"Understanding Eating Disorders Looking Beyond the Behavior" over a photo of a redheaded teen looking thoughtfully away from her mom in the background.

Understanding Eating Disorders: Looking Beyond the Behavior

When you or your child is struggling with food, whether that looks like purging, restricting, binge eating, and/or rigid exercise, it can be terrifying and confusing for parents. It can also feel deeply isolating for the person living inside the experience.

What we see on the outside is food behavior: increased rigidity around food, eating in isolation, eating large amounts of food, or purging. The behaviors can look or feel so baffling that it may be hard to get curious about what is happening on the inside. But having this understanding is key to long-standing eating disorder recovery. 

Most eating disorders serve some function, which means that they are “helpful” or serve a purpose for the person living with them. This may sound counterintuitive, because the behaviors can feel distressing and can be physically harmful. While the outcome is harmful, there is often a root need that it feels like the disorder is addressing.

Eating disorders are rarely about stubbornness or vanity

Eating disorder behaviors are the tip of the iceberg. These behaviors can look willful, defiant, obsessive, or confusing. But they are rarely about stubbornness or vanity. They are usually nervous system strategies.

When a child (or adult) cannot eat, eats beyond fullness, purges, or restricts, their body is often trying to regulate something overwhelming inside.

The nervous system is the hidden driver. Our nervous system is constantly scanning for safety or danger. This process happens automatically and below our conscious awareness.

Eating disorders are a survival response

When our nervous system is well regulated and feels safe, we can eat with flexibility, have awareness of hunger and fullness, digest food well, tolerate a wide range of emotions, and have the capacity for problem-solving.

In contrast, when our nervous system is in fight, flight, or freeze in reaction to distress, our brains and bodies do quite the opposite. Eating disorder behaviors often map directly onto these survival responses.

Not eating enough calories can subdue emotions

Dietary restriction, or not being able to eat enough, functions to dampen the nervous system over time, which reduces the intensity of our feelings. When the world feels chaotic, overwhelming or unpredictable, malnutrition can create a sense of safety and stability.

This is one of the reasons we think that anorexia nervosa often begins in early adolescence. During this time, lots of change is happening, including the onset of puberty. Additionally, the transition between high school and college represents another vulnerable period during which anorexia may emerge. 

Binge eating and purging can function to help reduce distress 

Binge eating is thought to be soothing when intense emotions crop up. In other words, food is used as an attempt to self-soothe or regulate distress. For someone who feels anxious, overwhelmed, depleted or lonely, eating can temporarily bring short-term relief. However, longer-term it makes one’s distress grow. 

Purging behaviors often follow intense nervous system activation, including overwhelm, shame, panic, or sensory overload. Purging can create a rapid physiological shift. It may temporarily reduce anxiety or provide a feeling of release. The body learns: This brings relief. And so the cycle repeats.

Similar to purging, rigid, compulsive or overexercising can create quick physiological changes. These changes include a release of endorphins and changes in dopamine and serotonin, which can improve mood. Exercise can create short-term relief from emotions such as anxiety, guilt, shame, stress or sadness. Because of this relief, the brain learns to repeat it, which leads to increased amounts of exercise. 

Understanding eating disorders is a key step in recovery

You or your child may be experiencing one or any combination of these eating disorder behaviors. The thing to remember is that eating disorder behaviors are serving some function. So, it makes sense that attempts to “have more willpower” or trying to abstain from the behaviors are often short-lived and ineffective. In fact, approaching eating disorders this way often causes an increase in shame, isolation and feelings of failure. 

Treating eating disorders usually utilizes a combination of insight-oriented & behavioral therapies. The goal of insight-oriented therapy is to develop a deeper awareness of unconscious patterns, past experiences, and internal conflicts that influence current problems. The goal of behavioral therapies is to identify, modify, and replace maladaptive behaviors with healthier ones by changing the learning and reinforcement patterns that maintain them. Both are needed to recover. 

