Communication & Intervention Strategies
My 18 year old daughter does not want to talk about her eating disorder. She has bulimia. She has gone to therapy, but her therapist does not tell me anything. I am desperate. Please help.
Dear Parent,
I sympathize with how difficult it is when your child has an eating disorder. I imagine you are feeling so many different emotions. You are probably desperate to help her and want to know if she is making progress. The therapist walks a fine line though because your daughter is of legal age and the therapist is obligated to protect her privacy. But I am sure that does not make you feel better.
I am wondering though if you have thought about getting support for yourself. It is not uncommon or unreasonable for you to see a therapist also so that you can discuss how you are feeling and doing, how you are feeling about your daughter’s illness, and learn coping skills and ways to help that do not feel intrusive to her. It is hard for parents to take a step back especially when a child is battling an illness, but I do think a therapist could help you find ways to deal with the situation. Maybe in time you could broach the subject of family counseling with your daughter and her therapist, but given that your daughter is not ready to discuss things with you, you should discuss that option privately with your own therapist first.
NEDA also has several resources available to you. Check out the Parent and Family Network and General Eating Disorders Information. You might also consider calling our Live Information and Referral Helpline at 1-800-931-2237 for guidance, information, and treatment referrals. I hope you are able to find some comfort and solutions.
Danielle Z. Kassow, PhD
5/1/2006
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My wife has suffered from an eating disorder most of her life. She will be 51 in July, and she says she is too old to get treatment and change at this age. She is currently 100% disabled, receiving benefits from the VA, and has received treatment from VA facilities in the past to no avail. My wife says she loves me and our kids (4, 19-25 years of age), but as you can imagine this has had a terrible effect on our family. Her own sister has said it is too late for her, but I don't want to believe it and I still hold out hope that she will realize what it is doing to her and our family. Yesterday, after another of many discussions, I got her to agree to make an appointment with the VA to once again go and seek help. Have there been cases of people this old turning this disease around?
Thanks,
A concerned husband
Without a doubt! In fact, quite a few of my clients are in this age range. Recently, I worked with a woman who was 55 years old and sick and tired of being food preoccupied and weight obsessed all her life. She was in therapy for 4 years, and worked with me, a dietitian, for several months. She gained some weight and had to get used to that, but is happier now than she ever has been.
The bottom line issues are whether or not your wife wants to get better, and if she is seeing a therapist skilled in the treatment of eating disorders. I recommend you and your wife read “Life Without ED” and that you read “Surviving an Eating Disorder,” both available at www.gurze.com.
Karin Kratina, PhD, RD, LD/N
6/10/2006
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My son is 19. He's been hospitalized twice in the last year for anorexia and has been on Zoloft for 1 year. He finally made it to a goal weight and his therapist started seeing him every 2 weeks. He attended college this past year while rehabing and doing aftercare. He lost 15 pounds right at the end of the semester and broke his contract with his therapist. He is living away for the summer and will not get a support system in place. At his age what can I do as a parent to encourage or put some pressure on him to return home and get in aftercare again? I've told him I will cut off his financial support and talk to his employer if he doesn't take action. What can you recommend and would that be appropriate action for me to take? Everyone else in his family has more or less deserted him.
This is a difficult situation. Parents of a 19 year old with a serious medical or psychiatric problem have a lot less control than parents of younger adolescents with these problems. However, you remain his parent and he your son and there is likely still a fair amount of leverage you can bring to the situation. It may be necessary to cut off his financial support if he is unwilling to remain in treatment, but you might start with a meeting with him and his therapist to discuss the events surrounding the recent termination. This meeting might also identify other treatment options at this point. Your son appears to be quite ill still and needs help from both you and professionals.
James Lock, MD, PhD
1/4/2007
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What should you do if you suspect you or someone you care about may have an eating problem?
If you believe that you have an eating problem one thing you can do is call the NEDA Helpline at 1-800-931-2237. You can talk to someone who will help you to identify potential therapists in your area. A trained professional can work with you to figure out the best solution to your eating and body image concerns. You should also see your primary care physician for a physical examination to get some idea as to the status of your general medical health and any specific negative health consequences that you’re having as a result of the eating disorder. Your primary care physician may also know of other resources in your area.
What if you do not feel ready to call a therapist? It is important that you discuss your concerns about your eating with someone who can help you sort out your worries. That person can be almost anyone you trust: a parent, a friend, a colleague, a teacher, a coach, a spiritual advisor, a sibling, or a spouse. NEDA has a tip sheet entitled Sharing with EEEase that gives you ideas about how to have these sometimes difficult conversations. Keep in mind that whomever you tell may be surprised by your concerns and may need time to adapt to the idea. You will need to be prepared to explain your concerns. This is difficult because, as we’ve already discussed, many people feel embarrassed or ashamed or disgusted by their eating or body shape problems. But it is important to try to put those feeling aside, just for an hour or so, just long enough to have this conversation, for your own good as well as for the people that you love (and who love you). Once you talk to someone, that person can help you sort out how to get effective help for your eating problem.
