Worried about your teenager?

Are you worried about your teenager? Many parents find that their children act differently during the teenage years.

It is common to worry that they may be affected by mental health issues such as depression or eating disorders, or be involved in risky behaviour such as taking drugs, abusing alcohol, having unprotected sex, or committing crimes.

Normal teenage behaviour or something more serious?

Teenage behaviour can be erratic and upredictable, so it can difficult to distinguish when they are just ‘being a teenager’ and when something more serious is going on. But, as a parent, there are certain warning signs to look out for.

Linda Blair, clinical psychologist, advises: “As a parent what you can do is look out for unexpected and persisting changes.

"Have they changed in any way that is particularly out of character for them? For example, if your teenager is usually very sociable – and he or she withdraws socially to a large degree – there could be a problem.

"If they’re normally very chatty and they become completely uncommunicative, it may be worth exploring whether it’s due to more than just teenage angst.”

Encourage teenagers to talk

Most teenagers become moody and uncommunicative from time to time. This is often due to hormonal changes, which make the teenage years an emotional time. Many teenagers haven’t yet developed the skills to talk about emotions, so communication becomes very difficult.

Teenagers also have to go through a process of setting themselves physically and emotionally apart from their parents.

However, if you’re worried about them, you may be able to encourage them to open up. Direct questioning can make them feel very threatened, so a more subtle approach is more effective.

Linda Blair suggests: “If you’re having trouble getting them to open up to you, be available to them as much as possible. Take every opportunity to be there for them at times when they feel comfortable talking freely.

Eat together whenever possible

A great example is to provide a taxi service – being in the car is a non-threatening situation for them because you’re not looking at one another. Have meals together whenever you can – perhaps take them out for a pizza, for example.

If they refuse to talk to you and you are worried that something more serious is going on, you may need to open up other channels of communication for them.

Be honest and explain that you’re worried that they’re going through something difficult, and if they can’t talk to you, that’s fine, but they should talk to someone. Try offering helpline numbers, or suggesting a GP or a friend of the family.

Let them `choose` where to go for help

Allowing them to make a decision about how and where to seek help can also be beneficial. Linda explains: “If you’re very worried, whether about drugs or an eating disorder, you can try offering them what’s known as a ‘forced choice decision’.

"Present them with two choices, both of which represent a positive step. For example, suggest they talk either to your GP or to a named family friend. That way, they feel more in control."

Spotting the signs of abnormal teen behaviour

Many of the symptoms listed below can often be attributed to normal teenage behaviour. However, if you’re worried, it can be helpful to know the signs of a possible problem. You may then choose to discuss your concerns with your teen, or get advice from your GP.

Depression in teenagers

Noticeable symptoms of depression in teenagers can include:

• continuous low mood or sadness
• voicing/showing feelings of hopelessness and helplessness
• frequent tearfulness
• being irritable and intolerant of others
• apparent lack of energy or motivation, and little or no enjoyment of things that were once interesting to them
• slowed movement or speech
• changes in appetite or weight (usually decreased, but sometimes increased)
• frequent unexplained aches and pains
• disturbed sleep patterns (for example, problems going to sleep and/or waking throughout the night, particularly in the early hours of the morning)
• losing interest or being disruptive at school or playing truant
• constantly complaining that they feel bored or lonely

Read more about depression.

Teenage eating disorders

The most common eating disorders include anorexia, bulimia and binge eating. Signs of eating disorders can include:

• having a preoccupation and concern about food and gaining weight
• a desire to lose weight even though their friends or other family members worry that they’re underweight
• letting people around them think they have eaten when they haven’t
• being secretive about their eating habits
• becoming anxious, upset or guilty when asked to eat
• vomiting, or using laxatives in order to lose weight

Read more about eating disorders.

Get advice if you have a child with an eating disorder.

Self-harming teenagers

People who self-harm usually try to keep it a secret from their friends and family and often injure themselves in places that can be hidden easily by clothing.

If you suspect that your teenager is self-harming, look out for any of the following signs:

• unexplained cuts, bruises or cigarette burns, usually on their wrists, arms, thighs and chest
• keeping themselves fully covered at all times, even in hot weather
• signs of depression, such as low mood, tearfulness, a lack of motivation or lack of interest in everything
• changes in eating habits or being secretive about eating, and any unusual weight loss or weight gain
• signs of low self-esteem, such as blaming themselves for any problems or thinking they are not good enough
• signs they have been pulling out their hair
• signs of alcohol or drug misuse

Read more about self-harm.

