Eating Disorders:
Don't Dismiss Signs of an Eating Disorder
BOSTON (Boston Globe) — In an episode late last year of ABC's "Once and Again," a visiting grandmother spots in two minutes what parents haven't noticed: Their teenage daughter has an eating disorder.
The parents in the show are caring, connected, and divorced. That last fact provides the plot with convenient room for finger-pointing - "You weren't paying attention!" - but it makes us squirm. Who's to say we would do any better by our child?
Of the 5 million to 8 million women in the United States who currently suffer from an eating disorder, 50 percent will fully recover without fear of recurrence. That's the good news, says psychologist Catherine Steiner-Adair, director of education at the Harvard Eating Disorder Center. Thirty percent, however, will have only a partial recovery, meaning they are still at risk; 20 percent will always struggle with it, and five 5 percent of those, or 50,000 young women, will die. Eating disorders are on the rise for boys, too, but statistics are not yet available.
Anorexia nervosa, an aversion to eating that typically affects women 14 to 25 but can begin as young as 8, has the highest mortality rate of any psychiatric illness. Along with bulemia nervosa, a related condition of binge eating and purging, anorexia is on the rise. A Public Broadcasting Service NOVA program last month, "Dying to be Thin," called it an "alarming epidemic."
This is a disease that needs to be caught early, when it's disordered eating, not an eating disorder.
What's both curious and frightening is that it is relatively easy to spot, yet parents tend to ignore what we see in the hope that it will go away, or we unwittingly cheer our daughter on. It's not just girls, after all, who have bought into the cultural stereotype that being thin spells beauty, success, and happiness.
"What we need to pay attention to is dieting. When a 10-year-old says she wants to go on a diet, we should treat it as seriously as if she asked to go on birth control," says psychologist Craig Johnson, director of the eating disorders program at Laureate Psychiatric Hospital in Tulsa, and president of Eating Disorders Awareness and Prevention, a nonprofit education organization.
Ignore the idea that dieting is an all-American activity or that it signals that your daughter is taking pride in how she looks. Even if you think she's pudgy, and no matter how much better she may look or behave as a result of it, dieting is your daughter's worst enemy.
"It tells you something is wrong," says social worker Susan Willard, director of the eating disorders program at DePaul-Tulane Behavioral Health Center in New Orleans.
What's wrong may be that she got a B instead of an A, or that she wasn't picked for first violin. It may also be, however, that she has an unrealistic perception of how she needs to look.
By 7, the typical girl thinks there is a right and wrong way to look. Steiner-Adair calls this disordered thinking.
"Even little girls get together and dissect body parts, generally starting with 'good' or 'bad' hair," she says. By 10, the meanest insult one girl can hurl at another is, "You're fat." Older girls bond through a litany of body-bashing: "You don't look nearly as fat as I do!" "Yes I do!"
Unfortunately, no matter what the cause of their misery, girls jump to the conclusion that the solution is to be thin. "That's what the culture has fed her," says Johnson. "And if her mom is body-conscious or diets, it's even more ingrained."
Feeling emotionally wobbly, the focus on her body and what she eats restores a sense of control and discipline. Unfortunately, even her body is working against her.
"There's a normal weight gain for all girls prior to puberty," says Willard. "It's what enables the body to start producing hormones." She tells parents to help a daughter anticipate this rite of passage, so a girl sees her body not as getting fat, but as getting ready to do the miraculous things only a woman's body can do. Include in the message, she adds, that most girls grow like crazy during and after puberty, so the weight will get redistributed.
The typical 8- to 11-year-old who wants to diet will look for our permission; an older girl probably won't. Either way, dieting can be a precursor to an eating disorder, says therapist Carolyn Costin, director of Monte Nido Treatment Center in Malibu and author of "Your Dieting Daughter" (Taylor Francis).
"Dieting alters the neuro-chemistry in the body. In some girls, it can trigger the kinds of obsessive-compulsive behaviors we see in alcohol or drug addiction," Johnson says. In other words, there is a genetic component that makes some girls more susceptible to an eating disorder than others. It's for that reason that even girls who are legitimately over-weight should diet only with professional advice.
