Fleeting Eating

Dear Anonymous,

Unfortunately, your situation is not unique and is a very difficult one to deal with. Our agency spends a significant amount of time supporting families like yours since easting disorders are almost never just an individual issue. Hopefully, my responses to each of your questions below will help you all get through this difficult time.

A: What do I do with a girl who is 17 and in her last year of high school who is taking diet pills and who won’t stop. I can make her promise to stop but I cannot make her actually do it. 

RD: You are totally correct, you can not make her do anything. Having her promise to stop only deepens feelings of failure, lack of control and sadness often associated with eating disorders. That does not mean there is nothing you can do, though. First of all, if it's a REAL safety issue (she is not eating anything, her period has stopped or you can see she is physically weak and tired) medical intervention is more important than a psychological intervention. It's time to have her admitted to the hospital immediately. 

If it's not a safety issue, I would not focus on changing her behavior (not right away at least) but get a better understanding of why she is using this coping skill. I'd like to know what pressures she is experiencing, why restrictive eating seems like the best way to get her needs/wants met. It sounds like she does not feel comfortable coming to you or any other family member and asking for help. I'd like to understand why. 

Now, let's talk leverage and responsibility. I'd like to know if she (and you) are planning on her leaving for college next Fall. Are you visiting colleges now? I'd also be interested to understand what sort of privileges she has right now (ie. iPhone, car, etc). Basically, going away to college is a privilege and is only an option for mental and physically healthy kids (this is what I would tell her). Next, if she is not taking care of herself, she needs to start working with a therapist. Having a phone, car, etc. are privileges she can use when she takes care of herself. Be specific with what you need to see (behavior - not attitude or motivation) and tie it to privileges. This can be tricky since you do not want to increase her stress but, you want to set specific and firm expectations. 

A: I am starting to feel like the police man in the house. Whenever she pours a big glass of water I am wondering if she is drinking to avoid eating and I bite my tongue to ask her but I often can’t resist and that does not help when I am badgering her about what she is doing especially when I cannot prove one way or the other what is going on in her head. I am so frustrated with her. 

RD: Don't bother spending time trying to prove anything or getting into power struggles. If she is in your house, your rules and expectations apply. It's not a bad thing to tell her how how behavior makes you feel ("When you don't eat, I feel scared and angry that you are unhealthy."). This may not change her mind or behavior, but you will at least accurately communicate your thoughts and feelings. 

A: She has taken diet pills in the past and I caught her and we had a big talk and she promised she would not do it again. She knows the risks. Then she lost a ton of weight this last month and I got suspicious again and I started asking her if she was taking anything. Of course she denied everything but then my youngest daughter found the pills in her bag and she still denies that she is taking them she says she is just selling them at school (she says they are not illegal). 

RD: Whether she is taking diet pills, restricting her eating, or purging after meals, she's not taking care of herself. It's not a bad idea to set a line with her and let her know what you will do when she crosses it ("If I see that you are physically too weak, unhealthy or look too thin, I will admit you to the hospital to get help. I would rather you be alive and angry at me rather than dead."). Even if she claims to 'know the risks' teenagers are neurologically designed to think the risks do not apply to them. Also - I'd set an expectation that your younger daughter NOT get in the middle of this. Tell her how she can support and care about her older sister without feeling the need to rat her out to you. Puts her in a bad spot. 

A: What am I supposed to do? I can’t make her do anything and being thin seems more important to her than her future health.

RD: The ultimate goal may not be to be thin, it more than likely to be attractive, be in control, or punish herself for not being good enough at something. It's vital that you find a therapist in your area that specializes in eating disorders. If individual therapy does not seem like it will be enough, agencies like ours (Fonthill Counseling) help families find residential treatment programs. We've worked with great programs around the country that provide great service to the client and fantastic support to the family. This issue is likely much bigger than any parent can handle on their own since your daughter does not likely have the internal desire to change at this point.