Seeking Help


Stop Press: Here’s how to get your copy of My Kid is Back – Empowering Parents to Beat Anorexia Nervosa as an E-Book: Amazon Kindle Apple iBooks Kobo

Opportunities for Parents and Carers

December 2nd: Carers Conference 2011 – Caring for your Loved One: knowledge and skills

Prof. Janet Treasure and Gill Todd will host a study day to share current research on how the Brain can affect Eating Disorders and how Carers can learn to adapt their skills to maximise the chances of recovery. Prof. Treasure will be keynote speaker. The event also will include:

Recovery Story
Emotional processing
Carers Skills Coaching project
FEAST Parents: helping to develop training films

Venue: Wolfson Lecture Theatre, Institute of Psychiatry, De Crespigny Park, London SE5 8AF.
Cost:  £45 per person; £80 for 2 people from the same family. Lunch:  Sandwiches.
Places are limited. To book, contact:, Sue Greenwood – 020 3228 4402.
Inquiries relating to external training or referrals to the South London and Maudsley NHS Inpatient Service: contact who will send the query to the appropriate person.

Reach out, communicate, share with people you trust and who understand your illness

An important tool in recovery is knowing when to reach out for help. With practice, and the development of self-awareness, this skill can be acquired. Accomplishing this challenge was a crucial step in gaining freedom from my illness as it enabled me to defuse the eating disorder’s triggers before they went off.  Reaching out takes courage as the eating disorder likes to isolate us from all who care about us.  Among the many wonderful women I have met on the ‘Net since gaining my wings is PJ, a brave and determined mother who is on her path to freedom and inspires me with her blog.

Mothers with Eating Disorders

Feeding their families but not themselves

Mothers living with an eating disorder while raising young children face a multitude of challenges, one of which is meal-time.

I received this e-mail query from ‘B’:

Do you know of any strategies that work with the Maudsley tenet of food being non-negotiable but translate this into an adult setting where giving over responsibility for the food preparation is not an option?


I’m struggling with knowing I need to eat, but also being responsible for having to feed everyone in the family, including myself – and the ‘including myself’ often becomes too challenging, so I give up. I talk myself out it! My husband is very supportive, but he also works very long hours, so it does not seem reasonable to expect him to come home at then cook for me – like it or not, being a mother, this is my job 🙂

I responded:

I know exactly how you feel. I experienced the same tussle of thoughts for too long – throughout my twenties, thirties and forties.

I often yearned to be in ridiculous confined and restricted places like hospital or anywhere, where meals would be provided at regular times. In such an environment I could eat the meals, as someone else would have prepared them, and they would be allocated. Somehow, this was acceptable. So for the few days I was in hospital after the birth of each child, or after an operation, I actually looked forward to meal time. The experience provided an insight that with support like this, I could become NORMAL!

Of course, when I returned home, my eating disorder behaviours took over. Within hours.

Like other mothers, at home in my own kitchen, I put the needs of others first.  In doing so, I was feeding my illness, allowing my eating disorder to thrive. I really needed someone as strong as a sergeant major in my kitchen, ordering me about, both in preparation and during the eating of the meals. I needed someone to take on my illness until I was strong enough (had regained sufficient of my identity) to take it on myself.

Certainly my recovery from my ED was much harder and was greatly prolonged for this reason. Recovery from an eating disorder requires full attention and support. It is hard for mothers to give their full attention to the recovery challenge.

For decades I would create nourishing meals for husband and children, and eat a few vegetables myself. Or maybe I had been upset and binged, and so would eat nothing at all.

Like ‘B’ I needed someone to take the control until I was recovered sufficiently to do so myself.

Strategies in the back of A Girl Called Tim evolved from my experience.

I know how hard it is to ignore the torment of our illness  — it will always try to convince us to put ourselves last. But ignore we must.  We must put ourselves first. Regain our identity, gain freedom from our eating disorder, and then the world is ‘our oyster’.

I suggested the following strategy to ‘B’:

Put a large calendar on your kitchen wall, and write down the meal times, and what you will eat for each meal. Show this menu to your husband the night before, and when he comes home the next day, get him to check that you have eaten at the correct time, and have eaten everything on the menu. After eating each item on the menu, use a highlighter to give yourself a tick for success. You must be honest with yourself.

