My 14-year-old daughter has dropped 15 pounds and has been diagnosed with anorexia. Her doctor and her therapist are encouraging us to make her eat, but she is so depressed and we see a lot of OCD behavior. Isn’t it important to address those concerns and treat them first? It seems to me that these are the real underlying problems.
Kara Fitzpatrick, PhD responds:
It can be compelling to want to chase what seems to be underlying anorexia, because that often feels as though we will resolve both if we focus on the “root cause.” Unfortunately, while anorexia is often associated with comorbid mood and anxiety disorders, nothing is more important than re-nourishment efforts. First, in a place of malnourishment and self-starvation, learning is impaired and individuals may not be able to benefit from standard therapeutic interventions. In addition, many of these symptoms are also caused or exacerbated by malnourishment, making it critical to regain to a healthy weight before focusing on these other areas. With luck, many of these symptoms will remit with re-nourishment efforts! Once your child is re-nourished and can maintain an ideal body weight, other symptoms can be assessed and treated as necessary. Remember, your daughter cannot make healthy choices for herself and her body at this stage and your efforts have to be directed toward eliminating self-starvation before you can all turn your focus toward other challenges.
Kara Fitzpatrick, PhD
Dr. Fitzpatrick is a psychologist working with Eating Disorders at Stanford University/Lucile Packard Children's Hospital and serves as clinical advisor to Maudsley Parents. She is widely trained in a variety of models for treatment and performs research in applied clinical treatments for adolescents and neuropsychological factors associated with eating disorders.