Part of any successful voyage, especially one that involves reaching a critical destination for you and your loved ones, involves deciding when to keep rowing and when it would be wiser to jump ship.
Rowing, especially when it sometimes seems that people are not pulling together in the same direction (and at least one entity – the eating disorder – is actively punching holes in the hull) is exhausting. Never underestimate the role of exhaustion in decision making.
It occurs to me that the short answer to this question (when do I jump ship?) is simple: whenever it’s clear what you are doing is not working.
In this case, I am talking about treating four principal behaviors: restricting/weight suppression, over-exercising (or exercising past the ability of your diet to support it), bingeing and purging. If you are a parent caring for a child who exhibits one or more of these symptoms you should understand that you cannot extinguish their desire to engage in them, but you can control the child’s ability to engage in them. And you should. An example of this would be direct supervision of all meals in order to combat restricting and achieve weight restoration.
Just taking that one example, supervising meals in a child who restricts, we see how hard treatment can be. Supervising meals – which means sitting with them and eating alongside them, not reading your emails or answering the doorbell – is demanding and exacting and…thankless. We can endure a lot for gratitude and a sense that we doing the right thing. But when the harvest of our efforts is resistance, ingratitude and resentment, wow can it be hard to persist!
Yet persist you must. There can be no recovery, no remission, without weight restoration and absolute extinction of bingeing, purging or exercising past our fueling.
So understanding the critical nature of treatment interventions makes the purpose of our efforts clear. But there are many ways to get to these goals: on your own, modified or supported “on your own” (ala Maudsley), with outpatient support (seeing a dietitian/therapist and doctor), in a structured day program, in the hospital, in a residential treatment center.
Yet no matter which form of treatment you are engaged in, as the goals are clear, when do you know you are on the “wrong” treatment track for your child? The answer is: when you make no progress towards achieving those goals.
There are still treatment programs and outpatient providers out there who tolerate little to no weight gain after weeks, hard as it is to credit. It is actually not necessary (or wise) to tolerate lack of weight gain after a few days, much less weeks. A successful team will offer several options for achieving needed weight restoration and cannot hesitate to use them. An example of a backup option where weight gain is stalled or going backwards is placement of a nasogastric tube.
For failure is not an option.
If your child is not gaining weight at a good clip (we use 0.2 kg [0.4lbs] a day, averaged over a week and our Australian colleagues use about 0.3 kg [0.6 lbs] a day) you must ask your team to help you identify the problem. Ask them what they think is preventing good weight gain. The slower it goes, the longer it takes and the longer your child languishes in a state of poor nutrition and poor brain growth. If the answers are vague or – heaven forbid – along the lines of “weight gain is not the most important part of recovery,” it’s time to jump ship. Do not allow your child to remain in the limbo of inadequate treatment. Don’t keep doing what you’ve been doing all along and expect a different result.
If you are doing the best you can and – to revert to our metaphor of the ship – rowing as hard as you can, and the team blames you for the lack of progress, it’s time to jump ship.
If you find yourself with a treatment team who believes that eating disorders are caused by poor parenting or trauma at home (e.g. divorce) or the fact that you let your daughter subscribe to Seventeen Magazine, it’s time to jump ship.
If your team won’t talk to you “because it’s about the child’s developing autonomy and they need to make independent decisions,” it’s time to jump ship.
Read, inform yourself, talk to other parents and go to the forums they have established, such as F.E.A.S.T. Remember, you are the decider, as one of our former presidents said. Only you will know when it’s time to jump ship…and take your child with you.