When your husband comes home:

IF YOU HAVE NOT EATEN EVERYTHING ON THE MENU, then eat it NOW. Even if NOW is 11pm at night. Eat it now. Sit at the table with all the uneaten food in front of you. Eat the lot.

No avoiding your meals, okay.

They are ESSENTIAL to breaking free of the ED prison.

And next morning, the menu continues…even if you have eaten yesterday’s breakfast at 11pm, you start the new day with breakfast at 7am.  DO NOT MISS ONE MEAL OR ONE SNACK.

Can you enter a contract with your husband that you will not miss one meal, or snack (3 meals, 3 snacks DAILY)?

Every night, set out your meal plan (or do it a week in advance).

Part of the contract is that you must be TOTALLY HONEST with your husband.

You must be extremely courageous and ignore the torment of your illness.


Share this message with your husband.

Is he strong enough to sit with you, if you have not eaten all your meals and snacks for the day, while you eat them, when he comes home?

LOVE YOURSELF. Love your self. Despite your illness. Get angry at your illness. Kick its butt. The more you do so, the more you will regain your identity.

Your husband can help you kick its butt. But the inner strength has to come from you.

You will be free soon as you master this habit of three meals a day, and three snacks at regular intervals. Food is our medicine.

I am here pulling for you. I know it is akin to climbing Mt Everest without a Sherpa in sight; I know you can do it.

‘B’ responded:

I can see I have a lot to think about! My first reaction is the vision of me sitting at the table with an entire day’s worth of food sitting in front of me! I’ll wait until the kids are in bed and sit down with hubby and have a chat – I think it’s going to need our full attention 🙂

I had a great experience earlier in the year when I helped on a school camp and all the meals were just handed to me on a plate (literally) – and I ate them! So I know how liberating that can be. But real life is not that simple.

I wrote:

‘B’, you sound exactly like I felt and thought in my thirties. I often would not start eating until 6pm. Dreadful. But I was too scared to start before then in case I did not stop. Please know that you can recover. I did and you can, too. I wish you and your husband could attend a great program for couples that features in the textbook due for release next month (A Collaborative Approach to Eating Disorders, edited with Janet Treasure). The program, that helps couples work together in the treatment of Anorexia, is called UCAN, and is part of the Eating Disorder Program at the University of North Carolina.

‘B’ responded:

I have heard of UCAN – I would love there to be a program near me. It would be so valuable for hubby to be supported like that – at the moment he relies on me to give him information, and I’m not always the most reliable source of uncensored info 🙂
To seek further advice, I contacted the Academy of Eating Disorders and three members offered the following advice for mothers who are struggling at meal times:

Sarah Ravin suggests:

1.) husband could take family medical leave from his job for a few weeks to jump-start the re-feeding process

2.) relatives, neighbors, and friends could come over to help with some meals

3.) a relative could come stay with the family for a week or two to help with meals, to jump-start the process

4.) the kids could go stay with grandma or another relative for a week or so, to give mom a break and allow her to focus on her recovery

5.) the woman and her husband could plan meals in advance, writing down exact foods and quantities that she will eat (non-negotiable)

6.) regardless of his job, husband can make time to eat breakfast and dinner with her to ensure that she eats what she should

7.) husband can call her or send text messages at lunchtime and snack times to provide encouragement and keep her accountable

8.) the woman and her husband should find a good therapist who can help them with a FBT approach

Abby Sarrett-Cooper writes:

I feel for this mom, how she is working so hard to take care of her children and yet is unable to care for herself.  Cynthia Bulik is working on a couples-based program called UCAN.  This might be of value.  I noticed that the mom, in her comments, mentioned that she cooks for her kids but can’t expect her husband to cook for her.  My first thought was why is she not eating with them, and why is she not eating what she cooks for her kids.  Why is another meal necessary?  In Maudsley or FBT we don’t prepare different foods for different people in the family.  If the mom feels this meal is healthy and appropriate in general, then it should be for her as well. Not to mention the role modeling that is happening as she does not eat with her kids.  Part of taking care of her children is modeling healthy behaviour.  She will be eating not only with them but FOR them, as a role model and making sure she is healthy enough to care for them.  Perhaps the ED voice can be argued with in that fashion and battled as a risk to her kids. Discussing the data on risk running in families might support that argument. I am sure that what I am suggesting is nothing new, but I thought I would suggest it anyway.

