Episode 80 Transcript: Supporting a child with an eating disorder

Title:  Parenting Children with Eating Disorders

Guest:  Dr. Tom Wooldridge, PsyD

Distribution Date:  Monday, July 20,2026

 

Well, welcome back to the Mind Dive podcast. We're very excited today to have Dr. Tom Woldridge.  I'll go ahead and start with  your bio, Dr. Woldridge, and then we'll hop in. Dr. Woldridge is a board-certified psychologist, an eating disorder therapist, an expert, and a psychoanalyst in private practice in Berkeley, California. He's the chair of the Department of Psychology at Golden Gate University in San Francisco. Dr. Wildridge has in-depth experience treating children, adolescents, and adults with eating disorders, including working with parents, negotiating the complexities of a child in treatment. He's published several books on eating disorder treatment for mental health professionals. Today we'll be discussing his latest book, End the Food Fight: Replacing Control with Connection to Help Your Child Heal from an Eating Disorder. Welcome, Dr. Wooldridge. We're so excited to have you with us today.

 

And I'm so excited to be here. Thank you so much for the invitation.

 

Yeah, thanks so much for joining. So, you know, we usually start with a question, and we'd love to hear from you. Like, how'd you become interested in specializing in eating disorders? Tell us a little about your career.

 

Sure. So it has really been a career-long focus for me, starting in graduate school, where I had the opportunity to work with young people and their families with eating disorders, largely from a systemic or a behavioral approach, which I found very illuminating, very helpful, but also limited in one particular respect. So while I found that those approaches could certainly facilitate weight restoration, which is key, which is so, so, important, I continually felt that they didn't really adequately get at the underlying emotional factors that were at play for children and their families. They couldn't really help people understand the meaning of the symptoms that they were struggling with. And so that led me to train as a psychoanalyst in psychodynamic therapy and the rest is history from there. I've done a lot of writing and thinking about eating disorders from that perspective, which is in no way meant to conflict with the more behavioral or symptom-focused approaches, but rather just to complement them.

 

And maybe expand, like you're saying, some of the underlying factors that end up at play.

 

Yeah, yeah. I think that's right. I think if we really understand what's going on beneath the surface, even if we're working from a behavioral approach, we're in a better position to have an effective behavioral intervention because we understand more about how it's likely to be received and what impact it's likely to have.

 

Well, you're sort of getting to this already, but I'm curious, you know, for this book, it's not geared necessarily towards clinicians, but right to the parents, right to the source, and I'm curious what inspired you to write this book. And I'm curious what need you perhaps saw in the field, and even with your own practice, that you thought, I have to write this book for parents and how they respond to children.

 

Yeah, I love that question because it gets right at my motivation for writing this book. So, you know, in my practice over the past decade and more, I've just had the opportunity to work with so many parents who have young people, teens or even younger, who are struggling with eating disorders. And so I've been, you know, witness to their struggle, their anxiety, their suffering on behalf of their children, their absolute best intentions to help in every way that they can. And I've just been so moved by that struggle, by that plight that these parents are engaged in. And so, you know, I spent a lot of time thinking about what would help. It's such a difficult journey, but I tried to put into this book everything that I think is  most grounding, most useful for a parent who's on that path. And the book is really written to be a kind of companion for parents, something that they could read, you know, read through once, but then return to again and again to steady themselves as they try to accompany their children  through the journey towards recovery.

 

Yeah. Can you say a bit about what you've learned from that, of some of the underlying dynamics that you've seen? Because it's interesting to hear and to read about that.

 

Yeah, yeah.  So, you know, first of all, the book is absolutely not about the question of what caused the eating disorder.

 

And I know, and I'm sorry that I'm delving in already.

