Anorexia warning signs and advice

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Who is most vulnerable?

In the past, conventional wisdom was that eating disorders most often afflict children from upper middle-class families. This is not the case. According to child and adolescent psychiatrist Dr Sloane Madden of Westmead Children’s Hospital in Sydney, sufferers come from no particular background or race. What they do tend to have in common is being high-achievers – successful in their studies or sport.

They are also likely to be more sensitive to criticism than other people, and to feel an acute pressure to achieve. This pressure doesn’t necessarily come from their families – more likely, it comes from themselves. Prior to adolescence, as many boys suffer from eating disorders as girls do. After adolescence, girls are 10 times more likely to succumb, and this number increases again in adulthood.

What to watch for

Although weight loss is one of the signs of anorexia, it can be hard to detect in young people, who are often small anyway. Unfortunately, children can lose enough weight for the disorder to become chronic and life-threatening very quickly – up to 15 per cent of their body weight in two to three months, according to Dr Madden. Eighty per cent of patients he sees arrive as emergencies, already medically unstable.

One sign to watch for is the child becoming very restrictive about what he or she eats. “They might start off being interested in healthy eating,” says Dr Madden. “They cut out junk food, which is good, but then they cut out dairy and other food groups, then become restrictive about where and when they eat. For instance, they might stop eating with their parents. They’ll say, ‘I’ve already eaten Mum’.”

In many sufferers, this attitude to food will be combined with extreme exercise, which might similarly start out as a healthy amount but can end up with hundreds of sit-ups a day, for example.

Other signs to watch for include the sufferer spending a lot of time alone, hiding their food, spending a long time in the bathroom, taking laxatives, vomiting after meals or wearing loose clothing to hide their bodies. They might also be finicky with food, pushing it around the plate or cutting it up into tiny pieces.

How serious is anorexia?

It couldn’t be more serious – it’s a deadly illness. Parents can’t tackle the problem alone because sufferers will actively work against those trying to help them. Apart from dramatic weight loss, not eating can impair the body’s ability to maintain a normal temperature and heart rate. It can result in brain shrinkage, depression, anxiety disorders, fractures due to weakened bones, and a slowing of normal development. “We have a lot of patients who are growth-retarded,” says Dr Madden. “They haven’t progressed through puberty due to their low weight. And half of them have quite depressive symptoms.”

What can you do?

If you believe your daughter is developing an obsession with food, the earlier you deal with it, the better. It doesn’t sound as if she’s displaying any of the typical behaviours, so she’s probably safe, but you’ll need to reassure yourself. Your own balanced attitude to weight and health seems helpful, and it’s probably best to continue as you are. If your daughter is obsessed with her weight, she’ll know how much she weighs. Why not ask her?

Apart from being alert to the warning signs, it could be helpful just to talk with your daughter about her feelings – about herself, other people and the world. All children need help to recognise their emotions and to name them in order to express them – it’s a basic tenet of good emotional health. Encourage her to talk for herself, and remain open and non-judgemental about what she shares. A mother naturally wants to protect her child and foster a positive self-image. It might be tempting to dismiss her concerns, but if she says, “I feel fat and ugly”, you’re going to have to accept that and just encourage her to talk more. It won’t help if you say, “That’s ridiculous, you’re gorgeous”, because she’s unlikely to really hear that.

What does she mean by “I feel fat”? How does feeling like that make her feel? Ashamed? Unattractive? Embarrassed? Not good enough? Ask her what she’d like to do about her poor self-image and how you can help. Perhaps she’d like to talk to a nutritionist, take swimming lessons or join a gym or tennis club. If you are still afraid that your daughter may develop an eating disorder, seek help from specialists such as those listed on The Butterfly Foundation’s website (see below).

When treatment is needed

Various approaches exist to treating eating disorders. One that’s having some success is ‘Maudsley family therapy’. It begins with the nutritional rehabilitation of the child – ‘re-feeding’ – followed by the positive involvement of family. The aim is to remove guilt and blame, and to encourage parents and children to work together against their common foe.

Dr Madden, whose team uses Maudsley family therapy, says it’s hard for the parents at first, but in the end they feel far more confident about their parenting. “We focus on the here and now and what works to get the young person better. We’re not looking for a cause or what’s gone wrong,” he says. “The reality is that these kids feel extra pressure but keep their feelings to themselves. They also tend to put their own needs second.” Since adopting Maudsley principles, the Westmead team has found that recovery time has been substantially reduced – from five or six years to between 18 months and two years.

Where to get help

The Butterfly Foundation is one of many organisations dedicated to raising awareness about eating disorders. It was established in 2002 by Claire Vickery, a mother of two daughters who suffered from eating disorders. She set up the foundation following a six-year struggle to find appropriate care for her children. It doesn’t provide counselling or treatment services but offers information on where sufferers can get help and how you can make a donation to the organisation. You can visit its website at www.thebutterflyfoundation.org.au .

Helpful books

• Help Your Teenager Beat An Eating Disorder by James Lock and Danielle Grange (The Guildford Press, 2005)

• Eating with Your Anorexic by Laura Collins (McGraw-Hill, 2004)

• When Food is Love: Exploring the Relationship Between Eating and Intimacy by Geneen Roth (The Penguin Group, 1992)

• Life Inside the ‘Thin’ Cage: A Personal Look into the Hidden World of the Chronic Dieter by Constance Rhodes (WaterBrook Press, 2003)

Helpful websites

www.something-fishy.org
www.edsurvivalguide.com

Got a problem? Ask Carolyn!

Get in touch with our relationship expert by emailing cparfitt@fpc.com.au, or alternatively you can write to her at:

Relate/Notebook Magazine
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Alexandria, NSW, 2015

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