Posted on 12/17/2004 9:25:01 AM PST by John Robertson
My wife and I just got word from my daughter's college that we will be shocked when we see her tonight, when she gets home for Christmas break. We were fairly shocked at Thanksgiving, at the weight she'd dropped. Her personality is off, she has lost her sense of humor, has mood swings, her menstruation has stopped, she can barely sleep. She's eating, but not much. A few granola bars a day, and water. She is not skeletal, certainly, but way too thin, and her "spark" is gone. She may or may not be taking some vitamin supplements we got her. Though she is not officially diagnosed, she exhibits enough signs of the syndrome that saying, "Let's wait and see" is simply major denial. She's got it. My wife is scrambling right now, looking for the right local program or specialist in our area (Pittsburgh) to deal with her. The situation is dire.
GREAT INPUT.
Certainly FOCUS ON THE FAMILY is a great resource.
. . . . I think I'll stop there.
God's best to you.
God bless.
My grandmother had it in her sixties. I had it at college, as did two of my first cousins on the same side of the family.Everyone looked up to my grandmother as having incredible discipline and self control, without seeing what was really going on.
Why someone gets anorexia is very complicated - in my case it had to do with parents on the verge of divorce,(Mom had extramarital affairs) and me being pressured into the role of peacemaker between them. I was also expected to be the good girl and not express rage. In order to get rid of the rage, I focused on trying to make my body disappear. Anorexics are perfectionist and have little sense of self and feel they have no control over their own life. Having an iron-clad control over one's body gives one the illusion of being in one's control over the unpredictability of life.
Everyone's case is a little different but there are similarities. I wish my parents had sent me to a therapist but they were too busy with their own lives. Good for you to be very concerned.
John,
Stop all sugar including fruit and sharply limit the starch of any type - including grains etc. Check her medications for any that cause anorexia. Get a good doctor and don't trust the first you go to.
Read my post 91.
Although the media is a real factor, if a girl has a great self-esteem, she is not going to fall prey to what the magazines tell her. If you raise a child truly knowing their self-worth, they aren't going to try and seek approval from strangers and friends as much through drinking, drugs, dieting, or otherwise.
Being a first born daughter, (most anorexics are), they are held in the position of the siblings to be an example. They also have had extra pressure from their parents as a firstborn to achieve and usually been treated more strictly than their other siblings.
It's VERY important to let the girl know she is beautiful and accepted no matter what. Because they are usually over-achievers, nagging them to do better and achieve more could be the worst thing you can do. Encourage them to sit in a room and relax and do nothing. (I wouldn't even allow myself to sit for 5 minutes...I felt guilty...I had to always be achieving...) Let her know that if she fails, she is loved no matter what and that "doing their best" is good enough even if it isn't perfect. Relaxing and just "being" is just as important as achieving.
do she eat beef (proteins, etc.) ...
gotta get some iron and protein in her diet.
Too many diets/eating habits are screwed up today.
People need a balance diet that contains carbs, proteins, and fat.
Try and get her to eat a variety of foods (get that girl a T-Bone) ... and try to get her to take vitamins regularly.
I know people who went on a vegan diet and looked like they were walking death (and got sick all of the time). Thankfully, they abandoned the diet.
Also ... as others mentioned ... you may need to get her closer to home ... to monitor the situation ... unfortunately, that may not go over well with her.
and actually be careful with certain anti-depressants ... as some suppress appettites ... others do not (some I think increase the appettite).
I would suggest that you ask the college to give you a health leave of absence, so your daughter can return if that seems advisable.
Getting help isn't easy, because not all health professionals can be trusted. I would certainly look around, get second opinions, and take care that you find a professional who will be supportive of your daughter's relation to her family. I agree that this probably isn't something that you can tackle yourself, but parental love and care can be important.
It could be some kind of vegan influence that she picked up. It also probably relates to the popular culture and to all those skinny, drugged-out models who have become the accepted version of female beauty.
It's important to deal with this promptly, because the longer it lasts, the more difficult it is to recover from.
SHARP, WISE, IMPORTANT, EFFECTIVE, BEEN-THERE ADVICE
as before.
Thanks.
Amen, they actually cause anorexia in many cases
John: My daughter was first diagnosed with anorexia about 18 years ago. For a time we thought we were going to lose her. One of our friends lost her daughter to the illness. It took many years, but slowly she came around with professional, eating disorder specialists and a good, understanding internist to treat her medical conditions. As mentioned above, it is not about the weight or the food. Equally important is for you and your wife to go into a group counseling session such as those offered by the American Anorexia/Bulimia Association. I'm sure there is a local chapter nearby. You can google search them. A word of caution: do not engage psychologists, psychiatrists or others that do not restrict their practice to eating disorders.