It can be equally difficult to approach a friend or family member who you think is suffering with an eating problem. You may be worried that you are wrong or that the person will be angry or hostile. You might be nervous about how the conversation will go or how things will be after the conversation. These are valid concerns. People with eating problems can be secretive. They also often have a lot of their self-esteem tied up in their appearance and their efforts to attain or maintain a particular weight or shape. Or they may already think they are effectively dealing with the problem. So these conversations can be challenging. But if you are worried about someone’s eating or exercise, it is important to talk to that person. Again, the NEDA website has some specific ideas about talking to and supporting a friend or family member with an eating problem.
As you approach this conversation, you should keep a couple of things in mind. First, your loved one can not just decide to solve the problem. Don’t expect her (or him) to do this. And don’t let her (or him) talk you into a simple “willpower” solution. Be supportive and non-judgmental, but be firm. Second, be prepared to ask someone else for help. You may need to go to someone even over the protests of your friend or family member. Third, do not promise your loved one that you will do anything or always be available. There are limits on what you can and should do. You shouldn’t promise not to talk to anyone about the problem. You can’t always take their phone calls. (What about work? Sleep? Your family obligations?) Be supportive but be realistic. Your overarching goal is to get your loved one to see a therapist who can help identify the problem and work towards a solution.
It is important to keep in mind that eating problems and disorders rob us of many things. They take our joy for living. They make us feel bad about ourselves. They put our health at risk. They even endanger our lives. Talking about these problems is a first step towards solving them. The next step is to find an effective counselor with whom you can establish a working relationship. These two steps can start you towards a healthier life.
Linda Smolak, PhD
11/1/2006
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Hi my name is Beau. My girlfriend has recently ended our relationship. We’ve been dating for over a year and a half now. We have been always very close. I was really upset and didn't believe her reasons for breaking up. I kept asking her and finally told me she has an eating disorder. I had no clue this was happening. I have always treated her good and never told her anything about her weight or looks. I really have no clue what to do. She is getting help, but I was wondering how I can help her. I try to hangout with her or talk to her, but it seems she is pushing me away. I don't bring up anything about her eating disorder. I want her to get better, but very unsure how to. I'm in a situation where it’s very hard for me to see her because of our break up. She seems very angry at me and wondering why. She always has other plans when I try to hangout with her. I want what’s best for her. I need to know how to support her. I need to why she is pushing me out of her life. Is it best to give her space? Please help me, I'm very confused.
Thank you, Beau
It sounds like you are feeling a lot of pain about your girlfriend’s decision to end your relationship. This is so very understandable: you have been dating for over a year and a half and you were very close. Also, you describe treating your girlfriend well and not commenting to her about weight or appearance. Your letter suggests that you still have strong feelings towards this woman. It will help you first to get support in dealing with your pain by speaking to a family member, another friend, or a counselor. Speaking, or writing (such as this letter), to others can also help in gaining new perspectives about what could be going on. One of the perspectives that is hard to hold, and yet is so important, is to accept that sometimes people we care about, and whom we want to support, actually need their space to work through things in their own. This can happen with an ex-partner, or between parents and children. In these situations, the best support we can give is to respect the needs of the other person, and, actually provide support by giving the other person the space she needs. It seems that you yourself have come to this conclusion at the end of your letter. You can send a note to this woman that expresses your respect for her need to take space, and that also clarifies that, in case she wishes, she is welcome to try and contact you. This may be hard for you, so make sure you take care of yourself and get the support you need.
Niva Piran, PhD
4/1/2007
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My 30+ fiancé has recently been successful in going from being overweight to becoming a healthy weight for her height and build. She was always the "fat" girl in school and her self-esteem has suffered for it. Now however, with the success and support she has received, her self-esteem has not changed. Now she still says she is fat when she is a healthy weight and is continually obsessing and trying to lose weight. I am now worried that she will keep trying to lose weight and nurture unhealthy mental attitudes about her body shape. I cannot seem to find a way to help her accept her new, healthy body and build good, positive self-esteem. In some ways, when she was overweight she had a better attitude, accepting that she was a certain body shape and there was nothing she could do about it, now she refuses to accept that she has a different body shape and seems addicted to the idea of weight loss instead of maintaining her new, healthy weight. How can I support her while not encouraging manic weight loss? Can I help build her self-esteem and help to get her to realize that she is fine the way she is?
