ACE- Atlanta Center for Eating Disorders

Helpful Information

Parent's Page

Frequently Asked Questions

In this section, we will try to answer the most often asked questions by parents at the beginning of treatment. Please understand however, that some of these answers are very general in nature and specific questions may be best answered in a family therapy session. Being involved in family therapy is the biggest contribution you can make in your child's recovery.

What does intensive treatment for an eating disorder involve?
Why don't all ACE participants have the same schedule?
How do we determine which level of treatment and which groups our child should attend?
When would an ACE participant be referred for inpatient treatment?
How involved should we be in our child's treatment?
What causes an eating disorder? A.k.a. Is it the parent's fault?
How do we find out how our child is progressing?
What is the difference between a case manager and an individual therapist?
Are people actually "cured" of an eating disorder?
Raising Resilient Children in an Eating Disordered Culture

1. What does intensive treatment for an eating disorder involve?

There are two levels of intensive treatment and an aftercare level:

Partial Hospitalization or Day Hospital (PHP): These terms are used interchangeably and refer to our most intensive level of care. In this program participants are at the center for six to eight hours during the day from 12:30-8:15 pm. (We offer no overnight treatment at ACE). This level of care is recommended for people whose symptoms are such that they need structure throughout the day to enable them to manage food. Most participants are only in this program for two to three weeks after which they taper to three to four hours a day.

Participants in the day hospital will have Relaxation Therapy, lunch with a therapist, and Recovery Skills Group. This group is designed primarily to educate participants on various topics regarding their eating disorder. There is evidence from research that education about eating disorders is an important component of the treatment process. This group includes the use of live and videotaped lectures, as well as practical application activities. At 4:00pm the group will join together with participants of the intensive program for evening groups.

Intensive Outpatient Program (IOP): A participant is considered to be in the IOP program if they are in two or more groups. IOP groups are held Monday through Thursday between 4:00pm and 8:15 pm. There are many different groups offered and each group meets once a week at the same time each week. Some participants may come only one day a week and others may come everyday depending on the severity of symptoms, their resources, their schedule and their level of commitment.

Aftercare Program (AP): The Aftercare Program consists of one group per week with individual and/or family therapy. When a person reaches discharge criteria (healthy weight, etc.) they are no longer in need of intensive treatment. However, most people benefit from continuing in therapy to maintain their progress, reduce the likelihood of a "slip", and to continue working on the underlying issues (for example, perfectionism). On occasion a person will be admitted to the aftercare program right after their initial evaluation if their symptoms are very mild and/or have just begun.

2. Why don't all ACE participants have the same schedule?

It is true that most intensive programs require that all participants attend the whole program. Our ability to individualize people's treatment schedules is a very unique aspect of the ACE program and one that we are most proud of. Our mission is to provide intensive treatment while encouraging people to maintain their normal lives as much as possible. Additionally, as people are progressing in their recovery, they can taper groups at their own pace. The groups are designed to address eating problems from many different angles and not all participants need all groups. Once a participant has been in the program for several weeks, she may recognize that some groups are more helpful than others for her particular needs (note, they may not be the ones she likes the best). Therefore, by consulting with her case manager, you and your child may revise her schedule over time.

It should be noted, however, that providing individualized treatment schedules is much more difficult from an administrative perspective. It is the most challenging administrative task at ACE to keep up with each person's schedule and keep up with the changes that are made over time. You can help by doing the following:

When a participant joins any particular group, she is asked to make at least a one-month commitment to the group (that is four meetings). Many times people feel worse at first, due to being in a new situation, and don't realize the benefits that they will get from the group until after a couple of weeks.
Bring your child to all scheduled groups and make every effort to be on time.
If you need to cancel, give 24 hours notice so that you will not be charged.
Whenever possible, write down any dates that you need to cancel and give to our office manager. If you are not at ACE, you may call in your cancellation.
Always discuss any desire to change the schedule with your child's case manager.

3. How do we determine which level of treatment and which groups our child should attend?

Initial Evaluation: People who are interested in the ACE program are asked to go through an initial evaluation, which involves approximately three hours. You as the parent will be asked to fill out a questionnaire and sign several consent forms while your child is also doing paperwork. This involves several questionnaires, which screen for eating problems as well as other problems which tend to accompany eating disorders such as depression, anxiety, self-esteem, perfectionism, etc. One of our psychologists then reviews the paper work and spends about an hour with the potential patient. We make it a point to go over the questionnaires and give feedback that helps you and your child understand the relative severity of various problems and symptoms. Our goal when reviewing the paperwork and meeting with you is to make a recommendation which is highly individualized regarding which parts of our program would be helpful in starting treatment (that is if intensive treatment is indicated). This assessment helps us determine which groups are going to be the most helpful and is necessary if we are going to individualize schedules.

