How to Talk to Your Daughter About Her Eating Disorder

No child is immune from the conditions that can lead to an eating disorder, but statistics show that parents of young daughters need to be especially vigilant in watching for signs of these destructive – and potentially deadly – conditions.

Experts estimate that women and girls account for nine out of every 10 cases of eating disorders, with those between the ages of 12 and 25 at greatest risk. For the past 25 years, beginning in the immediate aftermath of the 1983 death of singer Karen Carpenter, health care professionals and advocacy organizations have been working to raise awareness of the symptoms and dangers related to anorexia, bulimia, and binge eating.

But even with all the attention that has been given to these conditions, most mental health specialists concede that the majority of girls with eating disorders fail to get the help they need. One common theory that has been offered to explain this treatment gap is that the nature of the disease makes detection difficult, even among those who are closest to the sufferer.

Lucy Howard-Taylor, a survivor who wrote the recently published memoir Biting Anorexia, told interviewers with the Australian morning program “Sunrise” that failing to recognize an eating disorder often isn’t a matter of ignorance as much as it is an unconscious decision to look the other way.

“It’s very easy to hide [the condition] from people,” Howard-Taylor said during her July 17 appearance on the show, “because not only are you in denial, but the people around you are in denial as well.”

RECOGNIZING THE SIGNS

To defeat this denial, parents need to be on the lookout for signs and symptoms that may indicate that their daughter is struggling with an eating disorder.

The most common symptoms of eating disorders are drastic weight loss and an unhealthy focus on how much one weighs. Some girls may lose weight by refusing to eat, or restricting themselves to rigid diets built around tiny portions of very few foods. Others may eat what appear to be normal (even large) meals, then purge soon after by forcing themselves to vomit or ingesting large doses of laxatives.

As the effects of their disorders become more pronounced, girls may experience hypothalamic amenorrhea, which is marked by the absence of menstruation in women who previously had regular periods. Left untreated, hypothalamic amenorrhea can lead to loss of bone mass and density, and the onset of osteoporosis.

Though disordered eating can cause some girls to withdraw and become secretive, remaining active and social is not necessarily a sign that everything is OK. Athletically inclined girls may attempt to control their weight by exercising obsessively, while “social butterflies” may be sharing weight-loss tips and tricks with friends who also have eating disorders or other body image problems.

To hide the often dramatic effects of their disorders – which, in addition to the weight loss, can include the growth of soft downy hair on their arms, legs, and torso – many anorexic and bulimic girls take to wearing oversized or baggy clothes, insisting on long sleeves and long pants even in warm weather. Even with these extra clothes, though, they may complain about being cold, and may often appear to be overly tired or disoriented.

DEFEATING THE DENIAL

Parents who notice any of the symptoms or behaviors noted above need to address their concerns with their daughters. None of these signs constitute absolute proof of an eating disorder, though the presence of a preponderance of them does make it more likely that the girl is suffering from some type of medical condition.

Choosing to ignore an eating disorder in the hope that it will vanish on its own – or that your daughter will “grow out of it” – is a dangerous decision to make. Eating disorders are among the most devastating of all mental illnesses, with high mortality rates and brutal long-term effects even on those who survive the most severe cases.

Don’t wait for your daughter to “bottom out” or come to you for help. If you think she might be suffering from an eating disorder, discuss the situation with her, then get her the help she needs.

HAVING THE CONVERSATION

Few parent-teen conversations go smoothly, and a discussion about eating disorders isn’t likely to be an exception. To prepare yourself for a conversation that is likely to be fraught with anger, sadness, and hostility, keep the following thoughts in mind:

  • Learn, then talkEating disorders are complex conditions that even the experts don’t completely understand. Don’t assume that you’ll be able to learn everything there is to know about the disorders, but don’t enter the conversation without doing at least a bit of homework, either.

  • Ask, don’t accuse – Dr. Ted Weltzin, medical director of The Eating Disorder Center at Wisconsin’s Rogers Memorial Hospital, advises parents to approach this conversation in an inquisitive fashion. “The first thing to do is to ask … if they are having an eating problem,” Weltzin wrote during an online conference on the HealthyPlace website. “They may not admit to the eating problems, but this begins to open a dialogue about a potential problem.”

  • Discuss, don’t debate – If your daughter does, indeed, have an eating disorder, this first conversation will be followed by many more. Your goal here shouldn’t be to “win” by proving that you know more than she does; rather, you should aim for an open exchange of ideas in which all participants can share their thoughts and observations.

  • Be compassionate, not critical – You wouldn’t criticize your daughter for being diagnosed with cancer, so don’t attempt to blame her for having an eating disorder, either. Eating disorders are mental conditions, not faults. Whether she admits it or not, your daughter is likely suffering from considerable shame and frustration – what she needs now isn’t more disappointment, but rather the comfort that comes with knowing that she has your unwavering support.

  • Focus on behavior, not appearanceIt might not make much sense to you, but telling your daughter that she’s “wasting away” or “nothing but skin and bones” might make her think that what she’s doing is a good thing. Don’t ever forget that eating disorders affect minds as well as bodies, and your daughter’s condition may be misleading her into thinking that “skinny” and “scrawny” are compliments. Keep the conversation action-oriented – for example, talk about the many meals she has missed, her excessive exercise, or problems she may be having in school.

  • Listen – Your daughter may agree with everything you say to her, or she may respond with rage, tears, or silence. Regardless of what she says (or doesn’t say), make sure you pay attention. Soliciting her input is an important way of letting your daughter know that you value her opinions, and that you want to work with her to help overcome her disorder. Helping her take ownership of her condition – and, ultimately, her recovery – is an important step on her path back to health.

  • Act – Ultimately, the goal of talking with your daughter about her eating disorder is to help determine what type of help she needs. Once you’ve opened the lines of communication, follow up with whatever steps are necessary. The websites mentioned above can help you find the help your daughter needs, as can your family physician or your daughter’s guidance counselor or school nurse.

Talking to your daughter about her eating disorder might not be easy, but not doing so can be far worse. Remember: Though they can be devastating, eating disorders can also be overcome.
Let your daughter know that she’s not alone in this struggle, and show her every day how deeply you believe that she’s worth fighting for.