The Walking Dread

Dear Anonymous,

You clearly are a good brother and thoughtful person. Many have been where you are and ignored their loved one so cheers to you for getting curious about your options. I've responded to each of your questions below. Unfortunately, your experience is not unique and the path is not easy. 

A: My sister has anorexia. She is pretty skinny but she is not a walking skeleton. If you did not know her you would just think she was a really thin person. She has seen many therapists over the years. I am 10 years older than her so we are not all that close. My parents say she won’t listen to them and they don’t know what to do. They offered her a deal where she could live with me and they would pay her rent so long as I got to control her meals and she went for it. They didn’t ask me first but now they are asking me to try and help. She says she really wants to try and a change of environment is what she needs. From what I know about anorexia this is not a sensible plan. Do you think I have any chance of being able to control what she eats? 

RD: No - you have zero control over what she eats. Establishing that boundary with yourself is essential. There is something bigger going on here, bigger than just the food issue. Previous therapists were clearly inexperienced and in way over their head. Here's what you can do - 1) Ask her how best to support her, 2) Invite her to participate in family and social events, 3) Let her know you care about her and are worried because of the changes you have noticed. If you see an opportunity, you can delicately ask if you can participate in a therapy session with her since you are confused on how best to support her. 

A: She can be pretty manipulative to get what she wants. I want to help her but I do not see this working. On the other hand, I guess we don’t have too much to lose by at least trying. 

RD: You actually may have more to lose than you realize. Many, many families push their loved one to get better by subtly trying to get them to eat. Eating and food are not the real problems here. There are clearly identity and self-esteem issues co-mingled with control issues. This is not something for a family member to take on alone. Best intention with a bad outcome. 

A: She has never lived with anyone but our parents. She is 24 and unemployed. Do you have any thoughts, one way or the other? 

RD: Ok, let's break this down. There are clearly clinical, legal, ethical and financial issues intersecting here. First - As a competent (arguably) 24 y/o your sis is legally in control of her life until/unless you can convince a magistrate or judge to have her mandated to treatment or give someone power of attorney. I can tell you that's unlikely to happen in this case. Next - the clinical issue of how to treat the eating disorder is best handled by professionals with deep experience and training, especially those with DBT/CBT training (dialectical behavioral therapy/cognitive behavioral therapy). The hardest part is getting her to buy-in to treatment which is intense and long. It can also be expensive if her insurance refuses to pay. 

This is something common but complicated. I highly encourage you to seek outside support from a therapist and case manager. I trained and experienced professional will know how to speak with your sister to get the most positive change and ensure her safety and happiness. 

Good luck.