An Anorexia Primer

Professionals evaluating an eating-disordered teen
may be "helping" in ways they never expected

by Laura Collins


[The following is from "Eating with Your Anorexic: How My Child Recovered Through Family-Based Treatment and Yours Can Too" by Laura Collins; foreword by James Lock, M.D., Associate Professor and Director of the Child and Adolescent Eating Disorder Program at Stanford (McGraw-Hill, February 2005). This excerpt is from Chapter 9, "Folks, Don't Try This at Home"]

Finding a professional was not working out like it was supposed to. The prescription often accepted as gospel in eating disorder literature is the "team approach." In the fantasy world of these manuals, the family doctor notices the problem during a routine checkup and sits the parent down for a difficult talk. The doctor then refers the grateful and contrite parent to a therapist nearby who has extensive experience with eating disorders. The therapist meets with the young person, then assembles a team that includes the physician, a dietician, a psychiatrist, and -- if cooperative -- the parents. In that Disneyland of Eating Disorders Treatment, the team meets regularly to discuss the patient and coordinate treatment. The team is very professional and well qualified to understand and guide the family and patient. Everyone agrees on the method and prognosis and treatment goals. Everyone looks forward to a full recovery and their invitations to be on educational panels entitled "Success Stories."

But I live in the real world. Here where I exist, the magic team approach happens in rare and blessed confluence, which was no place I could get to. In the real world, the doctor isn't comfortable with the topic and your anorexic does not want to be "treated" (perhaps it sounds too much like a dessert). In the real world, you have to choose a provider from your insurer's list, your child's coaches just want their star player to keep playing, your husband wants the kid to "snap out of it," your other kids are starting to act funny too, the therapists you consult don't tell you anything, and your anorexic is laughing at you.

Meanwhile, during diagnosis and assessment appointments, your anorexic -- who is listening, not just providing data -- is tutored in his or her craft:

"Do you purge?" they ask with both eyes on the questionnaire, pen poised.

"Do you stick your finger down your throat to make yourself vomit?"

"What is YOUR ideal weight?"

"Do you use over-the-counter diet pills or diuretics?"

"Did you drink a lot of water before your weigh-in?"

"How many meals did you skip today? Only two? Is that all?"

Why not offer a primer? An anorexic gets so many of these questions and fills out so many questionnaires, you might as well just make a credit course out of it.

Meanwhile, although your anorexic is clearly growing more bizarre, no one examines her medically. None of the psychologists, psychiatrists, physical therapists, knee surgeons, coaches, or even our pediatrician ordered more than a perfunctory physical exam. No blood test or CAT scan. No one ruled out intestinal parasites, thyroid disease, a brain tumor, PANDAS, gallstones, chronic adrenal insufficiency, celiac disease, Addison's disease, diabetic gastroparesis, or any other of the kinds of illnesses misdiagnosed as anorexia that would have horrified me before, but at different points along the line might have sounded like welcome diagnoses.

They just kept weighing her.


[Laura Collins is the mother of two, wife of one, and a freelance journalist. She can be reached at Laura@eatingwithyouranorexic or at www.eatingwithyouranorexic.com.]

Reprinted from "Eating with Your Anorexic: How My Child Recovered Through Family-Based Treatment and Yours Can Too" by Laura Collins; foreword by James Lock, M.D., Associate Professor and Director of the Child and Adolescent Eating Disorder Program at Stanford (McGraw-Hill, February 2005). © 2005 by Laura Collins.)