Moods tantrums and irrational behaviour

Whilst it is emotionally draining watching your son starve himself and physically decline before your eyes, it is the psychological changes that can be the most difficult to deal with. All families quarrel, we all lose our temper at times, but an anorexic child can blow up into a frightening rage at the slightest incident. Anorexic tantrums and rages can be totally unpredictable. Often families with an anorexic in their midst end up tiptoeing around the house, trying to avoid upsetting the anorexic child and triggering yet another torrent of verbal abuse and upset.

In the same way that an anorexic boy might threaten to throw up if you make him eat too much, he is likely to make other even more alarming threats if you make him do something else he doesn't feel like doing. It might be a fairly major issue that you have raised which he finds frightening such as:

• I think you should stop doing sport and exercise until you start eating more.

• I am going to take you to see the doctor about your illness.

• We need to consider sending you to an in-patient unit for treatment.

On the other hand it might be a simple daily task you have asked him to do such as:

In response to your latest request he might fly into a rage and tell you:

Common threats include:

• I'm going to cut, burn or self-harm in some way.

These threats are frightening and if you believe that he has any intention of carrying them out it is important to see your doctor and get an emergency referral to a child psychiatrist. Some anorexics have such low self-esteem and feel so out of control that they do revert to self-harm and even suicide. Fortunately the numbers who actually attempt suicide are very low. Self-harm is more common and you should be on the look out for the appearance of unexplained cuts, burns and bruises. Children who do self-harm often say it helps relieve the stress they are feeling.

In many cases the anorexic child has no intention of carrying out these threats. Joe threatened to kill himself by jumping out of his bedroom window at his in-patient unit on several occasions when I refused to discharge him. Having read about typical behaviour of patients recently admitted to such units I knew that such threats were fairly common. Of course I was extremely worried that he might carry out his threats but at the time he was under very close observation by the staff and he wasn't allowed up to his bedroom on his own. He was extremely upset about being admitted to the unit, he was scared that the staff would make him fat and so was driven to saying anything in his desperate attempt to persuade me to take him home.

In his starvation induced irrational state of mind, your anorexic son might also do things that affect the rest of the family and are totally unacceptable. Very often he is simply seeking yet more attention. For example:

• He might take an older sibling's clothes, DVDs, CDs and so on, without asking and with no intention of giving them back.

• He might break a younger sibling's toys, especially if they are annoying him.

• He might break other household items just to get attention.

• He might lash out at other members of the family, either physically or verbally.

All of these actions are likely to cause upset and are not acceptable.

It is important to recognise that your son is ill and it is the anorexia, which is leading him to behave in this unpredictable and irrational way. However, it is also important to try and set him boundaries of behaviour that he can understand. He needs firm guidance and someone to try and take control. We eventually realised that tiptoeing around and trying to ignore Joe's behaviour was like giving in to the anorexia and letting it take control of the whole family. A gentle but firm approach was the best way of coping with his behaviour:

• Arguing back and shouting simply adds fuel to the fire.

• Keep reminding yourself to stay calm.

• Remember that some things aren't worth arguing about, it might be best to walk away if he isn't upsetting the rest of the family by his behaviour.

If his behaviour is affecting the rest of the family try approaches such as:

• I love you very much and I know it is the anorexia making you do this but it is not acceptable to the rest of the family when you do this and I want you to try really hard not to do it again.

• How would you feel if your brother or sister did this to your things? In future if you are feeling upset about something I would like you to come to me and talk about it.

Sometimes these approaches will have the desired effect. Other times they might not, but it is important not to give up. Take a deep breath and carry on trying to give your son as much support and guidance as possible. He needs your help to try to take control of the anorexia.

It is very stressful trying to keep some sense of normality in your household when you have an anorexic child within your midst. The anorexia is very powerful and will use every opportunity to take control of the whole family. Try to remember that whilst you cannot control what the anorexia is doing to your son, you can control how it affects you and the rest of the family. In addition with lots of love and support you can help your son start to take control back from his anorexia.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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