 

Yeah, yeah, yeah. Well, I just want to clarify that because I think it's so important, right? I mean, eating disorders are a complex kind of biopsychosocial storm. And teasing out what the different factors were, it so depends on each individual case, genetic temperament, biology, relational factors, traa. I mean, it all can be in the mix in different ways for each individual. Parents so often come in like “what I did wrong.” Yeah, absolutely not, right? And parents so often come in with feelings of guilt, you know, regardless. And the book takes that up. It really tries to help parents with those guilt feelings so that they can digest them and put them aside so that they can be there for their children, which is really the goal, right? It's not to assign blame to anyone. So, with that in mind, the book has, I would say, three pillars, which are emotional attunement, self-regulation, and then reflection or the ability to think about one's own mind and the mind of the child. And, you know, we can go into each of those pillars more, but but those are the things that I see as the kind of common factors that make any other treatment path work. So if you're doing, guided refeeding and an FBT model, or some other kind of behavioral system, it's not at all meant to conflict with those priorities. It's meant to kind of undergird them and support them.

 

You know, one of the things you speak about, I think, in the first pillar of the book, is that eating disorders are not just about the food. Obviously, that's the content, that's what's right in your face as a parent watching your kid go through this. It's the struggle with specific foods and how to get them to eat. But you talk about and I think really do a good job of explaining and trying to help parents understand it's not just about the food. And I wonder if you can speak a little to that, what are some of those common pieces of what eating disorders tend to be about that are not about food?

 

Yeah, I think the key idea there, right, is that behavioral compliance is not the same thing as emotional recovery. And so the parents' task is not so much to analyze their child and come up with, you know, oh, this is what it's really about, but to adopt a certain stance towards their child. And the way I would describe that stance, you know, it certainly can have aspects of guidance and structure. I'm not at all saying we need to give up limits, expectations, routines, all of that is so important. But the additional factor that I think this book introduces is a stance of curiosity. So if you can hold your child's behavior in mind with a stance of curiosity, you know, what might be coming up for them right now? What might they be feeling in this moment as they struggle to eat this snack today? What might their experience be like on the inside? I think that allows the child to feel that you're holding their mind in mind. And, you know, by holding their mind in mind, they can feel understood, connected, more resourced to actually engage with the program that the family is on track to do.

 

It’s reminding me of times when I've met with parents whose child is going through an eating disorder. And as part of, you know, often it's like I've done psychological testing or I've been working with the family or the child in therapy. And you know, I mean trying to explain some of this to the parents, and I do feel like there's such a light bulb moment when you can tell they're like, oh, this is very, very hard for my child. As they're trying to, for example, drink an Ensure to supplement their meals, they're feeling so out of control and so scared. And it can fit, trying to help them see and understand as best they can, what it's like to be that kid in that moment. Because I think it's so easy to be like “just drink the Ensure, it’s not that big of a deal.” Because from our perspective, it might not be, you know, if it was me, I'd be like, all right, I’ve got to do this, not a big deal. And I think that I've watched parents have those moments of like, oh, this feels like a behemoth task for this kid at this moment. This is not just them being defiant or whatever. This is a really scary and out of control experience. I just think that's so critical because you do you see parents shift, their tenor towards the kid all of a sudden softens and it's like, I'm sorry, this is so hard. I'm with you in it. Yeah.

 

I think that's beautifully said because you know, just a human truth, right? If we're not curious about another person's state of mind, then we tend to make automatic attributions to why they're doing what they're doing, you know, they're being difficult or they're being resistant or they're being willful. And so, for clinicians listening, the framework I'm talking about is one of mentalization, right? Which is a kind of offshoot of attachment theory. This idea of when you interact with other people, can you keep track of or can you imagine what's going on inside them and also keep track of what's going on inside you, which supports your own ability to remain calm and grounded and present as you engage with your child.

 

And in your experience, I mean, what are some of the things that you see the children struggling with apart from food?

