Dear Dr. Batya, My 22-year-old daughter has recently told us that she thinks she has an eating disorder. While she has lost and gained weight off and on during the years, this is the first time she has admitted to us that there is a problem. She is very thin at the moment. What lies in store for her now and what do we as her parents do?
- B. H. Zichron Ya'acov
I'm so glad that your daughter felt that she could begin a discussion about such a difficult topic with you. She does need help and depending on the reason for the weight loss, having her seen urgently is important. Often as a clinical psychologist, I work hand-in-hand with both a physician and a dietician, and your daughter's first step is to be medically evaluated to determine the cause of her weight loss. Assuming that she has a true eating disorder, psychological treatment is almost always indicated.
Most people with eating disorders don't seek treatment until they have tried unsuccessfully to manage things on their own. While initially they may deny that a real problem exists, often it takes a while to acknowledge that there is a problem and even longer to admit that the issue has become quite serious. By the time they enter my office, the weight loss is often quite remarkable and usually there are many other issues as well that must be dealt with.
Often highly critical and demanding of themselves and quite unhappy, these women (and sometimes men) speak of years of roller-coaster dieting, obsessive thoughts concerning food and weight and a feeling of never looking quite good enough. Success is difficult to attain on any level. Food restriction and alternating binge eating and vomiting may be commonplace and coping can at times become tenuous.
As things progress, it can become difficult to focus on things other than weight, concentration may be impaired and if the eating disorder is severe enough, cognitive impairment may be evident, usually to all but the person affected. Mood swings, erratic behavior and signs of depression may make it both difficult to be around this person or to offer help. School work and interpersonal relationships may suffer and self esteem may be at an all time low. Depending on how much weight is lost, menses may stop and other medical problems such as cold intolerance and dental problems as a result of vomiting may become evident. During this time, excessive exercise may enable one to secretly cope with a distorted body image.
While your daughter may have some or all of these characteristics as I have painted above, one thing for certain is that the journey to recovery for patients who have eating problems is neither quick nor easy. The problems rarely started overnight and as such are often quite resistant to treatment. In part, people that have opted to become thinner don't want to make changes that involve weight gain, even if it might be considered a healthy thing to do.
Therefore, while treatment involves the encouragement of normal eating behaviors and helping the patient attain and keep a healthy body weight, one must pay close attention to both the psychological and physical difficulties that are involved in order to successfully treat the eating disorder. This is an extremely difficult balance to achieve. Treatment at the very least involves lots of education, possible referral for medication and above all a good regime of cognitive behavioral therapy.
The goal of cognitive restructuring is to provide normalization and control of both weight and behavior with a lasting change in thinking and one's belief system. Because up until now, your daughter has valued thinness above all else, she must learn to appreciate feeling good and feeling in control in a very different way than she has in the past. Your daughter will need to address her fears and concerns and have them understood and validated, look at her distorted perceptions, work with issues around her body image, explore any irrational thinking and, most importantly, begin to feel good, or at least better about herself. She may also have to seriously begin to address her many other issues around eating, food and weight.
Finally, both you and your daughter will need to know that fighting an eating disorder is a lifelong battle. With good help now, she can be well on her way to good physical and mental health. I suspect that she has the strength and is up for the challenge. Good luck.
The writer is a licensed clinical psychologist in private practice in Ra'anana. firstname.lastname@example.org