Mary Cooper writes:

I have a couple of ideas that I hope would be of help to ‘B’. The first would relate to building in ways to remind herself of her commitment to eat that could help to counteract her tendency to talk herself out of eating a particular meal. So she might write herself a list of all the reasons she needs to feed herself regularly, including to be able to function as a mother, and read it every morning or before every meal. She can also keep a record of how she handles every meal.

So for breakfast, lunch, and dinner she could record whether she ate at all (0 if not), ate something (1), or ate adequately (2).

Monitoring herself in this way can help cut through a defensive tendency to tell herself she is OK when she’s not.

The second element I think of relates to trying to use her wish to nurture her children and feed them well. Maybe the starting point of meal planning and preparation could be the children’s nutritional needs and her attunement to their needs. Might there be a way she could cultivate a similar attunement and compassion for herself as another being who also needs to be well nourished?

It might even help her to have an image of herself as a child and to think of putting the food on a plate for her younger self who is hungry and needs nurturing.

Where to from here…

You can probably guess the outcome. ‘B’ suffered a few tough days as her eating disorder tried to make her feel guilty about reaching out for help. She also felt guilty, as I did, because mothers like us KNOW what we SHOULD be doing – eating meals with our children – but the fear and anxiety of actually doing so is like being shot into space without a spaceship. It is plain scary. It is horribly debilitating.

I am sure that ‘B’ can beat her eating disorder. She is courageous.

All she needs is support to allow her to focus on this one enormous task – beating ED, and regaining her SELF. My heart goes out to her, for I understand the struggle.

She knows what she needs to do; we need the health services and the employment sector to support her and her family, and allow her to do it. We need a bunch of UCANs.  The rewards will be great.

New! Information for Paediatricians
Maudsley Parents provide new information and resources on eating disorders and family-based treatment for paediatricians here.

Help is on its way with release of new textbook

The Centre for Eating and Dieting Disorders, (CEDD) Sydney, recommends my upcoming textbook with Janet Treasure:
A Collaborative Approach to Eating Disorders by June Alexander & Janet Treasure draws on up-to-date evidence based research as well as case studies and clinical vignettes to illustrate the seriousness of eating disorders and the impact on both the sufferer and their loved ones.
With contributions from key international figures in the field, this book will be a valuable resource for students and mental health professionals including family doctors, clinicians, nurses, family therapists, dieticians and social workers.

The official release date is June 2011 but you can order right now. Go direct to Routledge Mental Health.

Herald Sun Weekend magazine

A Living Hell — By Cheryl Critchley, Weekend magazine, Herald Sun newspaper, Melbourne, Saturday, April 30, 2011. Cheryl interviews June Alexander  about A Girl Called Tim in this article for parents, partners and people with eating disorders. Australian readers, especially, will find the web links helpful.

Eating Disorders – Early Identification in General Practice
This excellent article on early identification of eating disorders in General Practice appears in the March 2011 edition of Australian Family Physician, pages 108 to 111. A ‘must-read’ for every GP. A ‘must’ for every pinup board.

Is there an eating disorder in your family?
Information in this section is drawn from A Girl Called Tim – from author June Alexander’s experience and resources listed here. Explore the links for further information on treatments and support on caring for a loved one with an eating disorder, and in seeking help for you:



Eating disorders are serious, sometimes fatal, mental illnesses that usually develop in childhood or adolescence but affect people of all ages. Prompt intervention is crucial for the best hope of a full recovery.

Families can help! If worried about your child, educate yourself, especially on Family-Based Treatment, (sometimes called the Maudsley Approach), which is currently the most effective evidence-based treatment for children and adolescents with eating disorders. In this treatment, the family consults with a therapist who helps parents take an active and positive role in restoring their child’s health. The later stages of treatment centre on re-establishing independent eating and addressing concerns that interfere with resumption of healthy life and development. With good treatment and family support, there is every reason to be hopeful. If you are a parent or partner and feel concerned, make an appointment with a doctor, preferably one with experience in treating eating disorders. Above all, trust your gut instinct and seek help immediately.

