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Ask the Mental Health Expert Archives 2001-2004

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Disordered Eating Pattern

Q. I am very worried about my cousin, who is 17-years-old. She has always been normal weight, until about a year ago when she started obsessing about every calorie she puts into her body.

She measures out a tablespoon of jam for a piece of toast. She'll eat half a vegetable burger patty with a cup of broccoli. Sometimes that's all she'll eat in a day. Her mom has taken her to doctors, but instead of diagnosing her with anorexia, the first doctor said she was fine and the second said she has a disordered eating pattern.

She has been told to put on weight, but her behavior isn't changing. She's now a size 0 and her clothes are sometimes loose. What can be done? Could she be anorexic? Can you recommend a specialist in the Midwest near Eau Claire, WI or anywhere near the WI/MN border?

A. I think you are right to be concerned about your cousin, though I can't say whether or not she has an eating disorder. Some of the habits you describe are certainly worrisome, though. Two disorders that could be relevant are bulimia nervosa (BN) and anorexia nervosa (AN). Basically, with BN (a much more common condition), the individual binge eats huge amounts of food, then uses compensatory behaviors to avoid weight gain. These may include excessive exercise, use of laxatives, or self-induced vomiting.

With AN, the individual refuses to maintain body weight at or above a minimally normal weight for age and height; has an intense fear of gaining weight or becoming fat; and has a severely disturbed body image. The latter refers to the individual's belief that she is fat even when she is extremely thin and undernourished. AN appears in two forms: the restricting type, in which the person uses diet, fasting, or exercise to keep from gaining weight; and the binge-eating/purging type, in which the person binges (like the bulimic) then uses self-induced vomiting or other methods to prevent weight gain.

Both BN and AN are much more common in females than in males. The Rogers Memorial Hospital in Oconomowoc, WI has a specialized Eating Disorders Center, which you can contact at 800-767-4411. It is probably a couple of hours drive from your cousin's area, but they should be able to give you some local referral sources. Keep in mind that your cousin will need to take the first step. Maybe the best approach is to sit down with her and gently express your concerns, in a non-accusatory and non-judgmental way.

For example, you might say, "You know, I've been a little worried about how you are doing lately. It seems like you've lost a lot of weight. What's going on, anyway? Is there something I can help you with?" Depending on your cousin's receptivity to exploring these issues--and don't count on it!--she might be able to accept a referral source for treatment. But bear in mind that people with eating disorders are notoriously hard to engage in treatment, and often resist it as part of a larger power struggle with parents and other figures of authority. But, by showing an interest, you may at least help pave the way for your cousin's treatment.

May 2002

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