4. When would an ACE participant be referred for inpatient treatment?

As a result of the initial assessment, if the symptoms are considered too severe for outpatient treatment.
Whenever a medical doctor determines that the child may be in medical danger. (Note that we need to have bloodwork and physicals conducted by your physician at the start of treatment).
If symptoms are worsening after two weeks of intensive treatment.
Purging multiple times per day and below 70% of expected weight are often considered criteria for inpatient treatment.

5. How involved should we be in our child's treatment?

Research has shown that the more the parents are involved in treatment, the faster and more fully their child will recover. The younger the child, the more vital your involvement is, however, we recommend that any ACE participant who is living at home with their parents be involved in family therapy and the Multifamily Group (which you will find a description of on our Group Therapy page). Some insurance companies even require family treatment as a condition for receiving benefits for an eating disorder.

6. What causes an eating disorder? A.k.a. Is it the parent's fault?

There is no single known cause for eating disorders, so we never place blame on the parents. However, you are very significant people in your child's life and your involvement and openness to explore your own issues can greatly enhance your child's recovery. See the article "Raising Resilient Children in an Eating Disordered Culture" for more information, and our page on Causes, Prevention & Treatment.

7. How do we find out how our child is progressing?

The very best source of information is through family therapy. In these sessions, you are encouraged to talk about anything which concerns you about your daughter and all family relationships. A second source is your child's case manager. You may be in contact with the case manager, however, whenever possible, do so in the presence of your child so that trust is facilitated.

8. What is the difference between a case manager and an individual therapist?

If your child is seeing an ACE staff member for individual therapy, this person will also act as her case manager. If the individual therapist is outside ACE, a case manager will be assigned at ACE. The case manager will meet with your child for approximately 15 minutes a week to monitor progress and set goals and will act as a liaison with you and with her outside therapist. There is no charge for this service.

9. Are people actually "cured" of an eating disorder?

It is our opinion and experience that people can and do fully recover from eating disorder symptoms although they may go on to struggle with the underlying issues (such as perfectionism) for years. Our outcome statistics show that the average length of stay at ACE is three months and that not only do patients' eating disorder symptoms improve greatly in that short period of time, but so do the underlying problems. It should be noted, however, that no two people are alike and that some people meet discharge criteria within a month while others take up to two years. Additionally, some people leave and return to treatment several times during the course of their recovery, which is understood as movement toward the end goal. Finally, some studies suggest that relapse prevention is enhanced the longer a person is in treatment.

10. Raising Resilient Children in an Eating Disordered Culture

Not too long ago, most clinicians considered eating disorders as a problem that primarily affected young women in their teens and twenties. Recently, however, the age of onset has drastically decreased to include children and it is not at all uncommon for even kindergarten children to talk about being too fat or to be teased about being fat (even when they're not). This article will address factors affecting the development of eating disorders in children and what parents can do to raise resilient children in an eating disordered culture.

Facts and Figures
The Eating Disordered Culture
The Skin Cancer Analogy
Examine Your Own Attitudes

Facts and Figures:

The incidence of eating disorders has increased by 500% in last two decades
Highest mortality rate of all emotional/mental disorders
20% of people with eating disorders do not fully recover and 5 - 10% die
Second only to Schizophrenia in number of hospital beds used in psychiatric hospitals
The expected weight for models and TV stars meets criteria for Anorexia Nervosa
Various studies have found that:

55% of girls and 35% of boys in grades 3-6 to wanted to be thinner
70% of normal weight adolescent girls feel fat and are engaging in unhealthy eating practices for the purpose of losing weight
10% of aged 9-10 year old girls were on highly restrained diets

Most prevention studies have disappointing results which has added to the impression that unhealthy ideals of beauty and eating behaviors are fairly intractable by the middle school years (ages 11-14)
In contrast some prevention programs with younger children seem to have had negative results (i.e., increased awareness may have brought on the problem earlier
Eating disorders runs in families
Minnesota twin studies suggest that eating disorders are hereditary, though primarily when the onset is at or after puberty
Before puberty, parents were found to be the most significant factor affecting children's attitudes