Signs of an Eating Disorder

You do not need to be thin to have an eating disorder. This manipulative illness comes in many shapes and forms. Anorexia nervosa is not the most common but is the most serious, with the highest death rate of any mental illness. It is a very visible illness while bulimia nervosa and binge eating disorder are easier to hide. All three illnesses – together with variations under the umbrella of Eating Disorders Not Otherwise Specified (EDNOS) – are isolating for not only the sufferer but also the family.

Anorexia nervosa: This illness is characterised by self-starvation and excessive weight loss, or failure to make expected weight gains in children or younger adolescents. Worry signs: limiting food portions, cutting out groups of foods, avoiding family meals, exercising excessively, and becoming secretive. There may be anxiety or uneasiness about eating, or preoccupation with food, calories, or exercise.

Bulimia nervosa: This can be even more secretive, and any signs of bingeing and purging should be taken seriously. This illness is characterised by a cycle of bingeing and compensatory behaviours such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

Binge eating disorder (BED) is characterised by recurrent binge eating without the regular use of compensatory measures to counter the binge eating.

When an Eating Disorder develops in your Family

Eating disorder symptoms are frightening, intrusive, anti-social, anxiety provoking and frustrating and the behaviours involved in limiting calorie intake or increasing calorie expenditure take many forms. The physical consequences are alarming and distressing; all semblance of normality disappears, social life evaporates, future plans are put on hold and interactions around food increasingly dominate family relationships.

Carers often have difficulty coping, and unfortunately can get trapped into a cycle of behaviour and emotional responses that can inadvertently perpetuate the illness. Professor Janet Treasure and her team at the Eating Disorder Unit of the Department of Psychiatry at King’s College, London, have created a collaborative care skills training approach to help carers identify ways of reducing stress. Animal analogies are used to show how different patterns of emotional response by parents and carers can help or hinder the recovery process. A short explanation of this important work follows:

Anorexia nervosa has a profound impact on other people both through the direct effect of the symptoms and indirectly by changing the person families know and love.  It can seem as though the loved one has been taken over by an “anorexic minx” who thrives on feeding misinformation.  A family’s reactions to this anorexic minx can change the course the illness takes.

Impact of anorexia nervosa on the sufferer

Brain starvation affects the core being of the sufferer, causing some aspects of personality to be accentuated or new facets to emerge. For example, at a low weight, behaviours often become ritualised and rule bound. Attention becomes focused on small details, particularly relating to food and weight and it is hard to see the bigger picture of life.

The cognitive resources that humans use to make complex decisions and to understand the perspectives of other people are depleted secondary to a low physiological reserve. Communication and social interactions are less rewarding and the sufferer withdraws, becoming isolated.  Furthermore, the loss of self-esteem and cognitive introspection that follows makes regulating emotions difficult.  Frustration escalates into anger. Anxiety ascends to dread and fear becomes terror, sometimes manifesting as a panic attack. For other sufferers, there is too much inhibition of emotions. They may rely on their eating disorder to numb unpleasant emotions and therefore appear emotionally ‘apathetic’ or frozen; neither expressing pleasant or unpleasant emotions.

Parents, siblings and partners may think the person that they have known and loved is lost or transformed because of these deficits in complex aspects of brain function.

Causes of eating disorders

Pinpointing the root cause of an eating disorder remains an enigma, although recent research into genetics and neurobiology is beginning to shed light on these biologically based mental illnesses. Several factors play a role. Certain temperament and personality traits, including childhood anxiety, are common in those who develop anorexia nervosa:

•       A person who is more sensitive to punishment or threat. There may be many causes of this excess sensitivity including genetic or even indirect difficulties experienced while in the womb or during childhood.

•       An enhanced ability to perceive and analyse detail. This may be associated with a tendency to be focused and somewhat rigid.

•       Stress (minor or major) can trigger onset, especially if it occurs during adolescence.

Many questions remain and misunderstandings abound. What is becoming clear is that it may not be possible to reverse this causal chain … but treatment can be effective if it focuses on factors that cause the illness to persist, rather than those that have caused it.

A Message for Parents, Partners and Close Others

Banish any assumption that you are to blame for the eating disorder.  You are part of the solution.

