Show of Strength

Confronting eating disorders with care and compassion
Photo: Parent support worker Mary McCracken with peer support worker Amy Pezzente.


Mary McCracken had watched her 17-year-old daughter become a different person over the summer before she started Grade 12.

She was exercising obsessively, restricting food, and losing weight. Others were telling her she looked great, but Mary knew something was wrong.

After trying various health professionals, she took Claire to see a doctor who gave her a thorough examination at the Eating Disorder Clinic at BC Children’s Hospital.

“I’ll never forget this moment,” says Mary. “The doctor said, ‘She can’t leave, because her heart rate is so low.’”

Claire was given a bed in the inpatient unit of the clinic, beginning a long journey to recovery. Eventually she moved to the day treatment unit, and they adopted strategies to help her eat. Mary was gratified by the respect and understanding of all the staff: nurses, pediatricians, psychiatrists, dietitians, and physiotherapists. “The family is embraced, and that was so important,” she says. “I feel passionately that as a mom you know your child better than anyone else.”

Dr. Lucinda Kunkel, a psychiatrist in the clinic, agrees. The clinic uses a model called Family-Based Therapy, which is considered the “gold standard” treatment for adolescent anorexia nervosa.

An eating disorder, Dr. Kunkel says, often begins when a person is not happy with her life. (Eating disorders are much more prevalent in girls than in boys. The dissatisfaction could stem from anything from a traumatic incident to a general sense of not fitting in. She may start looking for a way to feel better, and perhaps prompted by media images of slender celebrities, she concludes that she would be happier if she were thinner. She restricts her diet and exercises more.

“Those that have the genetic complement or risk toward an eating disorder may lose a threshold amount of weight that might trigger these certain genes and then the eating disorder gradually creeps in,” says Dr. Kunkel.

“It’s like a parasite on the brain. It feeds on the host. It takes the child’s strength of being detail-oriented, wanting to please, perfectionism, and it uses it against them. It kind of feels like a friend, it feels like it helps them cope, but not in a healthy way.”

The child forms an “alliance” with the eating disorder, which becomes stronger than the child’s bond with family and friends. With malnutrition, the child focuses more on food, but the eating disorder demands more weight loss.

“What we try to do with the family,” says Dr. Kunkel, “is to break the alliance with the eating disorder. Family-Based Therapy is a method to help the parents re-feed their child, identifying with the struggle and anxiety around food, saying ‘I know this is hard, but you need to eat.’ An eating disorder regresses a child, physically and developmentally, so I think there’s something healing, maybe even biological, about a parent nursing their child back to health.”

During treatment, a child’s eating disorder typically leads to manipulation around food; the patient refuses  treatment and the parent has to fight these behaviours. Dr. Kunkel is currently researching “perceived coercion,” and surveying former patients about their admission and the role that their parents played. Often, she says, the parents and the treatment team receive a “retrospective thank-you,” when the child begins to recover.

For Mary, “re-feeding” her child was an exhausting process. She was taught how to provide “meal support,” having breakfast, lunch and dinner with her daughter as well as two snacks during the day. She learned how to make her feel more relaxed while eating, and stayed with her for 45 minutes afterwards, when she would often feel uncomfortable.

Claire slowly gained weight and eventually recovered. Mary felt that the staff of BC Children’s Hospital had saved her life. She currently works as a Parent in Residence (Peer Support) with The FORCE Society for Kids’ Mental Health. In this role she empowers and connects families from across the province to services and resources. She works out of the Kelty Mental Health Resource Centre at BC Children’s Hospital, which provides mental health and substance use support to children and youth up to age 25.

One of her colleagues at Kelty Mental Health Resource Centre, Amy Pezzente, is a peer support worker who struggled with an eating disorder in her teens and early 20s; today, she provides peer support to people of any age with an eating disorder. Despite her family’s best efforts to help her, she would sneak out of the house to go running after midnight, or purge a meal secretly in her bedroom.

“Looking back now, I realize my mom was terrified. But it wasn’t Amy that she was trying to fight, it was the eating disorder. She was saying, ‘you took my Amy away from me, she’s lifeless now, she never smiles, she lies, and she never lied before you took her away. So get the hell out,’” Amy recalls. But I thought the eating disorder was me. So I tell parents, they’re not going to understand what you’re doing, but you have to do this for their life.”

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