See a leaflet for parents and carers of young people who are self-harming.

Teenagers who take drugs

Signs that your teenager is taking drugs can include:

• losing interest in hobbies, sports or other favourite activities
• losing interest in their appearance or personal hygiene
• dramatic changes in behaviour
• suddenly forming an almost totally new group of friends
• excessive tiredness and lack of appetite
• playing truant from school
• dilated pupils, red eyes, bad skin
• spending an increased amount of money, coupled with a refusal to explain why
• stealing money from you

Finding any of the following items in their room or in the house, could indicate that they are using drugs:

• pipes
• rolling papers
• small medicine bottles
• eye drops
• butane lighters
• homemade 'bongs' (pipes that use water as a filter) made from tin cans or plastic drinks bottles
• scorched tinfoil
• razor blades
• syringes

Find out more about drug use and getting help.

Eating disorders: advice for parents

If your child develops an eating disorder, you may feel unsure how to help and how to act around them.

Eating disorders and your child

Your son or daughter’s behaviour may suddenly become very different from what you're used to: withdrawn, touchy and even rude. This can make it very difficult to talk to them at a time when communication is so important.

Get advice on how to talk to your teenager.

It can help to remember that they are likely to be defensive because their eating disorder is their way of coping, therefore they will be reluctant to let go of it.

If your child is having treatment for their condition, the treatment team will play an essential part in their recovery. But don't underestimate the importance of your love and support.

Susan Ringwood, chief executive of the charity beat, explains: “Everyone who recovers from an eating disorder tells us how important it was to have unconditional love and support from those who care about them, even when they knew their behaviour was quite difficult to understand.”

Speak to one of the health professionals in your child’s treatment team about your role as parent and carer. Get their advice on what you can do at home to help. The following tips may also help with communication and dealing with mealtimes.

Tips for talking about eating disorders

Talking to your child about their condition can be very difficult, especially if they still can’t accept that they have a problem. However, communication is essential to help with recovery, so keep trying.

When you want to talk to them directly about the eating disorder, Susan Ringwood advises that you:

• Prepare what to say.
• Don’t blame or judge.
• Concentrate on how they’re feeling.
• Stay calm.
• Have resources to refer to.
• Be prepared for a negative response.

It can also help to:

• Learn as much as possible about eating disorders. It helps you understand what you’re dealing with.
• Emphasise that no matter what, you love them and will always be there for them.
• Avoid talking about their appearance, even if it is meant as a compliment. Try to build their confidence in other ways – for example, by praising them for being thoughtful or congratulating them on an achievement at school.
• Avoid talking about other people’s diets or weight problems.
• Talk to them about the range of professional help available, and say that you’ll support them through it when they’re ready.
• Talk positively about activities they could be involved in that don’t involve food, such as hobbies and days out with friends.
• Try not to feel hurt if they don’t open up to you straight away, and don’t resent them for being secretive. This is due to their illness, not their relationship with you.
• Ask them what you can do to help.
• Try to be honest about your own feelings. This will encourage them to do the same.
• Remember that the feelings behind the eating disorder may be really difficult for them to express. Try to be patient and listen to what they’re trying to say.
• Be a good role model by eating a balanced diet and taking a healthy amount of exercise.
• Try to use sentences starting with "I", such as "I'm worried because you don't seem happy", rather than sentences beginning with "you".
• Your child may come across as angry and aggressive, but bear in mind that they may actually be feeling fearful and insecure.

Tips for coping with mealtimes

• If your child is in treatment, ask their treatment team about the most appropriate way to arrange your mealtimes.
• Consider going shopping together and agreeing on meals that are acceptable to you both.
• An agreement with the whole family about what and when meals will be can help to set everybody’s expectations.
• Agree that none of you will talk about portion sizes, calories or the fat content of the meal.
• Avoid eating low-calorie or diet foods in front of them or having them in the house.
• Try to keep the atmosphere light-hearted and positive throughout the meal, even if you don’t feel that way on the inside.
• If they attempt to get too involved in cooking the meal as a way of controlling it, gently ask them to set the table or wash up instead.
• Try not to focus too much on them during mealtimes. Enjoy your own meal and try to make conversation.
• A family activity after the meal, such as a game or watching TV, can help to distract them from wanting to purge themselves or over-exercise.
• Don’t despair if a meal goes badly, just move on.