Raising Resilient Children

The Eating Disordered Culture

About three generations ago, the round and "filled out" figure was considered ideal. Two generations ago (that of most mother's today), the very thin and straight figure was ideal. This generation (that of the children) suggests that beauty consists of extreme thinness with cosmetic surgery (primarily breast implants). At least in previous generations a percentage of women did naturally have curvy or straight figures. Recently, the ideal is not even found as a naturally occurring phenomenon. The pressure that this puts on children is unfathomable. I remember when, as a little girl, I heard of the Chinese tradition of binding the feet of little girls. My reaction was one of horror. Now our culture's emphasis on thinness results in a sort of binding of the entire girl, both inside and out. Most women in entertainment and modeling have body weights that meet criteria for anorexia nervosa, indicating that internal damage is slowly occurring. This is even worse than the external damage of binding feet. But what can be done? We may feel helpless as parents to fight the cultural ideal, yet we may have more power than we realize. The first step is realizing how this culture has affected your attitudes about your and others' bodies. Men and women alike have been affected by these attitudes and preoccupations with weight and we all need to become more aware of this as we raise the next generation of children.

A combination of the following factors is usually present:

Number 1 predictor is a feeling of body dissatisfaction (regardless of body size)
Cultural emphasis on the "thin ideal"
Parent with an eating problem
Family stressors and values (before puberty, parents were found to be the most significant factor affecting children's attitudes toward food and their bodies)
Personality factors (perfectionism, caretaking, difficulty expressing feelings)
Biological factors (increased CNS sensitivity, i.e., more anxious; genetic transmission)

Raising Resilient Children

Summary: The Skin Cancer Analogy

As indicated above there are many factors which combine to "cause" a person to develop an eating disorder. Therefore, blame cannot be placed on any particular person or factor. Twin studies are used to determine how much of the development of the problem is due to genes versus environment. These studies suggest that, although some people seem to be born with a predisposition to develop an eating disorder, this does not show up until adolescence. Prior to adolescence the development may be more related to family factors. Children are most motivated by their parents attitudes prior to turning to their peer group and children who are more "anxiety-prone" may be more susceptible to negative attitudes toward weight and food expressed by their parents.

Consider that the cultural emphasis on thinness is analogous to the sun in that its damaging effect shines on all children. You also may have been affected by this exposure and need to examine ways that you may unknowingly affect your children by your own attitudes. Women have been taught that their bodies are unacceptable in their natural state. But males have not been spared entirely. Male action figures over the past 20 years have changed from normal sized men (such as GI Joe and the early forms of Luke Skywalker) to figures resembling a beefed up version of the incredible hulk. Men also have bought the belief about women that thinner is better (even to the point of risking health). Boys have reported that they feel like something is wrong with them if they cannot attract an extremely skinny girlfriend. By examining your own attitudes and habits around eating and weight, you as a parent can increase your child's resiliency to the danger (like putting sunscreen on their skin).

All of our children are under incredible pressure about appearance due to the culture in which we live. What may have seemed like innocent beliefs and comments in another time (she shouldn't be eating that) now may be the proverbial straw that breaks the camel's back. To protect your child from the harmful rays of our society, consider your own attitudes and beliefs.

Stop dieting and develop healthy eating habits that you can maintain for the long run:

Offer balanced meals including both nutritious and pleasurable foods.
Educate your children on the dangers of diets.
The value of healthy exercise
The role of metabolism
Refer to all food as "good in moderation". Stop referring to certain foods as "bad or good".

Consider the way that you refer to your own body and others' bodies in front of your children:

Do not make negative comments about your own weight.
Do not refer to others in a negative manner related to weight.
Find positive things to say about yourself, your children and others that has nothing to do with weight or appearance.

Educate your children about the genetic basis for natural diversity of human body shapes and sizes (we all have different size noses, for example).
Do things you enjoy regardless of your size:

Don't wait until you lose weight to do something you enjoy.
Learn to appreciate your body for all that it can do regardless of your size (such as dancing, seeing, talking, walking, smelling, etc.).
Exercise for the pleasure of feeling your body move and grow stronger, not for the number of calories burned.

Educate your children about various forms of prejudice (including weight).
Develop a relaxed manner about food:

Allow children to eat for both the nutritional and pleasurable aspects of food.
Don't rely on food as your only source of rewards (though using treats as one of many types of rewards is perfectly natural).

Raising Resilient Children

Examine Your Own Attitudes by Honestly Considering the Following:

How often do you:

make negative comments about your body?
make these comments in front of your children?
make negative comments about someone else's size?
make comments about food as being "bad" or "good"?
talk about "being good" or "being bad" in terms of eating?
tell fat jokes?
support the diet industry by buying their services or products?
ask someone if something that you're wearing makes you look fat?

Do you believe:

that no one should be fat?
that fat people are unhealthy?
that thin people are healthy?
that fat people are suffering from emotional problems?
that fat people should lose weight?
that people who can follow strict diets are admirable?
that fat people eat too much?

Raising Resilient Children