July 9, 2019

Helping teens who have anorexia and anxiety: Q&A with an experienced professional

About 90 per cent of people diagnosed with anorexia are women, often in adolescence. Anorexia also often goes hand-in-hand with anxiety. We talk to Dr. Gina Dimitropoulos, PhD, a leading anorexia researcher, about how to support teens in recovery from this eating disorder.

Anorexia nervosa has been prevalent in the news ever since 32-year-old singer Karen Carpenter died of heart failure related to anorexia in 1983. Carpenter’s death not only sparked an immediate upsurge in public awareness around anorexia, it inspired other celebrities like Tracey Gold and Princess Diana to open up about their own experience with eating disorders.  

Now, more than three decades later, anorexia nervosa continues to populate news feeds; Kim Kardashian apologizes for implying that being anorexic is somehow desirable; actor and singer Demi Lovato reveals food as one of the biggest challenges of her life; Little Mix singer Jade Thirwall reveals that she was hospitalized for anorexia at age 13.

But anorexia nervosa, which often presents with anxiety disorders, is not simply a disease of the rich and famous, and has not lost its grip on young people since the days of Karen Carpenter. Anorexia affects between .5 and 4 percent of Canadian women. So if your high school had a population of 1000 students, it’s likely that between 5 and 40 of those adolescents struggled with anorexia and anxiety. And almost all were likely girls: about 90 percent of people diagnosed with anorexia are women (Canadian Mental Health Association).

Anorexia nervosa is a serious and complex illness which causes people to restrict their food intake or increase their exercise regime to the point where their weight dips well below normal levels (CMHA).  They often feel overweight despite their weight loss and may define themselves by the number on their scales. It’s a challenging disease to recover from, especially since anorexia often begins at a time of life that is already full of physical and mental stress – adolescence.

Dr. Gina Dimitropoulos, PhD, is an assistant professor in UCalgary's Faculty of Social Work and research leader for the Calgary Eating Disorder Program at Alberta Health Services. Her research focuses on young people who have anorexia nervosa. For more than 20 years she has been ushering adolescents down the road to recovery by nurturing connections with family members.

How should parents and family members react to a diagnosis of anorexia?

As a parent or sibling it can be hard to get your head around that initial diagnosis. When your child loses weight quickly you might think it’s a medical issue. When you realize it’s anorexia it can be very frightening. It’s absolutely normal to feel frightened at this stage.

But what I really want to say to parents is this: Don’t blame yourself. Families often move quickly into the blame game, asking themselves what they could have done differently. Families need to know that they're not going to be effective in helping their child if they're wrapped up with shame. When you focus on blame you’re looking for a cause and there really isn’t time for that. Anorexia is life-threatening, so you need to focus on doing what you can to help your child now.

The same advice about shame and blame goes for the adolescent with anorexia. No one chooses to have anxiety or anorexia. These are serious mental illnesses that people have very little control over. That’s why it’s crucial to involve family members in the recovery process.

What advice seems to work in helping adolescents turn the corner during their recovery?

What I say to kids who are really struggling is, "I know there is a healthy side of you that wants more out of life. I know you don’t want to make a career out of anorexia. You don’t want to be so immobilized by anxiety that you can’t be with your friends or go to school or do whatever it is you love to do. I know the fear is strong but I know you want more from life than this. And along with your family, I have your back. We’re all together here."

Why is it important to seek help right away?

The longer you live with anorexia nervosa, the more it becomes your identity. Parents should step in and start treatment right away, before the disease has a full grip on their child. When young people struggle for a long time with anorexia it really affects their thinking. So if a family comes in early, I tell them this is a very good sign.  "We’re going to help you before this becomes so entrenched that it’s part of who you are, and you can’t separate what’s you and what’s your illness."

What steps should you take when you think your teenager has anorexia?

The first step is make an appointment to see your family physician or pediatrician. They may give you a referral to a mental health provider or specialized eating disorder program.

Second, you can check out the information and peer support networks on the more credible provincial or national websites. The more you can educate yourself the better.

Third, you should keep talking. Anxiety disorders and anorexia are diseases of avoidance; people want to avoid what frightens them. But the last thing you want to do as a parent is avoid difficult conversations or treatments, because this is the road to recovery.

Fourth, be kind to yourself. This process is hard and overwhelming, so all family members need a lot of formal and informal help to get through this.

How do you get your child to eat?

I always say to families that we won’t know right away what will work for their individual child. There are generic strategies that work for most kids but I want parents to think about what their child is like and what tends to work well with them. Parents have much more in-depth knowledge of their child than I do. 

What we typically say to parents is that food is medicine, so they need to treat it like a medicine. If you’re diabetic, you need insulin; it’s the same thing with anorexia. Your body needs the food, so you have to take it. Now, keep in mind that that works for some but not all.

The other thing I suggest is to eat at regular hours. Provide meals at consistent times. Have structured, regular family meals. Nobody wants to eat alone and no one wants to be watched as they eat. It’s hard, but try to make meal times as normal as possible.

Should parents negotiate with children about food?

Think about the strategies you’re using to help your child. Then ask yourself if you’re helping your child or if you’re helping the anorexia. When parents hear that they get it right away. For example, are you negotiating with your child about how much they eat, or what they eat?  If you allow your child to negotiate the ability to eat something lighter, or skip a meal, then anorexia wins. Parents need to align with their child, not the illness.

Research shows that when parents start to back off from helping their child or when they negotiate with their child, that young person will do worse in treatment and have a longer illness course. So even though it feels tense at first, you have to accept that there will be some tears. You have to be able to sit with your kid and tolerate the conflict. If you can work through that, your child is much more likely to recover. The last thing you want is to be doing this for ten fifteen years because it was hard to tolerate the tension.  

What do recovered adolescents say about family involvement in the recovery process?

I always ask young people what worked or didn’t work during their treatment. What I hear most often is something like, "although I absolutely hated it, I needed you to tell me to eat and to not negotiate with me. Because as soon as you negotiated, my anorexia became more powerful."

Ultimately, adolescents want parents to be consistent, persistent and clear about expectations. If parents go back and forth about eating, it’s really difficult for young people.

I’ve also heard young people say that parents shouldn’t stop supporting them if it looks like they're doing better. Even if their child has gained back the weight they lost, they still need help to stay well.

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Dr. Gina Dimitropoulos, PhD, is an associate professor in UCalgary’s Faculty of Social Work. Her research focuses child and adolescent development, accessibility and inclusion, social work education, mental health, and family. Read more about Gina

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