From:
http://www.psych.org/psych_pract/treatg/pg/eating_revisebook_2.cfm?pf=y
I. EXECUTIVE SUMMARY
A. Coding System
Each recommendation is identified as falling into one of three categories of endorsement, indicated by a bracketed Roman numeral following the statement. The three categories represent varying levels of clinical confidence regarding the recommendations:
[I] recommended with substantial clinical confidence.
[II] recommended with moderate clinical confidence.
[III] may be recommended on the basis of individual circumstances.
B. General Considerations
Patients with eating disorders display a broad range of symptoms that frequently occur along a continuum between those of anorexia nervosa and bulimia nervosa. The care of patients with eating disorders involves a comprehensive array of approaches. These guidelines contain the clinical factors that need to be considered when treating a patient with anorexia nervosa or bulimia nervosa.
1. Choosing a site of treatment
Evaluation of the patient with an eating disorder prior to initiating treatment is essential for determining the appropriate setting of treatment. The most important physical parameters that affect this decision are weight and cardiac and metabolic status [I]. Patients should be psychiatrically hospitalized before they become medically unstable (i.e., display abnormal vital signs) [I]. The decision to hospitalize should be based on psychiatric, behavioral, and general medical factors [I]. These include rapid or persistent decline in oral intake and decline in weight despite outpatient or partial hospitalization interventions, the presence of additional stressors that interfere with the patient's ability to eat (e.g., intercurrent viral illnesses), prior knowledge of weight at which instability is likely to occur, or comorbid psychiatric problems that merit hospitalization.
Most patients with uncomplicated bulimia nervosa do not require hospitalization. However, the indications for hospitalization for these patients can include severe disabling symptoms that have not responded to outpatient treatment, serious concurrent general medical problems (e.g., metabolic abnormalities, hematemesis, vital sign changes, and the appearance of uncontrolled vomiting), suicidality, psychiatric disturbances that warrant hospitalization independent of the eating disorders diagnosis, or severe concurrent alcohol or drug abuse.
Factors influencing the decision to hospitalize on a psychiatric versus a general medical or adolescent/pediatric unit include the patient's general medical status, the skills and abilities of local psychiatric and general medical staffs, and the availability of suitable intensive outpatient, partial and day hospitalization, and aftercare programs to care for the patient's general medical and psychiatric problems.
2. Psychiatric management
Psychiatric management forms the foundation of treatment for patients with eating disorders and should be instituted for all patients in combination with other specific treatment modalities. Important components of psychiatric management for patients with eating disorders are as follows: establish and maintain a therapeutic alliance; coordinate care and collaborate with other clinicians; assess and monitor eating disorder symptoms and behaviors; assess and monitor the patient's general medical condition; assess and monitor the patient's psychiatric status and safety; and provide family assessment and treatment [I].
3. Choice of specific treatments for anorexia nervosa
Goals in the treatment of anorexia nervosa include restoring healthy weight (i.e., weight at which menses and ovulation in females, normal sexual drive and hormone levels in males, and normal physical and sexual growth and development in children and adolescents are restored); treating physical complications; enhancing patients' motivations to cooperate in the restoration of healthy eating patterns and to participate in treatment; providing education regarding healthy nutrition and eating patterns; correcting core maladaptive thoughts, attitudes, and feelings related to the eating disorder; treating associated psychiatric conditions, including defects in mood regulation, self-esteem, and behavior; enlisting family support and providing family counseling and therapy where appropriate; and preventing relapse.
a. Nutritional rehabilitation/counseling
A program of nutritional rehabilitation should be established for all patients who are significantly underweight [I]. Healthy target weights and expected rates of controlled weight gain (e.g., 2-3 lb/week for most inpatient and 0.5-1 lb/week for most outpatient programs) should be established. Intake levels should usually start at 30-40 kcal/kg per day (approximately 1000-1600 kcal/day) and should be advanced progressively. This may be increased to as high as 70-100 kcal/kg per day during the weight gain phase. Intake levels should be 40-60 kcal/kg per day during weight maintenance and for ongoing growth and development in children and adolescents. Patients who have higher caloric intake requirements may be discarding food, be vomiting, be exercising frequently, have increased nonexercise motor activity (e.g., fidgeting), or have truly higher metabolic rates. Vitamin and mineral supplements may also be beneficial for patients (e.g., phosphorus supplementation may be particularly useful to prevent serum hypophosphatemia).
It is essential to monitor patients medically during refeeding [I]. Monitoring should include assessment of vital signs as well as food and fluid intake and output; electrolytes (including phosphorus); and the presence of edema, rapid weight gain (associated primarily with fluid overload), congestive heart failure, and gastrointestinal symptoms, particularly constipation and bloating. Cardiac monitoring may be useful, especially at night, for children and adolescents who are severely malnourished (weight <70% of the standard body weight). Physical activity should be adapted to the food intake and energy expenditure of the patient.
