In the period of late January through March 2009, our daughter lost 20 pounds through intense exercise and starvation. Her therapy with a nutritionist/therapist began soon after we realized what was happening (early April). She also sees a adolescent medical doctor who specializes in eating disorders. Since then, she has gained back 9 pounds and is now medically stable and in the low range of her target weight. Her period has also resumed. We have been buying her all of the things that she wants such as soy milk, protein drinks, cinnamon covered almonds, banana chips, and vegetable chips. She is obsessed with eating alone and refuses to eat at family mealtime. She picks at things all day and rarely will put something on a plate. She also says she does like to eat anything that I (her Mom) make. While she is in a better place in a very short period of time and her medical doctor is pleased with her progress, her eating quirks only seem to be getting worse. While I have tried to be compassionate and helpful, there are times when I absolutely lose control of my temper and tell her awful this thing is that she is doing to herself and her family. I know that this is not productive, but the frustration levelbuilds and then explodes, especially when she refuses to eat with the family. How can we get her to eat with us? Please help. Her therapist does not seem to be offering concrete ideas for intervention.
Joy Jacobs, JD, PhD responds:
Your frustration at this point is understandable. Oftentimes, the path to recovery from an eating disorder is an endurance contest for family members (analogous to a marathon rather than a sprint). The good news is that your daughter’s weight is headed in the right direction. Nevertheless, she may still be quite underweight and the behaviors you describe may be reflective of significant eating disorder ideation. Most likely, your daughter’s need to eat specific foods and to eat them alone is part of the eating disorder and should be discussed as such in therapy session. If your daughter refuses to eat with you when asked, you may need to take a more directive approach—requiring that she eat meals with the rest of the family, in the same way as you may require that homework be completed, chores done, etc. If you take this route, be prepared for a great deal of initial resistance. Remind your daughter that you love her and will be supportive at meal time. Your goal is not to critique or judge but to restore her to full health. Try to be patient and lean on friends and family members for support. Ideally, your therapist is equipped to support your decisions and to help you map out a game plan for implementing these changes. Best of luck!