Re-feeding is a vital first step. Our brain needs nourishment to think clearly and rationally, and our bodies function best at a healthy weight. Stand up to the illness on the sufferer’s behalf until weight is restored, and eating disorder behaviours diminish, and then remain vigilant.

You can help to interrupt the vicious circles that maintain the illness. Breaking through these traps will not be easy but the more heads that are used in this process, the better. You can gain skills to assist with the re-feeding and to recognise and respond to behaviours which are traits of the illness and not your loved one.

Animal metaphors help define effective responses

Eating disorder symptoms and their consequences may lead family members to react in particular ways, and the sufferer may feel increasingly alienated and stigmatised, retreating further into eating disorder behaviour.

Professor Janet Treasure and her research team at King’s College, London, have developed animal metaphors  to illustrate how these instinctive reactions can be unhelpful. Altering these responses is a challenge but with awareness and skills training, life-changing results can be achieved:

The jellyfish  — too much emotion and too little control

The ostrich  — avoids emotion

The kangaroo  — tries to make everything right

The rhinoceros  — uses force to win the day

The terrier  — uses persistence (often criticism)

Inspirational animal metaphors include:

The dolphin — just enough caring and control.

The St Bernard  — just enough compassion and consistency

Looking back, my family of origin seems to have resembled the ostrich. Living in a family of ostriches, where emotions were not discussed, was difficult and confusing for a child who was very anxious. To survive, I had to climb a mountain to escape the triggers that fed my illness. Only since reaching the summit of that Recovery Mountain at age 55 in 2007, did I start learning of evidence-based research, and begin to understand WHY I had to climb that mountain. I wish my family had climbed with me.

But I am fortunate, for my family of choice comprises a great line up of dolphins and St Bernard dogs. And this, together with a supportive, progressive health team and loyal friends, has made all the difference.

What does your family comprise?

Changing your behaviour and response requires hard work but the reward—that of saving and uniting your family—is priceless. In challenging times remember the adage, ‘every mistake is a treasure’ and as Martin Luther King said:

‘You don’t have to see the whole staircase—just take the first step.’

A Message for Sufferers

Whether you are 16 or 76, the strength and willpower required to break free from an eating disorder is immense. The first step is to reach out for help. Secondly, accept thatas in preparing for and attempting any great mountain climba support team is essential. I hope your family is there to support you but if not, create a surrogate family from trusted friends and health team. Self-awareness and mindfulness will help prevent eating disorder thoughts from sabotaging your progress. If you become aware of feeling lost, alone or vulnerable, be brave, reach out immediately and allow your support team to guide you.

Recovery is complex. First there is our physical self, requiring a regular and balanced eating pattern. This essential ‘medicine’ of three meals and three snacks a day is as vital in maintenance as in recovery. Then there is our psychological self. We must acquire skills and tools to cope with life and its resulting emotions without depending on our eating disorder. We must guard against anxiety buildup by exploring, addressing and resolving any underlying emotional problem. Dealing with problems immediately reduces the risk of eating disorder thoughts creeping in. I have found that being a few kilograms over the ‘ideal weight’ also helps provide a buffer and alleviates feelings of anxiety that can drive eating disorder thinking.

Setbacks are common but even without the ideal of support from one’s family of origin, recovery is achievable. Moreover, the temperament and personality traits that might create a vulnerability to develop anorexia nervosa may also have a positive aspect. These traits include attention to detail, concern about consequences and a drive to accomplish and succeed. Take heart from knowing that many people who recover from anorexia nervosa do well in life.

Empower Yourself

Explore the links for further information on treatments and seeking help for you and your loved one:


Eating Disorder Association of New Zealand (EDANZ) provides support and advice for families and whanau of people with eating disorders throughout NZ. Ph: (09) 5222 679.

The Butterfly Foundation offers support for sufferers of eating disorders, their family and friends. A confidential and supportive National Support Line staffed by professionally trained personnel is available on 1800 ED HOPE (1800 33 4673), on their website: or at

The Victorian Centre of Excellence in Eating Disorders (CEED), provides consultation, training and education to health professionals treating people with eating disorders and their families.

