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Ask Dr. Sue
ANOREXIA AND TEENAGERS
Dear Dr. Sue,
I have a daughter who is 14 years old, and who has lost
about 10 pounds over the past three months. She
wasn't fat to begin with, maybe just a little bit
stocky. Now I think she looks too skinny. I
think she's too young to have anorexia, isn't she?
How would I know if I needed to worry about that?
Dear Mom,
The first thing you need to do is to schedule a complete
physical exam with your daughter's pediatrician.
There are certainly conditions other than eating
disorders that can cause weight loss in a fourteen year
old girl, and those medical problems need to be ruled
out before any other assumptions are made. Please
schedule this visit right away, because your daughter
needs evaluation for this weight loss. Without
knowing her height and original weight I can't tell you
whether this is really an alarming amount to lose in
three months, and without knowing her recent activity
level and diet I can't tell you that it is normal.
The incidence of Anorexia Nervosa has doubled in the
last 20 years. It is more common in girls who are
involved in sports like gymnastics, ice-skating, and
ballet, and also in those who are involved in modeling;
all activities where size and shape receive a lot of
emphasis. The usual age range is from 10 to 25
years, and there is actually a peak of cases right
around your daughter's age, when the majority of girls
are seeing their bodies change into fully adult forms.
There is another peak around age 18, when life change
has to do with other things, like entering college or
the work force.
What causes eating disorders like anorexia? No one
knows exactly what brings them on, but certain factors
appear to play a leading role, when they occur in
someone who may be susceptible for genetic or
psychological reasons. These factors may include
feelings of insecurity, an excessive need to feel in
control, a distorted body image, a family history of
depression, severe family problems, a history of sexual
abuse, extreme social pressures, or pressure from sports
or other activities, as mentioned above. Even if
you doubt the presence of any of these circumstances in
your daughter's life, though, she still could suffer
from an eating disorder.
When should you worry? If you see any of the following
warning signs:
-
Abnormal weight loss (ask at your
daughter's physical exam whether her weight loss has
been excessive).
-
A reduction in food intake, denial of
hunger and a decrease in consumption of high
carbohydrate and fat-containing foods.
-
Prolonged exercising in spite of
fatigue and weakness.
-
An intense fear of gaining weight.
-
Peculiar ways of handling food.
-
Loss of previously established
menstrual periods.
Anorexia can cause a number of physical
problems besides the loss of menstrual periods. It
can lead to chronic kidney problems, irregular heart
rhythms, electrolyte abnormalities, lightheadedness and
dizziness or fainting, sensitivity to cold, dry skin and
thinning hair on the scalp, stomach and intestinal
problems, loss of bone mass, some loss of brain tissue
in severe cases, and a change in white and red blood
cells with corresponding changes in immune function.
What should you do if you suspect your daughter might be
anorexic? Talk to her pediatrician, who will guide
you through the process of determining if she really
does have this eating disorder. If she does, she
will be followed very closely from a medical standpoint,
and will probably become involved in individual therapy,
group therapy, and possibly family therapy as well.
Support groups are often very helpful in helping people
with eating disorders realize that they are not
"freaks," and that others have experienced the same
feelings and have recovered.
Here are some things to keep in mind:
-
DO talk with your daughter about what
you have observed, and what your concerns are.
-
DO be firm about taking her to
medical and therapy appointments.
-
DO collect information (The National
Eating Disorders Organization, (918) 481-4076 is a
good source).
-
DO listen to your daughter when she
wants to share feelings and fears.
-
DO assure your daughter that she is
not alone, and that you love her and will be there
for her always. Tell her that you want to help in
any way that you can.
-
DO be patient, since recovery can
take a long time.
-
DON'T threaten ("If you don't eat
you're going to the hospital.")
-
DON'T negotiate ("If you'll eat you
can go to that party.")
-
DON'T discuss eating, weight or
appearance. Those are not the real issues.
Don't insist on weighing your child at home.
-
DON'T try to force your child to eat.
-
DON'T blame your child or get angry
with her; this is a condition she cannot control and
is not her fault.
-
DON'T take on the role of therapist;
let the professionals handle that.
 
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