Eating disorders are not just about food. They are about regulation, safety, and survival. If you or your teen are living inside this experience, your behaviors make sense in the context of your nervous system. They are not proof that you are broken or weak or that you failed as a parent.

Remember: recovery is possible.

Do you want to learn more about your treatment options? Sign up for a free consultation to learn more about how I can help you.

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A Note to Parents of Teens with Anorexia Nervosa

A Note to Parents of Teens with Anorexia Nervosa

If you’re reading this, chances are you’re scared, confused, and doing everything you can to help your teen who seems to be struggling with anorexia nervosa. Maybe you’ve noticed weight loss, increasing rigidity around food, or a once joyful child who now seems consumed by rules and restrictions. You’ve already tried reasoning, negotiating, and reassuring them, only to be met with resistance, tears, or even silence. You’re not alone—and you’re not to blame.

Eating Disorders Don’t Happen in a Vacuum

First, let’s clear some things up: eating disorders happen for a variety of reasons, and you did not cause this. Your child is not being difficult or manipulative. Anorexia nervosa is not a choice—it’s a serious mental illness, one that often emerges as a way to cope with overwhelming emotions, stress, or internal distress. While it’s common to want to understand the “why,” we’ve found that what’s often more helpful is understanding the “function” of the eating disorder.

Many teens develop anorexia as a way to regulate their nervous systems. It gives them a false sense of control, numbs emotions, or provides structure during times when life feels chaotic or uncertain. To you, their stressors may look like typical teenage challenges—school pressure, friendships, body changes—but to them, it may feel unmanageable. Anorexia becomes their coping strategy.

The First Priority: Nutrition

It’s completely understandable to want your teen to be motivated to recover. That desire is beautiful—and sometimes, they do. But more often than not, especially early on, they don’t. That’s because the eating disorder is serving a function that feels protective, even comforting. This is why insight is often low, particularly in the early stages. Your teen likely does not recognize the danger they’re in.

But as a parent, you must.

Malnutrition affects every system in the body—heart, bones, hormones, digestive system, and most importantly, the brain. When the brain is undernourished, it struggles to think clearly, manage emotions, and perceive risk. That means your child may not recognize how sick they are—or even that they’re sick at all. In this light, food is not just fuel—it’s medicine. Without nutritional rehabilitation, anorexia becomes more dangerous and more entrenched. Left untreated, it can be fatal.

Supporting Your Teen: Think “Food First, Life Second”

Your role as a parent is critical—and powerful. You don’t have to wait until your teen agrees there’s a problem. In fact, waiting can lead to more severe illness. Instead, treat this the way you would treat any other safety concern. If your child was struggling to breathe, you wouldn’t wait until they acknowledged the problem—you’d act. Anorexia nervosa requires the same kind of decisive care.

So what does that look like?

  • Offer three meals and three snacks a day. These should be complete, nourishing meals designed to support weight restoration and healing—not what your teen requests or feels “safe” eating. (Remember, the eating disorder is often dictating their choices right now.)
  • Before starting nutrition rehabilitation process, first get a full medical workup from your teens doctor, as they may be at risk for refeeding syndrome, which can be life-threatening.
  • Sit with them while they eat. This isn’t just about supervision—it’s about support. Offer to distract them if they’d like—scroll through social media together, play a card game, or watch a show. Distraction can be a helpful tool.
  • Validate, validate, validate. Acknowledge how hard this is. Say things like, “I know this is scary,” or “I can see how uncomfortable this feels.” Your calm, steady presence will help more than you know.

You’ve probably already tried to help your child eat more and have been met with pushback. That’s normal. Remember, the eating disorder is helping them cope, and asking them to let go of it—especially before they’ve learned other ways to regulate—is asking a lot. But with nourishment, the brain begins to heal. With nourishment, new coping strategies become possible.

You’re Not Alone

Recovery from anorexia is hard—but it’s possible. And no one should do it alone. Reach out to treatment professionals who understand eating disorders, and look for support groups for families walking the same path. Family-Based Therapy (FBT) is designed to support you as you support your teen.

