Eating Disorder Denial. Missing the Big Picture Isn't Pretty.

Professional conferences don't tend to bring me to tears. But the opening session for this year's MEDA conference (Multi-service Eating Disorder Association www.medainc.org ) broke with convention.

Doris, now a therapist, was simply a mom, a seemingly fine and quite likeable mom at that. She had a lovely husband (or so he appeared from the video clip displayed), provided a nurturing home (from what I could casually assess from her words and images) and had two lovely daughters. And now she has only one. Her younger daughter, Andrea, died 12 years ago from bulimia.

I am not new to this field of eating disorders, nor am I naive about the risks of having an eating disorder. In fact, not infrequently I am the treatment team member reality checking about the need for a higher level of care, pointing out the writing on the wall, so to speak.

Yet Doris caught me off guard. Even for me, her story about Andrea was alarming. Andrea became bulimic toward the end of her first year of college. Perhaps not atypical. But Andrea got help reportedly after only 2 weeks of eating disorder behavior, of purging. A therapist, MD, and dietitian were all a part of her recovery team, seeing her weekly.

Andrea reportedly looked healthy, by her mother's account. She was a normal weight—also not unusual. Bulimics are often normal or average weight, but restricting bulimics may present underweight. The danger, of course, is that being a healthy weight in many ways increases your risk. Strange? Here's why. At a healthy weight your risk may be minimized—by your own distorted thoughts, by your family and loved ones who see you as visibly healthy, and by the medical community which may not be triggered to ask the necessary questions about your eating disorder behaviors. Yes, we could all be in denial.

Just last week I had a rather unpleasant situation arise following a new patient session. Abby presented for her first visit along with her mother. Here's the summary: Her weight was below a healthy BMI and less than 90% of her healthy and usual body weight. She had lost significant weight, about 20% of her weight from the past year. Abby was restricting her food intake, eating close to nothing all day. Abby planned a binge, and subsequently purged once daily. She also was active, playing a team sport and exercising on her own. Admittedly the exercise wasn't compulsive, just frequent.

Oh, I forgot to mention that one month prior she presented to her pediatrician because her mom was concerned about Abby's hair loss, a common occurrence in eating disorders and with malnutrition, which can certainly also be caused by other conditions. At that time, her weight was just as low, and she had been in her disordered pattern for close to a year and a half.

Well, how would you assess the situation?

Toward the end of our lengthy initial session, it was clear that Abby was struggling to accept much if any change. I think a glass of skim milk was about all she would agree to increase—certainly not enough to keep her safe. So I made it clear that all exercise needed to cease. I urged a higher level of care—given how little change she was prepared to make—and a follow up with the MD (sooner that the 3 month visit that was planned).  And what was the end result? I was fired by Abby's family, and not thought  favorably of by the MD;  my direct acknowledgement of the need to be addressing this case differently was not well received.

Why share all this?

Because even I can get sucked into denying the reality of a situation. Because all of us are far too accustomed to measuring health and risk, based largely on body weight. And often that misses the boat. Because while I like to focus on the positive changes, the improvements patients are making over time, sometimes just heading in the right direction is not enough protection from the risk of maintaining an eating disorder. Because the health impact of eating disorders, both physical and psychological, are major, and shouldn't be minimized—not by the dietitian, the therapist, the physician, your family or community. 

And certainly not by you. Because eating disorders can result in death. And Doris can attest to the fact that this is no exaggeration.

Thank you, Doris, for sharing your wisdom with all of us at the conference and for allowing me to reference Andrea’s story on this blog. 

If this blog motivates even one eating disordered individual to change, or one health practitioner or family member to shift her thinking, it will be a great achievement. And please check out Doris’s website at www.andreasvoice.org

Thanks for taking this post seriously, and for passing it along to all those who need to read it.