Many people who have a child with an eating disorder (ED) feel overwhelmed and exhausted by the constant meltdowns or emotional storms. These episodes may include verbal abuse, prolonged crying, physical outbursts, self-harm, suicidal ideation, or, in sharp contrast, complete withdrawal. Meltdowns are a common part of eating disorder recovery but often are the most challenging.

What you knew as a parent or carer before ED is very different to the now. Any strategies that you used before, to calm and soothe your child, most likely do not work now. This is because the underlying driver of eating disorders is often emotional dysregulation. Added to this, there is often an underlying mental health condition, and their physical body may be under enormous strain because of malnutrition. People with eating disorders can also exhibit abnormalities in their brain structure.

During any meltdown it’s important to remember two things:

1. Eating disorders are extremely serious mental health conditions, complicated by starvation.
2. Fight, flight, freeze or fawn (FFFF) are the body’s stress reactions to perceived or real threats. A person with an eating disorder has a very low threshold for these perceived or real threats (food is one obvious threat) and can easily become overwhelmed by their FFFF responses. It is recognised that people suffering from an eating disorder can physically or verbally attack their parents/carers (fight), lash out at treatment providers (fight), turn their rage toward themselves with self-hatred, self-injury, suicidal ideation/attempts* (fight); flee or run away (flight); become catatonic or unresponsive (freeze); or use distracting techniques such as cooking for others (fawn), or ask barrages of questions (fawn).

Meltdowns may seem unpredictable and unprovoked. But if you look deeper, you’ll learn that it is your child’s way of asking you for help. It’s also often the only way they can ask for help.

Rather than seeing meltdowns as a catastrophe, see them as an opportunity to help your loved one.

What to do when a meltdown happens.

In the eye of the storm

• Don’t freak out, even though it’s very distressing. Your first instinct may be to yell back, or simply leave the room … but focus on giving them what they need, which is emotional support. Just show up for them during the storm.
• Use a calm voice.
• Forget about time pressure. This won’t last forever.
• Decrease sensory stimulation / calm the environment.
• Make it about your child, not you.
• Use visuals (such as nodding) to communicate, rather than words.
• Be silent / don’t talk / listen.
• Give extra physical space.
• Reassure them; let them know you are there if needed.
• Ignore any inappropriate language for this moment.
• Contain physical outbursts, if safe to do so.
• Validate their feelings. Don’t debate, deny or judge what they say. Just reflect.

Once the storm has passed

• Allow extra processing time for both of you.
• Slow everything down. Break the problem down and reflect back to them what you heard, so that they know you were listening.
• Suggest small achievable steps.
• Don’t try to reason, as this will only cause things to escalate again.
• Answer questions but try not to coach or correct. This will be seen as criticism or judgment and may send you both back into the eye of the storm.
• Give lots of positive feedback on what they can do rather than what they cannot.
• Avoid saying ‘No’ as they will hear this as ‘Never’.
• Work on acceptance-based language rather than conducting a post-mortem. Accept that each of you will probably see the same situation differently, and our feelings are still valid.

Other factors that may help

Acceptance

Once you (the parent or carer) accepts that life is going to be difficult for some time, then your own emotions can shift from resistance to empathy. Accept that life may not return to ‘before’. Accept that this is a serious, life threatening medical condition that needs extensive treatment. And most importantly accept there is hope.

Grief

Take time to grieve. Grieve for your old life. Grieve for your child’s old life. Allow them to grieve too.

*If your child is suicidal

According to leading psychologists and clinicians, “suicide is the second leading cause of death among individuals with anorexia nervosa (AN), and suicidal behaviour is elevated in bulimia nervosa (BN) and binge eating disorder (BED) relative to the general population.”

If a meltdown leads to suicidal thoughts:
● Call for help if there is immediate danger: 000, a family, or a friend.
● Move both of you to a safer place: away from danger; a calm space or a place of support such as a hospital.
● Do not leave them alone.
● Try to convey calm (fake it by lowering your voice, slowing your speech and breathing).
● Be assertive and show them you are in control (even though you don’t feel it).
● Care out loud (let them know, out loud, that you are there, you care for them, you
will stay with them). Don’t worry if you repeat yourself or your caring messages.
● Keep them connecting and communicating with you.
● Distract them by talking about something easy or which brings them joy (a pet).
● Use breathing or grounding techniques if possible.
● Refer to their safety plan. Remind them of their safety plan. Or afterwards, ask them to consider or review the safety plan.
● Ask your child to promise to tell you, or an adult friend, psychologist, teacher, GP or helpline like Lifeline – if they have suicidal thoughts again.
● If your child has suicidal thoughts, they need professional help.

Need urgent assistance?

Dial 000 or go to a hospital emergency department.

Suicide Call Back Service (24 hours) 1300 659 467

Lifeline (24 hours 7 days) 13 11 14

Kid’s Helpline (24 hours 7 days) 1800 551 800

SuicideLine (24 hours 7 days) 1300 651 251

Headspace  9am – 5pm, Monday – Friday  www.headspace.org.au

– Karina Smith