 

So, you know, this is tricky territory. And I absolutely want to answer that question, but I also want to say I don't want to get into a place, and this is where I think psychodynamic therapy went wrong, you know, 30, 40 years ago. They got into a place of saying, you know, oh, this means that. And it becomes almost like a kind of code book. And the truth is, while there are certain themes, you know, for example, perfectionism is a common theme, right?  They're so individually variable. And the whole thrust of the book is that you have to look at the person in front of you, think about their history, who they are, what you know about them, and use that as a sort of platform to consider what might be going on for them. But to get to that question, I think people with eating disorders have a range of experiences that would sound familiar to many of them. You know, one would be  perfectionism or kind of high ideals that they have to live up to. And who knows where they come from? They could really be variable for each individual case. But those ideals can be quite crushing in their weight. There's always a feeling of falling short. And so always a feeling of trying to control the self to meet those ideals. At the same time, people with eating disorders often feel quite out of control, especially once they get to the phase of refeeding, right? Because suddenly they've oriented their self around controlling what they take in, and suddenly somebody else is telling them what to take in, right? So suddenly the thing that they've been using to feel in control has been stripped away. And that's a terrifying experience. I mean, here I'm talking about people with anorexia for the most part. There are many eating disorders that are relevant -- bulimia, binge eating disorder, muscle dysmorphia, you know, they're all going to have variations depending on the nature of the struggle. But this idea of feeling out of control, I think is an important one. And you often see parents, because of their own anxiety, take up a position of feeling that they need to control the child. Because, of course, they want to save the child's life. They want the child to be healthy. It's a completely understandable anxiety, but it can also create a kind of power struggle that's really important to be able to think about.

 

Dr. Bob Boland: 

Yeah. It is interesting, though. I get you're kind of worrying that you don't want us to get into the habit of making assumptions. And it's more of an overall understanding, right? Not looking for particular themes before you know what they are.

 

Which goes back to, I was really impressed and just delighted with this part of your book. And I think this is kind of the second pillar part of your book or the second kind of chunk about teaching these families about mentalizing. You know, people who've listened to the podcast before know mentalizing is sort of the main framework I operate out of. And I feel like you did such a nice job of like putting what can sometimes feel like a pretty jargony concept. John Allen, who we've had on a couple of times, who's one of my dear colleagues and mentors, he's always saying, mentalizing is this super simple thing that we've jargoned up and made it complicated. And as I was reading through that part of your book, I was like, oh, this is really getting at the core of it in a way that's very digestible to families. Even going through the examples you give for teleological mode and pretend mode? I feel like it just really helps parents, I imagine, dig into this. And I wonder if you would, if you don't mind sharing a little bit about some of those, especially for this struggle, eating disorder, parent-child struggles, of what pretend mode looks like. What does teleological mode look like? And what does healthy mentalizing look like? I know that's kind of a big question but take that.

 

No, no, yeah, yeah, sure. You know, I love John's work and I completely agree with him that even those terms, teleological and pretend, I don't know where they come from or who coined them, but they make it sound a lot more complicated than it actually needs to be. Just to take the idea of teleological, this idea that you look at certain outcomes to sort of reason about behavior. For example, “if my child would just eat, then everything would be okay.” But is that really true? I mean, it would certainly be good if your child would eat, but is there not more going on inside them that we need to think about here? I mean, that would be the kind of reflection-based question, you know, okay, they just ate, that's good, but don't stop there. You know, how do they feel about having eaten this snack? You know, what's your sense of what's going on inside them? Did that just suddenly alleviate some anxiety in me? It's good, you know, to feel less anxious. But what does that mean about the anxiety that I'm carrying in the relationship completely understandably? It's not about blame, but what does it mean about the anxiety that I'm carrying in the relationship much of the time? Or, you know,  at other times a person can be seeming to be thoughtful and sort of engaged with the plan, a child or a parent, but sort of really disconnected from the underlying emotions that are driving the process. And so part of mentalization is being able to reflect on your own state of mind, but while also staying connected to your internal experience, to your feelings. And so that's something we want to help parents think about. Am I connected to my feelings? Is my child connected to their feelings? That's the sort of platform you want to be standing on as you do this work.

