Dr Ahmed Boachie is Program Director of the Eating Disorder Program at Southlake Regional Health Centre in Newmarket, Ontario, Canada, and Staff Psychiatrist at The Hospital for Sick Children in Toronto, Ontario. Dr Karin Jasper is Clinical Mental Health Specialist and Research Co-ordinator of the Eating Disorder Program at Southlake Regional Health Centre, and Assistant Professor in the Department of Psychiatry of the University of Toronto.

Drs Boachie and Jasper are co-authors of the new book, A Parent’s Guide to Defeating Eating Disorders: Spotting the Stealth Bomber and Other Symbolic Approaches. Here, they discuss their unique approach to helping parents and professionals get to grips with the challenges faced by young people with eating disorders and, ultimately, help overcome them.

How did you each come to work in the field of eating disorders?

AB: I trained as a child psychiatrist in Great Britain with extensive developmental pediatrics background knowledge. With eating disorders there is always a need to understand the child from both perspectives. Bringing this integrated perspective also really helps parents appreciate the need to intervene without delay, and to understand how indispensable their role is in helping their child recover. Eating disorders are among the most common causes of morbidity and mortality in children and they have a high potential for becoming chronic. Yet, in comparison with other illnesses they are paid little attention. It is still very common for an eating disorder to go undetected until it has become entrenched and is affecting a child or teen’s physical, psychological, and social development.

KJ: At first what caught my attention was the impact of our culture’s obsession with dieting and body shaping as solutions to nearly every life challenge. I saw that this obsession was particularly stifling to the lives of girls and women. It has intensified and today increasingly affects males as well. Specializing in the area of eating disorders, what I see is that children and teens who are caught in the grip of the disorder and whose lives and development are at stake, are able to recover. When they first come for treatment their personalities and voices are muffled and muted by the eating disorder. As their parents help them get well, their individuality returns. It’s the most beautiful thing!

Tell us about the new book – what is unique about the approach it takes?

Our book is innovative in that it uses analogies and metaphors to crystallize an understanding of eating disorders and crucial aspects of their treatment, which can improve the therapeutic alliance among professionals, parents, and children. Children and teens with eating disorders think that no one understands them and find it difficult to trust anyone, which presents a major obstacle for recovery. Parents often try to calm their children’s anxieties about food and weight-gain by minimizing expectations for food intake. The analogies and metaphors in our book help parents understand eating disorders in a way that allows them to ally themselves with treatment rather than with the eating disorder. Children who believe that others grasp their experience find it easier to open up. They feel understood, respected, appreciated, and supported, thus decreasing their guilt and improving their listening. Professionals may find the book increases their understanding of the complex presentations of eating disorders and thereby find it easier to explain them to parents. It can help everyone to work together effectively.

Why is the use of metaphor so effective in helping young people with eating disorders and their parents understand eating disorders and treatments?

Just as comedians make us laugh about things that are difficult to talk about and help us focus on the right rather than the wrong things, with metaphors and analogies we can make eating disorders understandable, reduce parents’ self-blame, and help them focus their strengths in a way that facilitates their child’s recovery. Children or teens may be unable to appreciate the real danger they are in because they are focused on the perceived “benefits” of the eating disorder and are fearful of being without it. Analogies and metaphors can help them shift their focus and see that there is a way out.

The 911 Call

A young person with an eating disorder may ask for help and then deny that she wants it, like someone who has an intruder in her home and calls 911 but, when help arrives, finds that the intruder is standing at her back with a gun, forcing her to say everything is all right after all. After some time living with the illness and giving up hope of being rescued, the young person may also start thinking of the intruder as her protector, believing that it is better to live with the eating disorder than to give it up for some other coping mechanism which may not work. When parents bring the young person for treatment, she experiences the professional who treats her as an unhelpful or dangerous alternative to her protector, the eating disorder.

– from Chapter 1: Rationale for Anologies and Metaphors

What are some common obstacles that parents face when trying to help their child overcome an eating disorder, and how will this book help?

The most important obstacle is that parents have traditionally been put to the sidelines in the treatment of their children with eating disorders. More recently it has been demonstrated that parents have a central part to play in helping their children get well. Our book will help by making eating disorders and their treatment transparent to parents in a way that empowers them to take the key role in their children’s recovery.

There are many myths about eating disorders that contribute to delays in identifying and treating them – for instance, that a girl who eats candy, chocolate, and chips cannot possibly have an eating disorder, or that boys don’t get eating disorders at all. Once recognized, thinking that an eating disorder is just a phase and that the child will just grow out of it, can contribute to delay in treatment. Because eating disorders also resemble other illnesses like depression or digestive problems, especially in the earlier stages, it can be difficult to get a diagnosis that leads to appropriate referral for treatment. Illnesses like pneumonia are not like this – it is straightforward to get a diagnosis and treatment. Specialized treatments for eating disorders may be available, but can also be expensive or difficult to access because of location or long waiting lists.

Eating disorders are a-motivational illnesses, which is to say that the person with the eating disorder does not feel motivated to change or is unable to sustain a motivation to change that would see her through treatment. There are perpetuating effects of the eating disorder related to semi-starvation – for example, depression – that contribute to the child or teen’s a-motivation for treatment.

A child or teen with an eating disorder needs her parents to understand the nature of the illness, to persist through systemic barriers, and to guide her firmly but compassionately through the process of recovery. Our book helps by using analogies and metaphors to inform parents about this process and to help motivate them through it.

Parents are the Priceless Resource

What is the most priceless thing to human beings? Air. It’s everywhere and it costs nothing. It comes to you even if you make no effort to find it. Just because we take it for granted, doesn’t mean it isn’t priceless. Parents may ask: “Is there any other facility I can take her to?” thinking that a more specialized or better hospital will be the answer. This is not the answer. It is you helping her to eat that will make the difference. The key is your own presence and involvement, at whatever stage of the illness your child may be.

– from Chapter 1: Rationale for Anologies and Metaphors

Copyright © Jessica Kingsley Publishers 2011.

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