Current Q&As
I am a 19 year old who does NOT have an eating disorder. However, my 50 year old mother does. She has never told me, but I have heard her throwing up after almost every dinner and have seen vomit on the toilet seat once. Concerned, I did a bit of investigating and found out she HAS been seeing a doctor about it. She has been vomiting for at least 6 months, and it doesn't seem to stop. How can she think I don't know? Should I still confront her even though she is already getting medical attention? Please help!
Regular vomiting, in this case most likely as a form of purging, is a serious problem, so I can understand how this constitutes a very difficult, even frightening situation for you and (probably) your family. However, unless you have other evidence to suggest that your mother’s problems are worsening (e.g., fainting, unusual and costly dental problems) in ways that indicate a medical and/or psychological emergency, I would not “confront” her and I would ignore the matter of whether she thinks you do or do not “know” what is going on.
Rather, I would take the following steps (see Tips for Talking to a Friend, which is intended for reaching out to friends, but would serve you well in this instance too). First, I would arrange to speak with her, in private and at a time when neither of you has other commitments or is “on the go” from one activity to another. Then I would ask her to just listen carefully to what you to have to say, for about 3-5 minutes, before she speaks or answers; then you will do the same for her. Next, say directly and kindly, without melodrama, “I am very, very concerned about you.” Follow this up immediately with “I have noticed (or seen) that you are throwing up after almost every dinner, and [add anything else in the way of specific behaviors that you have noticed].” Then say: “Repeated vomiting, for whatever reason, is a serious matter because it is bad for your heart, your esophagus, and your teeth.” Conclude your opening “statement of concern” with something like the following: “I love you, and, as I said, I am very concerned about you. I hope you have been clear in telling your doctor about this [and whatever else is clearly going on].”
If your mother is “seeing” or “being treated by” a family physician (“a doctor”) who thinks he or she can help your mother, then I would go on to say something like “Mom, I really feel that this problem is too big and too important for you to be working with a family practice physician, even someone as good as our family doctor. I feel strongly that you need to be working with a counselor, psychologist, or psychiatrist who has expertise in evaluating and treating problems like this.”
After you have said these things in a loving but firm manner, allow your mother the same courtesy of 3-5 minutes of response. Resist the temptation to interrupt, argue, or correct. Instead, be affirming of her feelings, but firm and direct in stating your feelings, the basis for them, and your conviction that she needs to be seen, evaluated, and supported by a professional with experience and expertise in these matters. If your mother’s reactions are some combination of defensive, argumentative, vague, or indecisive, do not argue or threaten. Rather, say something like “I’m not going to argue, but I am open to talking with you further, and I am very open to helping you get the help I think you need. Please think about what I’ve said, and let’s talk again about what I said.”
If things do not move in the direction you think is healthy for your mother and your family, then I would consider your options in terms of support. If you are a college student or in the military, for example, there may well be low-cost counseling and support services available. Not too far from where I live in central Ohio there is an organization that provides free support groups (facilitated by a professional) for families and friends of people who are at different stages of admitting, getting treatment for, and recovering from their eating disorders. There are also a number of very good books that may provide practical and humane advice. For example:
Sherman, R., & Thompson, R. A. (1997). Bulimia: A guide for family & friends (rev.). Lexington, MA: Lexington Books.
Siegel, M., Brisman, J., & Weinshel, M. (1997). Surviving an eating disorder: Strategies for family and friends (Revised & updated). New York: HarperPerennial.
Michael Levine, PhD
8/20/2007
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First of all, thank you so much for your great site and Helpline, which I have used on behalf of my daughter. My question is: Can you provide specific resources (books, articles, websites etc.) that illustrate success stories for people with anorexia? I feel it would be very helpful to patients and family to hear more about successes. I have done extensive research and find so much valuable information about anorexia, but little on success. My daughter sometimes states that she can never get better, and that professionals have told her this, which seems counterproductive to recovery. I know there are success stories out there. Where are they? Thank you so much!!!
This is an excellent question. Anorexia nervosa is indeed a serious mental illness (or biopsychological disorder, if you prefer that terminology), and for approximately 20-30% of sufferers it is also a chronic (and sometimes deadly) illness. Moreover, eating disorders often co-occur with depression, which means that demoralization and hopelessness can blacken one’s beliefs about the chances of recovery. However, the research literature, as well the clinical experiences of countless professionals (including dietitians), indicates that people can indeed recover from anorexia nervosa.
One such person is my friend and colleague, renowned eating disorders therapist Carolyn Costin. In a 7-page section of the prologue to her book Your Dieting Daughter: Is She Dying for Attention? (New York: Brunner/Mazel, 1997) she chronicles her descent into anorexia nervosa and her recovery. Another of my friends, Lindsey Hall, has combined her story with those of various others in a marvelous paperback book entitled Full Lives: Women Who Have Freed Themselves from Food & Weight Obsession (Carlsbad, CA: Gurze Books, 1993). In my opinion, another narrative of pain, struggle, doubt, development, and recovery is Bronte’s Story: Tears, Trials and Triumphs—A Personal Battle with Anorexia, by Australians Bronte Cullis and Steve Bibb (Milson Point, NSW: Random House Australia, 2004). A recent book that I have not read but that has been very well reviewed is Gaining: The Truth About Life After Eating Disorders by Aimee Liu (Warner Books 2007). Lastly, NEDA has recently created a section of their website devoted to sharing courageous and inspirational stories, titled “Voices of Hope.” To read these stories, or to contribute to this community of hope, please click here.
