On Healing 3/23/2009: Parents worry about daughter’s diet

Eating disorders affect 10 million women, and the numbers increase each decade. But when someone with an eating disorder wrestles for control, other family members often feel out of control. In my Web chat tomorrow, we will be joined by Beth Weinstock, a psychologist in Narberth who specializes in treatment of trauma and eating disorders. Today’s Voices in the Family, at noon on WHYY-FM (90.9), will also focus on eating disorders and current research.

Dear Dan,
My husband and I have concerns about my adolescent daughter and were hoping you could steer us. Our daughter’s diet has become increasingly restrictive and rigid over the last two years as she always seems to be trying to lose more weight. Before all this, she seemed to have a good self-image and self-esteem. She is a heavily involved student and athlete, with lots of friends.

I have underlying fears, as I grew up with a sister who was both anorexic and bulimic for all of our shared teen years. I lived through the lies she told and the denial of my parents until she was almost dead, twice. I need to make sure that we intervene if it is appropriate. So if you can tell me if any of the things I describe seem like red flags, please help. If not, I hope you can suggest ways to get additional advice.

Lately she has been lying, and all of our efforts to stop this have been unsuccessful. Usually the lies are about food; and when we confront her with questions, she gives us poor explanations.

When does this become a concern? I will not fail to act if needed. I was always told that eating disorders are steeped in the need to gain control over a portion of one’s life. When does this become about “control”?
– Concerned Mother

You are right, eating disorders are always about control. Your daughter is trying to control her body, her life, and possibly her mind. But if you are locked in a struggle with her, then you are trying to control from the other side.

When I specialized in addiction many years ago, I watched these same power struggles. And what I learned was that the family thought the problem was alcohol and the alcoholic thought the problem was the family!

Your daughter may well have an eating disorder. They affect one in 20 women between the ages of 18 and 30. Features associated with eating disorders are perfectionism, depression, and low self-esteem. And if your daughter is being deceitful, it’s unlikely she feels good about herself.

One of the biggest red flags is the genetic one, since research suggests a genetic link. She may have an eating disorder, and any parent with a child like that shares the same sense of being out of control when the stakes feel like life and death.

Most parents’ emotions range from terror to helplessness to rage and back again. But because of your history, you have an even more complicated reaction. As you describe life with your sister, I wonder if you experienced trauma as a child and now as you endure this nightmare with your daughter, you may be reliving your childhood.

So, clearly your daughter has a problem, but so do you. And I would guess both issues revolve around control, anxiety, and helplessness. It also seems that family communication has broken down behind all of the anxiety.

So let’s not make this about food or whether she is being truthful. Let’s start by assuming this is a family problem and everyone is contributing and has some role to play in resolving it. That way we get away from issues of shame, blame, and power struggles.

Ultimately, treatment of eating disorders involves group and individual therapy. The work is hard and the illness is chronic, so there is a chance this will not simply be treated and go away.

But your daughter is not interested in treatment right now. So my recommendation is to find a good family therapist who specializes in eating disorders. And go as a whole family understanding that everyone needs help to make changes in the way your family is functioning.

Once your daughter understands that she is not being blamed but that everyone is looking at him or herself, she may well develop a different perspective on her own life.
– Dan

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