Help and support with eating disorders

If you need further support, there are a number or organisations that can help you. It's important that the whole family understands the situation and gets support. See your GP as soon as possible. Your GP and your child’s treatment team will then be able to offer advice.

Alternatively, you can call the beat helpline on 0845 634 1414 to speak to an advisor about any issue related to coping with eating disorders, including how to find local self-help and support groups.

For information on caring, including day-to-day living, claiming benefits and advice on combining caring with work or study, go to your guide to care and support.

Eating disorders explained

Find out the facts about eating disorders, including what they are, who’s affected by them and what to do if you need help and support.

What is an eating disorder?

For further information about diagnosis and treatment for the different types of eating disorders, go to anorexia, bulimia or binge eating

There are different types of eating disorder, the most common ones being anorexia, bulimia and binge eating. Eating disorders are mental health conditions. They all involve an unhealthy relationship with food and eating, and often an intense fear of being overweight. If you have an eating disorder, you may experience one or more of the following:

• You have an obsession with and worry about food and gaining weight.
• You would like to lose weight even though friends or family worry that you are underweight.
• You let people around you think you have eaten when you haven’t.
• You’re secretive about your eating habits because you know they’re unhealthy.
• Eating makes you feel anxious, upset or guilty.
• You make yourself vomit or use laxatives to lose weight.

What causes eating disorders?

It's unlikely that an eating disorder will be the result of one single cause. It's much more likely to be a combination of events, feelings or pressures that lead to you feeling unable to cope.

These can include low self-esteem, problems with friends or family relationships, the death of someone special, high academic expectations, problems at school, college, university or work, lack of confidence, or sexual or emotional abuse.

Lots of people with eating disorders talk about simply feeling too fat or not good enough. You might use food to help you cope with painful situations or feelings without even realising it.

Traumatic events can trigger an eating disorder. These might include bereavement, being bullied or abused, a divorce in the family or concerns about sexuality. Someone with a long-term illness or disability (such as diabetes, depression, blindness or deafness) may also have eating problems.

Studies have also shown that some people are more likely to develop an eating disorder because of their genetic make-up.

Who is affected by eating disorders?

Anyone can develop an eating disorder, regardless of age, sex or cultural or racial background. The people most affected tend to be young women, particularly between the ages of 15 and 25. Around 10% of people with eating disorders are men.

What should I do if I think I have an eating disorder?

People with eating disorders often say it is the only way they feel they can stay in control of their life. But, as time goes on, it is the eating disorder that starts to control you. You may also have the urge to harm yourself, or misuse alcohol or drugs.

If you think you have an eating disorder, talk to someone you trust. You may have a close friend or family member you can talk to.

There are also some organisations that you can talk to, such as the eating disorders charity beat (0845 634 1414) and the Samaritans (08457 90 90 90).

Your GP can also give you advice and talk to you about getting a diagnosis and the possible treatment options. This will depend upon your individual circumstances and the type of eating disorder you have.

Your adopted child's health needs

Children adopted from care will have experienced trauma and loss, even if they were adopted shortly after birth. Some may have additional needs resulting from physical, mental or emotional problems or disabilities.

When a possible match is suggested with you and a child, this is often an exciting time. It is important that you find out as much as possible about the child's health history and needs, so that if you decide to go ahead with the match, you will be as well informed as possible. Having realistic expectations will increase the chances of a successful adoption.

Your adopted child's health history

When children go into care (become 'looked after') or have a plan for adoption, the law requires a detailed assessment of their health. A report on their health should include information on:

• their mother's pregnancy, their birth and early development
• their birth family's medical history
• their own medical history, including any experiences of abuse and neglect, and a chronological list of any immunisations, injuries and illnesses they've had
• their current physical health, including vision, hearing and dental care
• their mental health and behaviour, including experiences of trauma and loss

It can sometimes be difficult to get all this information. For example, birth parents may not want to share information about their child if they are unhappy with the plans being made. Sometimes they may be absent or the father may be unknown. Not having full health information can make it harder to understand a child's difficulties and to predict what will happen in the future.

However, the medical assessments that a child will have had throughout their time in care means there should be existing information on their health by the time they're adopted.