Above all, remember this: your love is not enough to cure anorexia, but it is the foundation on which recovery is built. You can be firm and compassionate. And set boundaries and offer comfort. You can lead your teen through something they don’t yet want to leave behind.

You’re not failing. You’re fighting for your child’s life. And that matters more than anything else.

This article is meant to be educational about anoerxia nervosa, but it does not suffice as treatment. If you think your teen has an eating disorder, please seek a medical evaluation from your teen’s doctor. 

If you would like to connect about how I work with families, feel free to schedule a consultation here. 

Eating Disorder Recovery: Gain Momentum Over Summer Break

Eating Disorder Recovery: Gain momentum over summer break

For college students working towards eating disorder recovery, during the school year can feel like a constant balancing act. Between deadlines, exams, social stressors, and navigating independence, there’s often little space left for the deep emotional work that recovery requires. You may have found yourself just trying to stay afloat—doing your best to maintain stability, but without the time or energy to develop new skills that support long-term recovery.

Summer break, however, offers something the school year rarely does: breathing room. With fewer academic pressures and more control over your schedule, summer can be an opportunity to gain real momentum in your recovery journey. Here’s how you can use this season to refocus, reconnect, and strengthen your foundation for eating disorder recovery. 

1. Re-Engage With Your Eating Disorder Treatment Team

If you’ve had to scale back on therapy or nutrition sessions during the semester, summer is the time to plug back in. Reach out to your treatment team—therapist, dietitian, physician—and schedule regular appointments. Even a few months of more consistent support can create noticeable progress.

If you’ve been away from care altogether, summer is a great time to re-establish those connections or seek out new providers who can help you move forward. Virtual care has made this more accessible than ever, whether you’re at home, traveling, or staying on campus.

This could also mean considering a more intensive level of care, such as a partial hospitalization program (PHP) or intensive outpatient program (IOP). These structured treatment options—often called “day treatment”—can be an incredibly effective way to reinvigorate your recovery. With daily therapeutic support and a more contained environment, you can focus deeply on healing without the academic stress that might otherwise get in the way.

2. Learn (or Re-Learn) Coping Skills

It’s completely normal to feel too emotionally taxed during the school year to take on new coping strategies. That doesn’t mean you’ve failed—it means you were human in a high-stress environment. Summer gives you the bandwidth to revisit or discover skills that actually help regulate your nervous system and reduce the urge to rely on disordered behaviors.

Here are a few to explore:

💬 Connection with Others

Recovery can feel isolating, and sometimes shame convinces us we’re better off alone. But notice this: What happens when you simply connect with someone—a friend, a family member, even a kind stranger? Does your anxiety dip, even a little? Human connection is powerful. It doesn’t need to be deep or intense to be healing. A short walk with a friend, a phone call or text exchange, or a shared laugh can ground you and remind your brain that you are safe.

🌳 Spending Time in Nature

Nature has a unique way of soothing the nervous system. Research shows that even short periods outdoors—walking through a park, sitting near water, or lying in the grass—can reduce stress hormones and improve mood. The natural world invites presence, which is often the opposite of the chaos and noise that feed disordered thoughts.

Try noticing the small things: the sound of wind in the trees, the feel of sunlight on your skin, the rhythm of your footsteps on a trail. These aren’t distractions—they’re grounding tools that help rewire your stress response over time. 

✍️ Journaling and Self-Reflection

Without the constant stream of assignments and obligations, you may find space for reflection. Journaling can help you process emotions, track your recovery progress, or simply notice patterns in how you’re feeling. You don’t need to write every day or follow a strict structure. Even jotting down a few thoughts each week can increase self-awareness and offer insight into what’s helping (or hurting) your recovery.

3. Give Yourself Permission to Slow Down

Recovery isn’t just about doing more. Sometimes the biggest breakthroughs come when you give yourself permission to rest. Summer may feel like the time you “should” be catching up or making huge leaps—but remember, slowing down can be the leap.