You’re hoping, reasonably enough, that your fiancée can accept her current weight and become less preoccupied with shape and weight, particularly with losing even more weight. You probably have already talked to her about your concerns, and how you would like to help her and support her. Unfortunately, I’m not optimistic that you alone can get her through her current difficulties. The standard advice would be for her to undertake a course of cognitive-behavior therapy to deal with her distorted cognitions. There are at least two problems to overcome. One is her disturbance of body image, with a marked dissatisfaction with a normal weight. The second is that while she has lost a lot of weight, weight loss is difficult to maintain, and she may be feeling that she is struggling against cravings for food, and that the only way not to gain weight is to be in the “lose weight” mode; in other words, she may feel that she cannot relax her control over eating for fear she will gain everything back. Returning, then, to what you can do. You could gently suggest that she seek help from someone, preferably someone who uses cognitive-behavioral techniques, and you should continue to keep your balanced perspective and maintain your support while she struggles with these problems.
James I. Hudson, MD, ScD
2/1/2007
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One of my really good friends has an eating disorder. I forgot the exact term for it, but he is anorexic and bulimic with body dysmorphic disorder and maybe bipolar disorder. I try to help him and try to just be there and show him that I love him. I understand that it is a mental illness, but I cant figure out how to get through to him so he at least understands that I (along with other people) will love him no matter how 'worthless' he thinks he is and how much he feels that the only reason he is worthless is because of his weight. It is even harder for me to help him because he is now in a different country and I can’t physically be there for him, so I just need to know how I can help him. Thanks
Your plea to help your friend is understandable. Eating disorders render the people who witness the toll on the sufferer feeling helpless and ineffective. However, you are being a kind and generous friend by reminding your friend how much you care about him, regardless of his weight. And it sounds as though you also understand that his weight is not the core issue, but that his focus on his weight is a communication about his feelings of worthlessness. I suggest that you ask your friend how you can help him and if he knows what he needs from you. Keep open the dialogue and encourage him to seek professional care. You might ask him about his support system and remind him that talking to others can help him feel less alone. Even though he feels worthless, this is not the impression that others, like yourself, have of him, so encourage him to be open to other perspectives! You also might have to come to terms with the limitations of your care; in other words, you can offer support but you will not be able to heal your friend. His recovery will be a long, complicated process. He is fortunate to have a friendship such as yours to support him along the way.
Catherine Baker-Pitts, LCSW-R
5/1/2007
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I have a dear friend who has an eating disorder and has had one for years in different forms. Currently, she is battling a "chewing and spitting" disorder. She is fully aware that this is indeed a problem and attempts to stop but cannot. She does not want professional help. Is there anything I can suggest for her to do on her own or with me? A routine or something of the sort?
Chewing and spitting behaviors are more common among eating disorder patients than perhaps acknowledged. It would be important to establish whether behaviors such as chewing and spitting are occurring in isolation, or are perhaps part of a larger constellation of symptoms. Many patients with eating disorders would prefer not to seek help, and it is often up to family members, friends or other care givers to figure out an appropriate way to support their loved one in taking the difficult step and seeking help. One important first step is often an open discussion in which one expresses concern about the individual as well as a desire to help, even when that help is not necessarily wanted. Doing some homework and finding a suitable professional in one’s area, making an appointment and letting your family member/friend/spouse know that you have taken these steps and would be happy to accompany them to such a consultation is a helpful second step in bringing ambivalent patients to consider professional help.
Daniel F. Le Grange, PhD
6/26/2007
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I work with a foster child who is presenting eating disorder behaviors. She is storing food in her room, binging, and sometime purging. Her foster mother isn't sure if she is purging because she ate too much or if she is forcing herself to throw up. She does not purge very often, she does over eat every day. This 14 year old female finds food as a comfort and is trying to fill a void inside of her. Her foster mother understands she will need therapy and is going to have her see a nutritionist, but is not sure how to approach the situation at home.
What should the foster mother do? Should she help her control her eating habits? What can she say that would be helpful when she sees this foster child binging on food? What are some interventions in the home that would be helpful? Thank you for your time!
Having a child with disordered eating at home can certainly be very frustrating. My assumption is that the person submitting the question is probably a therapist who is working with the child. I can offer several points, based on the circumstances:
The first question is whether the child is interested in working on the problem. Does she acknowledge it? If she does, then the foster mother can try certain things:
- Plan regular balanced meals.
- Do not allow food in her room.
- Sit with her after these meals until she feels comfortable with the fact that she has eaten and felt full.
However, if the child denies that this is a problem and indicates she doesn't want help the situation is very different. Then the foster mother may find herself in a situation where she is trying to police the child , which probably will result in more rather than fewer problems.
Perhaps the best way to work with adolescents with eating disorders is a family-based manualized approach referred to as the Maudsley approach. Using this approach would require finding a therapist who is skilled in this method.
Probably the best overall approach is to arrange for the child and her foster mother to be seen by a therapist who is skilled in the family therapy approaches to treatment of adolescent eating disorder.