Under care planning requirements for looked-after children:

• Health assessments should take place at least every six months for children aged four and under, and at least every 12 months for children aged five and over.
• Where possible, birth parents should be involved as they can help to provide more detail about the child's medical and birth family medical history.
• Based on the report of the child's health needs assessment, a health plan is developed, including any current arrangements for their healthcare and details of further healthcare that may be required.

Increasingly, it is accepted as good practice for the adoption agency's medical adviser to meet with the prospective adopters to discuss the child's health. This provides them with a better understanding of the child's needs, any gaps in their health information, and an opportunity to ask questions about the child's health. The medical adviser should then provide them with a written report, which documents what they have been told.

If the adoption goes ahead, a copy of the health assessment report will be sent to your child's GP as well as to you. You may want to discuss this with your GP, or ask your GP to talk to the medical adviser on your behalf. This can happen even after an adoption order has been made.

Parents of older adopted children often find post-adoption that medical appointments can be particularly difficult for the child as the subject of their adoption often arises, for example, if the doctor asks about family medical history. Anything you can do to help the appointment go smoothly, such as making sure the GP is aware of the situation in advance, will help your child feel more comfortable.

Developmental delays in adopted children

For a child who has been taken into care, the extent to which their development may be delayed can vary greatly. The delay can be physical or emotional, or both – the child may act younger than their age, or be unable to do things most children their age can do. Or the delay can relate to a specific area, such as their speech.

Developmental delays in looked-after and adopted children can be caused by the following factors:

• The delays have been caused by something that happened during the mother's pregnancy, such as her alcohol or drug use. This can lead to the child being diagnosed with foetal alcohol syndrome (FAS) or a foetal alcohol spectrum disorder (FASD).
• Extreme and prolonged levels of stress or anxiety during pregnancy have also been shown to be damaging to the unborn child, affecting their brain development.
• The child's environment after they are born may affect their development, such as developmental trauma caused by abuse or neglect, or both. If they are not properly cared for and stimulated, this affects the growth and development of certain areas of their brain leading to a lack of emotional development. This is often referred to as "attachment difficulties" or "attachment disorder".
• Some delays may be characteristic of genetic conditions, such as Down's syndrome.

Different children have different levels of resilience to delays caused by trauma in the womb or abuse and neglect after birth. They also have different capabilities to overcome this trauma and "catch up" developmentally.

It can be difficult to predict the long-term impact of these delays. This means that potential adopters need to accept there may be uncertainty around whether their adopted child will need specialist support services in the future. It takes a lot of perseverance, patience and determination from parents to help children overcome their difficulties, but post-adoption support is available.

Parenting neglected children

While some children in the care system may have been physically or sexually abused at some point in their lives, many of them are being looked after because their basic needs have been neglected. Studies show that neglect, such as being deprived of food or care, is often more damaging to the child than individual episodes of abuse.

Professor Peter Fonagy is chief executive of the Anna Freud Centre in London, which conducts research into attachment disorders and child mental health. He says: "The more dramatic reasons for children being taken into care, such as sexual or physical abuse, have in fact been shown to be less toxic experiences than long-term neglect. Yet neglect is more subtle and more likely to be overlooked by other adults in the child's life."

Both abuse and neglect can lead to psychological problems in children, including issues around trusting adults, which can take many years to overcome. Professor Fonagy explains that this is because they are in a state of "hyper vigilance". He says: "Children who have had bad experiences, particularly in care, are on high alert and don't believe anything anyone tells them because they don't trust them. They're shut off. They understand what they're being told but won't bring it into their own world as a truth, and they can't modify their own belief that they are not loved or that they are 'bad'."

For this reason, adopted children will not only need love and care from their adoptive parents. "There are good treatments available for a lot of childhood mental disorders," says Professor Fonagy, who has worked to improve children and young people's access to psychological therapies.

Ask your local authority or social worker about therapeutic parenting courses available to you, such as Theraplay, life story work and TAPPs courses (Trauma Attachment and Preparation for placement).

Find out more about post-adoption support.

Eating anxieties in children who have been adopted

Looked-after and adopted children often have food anxieties linked to their early experiences.

These include:

• overeating
• hoarding food
• stealing food
• problems eating certain foods, such as solids and specific textures

For example, if a child has experienced not being fed enough or regularly, this could lead to them overeating or hoarding food even after they have been placed with their adoptive family. This is because they may not fully trust that another meal will come.