There are many, many books that chronicle recovery from anorexia nervosa and/or bulimia nervosa. I often recommend that people in search of such narratives consult with the reference librarian at their local library. When searching for such narratives, it is important to be aware that sometimes personal story content may contain information that could be potentially triggering (i.e. a focus on the tragic past, or graphic details such as pictures or numbers). Note that the three things that are so striking about effective “success stories” are that they provide the messages that: (1) Recovery is indeed possible, and in fact is likely if one sticks with the process and does not give up; (2) recovery can be achieved by a wide variety of people; and (3) there is no “single path to recovery” or “one true answer” for anorexia nervosa.
Michael Levine, PhD
8/20/2007
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Why are the causes of eating disorders so poorly understood? What current research is underway? What can individuals who have been impacted by eating disorders do to help support and further such research?
There are at least three reasons why the causes of eating disorders are indeed poorly understood. First, “eating disorders” encompass a spectrum of complicated problems which have some features in common (e.g., an overvaluation of weight and shape as a determinant of self-concept and self-esteem), but differ in other significant respects. The causes of restricting anorexia nervosa in girls ages 11 through 14 are likely to be different in at least a few meaningful ways from the causes of bulimia nervosa in males ages 20-25 who are also dependent on alcohol and cocaine. Second, establishing a factor (e.g., perfectionism) as a “cause” or “risk factor” for a disorder—as distinct from a “correlate” or consequence of the disorder—typically involves time-consuming, expensive longitudinal designs (e.g., people who are at risk for these disorders have to be studied and followed for many years before you know the results). A very large number of people have to participate in this type of research, often scores or hundreds. Since eating disorders affect only a small percentage of the population, e.g. 0.5 to 3% of the populations at risk, it’s often difficult to get a large enough number of people to participate in these studies.
Finally, as is the case with depression, anxiety disorders and substance abuse, a variety of different developmental pathways can result in the same general outcome (e.g. different combinations of genetic predispositions, family influences and peer influences may lead to binge eating disorder). Conversely, even people who share what seem to be similar genetic makeups, similar challenges such as “low self-esteem,” and similar kinds of friendships can still have very different outcomes (such as an eating disorder or depression or substance abuse, or all 3 together) or no disorder at all—depending on the interplay of biological, psychological and sociocultural factors.
Individuals who have been impacted by eating disorders can support research in a number of ways. They can volunteer to participate in research, for example, studies of siblings of people with bulimia nervosa, or studies of the recovery process for young women with anorexia nervosa. People under age 18 will need the consent of a parent or guardian. There various ways to get involved in conducting hands-on research, especially if one is either a college student or a high school student who lives near a college or university. Make sure that the research is being conducted by a qualified professional and that it has been approved as ethical by an “IRB” (Internal Review Board). Many researchers welcome bright, energetic, and committed volunteers. Undergraduates majoring in psychology, social work, public health, dietetics, and so forth can take a series of classes and serve apprenticeships with faculty mentors so as to prepare themselves for advanced undergraduate research, honors projects, and graduate study.
One can also politically support the funding of eating disorders research by becoming involved in organizations such as the Eating Disorders Coalition (http://www.eatingdisorderscoalition.org/) that lobby the Federal Government for more attention to, and more money for, eating disorders research. Finally, one can “support” good research into the causes of eating disorders by understanding, and by communicating to others, that there is a great deal yet to be learned about these complicated and serious disorders. Financial donations to organizations such as the National Eating Disorders Association to support research are always welcome.
Michael Levine, PhD
8/20/2007
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I just graduated college with a BA in psychology and hope to go to graduate school for a PhD in clinical psychology. I want my research focus to be on eating disorders and I was wondering if you could direct me to schools that have researchers or programs focusing on this topic? Thanks.
Most Ph.D. programs in clinical psychology are based on the scientist-practitioner model of training. Regardless of what specific jobs graduate students hope to obtain when they finish their Ph.D. (e.g. clinician in private practice; university professor) in conjunction with their clinical training, they are trained first and foremost as experimental psychologists, under the tutelage of a faculty mentor. Thus, students with an MA and/or BA in Psychology who wish to conduct research on eating disorders are well advised to think carefully about (and to research) what specific aspects of the eating disorders field they are interested in. In the course of looking at relevant journals and books, you will come across researchers who are (a) clinical psychologists who are faculty members in a university graduate program; and (b) doing the type of work you’d like to be doing. When you find such researchers/faculty, go to the university’s web site to find out if the university has a Ph.D. program in clinical psychology, and to learn more about that specific program.
The American Psychological Association (www.apa.org/students) is an excellent source of information about the entire process of determining whether one wants to go to graduate school, the best graduate programs in terms of your interests, and the best ways to go about applying to graduate school so as to get into the program that is right for you.
Michael Levine, PhD
8/20/2007
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