Whether you call it an eating disorder, anorexia, bulimia, binge eating or disordered eating, it can turn into an excruciating ordeal for families. Despite growing evidence that all of these behaviors have a significant genetic component, many parents or loved ones feel they have caused the problem. The sense of shame, guilt or embarrassment can contribute to denial that ends up delaying treatment. Yet even understanding the genetic basis can cause conflicted feelings. In a recent story from MSNBC, one mom laments:
“… let’s face it, an eating disorder is a mental illness,…. who wants to admit their child has a mental illness?”
Many family members cling to the hope that the problem will just resolve on its own. Some realize, too late, that it won’t.
Dr. Priscilla Dann-Courtney Ph.D., a clinical psychologist and writer in Boulder, who specializes in eating disorders, has a wonderful way of describing how family members and patients should think about intervention: the person with the eating disorder is not the problem; the problem is the eating disorder. The eating disorder is a beast, and everyone – patient, parents, friends and treatment team – has to mobilize together as a non-violent army to defeat it.
Symptoms are easy to spot. But plenty of people engage in some of the behaviors occasionally, and never develop an eating disorder. Teens are especially likely to experiment with diet restrictions, only to move on to the next new thing in a few days. A teenaged girl doesn’t “catch” an eating disorder from reading fashion magazines, but a susceptible girl, in a triggering environment, may obsess over those magazines as part of the process. A desire to eat healthy or lose weight isn’t necessarily a bad sign, but if the behavior starts to spiral into more and more food restrictions, and more severe weight loss, it’s time to act.
An outpatient treatment team should include a therapist who specializes in eating disorders. Additionally, if weight loss is severe, or bulimia is out of control, a physician should evaluate the person for medical complications. A registered dietitian who specializes in eating disorders can help with nutrition assessment, and work with the family and patient to develop an eating pattern that’s healthy and appropriate.
Sometimes outpatient therapy isn’t enough. As Dr. Ken Weiner MD noted in our interview, 15% of patients won’t do well in outpatient treatment. Dr. Dann-Courtney says that sometimes outpatient therapy leads to acceptance of the need for inpatient treatment. The initial benefit of outpatient therapy is to get the patient healthy enough to understand she or he needs more. The therapy has improved the patient’s capacity for self-care.
While the focus remains on girls and women, the increase in the number of boys who develop eating disorders is very worrisome. Unfortunately it’s too easy for parents to ignore the signs in their son, especially if that boy is involved in sports and dietary changes are linked to improved fitness. Wrestling has long been linked to eating disordered behavior in boys trying to make weight, there’s a whole new list of competitive trigger activities: gymnastics, running, biking, dance, tennis, body building and theater/acting. Even team sports like football can trigger problems. MSNBC had an excellent feature on anorexia in boys earlier this month.
Fortunately there is a wealth of information resources for parents, prospective patients, friends and family:
Eating Disorder Referral and Information Center: a national resource, with listings for local therapists and lots of excellent information.
Something Fishy: a website full of information and support resources
The Eating Disorder Foundation: a unique local resource, with information and treatment options, including a new support center in Denver.
National Eating Disorders Association: resources and support information
Anorexia Nervosa and Related Eating Disorders website
Gurze Books eating disorder publications