Expert: Joanne - 3/13/2009

Question
Hi Joanne,
I am fifteen, and for the last year or so things feel like they're falling apart. I'm 166cm and 49kgs. I used to weigh 56kgs. I feel like I really haven't lost much at all, and would like to keep losing. I don't want to talk to anyone I know about this, in case they do something to make me stop. And as long as I'm being honest with you, I may as well let you know that I'm noticing some other 'signs' of anorexia - easy bruising, coldness, and skipped periods.

About 8 months ago I developed depression, and since have been in therapy for self harm, medication abuse, etc. I don't identify with the woman at all, and don't have the patience for her 'you have to THINK positive to feel positive' quips; so as of yet, she knows nothing about what I'm really feeling.
During the week I find it quite comfortable to restrict (anywhere from 100-300 calories a day), and exercise every night in my room for as long as I am physically able, as well as taking laxatives. However, towards the end of the week I lose control and sometimes end up eating nearly 1200 calories in a day :( I hate it when this happens, but am usually so angry at myself I go back to the restricting with renewed determination.

I know the diagnostic criteria for all of the eating disorders, so this couldn't be one, could it?... I'm not asking you to diagnose me, but I would really like some insight into what a doctor might tell me.

Thank you in advance.

Answer
Sarah

I think you know what I am going to say - you do seem to have an eating disorder!  I can't say whether or not you fit the exact criteria for anorexia nervosa, but even if you don't match that criteria, I think you would be diagnosed with an eating disorder.

Whether or not your eating problems are directly related to the depression, it would seem that you have a number of destructive behaviours, and I would imagine that the are all intertwined.  I think that you need to think about bringing this all up in therapy as the only way that therapy will really work is to be open and honest about everything.  If you aren't finding the woman you are working with just now helpful, then I would strongly urge you to try and find another one - whether this means looking for another yourself, returning to your doctor for another referral, talking to guidance teachers at school.  Therapists aren't a 'one size fits all', it is perfectly reasonable to not get on with your therapist and try to find someone that you do find it easier to open up to.

All I can suggest is that you do look for another therapist and visit your doctor.  You need to be assessed for an eating disorder and a diagnosis should also make it easier for you to get the right therapy for you as well.  As you are suffering from some of the symptoms of anorexia, then I strongly encourage you to visit your doctor soon and be completely honest with them.  These symptoms may not seem all that major, but as you are suffering from these, there is a possibility that your body could be at danger from some of the other effects of anorexia!

Please talk to someone about this.  It may seem hard to, but it will be worth it.

Joanne