Nutritional rehabilitation programs should also attempt to help patients deal with their concerns about weight gain and body image changes, educating them about the risks of their eating disorder and providing ongoing support to patients and their families [I].
b. Psychosocial interventions
The establishment and maintenance of a psychotherapeutically informed relationship is beneficial [II]. Once weight gain has started, formal psychotherapy may be very helpful. There is no clear evidence that any specific form of psychotherapy is superior for all patients. Psychosocial interventions need to be informed by understanding psychodynamic conflicts, cognitive development, psychological defenses, and complexity of family relationships as well as the presence of other psychiatric disorders. Psychotherapy alone is generally not sufficient to treat severely malnourished patients with anorexia nervosa. Ongoing treatment with individual psychotherapeutic interventions is usually required for at least a year and may take 5-6 years because of the enduring nature of many of the psychopathologic features of anorexia nervosa and the need for support during recovery.
Both the symptoms of eating disorders and problems in familial relationships that may be contributing to the maintenance of disorders may be alleviated by family and couples psychotherapy [II]. Group psychotherapy is sometimes added as an adjunctive treatment for anorexia nervosa; however, care must be taken to avoid patients competing to be the thinnest or sickest member or becoming excessively demoralized through observing the difficult, chronic course of other patients in the group.
c. Medications
Treatment of anorexia nervosa should not rely on psychotropic medications as the sole or primary treatment [I]. An assessment of the need for antidepressant medications is usually best made following weight gain, when the psychological effects of malnutrition are resolving. These medications should be considered for the prevention of relapse among weight-restored patients or to treat associated features of anorexia nervosa, such as depression or obsessive-compulsive problems [II].
4. Choice of specific treatments for bulimia nervosa
a. Nutritional rehabilitation/counseling
Nutritional counseling as an adjunct to other treatment modalities may be useful for reducing behaviors related to the eating disorder, minimizing food restriction, increasing the variety of foods eaten, and encouraging healthy but not excessive exercise patterns [I].
b. Psychosocial interventions
A comprehensive evaluation of individual patients, their cognitive and psychological development, psychodynamic issues, cognitive style, comorbid psychopathology, patient preferences, and family situation is needed to inform the choice of psychosocial interventions [I]. Cognitive behavioral psychotherapy is the psychosocial treatment for which the most evidence for efficacy currently exists, but controlled trials have also shown interpersonal psychotherapy to be very useful. Behavioral techniques (e.g., planned meals, self-monitoring) may also be helpful. Clinical reports have indicated that psychodynamic and psychoanalytic approaches in individual or group format may be useful once bingeing and purging are improving. Patients with concurrent anorexia nervosa or severe personality disorders may benefit from extended psychotherapy.
Whenever possible, family therapy should be considered, especially for adolescents still living with parents or older patients with ongoing conflicted interactions with parents or other family members [II].
c. Medications
For most patients, antidepressant medications are effective as one component of an initial treatment [I]. Selective serotonin reuptake inhibitors (SSRIs) are currently considered to be the safest antidepressants and may be especially helpful for patients with significant symptoms of depression, anxiety, obsessions, or certain impulse disorder symptoms or for those patients who have had a suboptimal response to previous attempts at appropriate psychosocial therapy. Other antidepressant medications from a variety of classes can reduce the symptoms of binge eating and purging and may help prevent relapse among patients in remission.
While tricyclic and monoamine oxidase inhibitor (MAOI) antidepressants can be used to treat bulimia nervosa, tricyclics should be used with caution for patients who may be at high risk for suicide attempts, and MAOIs should be avoided for patients with chaotic binge eating and purging.
Emerging evidence has shown that a combination of psychotherapeutic interventions and medication results in higher remission rates and therefore should be considered when initiating treatment for patients with bulimia nervosa [II].
I agree.
While there are likely good exceptions, the problem is complex enough and tricky enough it is best to have professionals who treat nothing but this problem.
Prosac and Zoloft have wreaked havoc with two people very close to me.
Please make sure that it is anorexia. A throrough checkup is in order to rule out other problems - among them is substance abuse. This is a hard thing to say, but people who use methamphetamine also exhibit those same symptoms. Meth users are frequently overachievers who think they just need a little extra "hit" to help them get things done.
Depression, and certain other medical conditions can also cause anorexia-like symptoms.
Whatever the cause, make sure that she gets a complete examination...
Get expert advice.
Excellent advice. Physiological causes must be ruled out first and any responsible therapist engaged for this disorder will do so first and foremost.
Good advice.
However, given the father's narrative and his typical sharpness . . . and the odds about such factors . . . I'd say the odds were extremely high that there's the usual complex anorexia going on here.
Your family is in my prayers.
Personally, I'd seek a psychiatrist specializing in eating disorders that knows how to diagnose the
underlying cause, such as a maladaptive response to [fill in the blank].
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.