Because adolescents with eating disorders rarely seek help on their own, it is important that parents act on their suspicions quickly and not retreat behind a wall of denial. Often, the teenager’s school nurse, teacher or pediatrician may be the first to alert the parents to the possibility of an eating disorder and that help is necessary.
Parents who raise the issue with their teenager should expect a heated denial of any problem. Unless the youngster appears to be in immediate medical danger, this conversation may need to be repeated many times before she admits to her illness and consents to treatment. You might begin by telling your daughter that you believe she is suffering from an eating disorder that is beyond her control and that you are extremely worried about her.
Next, calmly relate the observations that have aroused your concern. It could be your accidental discovery of cupcakes and other foods stashed under the bed, or having found laxatives and diet pills lying around on more than one occasion. This can have a sobering effect: A young person with an eating disorder, like a substance abuser, often assumes that she’s been outsmarting the entire world; no one, least of all Mom and Dad, could possibly be wise to her.
Allow her to respond. Listen carefully and nonjudgmentally. Do not criticize her behavior or try to shame her, which will only further isolate her from the rest of the family. It is best not to tell an anorexic or a bulimic she’s too thin. That’s precisely what she wants to hear.
Finally, present a plan of action. Discuss with your pediatrician how to proceed with an evaluation and treatment.
First: Stabilizing the Patient
“The purpose of the medical intervention is to treat the young person for complications, if necessary,” he explains. This may warrant admission to a hospital. Severe malnutrition, defined as less than 75 percent ideal body weight, is one indication for inpatient care. Others include dehydration, electrolyte disturbances, low blood pressure, low body temperature, slow heartbeat, pancreatitis and cardiac failure. A teenager who steadfastly refuses to eat or who is behaving erratically would also be admitted.
“Stabilizing the patient medically can usually be done relatively quickly,” says Dr. Golden. “The difficult part is trying to get someone who hasn’t been eating to eat. At first, these patients don’t want to comply. There’s also an art to it. You can’t just start feeding a two thousand four hundred calorie diet to a malnourished person weighing eighty pounds; patients have died unexpectedly that way.”
The medical term for this phenomenon is the refeeding syndrome. “It was first described in concentration-camp survivors, who were living in starvation at the time they were freed,” he explains. “After being fed, a number of these men and women died. The syndrome is thought to be related to disturbances in phosphorus and other electrolytes that occur when you refeed someone too rapidly.
“So we start off very slowly, maybe at one thousand calories. Then, in a very structured way, we increase the intake by two hundred calories every two or three days, based on the patient’s weight and metabolism.” The goal in anorexia, to get the person back up to 90 percent of her ideal weight and correct all nutritional deficiencies, can take some time. (Bulimics, who generally weigh within a normal range, rarely require the aggressive measures that might be necessary with an anorexic.) Some do well with partial hospitalization, where patients spend their days at the hospital, but go home at night.
One or more mental health professionals work with patients to help them identify the psychological aspects of their illness. Youngsters also learn how to change self-destructive reactions to stress. For example, a compulsive overeater might be taught a technique called “pausing”: Whenever she feels the urge to binge, she forces herself to switch to another activity; perhaps calling a friend on the phone, going for a walk and so on.
In addition to individual therapy, kids often take part in group counseling as well as family therapy. The entire family must make some adjustments as treatment continues. At home, parents need to resist the temptation to constantly scrutinize the recovering teen’s dietary habits. Mealtime should be an occasion for enjoyable family conversation, not charged with tension over how much or how little one member may be eating.
Parents can help to prevent relapses by monitoring their own attitudes toward weight and diet and the subliminal messages they send. For example, a young preadolescent may worry she is getting heavy, not realizing this tissue will, in due course, shift to the hips and breasts. A comment by the parents about this weight, even if meant in a positive or playful way, can help lead to the start of an eating disorder. Also, parents can be too concerned with their own weight and should be careful about what is said to their children in this regard.
Since depression is a common companion to bulimia, antidepressant medications may be prescribed in combination with various behavioral therapies.
Nutrition counseling is a key component of recovery from an eating disorder. The dietitian educates the young person about how to eat in a way that is healthy yet takes into account her past behaviors. For instance, bulimics often have difficulty deciphering the signals that the body transmits to the brain when it’s hungry or full. Youngsters with a history of bingeing and purging may worry that they’re overeating and be tempted to either starve themselves or return to their old habits. Eating small, frequent meals instead of the conventional three squares a day keeps both their hunger and their anxiety at bay.
The nutritionist may suggest that your teen keep a food journal, jotting down what she’s eaten, when, as well as her emotions and reasons for eating. However, this practice should be discontinued if it seems to promote a preoccupation with food and diet.
Outlook for the Future
The recovery rates for adolescents are more encouraging than they are for adults with eating disorders. About half of all bulimics and anorexics can be said to recover fully, while around 30 percent experience occasional relapses. A complete reversal is typically measured in years.
Even those who reach the point where they can say with confidence that their illness is behind them stumble from time to time, especially in the beginning. Again, parallels can be drawn between disordered eating and substance abuse, in that it becomes a lifestyle and colors a teenager’s thinking.