Eating disorders and the family

Eating disorders affect 10 million women and the numbers increase each decade.  But when someone with an eating disorder wrestles for control, the rest of the family often feel out of control.On Tuesday's web chat we will be joined by Dr. Beth Weinstock a psychologist in Narberth who specializes in treatment of trauma and eating disorders.  Today's edition of "voices in the family" will also be on eating disorders and will focus on current research.

 Dear Dr. GottliebMy husband and I have concerns about my adolescent daughter and was hoping you could steer me in the appropriate direction. Our daughter's diet has become increasingly restrictive and rigid over the last two years as she always seems to be trying to lose more weight.  Prior to all of this, she seemed to have a good self image and self esteem, is a heavily involved student and althlete, with lots of friends.  I have underlying fears, as I grew up with a sister who was both anorexic and bulimic for all of our shared teen years.   I lived through the lies from her and the denial of my parents until she was almost dead, twice.  I need to make sure that we intervene if it is appropriate.  SO if you can tell me if any of the things I describe seem like red flags, please help.  If not, I understand and I hope you  can give me some direction for seeking additional advice.

 Several other things have us concerned.  Lately she has been lying and all of our efforts to stop this have been unsuccessful.  Usually the lies are about food and when we confront her with questions, she gives us poor explanations.   When does this become a concern?  I will not fail to act if needed.  Is this just like cheating on any diet or weight loss plan?  When does this become about "control".  I was always told that eating disorders are a mental illness steeped in the need to gain control over a portion of one's life.

  Concerned mother 

Dear concerned, 

You are right, eating disorders are always about control.  Your daughter is trying to control her body, her life and possibly her mind.  But if you are locked in a struggle with her, then you are trying to control from the other side.  When I specialized in addiction many years ago, I watched these same power struggles.  And what I learned was the family thought the problem was alcohol and the alcoholic thought the problem was the family!

Your daughter may well have an eating disorder as they affect one in 20 women between the ages of 18 and 30.  And there are some red flags.  Features associated with eating disorders are perfectionism, depression and low self-esteem. And if your daughter is being deceitful, it's unlikely she feels good about herself.  And one of the biggest red flags is the genetic one as there is more research suggesting a genetic link.   She may have an eating disorder, and any parent with a child like that shares the same sense of being an out-of-control when the stakes feel like life and death.  Most parents emotions range from terror to helplessness to rage and back again.  But because of your history, you have an even more complicated reaction.  As you describe life with your sister, I wonder if you experienced trauma as a child and now not only are you experiencing this nightmare with your daughter, you may be reexperiencing your childhood.

So clearly your daughter has a problem, but so do you.  And I would guess both issues revolve around control, anxiety and helplessness.  And it also seems that communication in the family has broken down behind all of the anxiety.  So let's not make this about food or whether or not she is being truthful.  Let's start by assuming this is a family problem and that everyone is contributing to the problem and everyone has some role to play in resolving.  That way we get away from issues of shame, blame and power struggles.

Ultimately treatment of eating disorders involves group and individual therapy.  The work is hard and the illness his chronic so there is a chance this will not simply get treatment and go away. 

 But your daughter is not interested in treatment for herself right now. So my recommendation is to find a good family therapist who specializes in eating disorders.  And go as a whole family understanding that everyone needs help in order to make changes in the way your family is functioning.  Once your daughter understands that she is not being blamed but that everyone is taking a look at themselves, she may very well develop a different perspective on her own life. 

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