Can You Prevent Your Child's Eating Disorder?
I've worried before that writing again and again about eating disorders on BlogHer and on my personal blog could turn me into a one-trick pony. I've said I don't want to be ED Girl. I've told people I just want to be me, recovered, and be the proof that it's possible, publically. But then I recently got an email from a woman with whom I'd gone back and forth several times, and she'd decided to check herself into treatment:
It's much easier to ignore a single doctor telling me that I'm in trouble, but hearing it from someone who actually knows what it's like to be my position right now was really helpful. So thanks very much! I'll be working on recovery for the next few months instead of school which will be good I think.
And so here I am, again, writing about eating disorders. If it's helping anyone, it's worth doing.
This time, I'm talking about kids and adolescents with Dr. Bermudez of the Eating Recovery Center in Denver, Colorado.
Background on Diagnosing Eating Disorders in Kids, Adolescents and Adults
Dr. Bermudez is a pediatrician, not a psychologist, and eating disorders have been the focus of his career for the past 22 years. Yet, he seemed surprised when I asked he had any personal experience with eating disorders -- which he has not. In fact, he said no one had ever asked him that before.
It's hard for me to fathom how anyone with no personal experience with eating disorders could successfully treat them, but Dr. Bermudez is tremendously successful. I called him to talk about treatment for eating disorders, certainly for adults but particularly for adolescents.
Dr. Bermudez believes eating disorders are biopsychosocial illnesses. In other words, they are truly mind/body/spirit, with a healthy dose of environmental triggers thrown in. He rejects the idea that they are inevitable based on genetics or society. He rejects the idea of treating just the mind and not the body or vice versa, and he pointed out that as an anorexic restricts, her gastrointestinal tract can develop problems that makes it then difficult to eat normally (I'm paraphrasing), which makes recovery more difficult. As he talked, I sighed, as this communication of truths has become a bit of an obsession for me -- it seems so many eating disorder (ED) sufferers and particularly their families and friends have a tough time wrapping their heads around how the mind and the body negatively and positively impact each other as the anorexic or bulimic or overeater or what have you struggles to recover.
As we talked, I asked Dr. Bermudez how to advise friends and families about this problem. We discussed diabetics -- diabetes is a disease not the "fault" of the diabetic, but the diabetic has control over how ambitious she is in her treatment and control of the disease. It's similar with eating disorders, however, there is a mental illness component of ED that complicates the free will part of recovery.
According to Dr. Bermudez, roughly 2/3 of patients with eating disorders at the time they are diagnosed are also diagnosed with psychiatric comorbidity (they are also diagnosed with another mental illness at the same time). Mood disorders are the most common (depression and anxiety). He's quick to point out that mood disorders are also more common across the board in terms of mental illness, than say, schizophrenia, so it does make sense -- but to me the important part is what comes next.
Half of that 2/3 who are diagnosed with a mood disorder at the same time as the eating disorder had the mood disorder first.
Anxiety is most prevalent, followed by OCD, then depression. The average date of onset of anxiety syndrome is around 11 years old, while depression is a little later than that.
Recognizing Opportunities to Intervene With Eating Disorders
Here's where it got tricky for me, as a recovered anorexic and bulimic and a mother of a seven-year-old girl. I wanted a hard-and-fast, here's-when-to-worry checklist. And I wanted to freak out if my daughter showed any signs of anxiety, because it sounded like Dr. Bermudez was reading me my life story -- undiagnosed early-onset anxiety followed by a perfect storm of environmental triggers. But Dr. Bermudez is not that kind of doctor and refused to let me form that kind of a plan as a mother. Here's what he said:
All human characteristics can be considered part of our traits. You have to differentiate between "trait" and "state." Some of us are more anxious, and that can be adaptive. Just like anger -- no trait is "good" or "bad" -- it's how much and in what context does it serve or hinder us. Once your kid has gone from trait anxiety to a state of dysfunctional anxiety, you need to recognize it and go to work with that quickly. If they're having trouble functioning, having panic attacks or severe separation anxiety, the opportunity for parents is in knowing about their kids' nature and helping them manage their lives so their natural traits enhance their well-being instead of hindering it. Ease them into mastering and overcoming anything that could balloon into a bigger problem before it balloons.
Make their traits assets, not liabilities. Once a trait has become exaggerated or a problem, seek appropriate evaluation and help.
Okay. So anxiety under control or managed correctly doesn't necessarily blossom into an eating disorder. Got it. Anxiety as a trait could be helpful in some ways -- it could spur the child to study for a test instead of winging it, for example. So what to watch for? When the trait becomes a persistent state and the child can't amp down -- then it's time to act. And, from what I took away -- teaching the child to deal with her anxiety before the eating disorder occurs could very well be the sliding door to prevention. It's not a guarantee, but hell, yes, it's worth a whirl, right? I'm finding that to be the case with most of parenting -- nothing is guaranteed, and everything is worth trying if something is really hurting your child.