My teenage daughter is convinced she is overweight and hates the way she looks. Her doctor says she is still of average weight for height and age. She is eating less than before, and I suspect she is purging what little food she eats. She becomes very angry when I try to talk with her about this. She does well in school and is active on her high school basketball team.  Do you think she has a problem?   If so, how do I help my daughter who doesn’t think anything is wrong?
 

Excessive concern over weight and appearance, especially in teenagers, is epidemic in our culture. Self-hatred, inappropriate dieting and vomiting, however, are definitely cause for concern and signs that she may be developing an eating disorder.

Denial, minimization and anger are typical and understandable reactions to confrontation. Most teens feel ashamed of purging behavior and are reluctant to give up dieting because they feel it is the one thing they can control. It is important for your daughter to be evaluated soon because early intervention can make a big difference. The combination of restrictive eating, vomiting and compulsive exercise can be very dangerous. It will be important for her primary physician to screen for any medical complications and assess the risks of continuing to participate in her sports at school. Let her know that you are concerned for her and that an evaluation is necessary.

Many at risk teens benefit from individual, family or group psychotherapy. It will be important for your daughter to have some help with her critical evaluation of her self and body. Education about healthy eating and about the risks of developing an eating disorder may help her to develop a gentler and more realistic view and may help her adapt to the many stresses of being a teenager without relying on controlling her body and food. The National Eating Disorders Association’s (NEDA) website (www.nationaleatingdisorders.org) is a reliable resource for parents and friends who want to help a loved one.  

Kim McCallum  M.D.
Founder, McCallum Place Eating Disorders Treatment Programs
Clayton, MO
314-863-7700
www.mccallumplace.com

This question is not easy to answer. Bulimia is considered to be psychological and could exist with another psychiatric disorder. Typical behaviors are binge eating followed by purging. Bulimia includes eating a large amount of food in a short period of time, then getting rid of the food and calories through vomiting, laxative abuse or over-exercising.

Some people become addicted to behaviors to avoid disturbing feelings. Pressure from peers who applaud them for being thin tends to raise their self-esteem and contribute to repeated bulimic behaviors. Family problems, being teased about one’s weight and history of physical or sexual abuse may also contribute and result in an eating disorder.

If an eating disorder is suspected, seek professional help. Feelings and thoughts are challenged in therapy and intervention reinforces control of health behaviors. Counseling and guidance from a psychiatrist, nutritionist and medical doctor are the best ways to overcome an eating disorder. Local health agencies can provide lists of doctors and counselors who treat bulimia. Hospitals and medical clinics have outpatient treatment programs, and there are residential facilities that treat eating disorders exclusively. Cure is not instantaneous; recovery from a disorder is a process. Helpful websites are:

• www.nedic.ca    
  www.nlm.nih.gov/medlineplus/eatingdisorders.html
  www.eatingdisordersanonymous.org
  www.nami.org
  www.nationaleatingdisorders.org. 

Char Wheeler, LPC
Private practice
Bridgeton, MO
314-298-3937

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