Expert: Jeanne Rust, PhD - 7/18/2009

Question
QUESTION: Hi Dr. Rust,
I've been suffering with anorexia on and off (it goes through cycles) since i was 14, maybe younger. Recently this year, i had to undergo treatment for anorexia at an intensive day hospital program (so i ate all my meals and snacks there, but was allowed to sleep at home).

I'm currently struggling again, and i think im relapsing, although i dont even know if you can say that because in order to relapse, you have to be fully recovered first, which i dont think i was, since i was kicked out half way through my treatment.

Anyways.. the reason im writing to you is because things have gotten pretty bad now, and im fasting most days, and right now, at this moment, i'm dying to drink water.. im seriously so thirsty.. but im terrified that if i do, i'll retain the water and will "gain" weight. I know that the cure for water retention is to drink more water, but i cant help myself and make myself do it.

Do you have any advice for me?

Thank you very much.

ANSWER: Dear Steph,

I'm so glad that you wrote!  You're at such a critical place right now. Steph.  First of all, did you continue in therapy after your day program?  Also if you're starting to struggle, it doesn't mean that you've failed your treatment program, but it tells me that you didn't possibly receive the right kind of treatment!

Recovery from an eating disorder is a process.  It's not an event   -- such as in you attend 3-4 months of out-patient treatment and bingo, you're well.  It can take up a few years for some people.

In regards to the water, not drinking is an extremely dangerous behavior.  You could end up needing to be rehydrated by IV --
Please see your doctor.  It would be very easy for you to end up in the hospital. Being dehydrated will effect every system in your body.  This also tells me that the anorexia is progressing!  The anorexic voice that is telling you not to eat or drink is also the voice that wants to kill you!

Now is the time to see about getting a higher level of care than a day program.  When one level of care doesn't work, it's time to find a residential program that is more intense.  

Your life can depend on this!

Let me know if I can help!

Warmly,
Jeannie Rust, PhD
www.mirasol.net
www.edrecovery.com
888-520-1700

---------- FOLLOW-UP ----------

QUESTION: Hi Dr. Rust,
Thank you so much for getting back to me.

No, i didn't follow up w/therapy after being kicked out of the program. My parents dont really believe in that sort of stuff. It was hard enough to get them to let me go into treatment in the first place (yes, i'm 20 and can make my own decisions but since i still live at home, theyve pretty much got all the control)

It's hard to say whether or not I received the right kind of treatment since I didn't really get to finish it...

As for residential/IP - I'm not thin enough to get it. My bmi isnt lower than 15.. im not 65 pounds, though, i guess, it sort of sounds like it. I'm between 5'8.5" and 5'9" and i weigh (currently) 111 pounds although my lowest was a measly 101.64. If i get to 82lbs, then i can consider IP treatment. It would be SUCH an embarassment to go there and be this fat already, starting out...

Thank you very much for your reply again.

Answer
Dear Steph,

The way an anorexic's mind works is such a mystery!  If you were below a BMI of 15, I couldn't take someone your weight at Mirasol!  A person with a BMI under 15 needs acute care -- and the sooner they can get it the better!  The more your weight goes below a 15 BMI, the more cognitive dysfunction you'll experience --

Please don't let your weight get to 67# or anywhere close -- this is where people die!  Yes, it happens.  Anorexia kills more girls than any other condition, including depression or accidents!

I'm happy to spek with your parents if that would help.  If not, then you need to find a safe adult and tell them what you need.  You're life is really at stake!

Warmly,
Jeannie