Question: My daughter has just turned 11 and is a very anxious child in a way that manifests in aggression and low self-esteem. There have been problems since junior infants. For example, she wrote in note books in school in senior infants that: "I hate myself, I am stupid and I want to be dead." We did take her to see child psychologist and she has had play therapy and Cognitive Behaviour Therapy (CBT) and she is in a much better place now socially and emotionally.
However, she now has a problematic relationship with food. She steals it and hoards it and then eats it secretly. She is slim as she is hyperactive and burns it up but with puberty she is starting to put on weight. She hates herself for that and it is affecting her self-esteem.
I want to help her but am not sure what to do – we avoid keeping the treat food in the house that she likes to steal but then she will steal money to buy stuff.
Answer: Secret eating and binge eating are common problems among adults and children. As these problems take hold, treat food becomes an addiction that is consumed to excess and which is associated with shame and thus done in secret. Often, there is a common pattern to this addictive type of eating. Usually there is a trigger such as emotional stress, which causes the child to want to eat the treat food as a 'comfort' but once they start they find it hard to stop and then they feel shame and guilt for having consumed so much. This pattern of eating can easily become a vicious cycle with the child 'hating' themselves for doing it, but then this 'self-hatred' causes then to engage in the habit more.
Help your daughter open up and talk about what is going on
The first thing you can do is to try and break the shame and secrecy your daughter feels about the problem. Try to get her to open up and talk about what is going on for her. The key is to be sympathetic, understanding and non-judgemental. For example, you might acknowledge with her that lots of children and adults get into unhelpful secret habits about eating, and ask her to talk about what is happening for her. It is important to have an understanding tone and you may have to persist to get her to open up. For example, if she is defensive or denies there is a problem, you might say “listen, at some point we are going to have to talk to sort this out. As your mum, I can’t let you get into a habit of stealing . . . I care about you too much.” If she closes down, pick a later time or a better place to try and talk again. Gentle, caring persistence is important.
Breaking the habit
Once she begins to open up, the goal is to help her understand her habit and to discover new options in the face of it. Help her notice the triggers for binge eating and then brainstorm together different strategies and other choices she might have at that moment. For example, she might simply acknowledge her underlying feelings without acting on them or decide to talk about how she is feeling to you (or to note them in a journal). Or she might choose to do something instead of eating, such as drinking a glass of water or engaging in a fun, distracting activity. Also, it is important to help your daughter address any underlying stresses she might have and to help her develop new positive interests and habits in her life, whether these are sports or hobbies or new social outlets.
If she has benefited from CBT in the past, then this could be something you return to. This might mean visiting the therapist she worked with before for some booster sessions or you could relook at some of the ideas that worked for her. This might mean you encourage her to notice the negative thoughts that underpin her secret eating, so she can separate herself from them or you might practise some mindfulness or meditation with her. There are lots of good CBT workbooks for adolescents (just search online) that you could work through with her if she is open to this.
Creating a healthy environment
From your question, it sounds like you already have a positive eating routine in the home and it is important to continue this. It is not a question of having no treats, but keeping these limited to certain times and keeping them small. If your daughter is having difficulty changing her habit, it might be useful to make treats less accessible in the house for a period, but be careful of this backlashing or making the habit go underground (with your daughter resorting to stealing). Instead, try to talk through and agree these rules with your daughter, so she is on board with how you are trying to help her.
Don’t expect perfection
Changing habits take time and it is important not to expect perfection. If you catch your daughter secretly eating again, try not to over react by being annoyed or disappointed.
Instead, it is important to be matter of fact as you gently acknowledge that you know and then to make a plan to address the behaviour – “Its okay, everyone has setbacks. . . let’s talk tomorrow about getting back on track.”