Anorexia nervosa is an eating disorder that is characterized by grossly restricting caloric intake. While not eating or eating insubstantial quantities of food is the most common way that anorexics restrict caloric intake, this can also be achieved by purging-e.g. vomiting or using diuretics, or excessive exercise. Anorexic behavior is most common in adolescent girls and young women between the ages of 13 and 20 and is usually driven by deep emotional pain, a high level of perfectionism, and a desire for a level of control that seems elusive in other areas of life. Contrary to popular belief, it is not simply a reaction to media and cultural messages about thinness and beauty. Anorexia has been around for centuries and has social, familial, and possibly genetic causes.
Anorexia is a stubborn, self-perpetuating eating disorder that the sufferer typically works hard to hide; because of this, it can progress undetected to a point that is physically dangerous and even life threatening. With early detection and loving, well-informed intervention, however, anorexics can heal both physically and emotionally. Knowing the signs of anorexia and how to effectively intervene are critical to helping a loved one recover from this insidious, often deadly, disorder.
How do you know? Signs of Anorexia.
Of course, the main sign and symptom of anorexia is the avoidance of food accompanied by rapid weight loss. But anorexics typically exhibit a high level of denial and a strong commitment to personal control. Because of this, they work hard to mask behaviors that might gain the attention of loved ones. It is terribly painful and frightening to see our loved ones suffer, so parents, siblings, and friends often miss the signs of anorexia because of their own high level of denial. Some things to look for in addition to obvious weight loss and restricted eating include:
- Obsessive exercise
- Wearing thickly layered or baggy clothes (hides weight loss)
- Claims of not being hungry at meal time accompanied by excuses that cannot be confirmed such as, “I had a late lunch,” “I’m going to eat later,” or “I’ve been snacking all day”
- Skipping meals
- Moving food around on the plate (makes it look like food has been eaten)
- Eating unusually small quantities
- Distorted body image-e.g. complaining of being fat even when not fat or losing weight
- Signs of body obsession including frequently weighing oneself, looking in the mirror, talking about weight excessively, and critiquing one’s own body
- Eating only low calorie foods
- Taking meticulous food notes (e.g. a detailed food journal)
- Signs of malnourishment including bruises, hair loss, grey skin, difficulty sleeping, sore throat, complaints of coldness, swollen glands, and dizziness
- Evidence that diuretics or laxatives are being used
If you suspect that your daughter is suffering from anorexia, it is important to be honest with yourself and with her about your concerns and to know when to seek outside help.
What can you do?
Because anorexia can be so frightening for a parent or loved one, it is easy to communicate concerns out of fear, desperation, a desire to control, or even anger. It’s also common to want to monitor, point out, or control her problem behaviors. These strategies will tend to create defensiveness, anger, shame, and increased secrecy, so they’re not effective ways of approaching an anorexic young woman.
Instead, create a safe and private space to express your concerns. As scary as it can be to communicate such sensitive observations, share your concerns calmly and clearly, including specific examples of the behaviors that concern you. Offer your observations gently and let your daughter know that you are there to listen. Try to express yourself only using the first person, e.g. “I am concerned by what I’m seeing.” This is much less threatening and shaming than using “you” language, such as “you are not eating enough,” or “you need to change. “ If she initially resists your input or gets angry, do your best not to react in turn. Because her anorexia is a way of acting out extremely painful emotions, it’s likely to trigger fear and reactivity when you first bring up your concerns. Give her some space, let her know you’re still available to talk, and don’t give up. While it won’t help to badger your daughter, it’s important return to the conversation at a later time when things have cooled down and you’ve both had some space.
If your daughter will comply, a trip to the doctor’s office can help identify the extent and nature of her problem. Your physician can help determine if it is indeed anorexia and if there are any co-occurring physical or psychological issues that require treatment. When anorexia progresses to a certain point, hospitalization may be a necessary first step to ensure that the sufferer regains a healthy bodyweight. Research indicates that achieving a healthy bodyweight before or during the treatment process directly correlates to higher anorexia recovery rates.
If your daughter is resistant to your input and your requests to seek assessment or treatment, she may need a professional intervention followed by hospitalization and/or residential treatment. You can visit your physician and/or a therapist specializing in eating disorders without your daughter present. Your doctor or therapist can help you assess your daughter’s need for treatment based on your observations of her behavior. These professionals along with a special-needs educational consultant can help you select the best level and provider of care for your daughter’s specific needs.
The following online resources provide further information about eating disorders and treatment options that can help you help your daughter.
www.something-fishy.org: Free information about the diagnosis and treatment of anorexia and other eating disorders, including bulimia and binging.
www.helpguide.org: Free information about a variety of family issues and access to professionals specializing in each.
www.educationalconsulting.org: A list of educational consultants by region and specialty who can help you match your daughter to the best residential treatment option for her needs.