Ask yourself:

  • What pace feels sustainable to me?
  • Where can I offer myself compassion rather than pressure?
  • What kind of support do I need to keep moving forward gently?

4. Plan for the Fall—Without the Pressure

Toward the end of summer, consider how to carry your progress into the school year. Maybe that means scheduling therapy sessions ahead of time, setting boundaries around school-life balance, or identifying support systems on campus.

You don’t need to have it all figured out—but having a loose plan can prevent you from feeling like you’re starting from scratch once classes resume.

Final Thoughts on Eating Disorder Recovery

Recovery during the academic year can be a slow climb—but summer offers the chance to catch your breath, look around, and notice how far you’ve come. This season isn’t about perfection. It’s about presence, curiosity, and gently returning to the practices and people that help you heal.

Use this time to reconnect—with your team, your tools, your community, and yourself.

Are you struggling with eating disorder recovery ? Working with a therapist who is experienced in Family-Based Treatment can help. If you are in Texas and interested in working with me, click here to fill out a contact form.

2024 Eating Disorder Recovery Resource Roundup

2024 Eating Disorder Recovery Resource Roundup

As we close the chapter on 2024, we have the opportunity to take a few moments to reflect on the last year of eating disorder recovery & treatment. And make note of resources available to us for continuing care in 2025.

As awareness of eating disorders and recovery options continues to grow, families, clinicians, and communities are searching for tools and knowledge that prioritize compassion and effective care. Whether you’re considering levels of care for recovery or exploring family-based therapy for eating disorder treatments, these conversations have helped shape a community of care we’re excited to take with us into 2025.

Whether you’re a parent, caregiver, or someone in recovery yourself, there’s so much to be aware of, and as we learn more together. We can strengthen our communities and our possibility for a thriving recovery.

As we move into 2025, these insights can guide us to approach eating disorder recovery with greater intention. They challenge us to prioritize early intervention, understand diverse diagnoses, and advocate for inclusive and accessible care. Whether you’re navigating recovery personally or supporting a loved one, the lessons of 2024 can serve as a foundation for a hopeful and informed new year.

Stay tuned as we build on this momentum in 2025, continuing to explore the complexities of eating disorders and the paths to healing. Let’s enter the new year with renewed purpose and compassion.

Here’s what I wrote about this year:

When Your Loved One Doesn’t Want to Get Better: Understanding Anosognosia in Anorexia Nervosa

“Anorexia nervosa is an eating disorder characterized by severe food restriction, an intense fear of weight gain, and body image disturbance. Anorexia nervosa affects many individuals of all genders, ages, and identities worldwide.

The consequences of anorexia nervosa can be devastating, both physically and psychologically. However, one of the most challenging aspects of this disorder, particularly for family members and caregivers (and even clinicians!), is the phenomenon known as anosognosia.

What is Anosognosia?

Anosognosia, stemming from the Greek words “nosos” (disease) and “gnosis” (knowledge), refers to a lack of awareness of one’s illness. Anosognosia often can feel and look like denial.

Denial is a defense mechanism and psychological response to avoid dealing with anxiety or other uncomfortable feelings. In contrast, anosognosia in mental health conditions is better described as a lack of awareness of their own condition.”

Understanding ARFID: More Than Picky Eating

“Avoidant/Restrictive Food Intake Disorder is not just a simple case of picky eating; it is a complex psychological condition that can cause significant nutritional and reduced quality of life, particularly if it endures into adulthood.

Unlike other eating disorders that are often driven by concerns about weight and body image, ARFID is characterized by an avoidance of food based on sensory sensitivity, lack of interest in eating, depressed appetite, and/or fear of adverse consequences such as choking, throwing-up, or an allergic reaction.

Individuals grappling with ARFID may face a persistent difficulty when it comes to eating sufficient quantities or varieties of food. This can stem from deep-seated anxiety, gastrointestinal discomfort, or past negative associations with food.”

Book Review: When Your Teen Has an Eating Disorder is a Must-Read

“If you think your child or teen has an eating disorder this is a must read.

