Parental Denial of Eating Disorders

Following my live webcast presentation today on eating disorders, for the Children's Mental Health Learning Series, a viewer online asked about what do if you approach parents about your concerns about a student and they deny there is a problem.

I'd like to expand on my answer as I've had a bit more time to think about it.

Denial is a powerful protector. It shields us from things we feel are too frightening or too dire to face. For some people, denial seems as essential as oxygen; it helps them cope with a life that seems too stressful to face.  But, in the case of eating disorders, denial can delay treatment which can, in turn, have devastating affects on the chronicity of the illness.  Delaying treatment can also result in severe medical emergencies or even death. 

So clearly, we all have  a duty to contact parents if we witness warning signs of eating disorders. However, for some cultures and some families, mental illness is simply not acceptable. It creates extreme feelings of stigma and shame. It may be seen as a sign of their failure as parents. There may be a great deal of concern over what this "label" will do to their child's social standing or academic/career prospects. It may be personally excruciating for parents to face. 

And, research has shown that human beings are notoriously good at finding proof for the theory we support. So, parents who have a perfect, straight-A child, with a high commitment to fitness and health, will be hard pressed to believe that an eating disorder is likely.  They may point to the fact that she/he always  eats breakfast. She/he exercises regularly. She/he is getting great marks in school.  They may dismiss the authority of the person who is bringing forward the concern. ("You aren't a doctor. You don't know my child.") In short, they may deny any "proof" that doesn't line up with their preconceived view.  We believe what we want to believe.

So, does all this mean that educators and concerned bystanders should keep their nose out of other people's business and avoid the potential conflict? I say no. I think we have a responsibility to step forward when we see a child's health and well-being in jeopardy. We need to quell our own fears about how the conversation will go, and initiate anyway.

Here are a few pointers on how to help make the conversation a bit easier:
-Pick a quiet, private time to initiate the conversation. Make sure you have enough time to serve it justice.
-Give the family the heads up that you have concerns about the student/child's health and well-being.
- Adopt a collaborative, open, kind, compassionate attitude. 
- Watch for language that could be seen as accusatory, authoritative or judgmental.
- Expect (and be ready for) a wide variety of responses, including denial, rationalization, anger, shock or sadness. 
- Reflect back to the parents that this must be alarming news. (It's typical for parents not to know what is going on during school hours).
- Remain calm if they deny, dismiss or try to end the conversation. 
- State the specific behaviours you have witnessed. Be clear with your language to avoid confusion or misunderstanding.
- State (and restate) your concern for the child/student's health and well-being. (You may want to include some information here about the dangers of eating disorders). 
- Ask if they know where to go to find additional help (including accurate medical assessment, counselling, treatment, etc)
- Suggest they visit EDSNA's website to find out more. (including lists of options, the SCOFF questionnaire to screen for eating disorders, support groups, facts, books, etc.)
-  Ask them if they have support within their community, or family, to draw upon. (This may also be the time that you will get a feeling of how "acceptable" mental illness is for them and their community.)
- Offer to put them in touch with EDSNA or other supports. People often have no idea where to turn. 
- Keep the door open for future conversations. You may not be able to convince them, but if enough people express the same concern, eventually, the message will sink in. Be clear that your door is always open.

I would suggest also having a similar conversation with the student/child to determine if they may be interested in seeking support or treatment. Sometimes, youth are just waiting for an adult to notice, to care and to throw them a lifeline.