If your child shows signs of an eating disorder (such as weight loss, dieting when there is no need, binge eating, purging), we suggest that she see her primary care physician or pediatrician for evaluation. Ambivalence about getting help is understandably common in patients with eating disorders, and some may even resist. They may deny they have a problem or admit to feeling unwell but continue to defend their eating habits. Many feel ashamed-of their food behaviors, their bodies, or both-and this can be a deterrent to seeking help. It is not unusual for eating disorder sufferers to consult a doctor for a sports injury, stomachache, sore throat, or depression without volunteering a word about food or exercise patterns. Although presenting to a physician for help is a sign of strength, it is not often viewed this way by the patient herself.
Sometimes trying to give her that message can help her understand that seeking help is an important and courageous step to take.
In addition to performing a physical exam and blood tests, the doctor will ask your child about symptoms, offering compassion and aiming for a positive rapport. Questions are likely to include the following: How often do you worry about your weight or about food? Do you eat large amounts of food quickly within a brief period of time? Do you induce vomiting? Do you take laxatives or diuretics (pills to increase urination)? How frequently?
Since your child may feel embarrassed in the face of these questions, you’ll want to address this with her prior to her medical consultation in a gentle and empathic way. For example, you can offer such statements as “I know you don’t like to talk about your eating” or “Anticipating embarrassment is really hard” or “I’m sorry, this must be such a hard time for you.” This type of dialogue will help reinforce the notion that it’s important for her to be honest about her habits so the doctor can determine how best to help her and will also remind her how much you care and recognize that she’s hurting.
Meanwhile, you’re likely to have many questions for the pediatrician; in fact, you will want to make a list to bring to the appointment: Will she be okay? How serious is her condition?
What ramifications will the illness have for her everyday life? Can she continue to attend school and play sports? What kinds of treatment are available for eating disorders, and which of these will be most effective for my child? How do I go about getting her into treatment? What can I do at home to help the situation?
Looking back on her visit to the pediatrician, Roberta thinks of it as a positive turning point in her life. But back then, her feelings were mixed. “Until our visit to the pediatrician, part of me refused to believe Serena had an eating disorder. That last shred of hope crumbled when I heard the diagnosis. I desperately wanted to help Serena but didn’t know how. Over the next couple of days, I realized that she and I were operating on different understandings of the word help. She vehemently disagreed that improved nutrition or talk therapy [talking to a therapist or counselor] would help. When I’d ask her what would, her replies ranged from ‘I don’t need help’ to ‘Being good at something.’ “
David B. Herzog, M.D., Debra L. Franko, Ph.D., Pat Cable, RN
David B. Herzog, M.D., is the Harvard Medical School Endowed Professor of psychiatry in the field of eating disorders at Massachusetts General Hospital and the director of the Harris Center at Massachusetts General Hospital.
Debra L. Franko, Ph.D., is a professor in the Department of Counseling and Applied Educational Psychology at Northeastern University and the associate director of the Harris Center at Massachusetts General Hospital
Pat Cable, RN, is the director of publications at the Harris Center.