Eating disorders can perplex many parents and clinicians alike. Your teen may not be acting like their usual self, and it’s hard to know if this is just normal teenage angst or something more serious. If your teen has an eating disorder, they may have changed greatly right before your eyes: refusing food, feeling anxious around eating, or experiencing changes in mood and energy.

You may have tried several times to talk with them about the importance of eating and try to reassure them that they are not gaining weight. (In fact, they are likely losing weight.) But, your child’s struggles seem to be getting worse not better.

If your teen has not seen a doctor yet about their eating disorder this is the first step to make sure they are medically stable.”

Levels of Care in Eating Disorder Treatment: How to Choose the Right Option

“Levels of care refer to how much support is needed to reduce eating disorder behaviors during treatment. Several levels of care may be utilized throughout treatment for an eating disorder, based on what is necessary for the person in recovery.

Treatment choices can be overwhelming if you or your teen are newly diagnosed with an eating disorder. Residential, day treatment, or outpatient care – what does this all mean?

Levels of care in eating disorder treatment are selected based on many factors including:

  • Medical: This often is the driving factor in selecting the level of care. If you or your teen are medically compromised more care may be needed.
  • Severity of malnutrition: Different levels of care offer varied amounts of support for nutrition rehabilitation.
  • Co-occurring conditions: Often those with eating disorders have other medical or psychological conditions that also need to be treated.
  • Social support: Social support improves mental and physical health. The different levels of care offer varying levels of social support.
  • Motivation”: Most of us want to feel better and be healthy. However, change can feel scary, overwhelming and downright impossible at times. Those who feel more stuck in their eating disorder may need more support to feel like change is possible.
  • Access to care: Proximity to treatment, insurance, and specialty care are all considerations. Virtual treatment by clinicians and treatment programs are being utilized to increase access to care.”

Treating Anorexia Nervosa in Teens: The 5 Tenets of FBT

“Looking at all of the treatment options for anorexia nervosa in teens may feel daunting.

In this article, the focus is on family-based treatment (FBT), one type of treatment for eating disorders that is used for treating anorexia nervosa in teens. In particular, this article discusses the nuances of family-based treatment, which are referred to as the “Tenets of FBT”.

The focus of FBT is to empower you, the parent, to provide nutrition rehabilitation and restore your child back to health with the guidance of a treatment team. FBT is an outpatient treatment that can be used in place of residential treatment or partial hospitalization if your teen is medically stable. That means your teen can stay at home during treatment.

The tenets of Family-Based Therapy guide me as a clinician, and you as a parent, during eating disorder treatment and recovery. When working with families and teens throughout treatment I refer to these guiding principles frequently.”

Can Family-Based Treatment Help My Child Recover from an Eating Disorder?

“If you are a parent or caregiver, desperate to help your child who is struggling with an eating disorder, family-based treatment may be the solution you are searching for.

Often, families come into my office worried sick about their child.

Their child might have lost a lot of weight or been acting “sneaky” around food. Maybe their child has been over-exercising, using laxatives, or throwing up after eating.

Or, they might be worried because their child only eats a small number of foods, or eats a lot of food at once.

Or maybe your child has become an extremely “picky eater”.

On top of that, parents are often terrified because they have heard doctors mention hospitalization and many therapists have turned them away. When they do research online, things look bleak.

No matter their child’s symptoms, when families first come in they are often frantic, frustrated, and feeling powerless. They don’t know what to do.

If you find yourself in a similar boat today, you’re not alone. I have worked with countless families who walk into my office feeling this way. Sadly, there’s a lot of blame put on the parents. All they want for their child is to get better and live a happy life without the constant obsession with food.”

I’ll be back in 2025, writing more about eating disorder recovery, food peace, and weight bias. If there are any topics you want me to cover next year, let me know. You can send me a message here, and you can also follow me on Facebook. Every week, I share resources from myself + other eating disorder experts, so follow if you’re looking for more information.

