Expert: Joanne - 9/8/2008

Question
Dear Joanne,
My daughter is 17 and she told me today that she is very sick, she doesn't
want to eat and struggle with her weight, she thinks that she is way
overweight and she looks just right. She is trying to spend time with friends,
sleep over... avoids family dinners and looking into refrigerators. She was an
athlete for 7 years and now she has a break. I am sick to my stomach
thinking she will harm herself (like cut or else...) to distract from what she
feels. She told me she feels like atomic bombs explode in her mouth when
she eats something. Guild is overwhelming. She also seems to have 2 voices
in her had: one is telling her its not right and another one is winning making
her feel guilty of eating and looking like a pig.... If you could just see her, she
looks so beautiful, like an athletic model. I am crying all day and night. I know
it is good she told me all this, but how can I help her? I don't seems to have
power over this decease! She doesn't want to go to a doctor! She says it is her
security blanket, even if it hurts so much... Please help us, please. I am so overwhelmed...

Answer
Julia

I am so sorry to hear that you daughter is suffering so much right now!

It is common for athletes to worry about their weight with the belief that being thinner will make them better, and it is also quite common for athletes to take a break and become very anxious about gaining weight after giving up their normal high activity lifestyle so severely restrict calorie intake to try and compensate.  Do you think that she is at risk of self-harming?  Has she expressed that she feels that way?

It is very good that she has confided in you.  You must have a very strong relationship.   Some people can go for ages without telling their families, their families just sitting watching someone get ill, but not knowing why or how to help.  By the time that their family is aware of the problem, the person suffering from the eating disorder can be getting very ill and behaviours may be very habitual and hard to break.

You need to encourage her to go to the doctor!  I don't know what rules there are in your area about consent for treatment, but I'd imagine the majority of places would allow a 17 year old to make her own medical decisions.  At any point you are fearful for her life - whether she is becoming very ill due to starvation, or you think that she is a danger to herself and that she may harm herself badly, or becomes suicidal, then you need to take her to a hospital straight away.  At the moment, it is more about just making her realise that she needs help, but this needs to be done without a lot of arguements and avoiding making her feel more guilty about this illness.  She needs to realise that to achieve anything in life that she may ever want, she needs to be well, and that requires her to nourish herself.  Continuing like this, she may be unable to return to athletics in the near future.  In the longer term, she could even go on to develop osteoporosis, making her bones more fragile, so never mind athletics, a simple walk upstairs or down the street runs the risk of her breaking her leg!  Is she aware of all of these possible health problems that are associated with eating disorders.  It may be useful for you both to do some research on the topic.  While you are researching that, you should maybe look into what treatment facilities are in your area.

Your daughter should hopefully decide in the near future that she does want to recover from this.  If she realises just how much this can impact on her life and health, she may decide that it is the right thing to do!  Many girls try to recover when they decide that they do want kids in later life and realise that starving yourself may cause you to lose that ability forever.  For other sufferers (male and female) it is common for them to seek help when they read about the effects on their heart and are worried about that.  Everyone will have a different reason for wanting to recover, and most will come to that realisation at different stages of their eating disorder.  For those that are really struggling with depression at the same time, it could take ages as they basically don't want to live and believe that the eating disorder will eventually take care of that.

I think it is important that you are there for your daughter to come to for support at any time.  You need to try and avoid conversations about weight and food, especially if they are likely to turn into arguements, and these conversations should especially not take place around meal times.

If your daughter is not willing to visit a doctor, would she be willing to go to therapy, or to see a nutritionist?  To recover from an eating disorder, the underlying issue really needs to be addressed.  They need to work out what lead her to an eating disorder, and then help her work through those issues, and develop other coping mechanisms.  If she is willing to try and eat, but wants to eat a 'healthier diet' and one that will not make her gain weight after taking a break from her athletics, but will maintain her current weight, then it would be worth visiting a nutritionist or dieitican who can work out a meal plan that she may be able to follow.  Preferably try to find one that has had experience in working with eating disorder patients.

Until she is ready to start to recover, you just have to be available to listen if she wants to talk, there for support if she wants to try and eat something.  Talk to her about the available treatment in your area, or even talk to your doctor about the available treatment in the area.  Preferable this should be done with your daughter present, and some doctors may not talk about your daughter without her being present in the room due to patient confidentiality, but there is nothing to stop you talking to him/her.  And remember, if at any time you think she is in real  immediate danger from the eating disorder, or at serious risk of badly harming herself or committing suicide, then take her to the ER immediately, or call an ambulance!

Joanne