James E. Mitchell, MD
2/1/2006
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I have just learned that my sister has an eating disorder. I want to be there for her, however, I had plans to exercise and lose weight this summer to feel better about myself. I am afraid that if she sees me doing this she will feel she needs to lose more weight also. I don't want to do anything that will make her situation any worse. Do you have any suggestions?
You didn’t mention the types of eating disorder problems that your sister has, but the fact that you want to exercise and lose weight to “feel better” about yourself makes me think that you need first to check out your own motivations. To what extent do you link your own self-worth to your weight and shape? Isn’t that what your sister is doing? You may feel that your concerns are “normal” but that she does these things a lot more intensively and is much worse off.
In any event, if you openly discuss your own summer plans about exercising and losing weight with your sister, the two of you may have the opportunity to compare and contrast your motivations and the extent of your passions to exercise and diet. Simply laying out your own reasons and asking your sister for feedback as to whether she believes you need to lose weight may be helpful for her. Asking her questions will be generally more helpful than making declarative statements. For example, if you ask “Say, Sis… my physician has said that I could stand to lose 10 pounds, does that seem right to you? ” or “How would you feel if I started to exercise and went on a diet? Would my program make you want to do more of that yourself?”
If you’re concerned that your sister might react to your plans to exercise and lose weight as a competitive challenge, and that she might turn around and want to outdo you at these activities, you should quickly and clearly tell her that you’d be very upset if she responded to your plans as a “license” to do more harm to herself. You might suggest that the two of you read through and discuss some interesting books together, such as the “Eating Disorders: The Journey to Recovery” workbook, or others that frame the psychological issues contributing to eating disorders. Conceivably, these activities might bring the two of you closer together and help your sister to think anew about what drives her eating disorder.
Joel Yager, MD
12/13/2005
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Help!!! My children's soon to be step-mother has indicated that they both need to diet. My girls (5 & 8) are not overweight and are simply going through the "bulk then grow" phases of childhood. I have always been very cautious about body image with my children and now this has made my girls question their bodies. I need information to share with my ex-husband and his fiancée about the potential damage these comments can cause our children. What can I do?? I have impressed upon them all their lives that beauty is both inside and out and that their bodies are perfect for them at this stage in their lives. I am very concerned, afraid, and angry and need support to educate them both and stop this behavior.
You’re describing a problem that’s become increasingly common as parental duties are split in families that have gone through a divorce. There are several aspects to consider. Most important, how have you all (parents and step-parents) discussed, negotiated and understood exactly what level of responsibility, power and authority each of you has to decide how the children are to be raised? Even if the step-mother-to-be disagrees with you about how to approach issues of shape and weight, if she agrees that you’re the mom and should have primary say, you can provide her with information to support your opinion and ask that she honor your role as primary maternal authority by not giving the girls conflicting messages.
However, if the step-mother-to-be is competing with you in a power struggle as to who’s really in charge of raising the girls and tries to subtly challenge your maternal authority over them, and/or especially if she’s got body image issues of her own that may be contributing to her views, you’re likely to have a long, hard road. If that’s the case, here are several things you can do:
- If you believe that the step-mother-to-be is simply ill informed, for the sake of the girls you can still try to sit down with her to discuss your views, and, perhaps bolster your position with information that you can obtain from NEDA or elsewhere. You may also want to involve the girls’ pediatrician (who presumably shares your perspective) in these discussions. Some educational handouts that you may want to share with her include Ten Things Parents Can Do to Prevent Eating Disorders, Tips for Kids on Eating Well and Feeling Good about Yourself, Fifty Ways to Lose the "3Ds": Dieting, Drive for Thinness, and Body Dissatisfaction and Listen to Your Body.
- If the step-mother-to-be feels so strongly that when the girls are with her she must still say or do something about eating and weight that you don’t approve of, you can still ask her to do so in a way that is at least respectful of you and of the fact that your views differ. You can point how involving the girls as go-betweens in a competitive blaming game in which she tells them that “your mommy doesn’t know what she’s doing”, or something to that effect, will ultimately be destructive to them, as well as to all of you. If you feel that the step-mother-to-be is, in fact, initiating such destructive competitive blaming games, you will probably want your ex-husband to step in, if that’s possible in your situation, for the sake of the girls. You’ll also want to be certain that you yourself aren’t contributing to the inevitably destructive consequences of such games.
- You’ll want to ask the girls what they’re hearing from their step-mother-to-be about these matters and let them know that sometime adults disagree about things, but that they all have their best intentions at heart. You’ll also want to remind the girls that you’re their real mother and that you and their pediatrician are doing your best to raise them using the best available information.
- If the girls still receive very different messages in the two households, they’ll inevitably have to sort through and deal with these conflicts on their own. But, if you make every effort to communicate with them with honesty, love and support as they go through this, they’ll be comforted and come out stronger for it.
Joel Yager, MD
1/10/2006
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