that cannot be reasoned with. It is no longer about prioritizing “healthy” foods or eating processed foods “in moderation”. The idea of eating foods with fat and sugar has become simply unbearable. Therefore, the only way to alleviate the fear is to do the unthinkable--and eat the foods. Exposure therapy for eating disorders is like exposure therapy for OCD and other anxiety disorders in that they all share the same principle: exposure to a feared object, situation, or thought. These exposures are repeated until the person learns that the feared consequence either does not occur or isn’t as bad as they imagined it to be. As a result, fear no longer consumes the person’s life. In eating disorders, the feared consequence may be several things: fear of gaining weight, of losing control, of becoming unlovable. As such, facing these fears requires tremendous support and compassion from loved ones.  Supporting your child's eating disorder recovery through exposures can be difficult, so let's talk about how to do this.

Using Co-Regulation to Manage Exposures in Eating Disorder Recovery

It can be very helpful to come up with a plan for fear food exposures. This is especially important if you as a parent are also (understandably) feeling some anxiety. One way you can help your child is to practice co-regulation. “Co-regulation” means that your child uses your nervous system to help calm their own. When a child is facing something extremely anxiety-provoking, such as eating a fear food, their body goes into a threat response (fight/flight/freeze). In that state, they can’t access logical thinking or self-soothing skills. Your calm can help their brain feel safe. Here are some tips to try.

1. Calm your body first. Try 4-7-8 breathing. 

2. Don’t fear panic. When your child reacts to exposures with fear and anxiety, remind yourself that this is part of the process. Your job is not to remove their fear or convince them that the food is safe. Your job is to stay with them until the fear passes--and it will.

3. Speak less, not more, and use a low tone. Talking too much can escalate tension. 

4. When you do talk, try using a script. You can say things like:  

   “I know this feels impossible right now. I’m right here with you.” 

   “Let’s breathe together. One step at a time. You’re safe.” 

   “I’ll stay with you until the fear settles. I’m not going anywhere.” 

5. Don’t take their words personally. During panic, kids may say:

   “I can’t do this!” 

   “You’re making it worse!” 

   “I hate you!” 

   “Please don’t make me do it!” 

   This is the eating disorder speaking through distress. Remind yourself that this is not your child. It is their illness. 

6. Eat the fear foods with them. Remember, eating disorders distort a child’s sense of what is “normal” or “allowed”. Therefore, when a parent eats a full meal, includes fear foods, and demonstrates non-anxious eating, it sends the message that eating is not dangerous.  

The Eating Disorder is Not Your Fault

No research has ever shown that parents cause eating disorders. Choosing whole foods, limiting sweets, or cooking from scratch were acts of love, not harmful behaviors. Although you may need to make some changes in your approach to food to support your child’s continued recovery, nothing you’ve done in the past created your child’s illness. In fact, parents are invaluable resources for eating disorder recovery. Across decades of studies, experts consistently find that eating disorders are complex, biologically-influenced mental illnesses. They arise from a combination of genetic, neurological, psychological, and environmental factors. They are not caused by parenting style, food rules, or family dynamics. In truth, diet culture is everywhere. It is woven into media, conversations, schools, sports, and healthcare. Therefore, it is completely understandable if you also feel anxiety when purchasing fear foods or eating them alongside your child. You are not alone, and you are not to blame.  

A New Path Forward in Recovery

As you guide your child through eating disorder recovery by serving challenging foods, offering co-regulation, and confronting diet culture with them, you are playing a crucial role in their healing. Over time, these exposures to fear foods will help your child rebuild trust in eating and in their own body. And while the process can be overwhelming, every exposure, every shared meal, and every calm breath taken together brings your child one step closer to freedom.