Your daughter seems to be losing too much weight lately. She has become more finicky about food and hardly eats in your presence. She claims she is not hungry or feels "too full," when you know she has not eaten all day. Just as she appears to be going overboard with her dieting, she is also exercising excessively.

Could your daughter be suffering from an eating disorder? What is an eating disorder and what are the symptoms? If your child does have an eating disorder, what caused it, what are the treatment options and how can you help her?

WHAT ARE EATING DISORDERS?

Eating disorders are self-destructive patterns of behavior related to food. In all cases, there is a preoccupation with food, where the person is constantly thinking about dieting. With anorexia, for example, the intake of food may be controlled, severely limited and/or ritualized. Anorexics may be unwilling or unable to eat in another person's presence. They often complain of feeling full or bloated when they are, in fact, starving.

In all cases of eating disorders, the young person's body image is severely distorted.

Bulimia is characterized by alternating bouts of binge eating followed by purging, or induced vomiting. In some cases, laxatives are abused to reduce body weight. In all cases of eating disorders, the young person's body image is severely distorted. They see themselves as much heavier and unattractive than they are seen by others. And they strenuously resist efforts by others to correct those distortions.

Both anorexics and bulimics may exercise excessively in a desperate attempt to lose even more weight. They may work out for hours, engaging in strenuous aerobic exercises which they feel are necessary to eliminate excess body weight.

While there have been cases of children as young as seven or eight years old as well as middle aged adults diagnosed with eating disorders, the overwhelming majority of cases appear in the teenage years. And 95% of all those who suffer from eating disorders are female.

For the most part, those with eating disorders tend to be perfectionistic and highly self-critical. They suffer from low self-esteem and often lack confidence. They crave attention and approval from others and may even appear manipulative in their interpersonal relations. They are quite secretive about their eating habits and almost always deny they have a problem with food.

While eating disorders are very much a psychological problem, they have extremely serious medical consequences. The self-starvation of anorexics and the bingeing and purging of bulimics often so severely interfere with body functioning that menstruation often ceases. In addition, the drastic weight loss associated with eating disorders can lead to renal failure, heart attacks and even death.

WHAT CAUSES EATING DISORDERS?

Eating disorders are caused by a variety of factors. In any case, there may be one or more of the following contributing influences.

1. Media images. Even if your children do not watch television or go to the movies, they are exposed to clothing advertisements on billboards and in newspapers and magazines which glamorize thinness. The message conveyed by these images is that you cannot be socially accepted or successful unless you are as skinny as the models. For teenaged girls who may already feel insecure about their social standing and appearance, weight loss may rise to the level of urgent priority.

2. Abuse or molestation. When young children have been traumatized by physical abuse or molestation, they need professional help to prevent long-term psychological damage. If their parents were unaware of the trauma to the child or were unable, for any reason, to arrange for the necessary treatment, the child has a high risk of developing an eating disorder in adolescence.

3. Dysfunctional family dynamics. If children grow up in homes where there is considerable verbal abuse or high levels of conflict and hostility, regardless of whether the children are the targets or only the bystanders, they are at an increased risk of developing an eating disorder.

Teenagers who live in such dysfunctional homes often feel helpless to correct the problems which are clearly not under their control. By regulating their eating with an eating disorder, they are unconsciously attempting to exercise control in the one area of their lives, namely food, which is totally under their control. They may also be unconsciously attempting to unite their discordant parents by forcing them to focus their attention on the eating disorder, as illustrated by the following three case examples.

THE CASE OF ROBIN

Robin was the youngest child in her family. Her older sister set a standard that she felt she could never attain. The older sister was prettier, smarter and much more socially successful than Robin.

As if that was not bad enough, Robin's parents were quite critical and not very supportive or encouraging. Robin's mother was especially harsh in her disapproval of Robin's appearance, grades and friends.

By the time Robin entered high school, she was convinced that she could never please her parents. Seeing her older sister enjoy the approval Robin was yearning for made her own lack of affection from her parents all the more painful for Robin.

In order to soothe her wounded sense of self, Robin sought comfort in food. While she felt better temporarily, the extra weight she gained only prompted more disparaging remarks from her parents. Robin attempted to deal with that dilemma by inducing vomiting after her binge eating. This set the pattern for bulimia, which required gut-wrenching family therapy to finally resolve.