Caroline Archer, author and adoptive parent of four children, has the following advice:

• Keep mealtimes as low-key as possible and set regular meal routines.
• Provide small amounts of the things your child enjoys and slowly introduce new tastes and textures.
• Never demand they eat up or finish anything – but let them know you expect them to try.
• Watch out for foods that seem to be a trigger for memories of early traumas.

Find out more about eating disorders.

Adopting a child with a medical condition, disability or special or additional needs

Some children needing adoptive families have complex medical conditions. Those with conditions such as cerebral palsy, cystic fibrosis, Down’s syndrome or foetal alcohol spectrum disorder (FASD) need parents who can meet their needs and act as effective "advocates" to make sure their children get the services they require.

Many children will also have needs relating to trauma due to neglect or abuse, in addition to their physical or medical difficulties.

Additionally, some children may have a vulnerability to some psychological conditions, such as depression or anxiety, which can be inherited. Rarer conditions that may emerge in adolescence or later, such as psychotic illnesses, may also have a genetic risk factor.

Questions to ask your child's adoption agency medical adviser and social worker

• What is the extent of my child's medical or physical disability (if they have one), and should we discuss this with a medical specialist?
• What services does my child use at the moment (such as physiotherapy or speech therapy) and how frequent are the appointments, where are they held and who co-ordinates the medical services?
• How can I care for my child's additional needs at home, as part of a daily routine?
• What changes will I need to make to my home and car to support my child's condition? Is there funding available to make this possible?
• What plans have been put in place to ensure continuity of care and ensure that all their medical records are transferred to their new GP?
• What benefits are my child and I entitled to after placement, such as a Disability Living Allowance or a carer's allowance?
• Does my child have a statement of special educational needs (SEN), and if so, what provisions does the statement include?
• Would my child benefit from remaining in a class with younger children for a while, or even staying at home? What changes or adaptations should the school make?
• If my child doesn't have a statement of SEN, is that because they don't have any special educational needs or because they don't have needs that require a statement?
• If I think my child might have special educational needs that have not yet been identified, how should I go about getting an assessment?
• Are there any hereditary health conditions in the child's birth and extended family that may appear later in their life?
• How can we get further information about the child's family and medical history in the future?

More information on adoption health needs

You may find the following resources helpful:

• The FASD Trust raises awareness of foetal alcohol spectrum disorders and has a helpline, while The National Organisation for Foetal Alcohol Syndrome (NOFAS) supports people affected by FASD, as well as their families and communities.
• Family Futures is an adoption and therapy agency offering therapeutic help to children who have experienced trauma and are living in birth families, foster homes or adoptive families.
• Post Adoption Centre (PAC) also supports birth families and relatives as well as adopted children and their adoptive families.
• Adoption Plus offers an adoption placement service, specialist therapy services and training and conferences.
• Parenting Advice for Foster Carers and Adopters (PAFCA) is run by clinical child psychologist, Dr Amber Elliott, who specialises in early trauma, adoption and fostering.
• The Adopter's Handbook, published by CoramBAAF, has information on every aspect of adoption including legal and financial matters, and schooling and education.
• CoramBAAF also publishes a series of parenting handbooks, Parenting Matters, covering issues including developmental delay and parenting children affected by their birth parents' substance abuse.
• Contact a Family is a national charity that supports the families of disabled children whatever their condition or disability.
• Young Minds is a charity committed to improving the emotional wellbeing and mental health of children and young people.
• Visit the NHS Choices sections for learning disabilities, physical disabilities and carers.

Beating bulimia

Bulimia nervosa is often regarded as a condition that affects only young women, but it can affect men and women of any age. Read on to find out what it is and possible causes.

What is bulimia?

Bulimia is an eating disorder that is characterised by bingeing and purging. Bingeing is when you eat large amounts of food in a small space of time, often in secret.

Afterwards, you may feel guilty about the bingeing, and this can cause you to purge. This is usually done by deliberately making yourself vomit.

What causes bulimia?

There is no single cause of an eating disorder such as bulimia. It's thought that a variety of reasons may trigger it, for example:

• Low self-esteem. You may have a low opinion of yourself. Losing weight or constantly trying to control your weight can often be seen as a way of gaining self-worth.
• Being depressed. You may use bingeing as a way of coping with your depression or stress. However, purging doesn't relieve the depression, and the cycle continues.
• Emotional stress. Bulimia can sometimes occur following stressful situations or life events. It can develop after a traumatic experience, such as a death or divorce.
• Physical illness or sexual abuse. Bulimia can occur in people who have experienced physical illness or sexual abuse. Some people with bulimia have experienced difficult childhoods with family problems, arguments and criticism.
• Mental health problems. Research has shown that bulimia is more common in people with some other psychological problem, such as an anxiety disorder, obsessive compulsive disorder (OCD) or post-traumatic stress disorder (PTSD).
• Having an unhealthy body image. Bulimia can be caused by cultural and social pressures. Some people believe that the media and fashion industries create pressure for people to be thin.

