You stare blankly at the stove as you prepare dinner. Do I have enough protein? Is there enough variety? Are there enough calories? Did I remember to buy something for dessert? You look to see if you set the table and pause as you remember those once happy voices that sat there sharing their day as they ate. The conversation wasn’t about the food, and if it was, it was casual and involved a compliment or a request for an additional serving. What would tonight’s dinner conversation be……negotiating how much we’ll eat or if we will eat, how full or sick we feel if we eat this, whether or not dessert should be part of the meal, etc., etc.? And what about your other kids: will they become angry and yell at your son/daughter for their mealtime behavior? Will they sit quietly with wide and frightened eyes rushing through their meal and quickly asking to be excused? Will they try to be the peacemaker telling jokes and stories in an effort to distract and help mom and dad? You secretly wish you could go out and eat by yourself somewhere and then immediately feel guilty about the thought. Does this scenario sound familiar to anyone?
As parents of a child with an eating disorder we can all relate to the stress of mealtimes. I dreaded the approach of meals, especially dinner, and I knew that as stressful as it was for my husband and me, it was that much more stressful for our son. While there were many things that I could do to help manage some of my stress, mealtime would likely be stressful no matter what, at least for a while. My husband and I were the caretakers and would have the primary role in helping our son recover, so dealing with stressful meals was to be expected. What about our other kids though? Should they also be expected to endure meals that lead to little more than fear and indigestion? Should they always have to feel anxious hours before a meal begins?
I worried a lot about the impact that my son’s eating disorder had on our other children (see Collateral Damage). Even though dinner was stressful for us, my husband and I had an active role to play. We were there to encourage our son and we had the ability to insist that the meal be finished and to provide supplements and/or consequences if it wasn’t. Our other children were helpless though. They could be encouraging, but they had little control over the situation and that helpless feeling can be very frightening, especially for kids.
As parents of a child with an eating disorder we can all relate to how “all consuming” it can be. His illness very quickly consumed most of our time, not just physical time spent dealing with symptoms, but also the mental and emotional time. There was rarely a minute when this wasn’t on our mind. It would have become easy to lose sight of our other “healthy” children in the fog of the eating disorder and the truth is that we almost did. I cannot count the number of mistakes and things that I would like to do over again with regard to my other kids as it relates to the eating disorder. I talked about a lot of that in Collateral Damage, but today I will focus on what we did about making mealtime less stressful for our other children.
Prior to our son’s inpatient admission we argued over dinner every night. If we weren’t actually arguing about the food my eyes were at least fixed on his plate throughout the entire meal. There was conversation about other things: the events of the day, current events, etc., but it was anything but normal. It was that nervous, distracted conversation; the kind of conversation where everyone knows that no one is really thinking about, or even cares about, the subject being discussed at that moment. Nowhere did the expressions “empty conversation” and “awkward silence” have more meaning than at our dinner table in those days. This was not unnoticed by the other kids; they felt it acutely. When our son stopped eating dinner with us altogether (just before his hospitalization) and stayed in his room, things got worse for them instead of better. Having him absent from the table, but continuing to deteriorate, didn’t make mealtime more pleasant because now everyone felt helpless and desperate.
I’m not going to lie; while he was on the inpatient unit dinner was a more relaxing affair around here. It wasn’t because of his absence though; it was because our level of helplessness and desperation was removed or at least diminished. Everyone felt relieved that he was in a safe place and had hope that things were going to improve. That was important for the other kids. That feeling lasted for the time that he was in inpatient and PHP, but the anxiety quickly returned for all of them when time came for him to return to our dinner table. It wasn’t hard to read their faces and I was very concerned.
I was very determined that things would be different when he returned to our table. Despite that determination, it wasn’t always smooth. I anticipated that meals would be difficult for him, but we had other children as well and the meals were difficult for them too. We were using a kind of modified FBT after he was discharged and I felt that the plan needed to be modified again to include the well-being of our other children. I approached this with our outpatient therapist. It was decided that if our son was able to eat meals with us and not argue over completing the meal, portion sizes, dessert, etc., then we would all eat together. If, on the other hand, dinner did consist of those elements, we would not eat together. My husband or me would eat with the other children first and then one of us would eat with our son. We wanted to be sensitive to the difficulties that meals would present for our son, but we also wanted to be sensitive to the difficulties that they would present for our other children as well. Going back to the way things were before he was hospitalized was not going to work. We were well aware that this could backfire and having one parent all to himself during mealtime could be very gratifying and lead to manipulation (conscious or unconscious) to keep things that way, but we were ready to deal with that if it happened.
We were very open and honest about what we were doing and we all talked about it as a family. We were very clear that this was not a punishment for having difficulty with meals, but it was not negotiable either. Fortunately, we really didn’t have a lot of arguing about meals and were quickly able to consistently eat together as a family again. Our main problem was exercise and we did set very firm limits with that also which included taking away privileges such as the car, college assistance, etc., if the rules were not followed. Again, we were fortunate that it didn’t come to that.
I think that one of many improvements in our home was the fact that the other kids felt less helpless. Knowing that mom and dad had a plan and were going to take the lead made them feel less at sea. Even if there were difficulties (and there were) they felt more secure knowing that there were boundaries and that help was available. Kids need boundaries and to feel that someone is in charge and will take action. Even if it doesn’t completely resolve or cure the problem, knowing that mom and dad have a plan reduces the fear and the desperation that helplessness can bring.
Every family is different just as every child is different. This worked very well for our family and for our son. I will always continue to recommend working closely with your treatment providers when making changes or big decisions regarding dealing with the eating disorder. They know your child and your family. Don’t be afraid to talk with your child’s providers about your other children. Their needs are important as well and your providers need to know the entire picture in order to best treat your child. Family Based Therapy is just that and can’t be successful without considering every member of the family.