We need YOUR perspective

I received an email from a mom today whom I'll call Tracy.  Her teen is 18 months out of treatment and is doing okay, although weight is not at a level for proper hormonal activity and there are still some eating disordered tendencies: “…Drink[ing] diet soda, measure[ing] out … cereal, wary of fat/carbs, dessert [only] occasionally ...”

It was evident from Tracy's letter that she was aware that her child was not yet fully recovered. I felt fortunate that the Gurze e-news had just arrived. Coincidentally they included a response to a question about healing and provided a list of possible indicators of wellness.  I shared this with Tracy suggesting that it may give her an indication of how close her child may be to "healed":

(Every issue of the newsletter Eating Disorders Today contains a question and answer column, "Nutrition Hotline," by Diane Keddy, MS, RD. This question appeared in the Spring 2007 issue)1

Q. How will I know when or if I am recovered?
A. Experts cannot agree on a set of criteria for recovery from anorexia, bulimia, binge eating disorder, or eating disorders not otherwise specified. However, factors to be considered include:
•Maintaining a healthy body weight with normal menstruation (for females)
•Maintaining a healthy body weight with normal testosterone levels (for males)
•Normal laboratory data including protein and iron levels
•The ability to eat any food without guilt, anxiety, or the need for compensatory behavior (i.e., purging, restricting, or exercising)
•The ability to use alternate coping mechanisms when stressed
•The ability to eat when hungry and stop when comfortably full
•The ability to eat a varied diet with 3 meals and 1–3 snacks per day
•Being able to live a joyful life where eating disorder thoughts and behaviors do not interfere with enjoyable activities
•Being able to eat restaurant meals and feel comfortable
•Accepting that no body is perfect and having a positive body image

Tracy asked if she should “just be happy” with where her child was in the healing journey or if there was something more she could do.  What concerned me most about all that Tracy shared was that her child was about to transition from high school to college:  a time when many eating disorders either begin, return, or worsen.

I asserted that it is difficult to know what to do or how to respond in such a situation.  Tracy knows her child best.  Because she asked for advice I shared with her what I thought I might do if my daughter Andrea had been in the same situation:

I would line up a therapist skilled in eating disorder issues as well as a dietitian skilled in intuitive eating who were both willing to work with Andrea. I would then sit down with my daughter and share my concerns.  I would talk about how those who suffer or have suffered with eating disorders need to be especially conscientious during transitions in their lives such as: high school to college; college to profession; single hood to marriage; childlessness to parenthood; young adult to mid-life; mid-life to senior, and any other momentous transition or life event.

In this scenario, prior to allowing Andrea to leave for college, I would want her to continue her doctor's visits but to also begin seeing the therapist and dietitian. It would be important that Andrea exhibit the ability to gain the weight needed to support menstruation as well as increase her ability to eat food without guilt, anxiety (no measuring or tabulating calories), or the need for compensatory behaviors.  If these markers of health were not evident by September, I would tell Andrea that we would need to defer the start of college until they had become evident.

Most importantly, I would want to initiate family therapy so that we could be working on improving the dynamics between us.  If needed, I would get help for myself around whatever issues I may still have concerning weight, body, eating and food as I would want to model for my daughter the self-love and body acceptance I had asked of her.

Those were my suggestions, but I know that mine is just one perspective.  I invite all who read this blog to respond with their own suggestions and perspectives.  No one of us has all the answers, but we all benefit from hearing each other's thoughts.  I look forward to hearing yours.

Blessings until next time,

Doris

1 Diane Keddy, MS, RD, FAED, Nutrition Consultant, Newport Beach, CA, dkeddy5555@aol.com (949) 552-2385

Comments

[Harriet]

I agree about not letting anything slide. I would add that parents should trust their intuition about what's going on with their daughter. Every time I've had the feeling that something wasn't quite right, I have been proven correct.

I would focus on food and eating and skip the therapy, though. I don't see it as effective at all, even with a good therapist (and most are not so good). Therapy is most useful as a support during the really tough days of re-feeding, I think. I don't believe eating disorders are psychological illnesses; I believe strongly that they're biological illnesses that a sufferer cannot "choose" her way out of. Eating enough calories frequently enough during the day is the best therapy for anorexia.

[allie]

I think one of the most important things to do is not let anything slide. When my daughter makes a questionable comment about food I am diligent to share with her nutritionist. Sometimes I fear that I am being over-protective, but the I remember how things were 4 years ago, and realize that my daughter still needs my guidance and the support of her ED team.

[Lynda]

This is some of the most honest and helpful advice I have ever heard. It's a blessing that you are able to share what you have learned in such a helpful way.