"Seven girls can gather every week to watch 'Ally McBeal' and talk about dieting and whose thighs are fatter," says Steiner-Adair. "For six of them, it will be fun, a kick. But for the seventh, it could have a contagious effect that leads to a serious bout of bulemia," she says.
The cornerstone of prevention is getting across to young girls the idea that good friends don't bond through shared body loathing, Steiner-Adair says. That's one of the messages of the pilot curriculum she's co-authored for girls 8- to 14, "Full of Ourselves, Advancing Girl Power, Health and Leadership."
Another important message from the curriculum: "If a friend tells you, 'I feel fat,' it's code for, 'Something's bothering me.'" Parents would be wise to heed the same message. "As soon as a girl talks about being fat, even if she's 8, even if she's only 5, pay attention," says Steiner-Adair. Here are some other red flags:
- She wants to be a vegetarian. While this may be a genuine moral conviction for some girls, it's also a socially acceptable way to control what you eat. How to tell the difference? The animal lover will still eat ice cream and cake and peanut butter, and make exceptions for special occasions. The girl who's using it as an excuse will be rigid about foods, get anxious if she's offered the wrong ones and be more concerned about fat content than animal rights.
- She no longer eats favorite foods (hamburger, pizza, french fries). The list of what she won't eat keeps growing.
- She has a dozen reasons why she can't eat: "I'm late for school, I'll grab breakfast there." "I have too much homework to sit at the table for dinner. Save mine, I'll eat later."
- She withdraws from activities she loved but spends more and more time exercising.
Because this is a mercurial time for any girl, it's difficult to determine whether what you're seeing is the sign of a real problem or normal, developmental changes. The trick is to look for patterns and combinations of behaviors, researchers say. The typical 12-year-old, for instance, may change outfits three times before she goes to school because she's struggling with her "look." That's pretty normal, says Steiner-Adair. If she's also pulling back from relationships, however, talks admirably about people who are skinny, pushes her food around her plate one night and has a stomach ache the next, that's a problem.
One tell-tale tip-off, she says, is the girl who bakes her favorite cake but makes an excuse not to eat it.
"She's giving herself a trial," says Steiner-Adair. "She's denying her hunger to feel in control."
Once you start noticing eating changes, keep questions about food to a minimum. It's okay to ask once or twice, "Didn't you used to like meat sauce on pasta?" but not 20 times. "She'll see you as intrusive.", says Steiner-Adair.
Form questions, instead, about what's going on in her head: "You seem stressed and unhappy. Wanna talk?"
When disordered eating is caught early (seek help if you see two episodes in a week, especially if you can connect them to behavioral changes), most girls are able to pull back from it. Steiner-Adair stresses that staying calm is vital.
"Disordered eating feels like a lifeline to a girl. It's the only way she feels in control. If you panic, it could terrify her," she says.
Johnson suggests seeking professional advice yourself before mentioning it to your daughter. Start with your pediatrician. If she isn't helpful (Steiner-Adair says many are under-informed), find a nutritionist or eating disorder specialist.
Willard says, "Whatever you do, don't try to deal with this on your own."
TIPS FOR PARENTS
- Ask your daughter or son why she or he wants to diet. If the answer is about being teased or fitting in, brainstorm solutions but don't talk about size and shape. If the answer is about her or his body, seek help.
- The typical girl gains one-third of her body weight, about 40 pounds, between the ages of 11 and 14.
- Talk even to your 5- or 6-year-old (girls and boys) about media images of women and men and how unrealistic most of them are.
- Educate everyone in your home, including sons, about "weightism," a term coined by Catherine Steiner-Adair to refer to idolizing or demonizing a person based on body shape.
- Eating together as a family each night helps you keep tabs on what she's eating as well as how she's doing emotionally.
- Helpful Web sites:
www.hedc.org
www.4woman.gov/body
www.edap.org
www.PBS.org/NOVA/thin
- If your 5- to 7-year-old is overweight, avoid restricting how much she eats. Instead, have only healthy food at home, engage in physical activities as a family.
- Girls who are perfectionists, anxious to please, and compulsive tend to be most vulnerable to disordered eating.
- A girl who sequesters herself in the bathroom after a meal may be inducing vomiting or using over-the-counter laxatives.
- "I was good today," or "I had a bad day," is code for, "I did/didn't eat any fat."
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