Text in the bottom left corner reads "Treating Anorexia Nervosa in Teens: The 5 Tenets of FBT" and the rest of the graphic shows a stock photo of a white woman hugging a teenage girl on a couch.

Treating Anorexia Nervosa in Teens: The 5 Tenets of FBT

You may feel confused, scared, frustrated, and maybe even hopeless if your teen has an eating disorder like anorexia nervosa. You have seen your fun-loving and bright teen change drastically, becoming a shell of their usual self. 

There are many types of treatments for eating disorders that work for teens and their families. Cognitive behavior therapy (CBT), dialectical behavioral therapy (DBT), Family-Based Treatment  (FBT), and Acceptance and Commitment Therapy (ACT) are a few of the common treatment modalities that are used in eating disorder recovery. Additionally, there are different levels of care available for those with eating disorders, such as hospitalization, residential, partial hospitalization, or outpatient treatment.

Looking at all of the treatment options for anorexia nervosa in teens may feel daunting.

In this article, the focus is on family-based treatment (FBT), one type of treatment for eating disorders that is used for treating anorexia nervosa in teens. In particular, this article discusses the nuances of family-based treatment, which are referred to as the “Tenets of FBT”. 

The focus of FBT is to empower you, the parent, to provide nutrition rehabilitation and restore your child back to health with the guidance of a treatment team. FBT is an outpatient treatment that can be used in place of residential treatment or partial hospitalization if your teen is medically stable. That means your teen can stay at home during treatment. 

The tenets of Family-Based Therapy guide me as a clinician, and you as a parent, during eating disorder treatment and recovery. When working with families and teens throughout treatment I refer to these guiding principles frequently.

5 Tenets of Family-Based Treatment for Anorexia Nervosa in teens

Agnostic view of the eating disorder

In FBT, the focus shifts from why your teen developed the eating disorder to treating the eating disorder.

Eating disorders are complex disorders and can develop for a myriad of psychological, biological, social, and medical reasons, and beyond. The parents and the teen are not to blame for the eating disorder. I know it may feel like your teen is choosing their eating disorder because they are restricting food or purging, but they are not.

Additionally, parents don’t cause eating disorders-so let yourself off the hook.

How this is helpful:

It reduces blame, guilt, and shame for the teen, as well as their parents. It focuses on stopping the eating disorder in its tracks, restoring your teen’s health, shortening the length of illness, and preventing the eating disorder from becoming chronic. 

This is similar to if you found out you had cancer. You or your doctor initially wouldn’t spend a lot of time figuring out why you have cancer but rather focus on how to treat the cancer. Treatment for an eating disorder is similar, including for anorexia nervosa in teens.

Externalization of the illness

Externalization of the illness is a tool to understand that the eating disorder is separate from your teen. Although it may appear on the surface that your teen is refusing food, it is the anorexia that causes the food refusal. 

Externalization is commonly utilized in the treatment of OCD, schizophrenia, and other mental health conditions. 

How this is helpful:

This helps families understand how to separate their loved one from their eating disorder which can reduce blame and shame. The spirit of treatment feels more like us (family and teen) vs. the eating disorder, in contrast to parents vs. the teen. FBT helps you call on your years of parental experience and wisdom to help heal your child.  This can often increase parental empowerment leading to more successful nutrition rehabilitation.

An increase in connection between parents and teen is what I have observed when working with families during eating disorder treatment. Increased connection can contribute to improved physical and mental health for the whole family.

The therapist takes a non-authoritarian stance

In traditional adolescent-focused therapy, the therapist works predominantly with the teen, and the therapist is leading the treatment. In contrast, in FBT, the therapist acts more like a coach.

“The therapists are experts on eating disorders and parents are experts on their family and teen,” is something I learned during my training in FBT.  This lends itself to high amounts of collaboration between the therapist and family. Additionally, FBT utilizes the strengths of the teen to help aid in the healing process.

How this helps:

FBT is “not a one size fits all approach” to treating anorexia nervosa in teens. In Family-Based Treatment, the therapist activates the problem-solving skills of the family.