 

It's reminding me. I mean, again, I'm thinking of some families and patients I've worked with even recently who there's so much bargaining that happens around this. Well, gosh, if you just eat, then we'll be able to do this. And if you just recover, then we can go on that trip or we can do this thing. And there, I think again, it's coming out of such a place of love and hope for motivation and like, come on, you can do it. And again, I think the reflective piece of hey, that’s putting a ton of pressure on them, it's increasing their already profound shame. That now they're going to be the reason the family doesn't go on the trip or why things are slowing down. And again, this is all over your book. There is so much compassion. Your book is written from such a place of compassion, which I really want our audience of, primarily clinicians, but there might be some families listening that this is coming from a place of understanding, this is deeply complicated. Even again, when we might not be in that mentalizing mode or we might be struggling with that, usually that's even coming from such a loving place. But to help reorient to, hey, how can we think about this? Because again, I find that families just tend to be very hungry for that. They are ready and willing and happy to change course to do something that helps their kid feel better.

 

Yeah, I really appreciate that comment because you know, no family thinks to themselves as “Oh, let me sort of set my child up for a struggle.” Every parent wants the best for their children. And when a child has an eating disorder, there's so much shame, there's so much guilt, there's so much exposure, there's so much fear. And, it'd be hard for anybody. I mean, I think part of what I appreciate about the mentalization-based approach is that it's fairly non-hierarchical. I mean, I am not coming into the space thinking, oh, I could do this better. You know, if it were my family, my child, I would also really struggle. It's much more about coming in from a place of trying to model a certain stance, a certain state of mind that we think will be helpful, whatever treatment path a family decides to go on.

 

And I want to go into one of the pieces that, I think I'm correct in remembering, it was in the kind of third pillar of the book. We've touched on each of the pillars now, but I think this was in this last one. Correct me if I'm wrong. But you talk about the unit, spoken conversation or these things that are not maybe put out loud, and I found that part to be really helpful because again I do think that it's really tough for parents to recognize or reflect on what they are bringing to the table in regard to their own attitudes towards food, their own generational experiences about the body,  their own expectations and things that they've modeled. Again, I think the way you model this and talk about it is so not guilting. It's like can you reflect on this? But I wonder if you want to share a little bit about that piece of encouraging parents to do their own work in this process.

 

Yeah I think that is so important and I want to think carefully about how I talk about it here because I think it is such tricky territory, right? I mean as you said we all come into parenting with a history and a history even that started before we were born. So you know the generations before us. And it's one thing that I've really come to appreciate as I've moved through parenting myself is that you come in with the best intentions, you do whatever work you've done as you begin as a parent, but there are things that you're carrying that you don't even know that you're carrying until you're in certain contexts and then you find oh, okay, this is a factor that's at play. And it's true that we need to take responsibility for it, but that doesn't mean that we caused it, right? I mean we're all sort of links in a chain that really extends far before we came into the picture. And we can't always control sort of the ghosts that follow us. So the way I think about it is that we create an emotional atmosphere in our families. I mean that term emotional atmosphere I think really gets at this unspoken conversation the attitudes, the anxieties, the fears, the very kind of idiosyncratic reactions that we have in a given moment. You know our child is 10 or 11 or 12 and just starting puberty and they're starting to put on weight in their hips. For one parent that'll mean one thing and for another parent it'll mean a different thing. And what it means may not even be something that you choose for it to mean. It may depend on how your parents related to you or the images that you were saturated with growing up. So, it's not anything to beat yourself up about or to feel shame about. It's something to think about, to notice, to be curious about. Okay, so you know this is my reaction to this moment where my child's body is changing. What does that mean? Where does that come from in me? Maybe something that you never say out loud, but just that self-awareness. It promotes self-regulation. It allows you to bracket that aspect of your history so that you can be more attuned to who your child actually is. I think it's an incredibly supportive sort of thread to be working with as you're moving forward as a parent.

 

Wow and again it makes me think about one of the key pieces of mentalizing which is that, when you're thinking about it, you have more capacity to not act on it. When you give yourself that space to be curious and non-judgmental with yourself of where this might be coming from we have more space to say I'm not going to act on that towards my child then or I'm going to hold that in mind so that it doesn't come out in ways that I didn't even realize it was coming out.  I have to say, I'm a new parent and Bob's an old parent. Yeah, a grandparent now, but I'm a new parent and I think when I only a year and some change in, I'm already joking that I was like: Wow I had a lot of expectations of what I was going to be like as a parent and I have fallen short of those regularly daily. And so again I like the whole notion of you bringing your own baggage and stuff and kind of learn about it as you go. Yes that when you can bring even as a parent that compassion to yourself and that reflective curiosity, gosh it opens up so much space to you.  Then even model the compassion towards your child in the ways that they're struggling. I think

that's so beautiful.

