In general I do not especially like using the trivializing nickname “ED” to refer to a punishing condition like anorexia nervosa , but many of our families do. Perhaps this popular shorthand allows them to get their minds around an entity that has hijacked their child’s life-- and with it their own-- and which dominates every conversation they have at home.

We teach our parents to “externalize the illness,” that is to separate their child from the condition to help the parents understand that their child is not choosing it. The sufferer of anorexia nervosa (AN) is no more to blame for it than their parents are, or than a person who has diabetes is. When your child is screaming at you for making them fat, bringing their siblings to tears at mealtimes and slamming the door in your face when you try to keep them safe, it takes a great effort to “pan out,” to see the forest for the trees, something your child with an eating disorder cannot do. In the moment, it seems rational to ask: “why is she doing this to herself? Doesn’t she understand how this hurts her health? Can’t someone whose authority he trusts just tell him how unhealthy it is and make him stop?”

Well, for starters, your child is not “doing this,” it is happening to them. Because the organ most devastated by AN is the brain, it is primarily behavioral change that we see. Normally conscientious, loving and smart children can and do behave in ways that seem completely foreign to their personality and upbringing. It is not unlike some forms of dementia, where a formerly admired and loving grandparent becomes suspicious, hurtful and disinhibited. Fortunately, unlike most forms of dementia, which merely have to be endured, AN of childhood can be treated. Successfully.

So in externalizing the illness, talking about it as if it has a life of its own apart from our child, giving it a nickname that reminds us it is inhabiting our child but is not our child, we can refuse to blame the victim.  

All very well and good, but how can it backfire?

“I can’t eat that, Mom, because it contains lactose and I think that’s why my stomach is upset,” says a child who formerly enjoyed milkshakes and cheese sandwiches, and “I can’t eat that either because I’ve decided to avoid gluten because of my headaches,” .The next day, “I’ve decided to be a vegan now, Dad, because we should not rob animals of their lives and their products.” And that night: “I shouldn’t eat for three hours before bed”.

Through gritted teeth and fighting down a sense of panic, the parents practice what they have been taught: “That”s just your eating disorder talking, honey. You are not lactose intolerant, we had you tested, and there is no evidence that you are gluten intolerant either.”

“That’s just your eating disorder talking,” “I’m sorry, but we are not going to let ED hijack our dinners anymore,” “I think you may be taking dictation from ED tonight,” and to the other parent or grandparent: “Don’t be angry, dear, it’s just her eating disorder talking.”

It’s just your eating disorder talking.

In anguish the child replies: “No it’s not! It’s me! I’m talking!”

I wish I had a dollar for every time a teen has told me that they felt trivialized and diminished by being told that their internal thoughts and concerns are “just the eating disorder talking.” But what’s a parent to do? Revert to blaming them for the irrational, often selfish and cruel statements they make? Demand that they cease speaking altogether unless they can say something nice about the food prepared for them? Let everybody know that their child has made a choice to behave in a way that is unfair to her/his parents?

Talking back to ED is hard. ED is irrational and loud. ED is not amenable to logic and quiet convincing. ED is argumentative and cruel.

Is it hopeless?

I think of a young person on an airplane flight who has a terrible fear of flying and experiences a panic attack and screaming meltdown 30,000 feet above the Pacific Ocean. What can you do? The fear, while real, is irrational. Does that mean you abandon rational talk? No, it merely means that your quiet, comforting tone will be more powerful than what you actually say, that you will have to hold them when you want to shake them, repeat your reassuring comments over and over again, have them breathe into their hands, hold their hands, and soothe them until they can fall asleep or calm down.

Never give up. For sure ED won’t.