Expert: Joanne - 1/26/2009

Question
(Okay im not the one with the problem its my boyfriend Jayson.
And being his boyfriend for a while now im naturally going to get worried and ask around...... but he doesn't want me to.)

Well he has trouble eating.
When ever he does it never stays down.
To make it clear he doesn't make himself vomit.
It started in 2007 when he lost his twin to suicide

he's only 17 at about 5'9" and weighs around 50kg
His BMI is 16.3
He's underweight for his age

People think because he is gay and not that at all muscular its okay to be underweight
Well I don't think so


He used to drink alcohol quiet a bit, he smokes a lot.
He has attempted suicide.
He can hardly sleep

Can you PLEASE tell me what could be wrong?
Could he eventually die?
And can you tell me how to help him get back to a healthy weight like he was 2years ago?


PLEASE!

Answer
Tyler

I'm sorry to hear that your boyfriend is having such problems.  Whether or not is gay, or muscular or not, does not make a difference to whether or not his weight is healthy nor acceptable.

When you started, you mention that he vomits after eating, but not because he self-induces it - to begin with, I was worried that there may be a physical reason for this, so I would definitely discuss this with a doctor to make sure that there is no physical illness or disease causing this.

When his twin sadly died, did he ever receive grief or bereavement counselling?  This is something that he should have received, especially if he was close with his brother/sister.

The eating issues, smoking, drinking, sleeplessness and suicidal thoughts and actual attempts screams that he is potentially suffering from really severe depression.  Has he ever seen anyone about depression, take meds, etc.  If not, I would suggest making an appointment with a doctor soon to try and get a referral to a counsellor, therapist or psychologist in order to address this depression, and possibly even get some medications (medications can only help, not cure, he really needs to have therapy as well!).

Could he eventually die?  Well if he is severely depressed, and still having suicidal thoughts, then I'd be extremely worried and look for help NOW!  There is no point in putting off trying to bring in professional help or intervention if this is the case.  If he is no longer suicidal and this is much more just concern for his eating habits, the answer is still yes!  Unfortunately, disordered eating patterns can cause quite a slow death as the body begins to shut down through malnutrition in the very long term, but much more likely, if this behaviour continues is that he could suffer cardiac arrest, or oesophageal bleeding, etc.  Eating disorders can be deadly!

There is a chance here that he is not suffering so much from an eating disorder itself, but is suffering from depression which can cause you to not eat as your appetite is affected, but depression is also a side effect of an eating disorder.

Whatever way round the disordered eating and potential depression occured, the underlying causes are likely to be the same.  He needs to talk to someone about how he is feeling and why he feels the way he does.  The trauma of his twins death needs to be addressed, and possibly any other events that may have occured previously.

You need to be loving, supportive and unjudging, trying not to push him too hard.  He needs to be encouraged to seek out medical or psychological help soon, but he needs to recognise the problems and be willing to admit to them and discuss them!

If you think that he is in immediate danger from the health effects of his poor nutrition, or is at danger of seriously harming himself, you need to seek out help now, which may involve calling his family, a doctor or even an ambulance!

Joanne