In other words, the therapist is there to help guide you and your child through recovery – but you know your child best and what has helped them with other struggles in the past. This knowledge is essential as you work together toward recovery.

Additionally, FBT appreciates the uniqueness of each family and their teen including culture, gender, abilities, exceptionalities, neurodiversity, religion, and family values to name a few.

Parental empowerment

Simply put, parental empowerment means that parents feel confident about taking care of their children. Some parents have some experience with feeling empowered with things like setting a curfew, boundaries around school work, and expectations around chores, while others might second-guess their parenting choices. FBT is an opportunity for growth in this area.

One of the tasks of the FBT therapist is to help you harness the skills and confidence that you already have as a parent, and apply them to renourishing your teen. 

How this helps:

Empowered parents can be more effective at renourishing their teen. Since you, as the parent, are in charge of feeding your teen, it reduces distress and second-guessing about what and how much to feed your teen. 

Furthermore, empowered parents provide structure, consistency and boundaries that help children and teens thrive. 

Pragmatic approach

The initial focus of FBT is symptom reduction rather than focusing on why the eating disorder developed. In the case of anorexia nervosa in teens, parents are tasked with the nutrition rehabilitation of their child, similar to the staff at a residential treatment center. This allows the family to stay together during treatment.

How this is helpful:

This approach stops the eating disorder from getting worse, which can lead to medical complications or potentially death. Stopping the eating disorder behaviors will help keep them from becoming habitual for your teen.

One hypothesis for why eating disorders develop is that eating disorders have a function. That is, they are helpful in some way, despite causing physical harm. For example, if someone smokes a cigarette, although the cigarette is physically harmful, it reduces stress for the smoker in the short term. Eating disorders are thought to function in the same way.

In my work, I have witnessed families rally around their teens, and through connection and compassion help their teen develop new skills to manage life stressors so the eating disorder is no longer needed.

Do you have a teen who is struggling with anorexia nervosa? Working with a therapist who is experienced in Family-Based Treatment can help. If you are in Texas and interested in working with me, click here to fill out a contact form.

"When Your Loved One Doesn’t Want to Get Better Understanding Anosognosia in Anorexia Nervosa" in white text on a light purple background in the bottom left corner of the graphic. The rest is a stock photo of a white woman sitting on a couch next to a teenage girl, looking concerned. White text in the top left corner reads "www.alisonpelz.com Helping people make peace with food & their bodies."

When Your Loved One Doesn’t Want to Get Better: Understanding Anosognosia in Anorexia Nervosa

Anorexia nervosa is an eating disorder characterized by severe food restriction, an intense fear of weight gain, and body image disturbance. Anorexia nervosa affects many individuals of all genders, ages, and identities worldwide. 

The consequences of anorexia nervosa can be devastating, both physically and psychologically. However, one of the most challenging aspects of this disorder, particularly for family members and caregivers (and even clinicians!), is the phenomenon known as anosognosia.

What is Anosognosia?

Anosognosia, stemming from the Greek words “nosos” (disease) and “gnosis” (knowledge), refers to a lack of awareness of one’s illness. Anosognosia often can feel and look like denial. 

Denial is a defense mechanism and psychological response to avoid dealing with anxiety or other uncomfortable feelings. In contrast, anosognosia in mental health conditions is better described as a lack of awareness of their own condition.

Anosognosia can affect individuals struggling with bipolar, schizophrenia, eating disorders, and other psychological disorders. 

In anorexia nervosa, individuals may minimize the severity of their condition. They may adamantly believe they are not sick, or that their behaviors are justified, making it incredibly difficult for them to recognize the need for treatment. It can feel like your loved one is being “difficult” and in teenagers it can be especially confusing because during adolescence it is normal for teens to be contrary or contradictory. 

Anosognosia causes a person to be unable to achieve one or more of the following:

  • Accept that they have an illness or disorder.
  • See the signs and symptoms of their condition.
  • Connect their feelings and personal experiences back to that condition. 
  • Understand and agree that the condition is serious and needs treatment.