 

I know and as we're getting near that I kind of want to go a little bit outside, it's not exactly related to the book, but because we're talking now about sort of things beyond the immediate dyadic relationship and stuff. How do you deal with other influences like social influences? I mean obviously social media is the obvious example, but how do you help parents with all these other things that they can't necessarily control?

 

So my view about that is that there are different sort of frameworks, and different parents are going to land in different places. So some parents are going to say no social media until you're 18. Some are going to say limited social media when you're 12, but monitored. And everything in between, right? So there's a whole range of prescriptive approaches that you can take to all of these issues like peer influences, social media technology phones, whatever it is and I don't think of it as my position to recommend any particular approach. I mean good parenting always has some kind of structure, but beyond that I don't want to weigh in on that debate. What I do want to say is that, as a parent, I think you're in a much better position to make decisions that support your child if you can think about and reflect on who they are and who you are. So if you're able to think you know okay what kind of child is this that I have? Are they a kid, for example, that tends to be a little impulsive? That can be great, right? I mean that can lead to a lot of sort of interesting and productive developments in a life but maybe they tend to be a little impulsive or maybe they're very conscientious and restrained or somewhere in between. And all of these things we want to be able to think about and reflect on. And from there you then ask the question: What fits my child best? Because my view is that there are many ways to parent well. There are a few ways to parent badly that I think we could all agree on; but there are many ways to parent well and I think the best platform to make a decision is to have this idea of reflection in hand.

 

Well, I'm trying I'm definitely trying.  Well, as we begin to wrap up, you know one thing we always like to ask our guests is if there was a takeaway that you would want people to walk away with. And I will say, for this episode, I feel like a two-parter would make sense in regard to what you would want parents who are listening to be thinking about and then what might you want clinicians who are listening to be thinking about in regard to how they could use your book or again be thinking about your work.

 

Yeah I think you know I'll start with clinicians. I think the book is a useful read I hope because I think it models a certain stance. When you work with families and people with eating disorders you're going to be anxious, right? I mean it is an anxiety provoking kind of work. And when you're anxious it's very easy to be pulled into a mode of trying to do things, trying to control outcomes, which is not the optimal clinical stance. Of course, you want a certain outcome. Who doesn't want the positive outcome? But if you try to force it, if you try to do it, then you may actually be recreating part of what's implicated in the eating disorder itself. You want to be able to hold a stance of, in yourself, self-regulation, attunement and reflection. So that's the takeaway I think for parents or for clinicians. For parents, I'll just give you one line or two lines which is that I think you can't control the outcome, but with steadiness and a kind of reflective presence, that matters more than any plan for their recovery and your own. So, you know those three pillars attunement, reflection, and self-regulation, I think those are the the touchstones or the foundation of what I'm trying to get across.

 

Well, I can certainly echo that your book is an incredible resource. And again, I've said this but I feel like I want to reiterate it. It felt to me as I read it, like, it brought that curiosity and that compassion and that flexibility that really can be an ally in so much of the work that people, families and clinicians are doing with folks with eating disorders. To say here are some additional tools to bring alongside the interventions you're doing to help with where things can get lost around reflection and compassion and holding in mind the mind. So I'm so grateful for your work and thank you for coming on and sharing about it with us.

 

And the book is titled End the Food Fight: Replacing Control with Connection to Help Your Child Heal from an Eating Disorder and we're talking with Dr. Tom Wooldridge. Thank you, thank you so much for joining us.  

 

Thank you so much, I appreciate the questions.

 

Yeah, thank you again, it was just great hearing about it.  Once again, you've been listening to the Mind Dive podcast.  I'm your host Bob Boland…