Family Almanac: Treating daughter's eating disorder must involve entire family

Friday, March 5, 2010

My lovely daughter, now 24, is bright and personable and she graduated with excellent grades from a private high school and a well-known college, but for the past eight years she has suffered from anxiety, has been in therapy and has struggled with an eating disorder.

She now works full time at a job she loves, shares an apartment with a college friend and lives near us, so we see her often. She is close to us and her siblings and gets support at home and at work, but she seems more anxious and weighs less than she ever has.

We have discussed residential treatment since the beginning, but her doctors thought she would recover and it was never something she wanted to do. It is heartbreaking to watch her decline and we are feeling more and more desperate. How can we help her get over anorexia nervosa?

Any parent of an anorexic child would be desperate, because anorexia nervosa is a dangerous illness with the highest death rate of any psychiatric disorder -- if it is, indeed, a psychiatric disorder.

Doctors first documented AN, as it's called, 125 years ago, and knew that it usually struck in the early or mid-teens and that nine out of 10 anorexics were girls, but they didn't know the cause. Nevertheless, they called it a psychiatric illness, put the blame on parents and said that only doctors could make it go away.

Now doctors still don't know the cause, but they aren't blaming parents anymore because most of them think AN is a biological illness because it runs in families; because anorexics often have relatives who are depressed, bipolar or have mood disorders; and because they are usually anxious, like to be in control, are perfectionists, have a shaky self-confidence and are fearful.

Most people with these characteristics can diet easily, but they switch a trigger in others. Suddenly they become terrified of getting fat and they remain terrified, even when their heart rate slows down, their blood pressure drops, their energy sinks, their minds get foggy and their arms and legs look like twigs. None of that matters. They simply can't see themselves as others see them.

With help, your daughter can turn off that trigger, but she'll probably turn it off sooner if you can find a Maudsley-certified therapist who uses family-based treatment (FBT), which was developed to treat anorexic teenagers in London and is used at some of the best U.S. hospitals.

Studies show that anorexics in this intensive outpatient program can usually overcome AN in six to 12 months -- instead of several years -- and that 80 to 90 percent of them will still be fine five years from now. This is a much better outcome than patients have in other therapies, perhaps because parents are part of the treatment, as parents of sick children always should be.

In this three-phase program, the therapist will first assess your family and then teach your daughter how her dizziness, her cold hands and feet, her depression and irritability are actually signs of starvation, although she won't believe it at first. At the same time she will teach you how to use sympathy and compassion -- but not criticism -- to get your daughter to eat three meals and three snacks a day, and to sit beside her until she does, even though she will object vociferously while you're firmly repeating the Maudsley mantra: "Starvation is not an option."

When your daughter begins to eat more and gain some weight, you'll move into phase 2. Here the therapist will encourage you to give your daughter more control over her eating, and when she is about 95 percent of her ideal weight -- and isn't trying to starve herself anymore -- you'll move into phase 3, where she'll help your family correct any lingering problems you might have. After living with AN for eight years, you're bound to have a few.

If FBT doesn't help your daughter, however, you'll have to seek residential treatment. You'll have no choice.

To learn even more about AN than you already know, read "Demystifying Anorexia Nervosa" by Alexander R. Lucas (Oxford, $15) and "Life Without Ed" by Jenni Schaefer and Thom Rutledge (McGraw Hill, $17), a big favorite with recovering anorexics.

And for more about FBT, go to and read "Help Your Teenager Beat an Eating Disorder", by James Lock and Daniel leGrange, (Guilford; $18); "Skills-Based Learning for Caring for a Loved One With an Eating Disorder" by Janet Treasure, Grainne Smith and Anna Crane (Routledge, $25) and "My Kid Is Back" by June Alexander and leGrange (Routledge, $18), which comes out in May.

Marguerite Kelly is a freelance writer. Questions? Send them to or to Box 15310, Washington, D.C. 20003.

© 2010 The Washington Post Company