One of the most dangerous aspects of anosognosia in anorexia nervosa is the individual struggling with insight when the condition becomes life-threatening.

This lack of awareness around a loved one’s illness can further complicate the treatment plan and, many times, prevent treatment from occurring altogether. 

Parents frequently ask me if they should wait for their child to want to recover.

My answer is always no, because I know that anosognosia is most likely operating, and because the devastating effects eating disorders have.

Let’s face it – no teen really wants the devastating effects of an eating disorder. Contrary to popular belief, no one chooses to have an eating disorder.

How Anosognosia May be Affecting You

It’s already difficult enough to observe as a family member or loved one suffers from Anorexia nervosa, but anosognosia can make it incredibly distressing and frustrating. Despite your pleas, watching as your loved one deteriorates physically and emotionally, while they remain unaware of the severity of their condition, can evoke feelings of helplessness and despair.

To best help your loved one, you must recognize that anosognosia is not a choice but rather a symptom of the disorder. 

It is deeply rooted in neurological and psychological mechanisms impairing the individual’s ability to perceive reality accurately. This is completely out of their control, and without professional help,they may be unable to leave behind their problematic and highly dangerous behaviors.

The Role of Brain Connection in Anosognosia

Research suggests that anosognosia in anorexia nervosa may have an anatomical basis. 

Brain imaging studies indicate abnormalities in brain structure and function. According to a study published in the European Eating Disorder Review, up to 80% of individuals with anorexia exhibit some degree of anosognosia.

Malnutrition, a hallmark of anorexia, can lead to significant changes in brain chemistry and structure. This potentially contributes to the development of anosognosia. These neurological alterations can impair the individual’s ability to recognize their illness and hinder their motivation to seek help. This perpetuates the cycle of disordered eating behaviors.

The good news is with nutrition rehabilitation, anosognosia diminishes. 

Navigating Treatment and Recovery

Supporting a loved one with anorexia nervosa requires patience, empathy, and a comprehensive understanding of the disorder. Here are some ways you can help your loved one on their journey to recovery:

Show Compassion and Understanding

When you are speaking to your loved one about their eating disorder, it’s important to approach the conversation with compassion. You want to validate their experiences and avoid judgments, criticism, and shaming.

Encourage Professional Help

Although it may be difficult for someone with an eating disorder to want to receive treatment, it is still important for you to encourage it. Most success is found in early intervention. When the illness is treated, early on, there are often better outcomes than for those struggling without help for years.

Educate Yourself

One of the best things you can do to support your loved one if they are struggling with anorexia and/or anosognosia is to educate yourself on the facts. This should include the common signs and symptoms, possible treatment options, and debunked myths. This information is powerful in helping you better advocate for your loved one and their well-being.

Foster Open Communication

Create a safe and supportive environment where your loved one feels comfortable discussing their thoughts and feelings. Encourage open communication and active listening, allowing them to express themselves without fear of judgment or criticism.

Practice Self-Care

Supporting a loved one with an eating disorder can be emotionally and physically draining. Take care of yourself and prioritize your own well-being, seeking support from friends, family, or mental health professionals if needed.

Be Aware of Triggers

One of the most important things to keep in mind is that even those deep into recovery can and will experience triggers. You can avoid adding to these by educating yourself on avoiding phrases and conversations, such as calorie counts or weight loss.


Expert Eating Disorder Treatment

If you think that a family member, child, or friend of yours is struggling with an eating disorder, it is important to consult a professional. With proper treatment, individuals can overcome their eating disorder and live a healthier life, both physically and mentally.

I am Alison Pelz, a psychotherapist and registered dietitian with over 16 years of experience. I specialize in treating eating disorders in Austin, TX. 

If you or someone you care about is struggling with an eating disorder, don’t hesitate to reach out for help. To learn more about expert eating disorder treatment and schedule a consultation with me today. I am here to help you and your loved ones reclaim their lives and break through the chains of disordered eating.

Are you a clinician? Sign up for my mailing list and CE course!


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