The Centre for Eating and Dieting Disorders (CEDD) is a professional service and support centre, providing information for sufferers, families and carers.

The Eating Disorders Foundation of Victoria is a primary source of support, information, community education and advocacy for people with eating disorders and their families. Confidential support and information is available from the Eating Disorders Helpline, 1300 550 236, or by emailing

South Australia   Incorporating panic and anxiety, obsessive and compulsive, and eating disorder associations:  ACEDA.

Depression and Anxiety

beyondblue provides information on depression, anxiety and related disorders, available treatments and where to get help. Visit or call 1300 22 4636.

headspace provides mental and health wellbeing support to people aged 12 to 25 years, and their families, across Australia. headspace helps find solutions for depression, anxiety, alcohol, self-harm and psychosis. Funded by the Australian Government, headspace is the National Youth Mental Health Foundation.


Beat is the leading charity based in the UK providing information, help and support for people affected by eating disorders and, in particular, anorexia and bulimia nervosa.

Families Empowered and Supporting Treatment of Eating Disorders F.E.A.S.T. is an organisation of and for parents and caregivers to help loved ones recover from eating disorders by providing information and mutual support, promoting evidence-based treatment, and advocating for research and education to reduce the suffering associated with eating disorders.

Maudsley Parents has information on eating disorders and family-based treatment, family stories of recovery, supportive parent-to-parent advice, and information for families who opt for Family-Based Treatment (Maudsley Approach). Maudsley Parents holds an annual conference to bring together leading researchers, families and community clinicians.

National Association of Anorexia Nervosa and Associated Disorders (ANAD) works for the prevention and alleviation of eating disorders.

MentorCONNECT: This is an online eating disorders mentoring community, provides mentor matching services, monthly teleconferences, weekly support groups and recovery blogs. Go to:

National Eating Disorders Association (NEDA) is dedicated to supporting individuals and families affected by eating disorders. The website serves as an entry point for people to find information on eating disorders. NEDA’s information and referral helpline guides people toward treatment options. NEDA’s programs include toolkits for educators, parents and coaches and athletic trainers; an annual conference for families and professionals; sponsorship of National Eating Disorders Awareness Week; Young Investigator Research Grants; Parent, Family and Friends Network; and state legislative advocacy on behalf of families.

Proud2Bme: This free and anonymous online community forum for teenagers and adolescents, launched in the Netherlands in 2009, offers easy and direct access and attracts input from young women with and without an eating disorder. or  English version (via Google)

The National Eating Disorder Information Centre (NEDIC) is a Canadian, non-profit organisation providing information and resources on eating disorders and weight preoccupation and aiming to promote healthy lifestyles that allow people to be fully engaged in their lives.

The You Are Not Alone Support Letter is a monthly recovery email newsletter filled with encouragement and pro-recovery information.

Eating Disorder Research

King’s College, London:  the Institute of Psychiatry’s eating disorders research team, led by Professor Janet Treasure, works to understand the causes of anorexia nervosa, bulimia nervosa and other eating disorders, and to develop improved treatments and ways of supporting carers.

University of California, San Diego: Eating Disorders Treatment and Research Program, led by Dr Walter Kaye:

University of Chicago, Chicago: Eating Disorders Program, led by Professor Daniel Le Grange:

More information – updates!

A Girl Called Tim is listed on Shannon Cutts’ resources page on <>

MentorCONNECT, the first global eating disorders mentoring online community,  accepts females and males ages 14 and up who are actively engaged in recovery from anorexia, bulimia, binge eating disorder, and eating disorders not otherwise specified. Members can match with a mentor for individual support, participate in group mentoring activities, join in weekly support group meetings, receive daily supportive emails, enjoy monthly teleconferences, create a personal recovery blog, and more.

MentorCONNECT is a registered 501(c)3 nonprofit organization. For more information: <www.mentorconnect‐>

Learning about Diabulimia/Diabuleamia
Jane Cawley, of Maudsley Parents provides the following links on diabulimia that may help understand this illness:

Eating Disorders – Early Identification in General Practice
This excellent article on early identification of eating disorders in General Practice appears in the March 2011 edition of Australian Family Physician, pages 108 to 111. A ‘must-read’ for every GP. A ‘must’ for every pinup board.