Male bulimia

Eating disorders can affect anyone of any age and any sex. It can be difficult for men to admit they have bulimia, especially because of the common misconception that only women experience eating disorders.

In 2008, former Deputy Prime Minister John Prescott admitted publicly that he had bulimia. High levels of work stress had led him to binge as a way of comforting himself. Afterwards, because he worried about his personal appearance, he purged as a way of controlling his body weight. This cycle can become addictive.

Don't suffer in silence

People with bulimia can find it hard to admit that they have a problem with food, and it can be especially difficult for men. Bingeing and purging can be a way for people to gain control in their lives if they feel like they don't have any.

Many men are unwilling to admit that they can't control their eating habits, as they see it as a sign of weakness. This can stop them from seeking the help they need.

John Prescott says he only took control of the disorder after seeking help. There are several organisations in the UK that can support and help anyone who is experiencing bulimia. These include b-eat and the National Centre for Eating Disorders.

Supporting someone with an eating disorder

If your friend or relative has an eating problem, they will eventually have to get professional help from a doctor, practice nurse, or a school or college nurse.

Watch a video about anorexia

If a friend or relative has an eating disorder, such as anorexia, bulimia or binge eating, you might want to encourage them to speak to someone about it. You could go with them for support if they want you to.

But there are other things you can do. You're already doing a great job by finding out how to help them – it shows you care.

You may have noticed your friend has changed. They may no longer go out or want to be included in things.

Keep trying to include them, just like before. Even if they don't join in, they will still like to be asked. It will make them feel valued as a person.

You can also try to build up their self-esteem, perhaps by telling them what a great person they are and how much you appreciate having them as a friend.

Try not to give advice or criticism. Give your time and listen to them. This can be tough when you don't agree with what they say about themselves and what they eat.

Remember, you don't have to know all the answers. Just being there is what's important. This is especially true when it feels like your friend or relative is rejecting your friendship, help and support.

How are eating disorders treated?

Treatment for eating disorders varies around the country. Different types of help may be offered depending on where you live.

Treatment includes dealing with the emotional issues as well as the physical, but this must be done slowly so your friend or relative is able to cope with the changes.

Treatment will involve your friend or relative talking to someone about the emotional difficulties that have led to their eating disorder. It will also explore their physical problems, general health and eating patterns. Help with eating and putting on weight is usually not enough.

The earlier your friend or relative embarks on the treatment programme and the more they engage with it, the better their chances of making a good recovery.

Will they have to go into hospital?

Most people with eating disorders are seen as outpatients. This means they visit the hospital – for example, one day a week. In severe cases, they might need to visit the hospital more often, or be admitted to hospital for more intensive support and treatment (known as inpatient care).

Should I visit them in hospital?

This depends on what your friend wants, how you feel and what the treatment centre allows. Let them know you're thinking of them and would like to visit them. If this is not possible, you can always write to them or call to let them know you're still there to support them.

Can people be forced to get help for eating disorders?

If your friend or relative has lost a lot of weight, they may be in danger of starving themselves and developing serious complications. They may not be able to think clearly and may refuse life-saving treatment.

In these circumstances, their doctor may decide to admit them to hospital for specialist treatment. This can only be done after the doctor has consulted colleagues and they agree with the doctor's decision. This is called being sectioned and it is done under the rules of the Mental Health Act.

Will they be cured when they come home?

Your friend or relative will still need your support. Most people with an eating disorder do recover and learn to use more positive ways of coping.

But recovery from an eating disorder can be very difficult and can take a long time. Part of your friend may want to get better, while the other part might be very scared about giving up the eating disorder. They might think, "I want to get better, but just don't want to gain weight."

They will probably have good days and bad days. During times of stress, the eating difficulties may return. Changing the way people with eating disorders think and feel is never easy and it takes time.

The eating disorders charity beat has a dedicated online space for anyone who is supporting someone with an eating disorder.