What do I do if my adolescent refuses to go to treatment? That is a very valid question and one that gets asked often. You feel like your child has changed, the eating disorder has crept in, taken over and it has likely wreaked considerable havoc in your homes and within your families, not to mention how your child is suffering. You may even feel that you no longer know or recognize your child because they have been overcome by a force, almost like a demon who is holding them hostage. This is quite normal. Scary, but normal and all par for the course when your child has an eating disorder.
You probably are well aware that your child needs treatment, but they are pulling out all of the stops to prevent you from making them go. Here are some helpful strategies to consider when your child is refusing to attend eating disorder treatment.
1. Don’t give in to the disorder. While we know that a major hallmark of adolescence is developing independence and autonomy – and we want to honor that for sure when possible – this is not the time for that due to the consequences of having an eating disorder. When a child refuses treatment it is likely because they are terrified of losing their disorder. They may beg and plead and bargain and negotiate. They may even sit down and start to eat foods that were previously avoided in a last-ditch attempt to prove that they are not under the control of their eating disorder. As parents it is imperative that you hold the line and follow through with whatever medical professionals advise – because regardless of what your child is saying to prove they are well – the eating disorder is in charge and it will not go away without a fight. Your child may warn that if you follow through with treatment, they will refuse to eat or use other behaviors, they may even threaten to “get worse” if you make them go. Know that the absolute right thing to do is to pursue treatment no matter what level of resistance you get from your child.
2. Find their motivators. There are plenty of incentivizing measures families can use to encourage basic cooperation. We get calls from parents all the time telling us that their adolescent is refusing to get in the car to go to treatment – this is no easy feat when dealing with a strong-willed teenager who is living with an eating disorder. My advice? Find your child’s unique motivator because most of the time – there is something that can be used as leverage. Does your child love video games? Want to go to the spring dance? Have they been wanting to borrow the car? It is okay to use these incentives in order to get your child the life-saving care that they need.
3. Use consequences and hold the line. While we like to encourage incentivizing as opposed to taking privileges or material items away, this is certainly a time when all of the tools in our tool bags need to be utilized. Eating disorders have the highest mortality rate of any mental health condition which is why it is vital that you act quickly. Let your child know that if they don’t attend treatment, you don’t feel comfortable having them participate in sports, as it could medically compromise them. Do your best to link any consequences that you use to safety from the eating disorder. If you decide to take away the keys to their car, let them know that if they’re not going to treatment, and are most likely engaging in behaviors, it would not be safe for them to drive the car.
4. Understand your role in your child’s recovery. Hopefully you will be willing to explore some of your own values around food, shape, weight, and even mental health in order to progress–and that can make you feel vulnerable. But think about what we are asking our adolescents to do; give up their most valued and effective coping skill. They may fight you every step of the way. So, we can fight back against the disorder by examining how we communicate, how we validate, how we express our emotions, practice self- care (yes, that’s a thing!). Our kids are watching and learning from us. We are the best possible models that they will ever have to develop healthy identities free of self-defeating thoughts and actions. Now is the time to get into your own therapy and work on how to cope more effectively because your child needs you to be ready for the fight of their life.
While your child may be resistant to treatment, there is so much that can be learned, changed, and explored so that your child can begin to get better. Resistant adolescents don’t even need to participate in Family-Based Treatment (FBT) sessions and good things can and will happen. Your treatment team or clinician can help you identify patterns within the family that may be sustaining some of the eating disorder behaviors. Your child’s team can help you put new measures in place at home to discourage the use of destructive behaviors. They can help teach you how your child is separate from their disorder so when you get frustrated, and you will, you can direct it at the eating disorder, not the child.
This may all seem like a lot of work (and full disclosure – it is), but fear not warrior parent/caretaker! There is a light at the end of this long and sometimes dark tunnel. The sooner you get your child in for specialized care for anorexia, bulimia, or another eating disorder they may be struggling with, the better chances they have at long – term and sustainable recovery. FBT has very impressive short-term AND long-term results for adolescents living with eating disorders. Still have questions? Let us answer them.
Amy Parent, LCSW is a clinician in the adolescent partial hospitalization and intensive outpatient programs at the South Windsor, CT clinic. Amy loves working with families and helping them identify challenges within the family and then developing action plans for change. Amy spent most of her working life in the food service industry before making the leap to mental health treatment. But if you ask her, she will tell you they are pretty similar. In fact it was working in food that made her realize that she wanted to help people thrive under challenging circumstances. In her spare time, Amy enjoys spending time with her family, cooking, enjoying the outdoors (especially bird watching– raptors are her favorite) and yoga.