THE CASE OF HADASSAH

When Hadassah was twelve years old, her parents divorced. The divorce was uncontested and amicable. Her parents used one lawyer to file the papers and there were no adversarial court battles over custody. Her parents agreed to let Hadassah's mother have custody while her father enjoyed liberal visitation rights.

The divorce was triggered by the father's extramarital relationship, which continued following the breakup of the marriage. Hadassah's father was so preoccupied with this relationship that he hardly took advantage of his visitation rights with his daughter.

One year later, Hadassah's mother remarried and soon had more children with her new husband. Hadassah felt her mother showed much more attention to her new siblings and stepfather than to her. By the time Hadassah reached twelfth grade, she felt so overlooked and disregarded that she requested to move in with her father and his new wife.

At the same time, Hadassah was becoming somewhat rebellious and disrespectful towards both parents. Her clothing style and choice of friends reflected this new oppositional attitude. She moved back into her mother's home, but was clearly unhappy and resentful.

As the confrontations with her mother increased, Hadassah became more and more uncooperative and disobedient. Her grades also plummeted at school. It was then that her mother suggested that Hadassah might like to speak with a therapist.

Hadassah resisted at first, but finally relented. After a few weeks of individual sessions, the therapist invited Hadassah's mother in for a joint session. It was then that her mother first leaned what she already suspected, that Hadassah had become anorexic.

Individual therapy for Hadassah continued. Two hospitalizations and family therapy with both of Hadassah's parents were added. Hadassah's mother even entered her own personal therapy to gain more insight into her strained relationship with her daughter. It took a couple more years, but Hadassah's mother learned how to demonstrate her love for her daughter in the way that Hadassah needed, which resulted in Hadassah finally overcoming her eating disorder.

TREATMENT OPTIONS

Unfortunately, there is no single treatment option that has proven to cure eating disorders effectively. Consequently, it is often necessary to implement more than one of the following strategies:

1. Hospitalization. Because of the life-threatening nature of eating disorders, hospitalization is necessary at times. Aside from such emergencies, hospitalizations can also be useful as part of an in-patient treatment program designed specifically for patients with eating disorders. These programs are geared for teenagers and include nutritional education and retraining, as well as group and individual therapies.

2. Medical consultation. Although there is no medical treatment for eating disorders, it is often recommended for the young person to be monitored by a physician specializing in adolescent medicine. The purpose of this consultation is to help determine if and when hospitalization may be needed, as well as to treat any medical complications resulting from the eating disorder.

3. Individual psychotherapy. It is always helpful for the young person to have her own therapist who can help her work through the underlying emotional conflicts, distorted body image and unhealthy family relationships. Those with eating disorders tend to be secretive and mistrustful. Consequently, it is vital for them to have their own therapists in whom they can confide without fear of unwanted disclosure.

4. Family therapy. By the time a teenager has developed an eating disorder, her relationships with one or both parents have usually become strained. The best way to resolve these conflicts, build trust and reconcile the differences is with family therapy, in which the teenager is seen together with her parents.

HOW TO BE HELPFUL

Aside from making the necessary arrangements for treatment, there are a number of things you can do to help your child cope with and eventually overcome her eating disorder.

1. Do not discuss food. Although this condition is very much food related, it will not be cured by you encouraging your child to eat properly. Paradoxically, one of the best things you can do to help is to avoid initiating any conversations about food.

2. While arranging for treatment is important, it is equally, if not more, important to cooperate and participate fully with your child's doctors and therapists. If they give you guidelines and recommendations, follow them, even if you do not always agree. If they give you guidelines and recommendations, follow them, even if you do not always agree. If they request your attendance at family therapy sessions or group meetings, make every effort to attend. Your participation in your child's therapy demonstrates your concern for her welfare much more than anything else.

3. Whether in a therapy session or at home, try to accept your child's feelings without become defensive. You do not have to agree with all of your child's complaints against you. To be sure, some of them may be exaggerated or distorted. Nevertheless, your child may have developed an eating disorder as a result of feeling unheard or invalidated so it will be extremely therapeutic for you to listen as effectively as you can.

Encourage and even pull for your child to express suppressed feelings of resentment or disappointment towards you or any other member of the family. This may be difficult for you to listen to but it will greatly speed up your child's recovery.

* * *

It can be terrifying for you to see your beloved child imprisoned by the self-imposed and self-destructive regimen of an eating disorder. The serious consequences of this condition justify your high level of concern and worry. The good news, however, is that with proper treatment, considerable patience and ample time, eating disorders can be successfully overcome and your child can move on to a healthy marriage and family life of her own.