The eating disorder, anorexia nervosa, is attracting ever more media attention. Some of the more hysterical articles in the press have suggested that there is currently something of an anorexia epidemic and that the fashion industry, combined with our celebrity-obsessed culture, is largely to blame. Consequently, parents of teenagers, and particularly the parents of teenage girls, often have considerable anxieties in this area. Just what is anorexia, what, if anything, can be done to protect our children from developing it, and what can be done once it appears to have taken hold?
What is Anorexia? The signs and Symptoms.
Anorexia is an eating disorder which affects mainly adolescent girls but which can also affect boys (about 10% of cases), younger children and adults. The essential characteristic of anorexia is self-induced weight loss combined with an obsession with food, with eating and with dieting. 'Ideal' weight targets are often set absurdly low and sufferers may indulge in excessive exercise, may take laxatives or may force themselves to vomit after eating.
The side-effect symptoms of anorexia include tiredness, low mood, feeling cold, dry skin, brittle nails, extra downy body hair and, in girls, stoppage of periods. Many anorexics are very secretive about what they are doing. They may cover their thinness with bulky clothes, will purge in private, and may lie about how much (or little) they are actually eating.
Where Does It Come From?
There is no single cause of anorexia. In most cases a complex web of factors will have contributed to the condition but some of the following might be applicable:
- Low self-esteem is common during the teenage years and many teenagers are plagued by insecurities about their bodies. People who develop anorexia often have particularly low self-esteem combined with a tendency to evaluate their own worth primarily in terms of their physical appearance - that is, they tend to overlook the other 'good' things about themselves and focus on what they look like.
- Perfectionist personalities seem to be at greater risk of anorexia and perfectionism may be a trait which runs through an entire family. In some families there is a lot of emphasis on achievement and on doing everything as well as it possibly can be done.
- Interpersonal difficulties - difficulty in making or sustaining friendships - can be a risk factor. 'If only I was thin everyone would like me'.
- Teenagers who feel 'unnoticed' may be at greater risk of anorexia. Some teenagers may romanticise the idea of illness, imagining themselves thin, pale and frail and surrounded by concerned and attentive adults.
- Adolescence is a difficult time and many adolescents feel torn between wanting to become independent adults and wanting to hold on to the safety and security of childhood. There can be a sense of things being out of control as they hurtle towards adulthood and dieting can make them feel more in control.
- Our celebrity-worshipping culture means that role-models are often the super-skinny creatures who appear in magazines - no wonder, then, that young people equate thinness with success.
How Far Can It Go?
Anorexia is a bit like an addiction. The dieting is usually quite deliberately started, in just the same way as someone might decide to try alcohol or a drug. What happens next is a sort of 'high' as the individual discovers that he or she likes being thinner and that, in dieting, has found something that she is good at. Gradually control is lost to the point where the dieting controls the dieter rather than the other way round. What began as a simple desire to lose weight turns into a complete phobia of fat, calories and weight gain. Anorexics are usually totally preoccupied with food, with eating, and with maintaining weight loss. Perception becomes increasingly distorted so that a desperately thin individual may describe him or herself as overweight and may lead to paranoia where the anorexic accuses carers of deliberately 'sneaking' extra calories into their food.
The long-term health risks of severe anorexia include thinning bones, damage to the heart and kidneys, and, in girls, fertility problems.
What Can A Parent/Carer Do?
The most important thing that a parent or carer can do is to focus on nurturing the relationship that they have with their anorexic son or daughter. Keeping communication channels open and offering emotional support and unconditional love will be far more helpful than attempting to compel eating. Trying to force feed an anorexic will damage your relationship with them , as will criticising, nagging, shaming or blaming. It is fine to challenge their distorted thinking but this needs to be done gently and respectfully. It is also fine to point out the dangers of being too thin but this needs to be done without over dramatising. Above all, listen to what they are saying - really listen without judging and then see if, together, you can work on resolving some of the issues.
Remember that very low self-esteem is often an issue and focus on encouraging your adolescent. Tell them all the things that you feel they are good at and tell them why you love them - these things often go unsaid in families.
It is a good idea to offer a choice of help options because this encourages your teenage child to see him or herself as a responsible individual who can control his or her own recovery. The first lifeline you offer may simply be the website address of the Eating Disorders Association or a book on the subject - dragging them kicking and screaming to the G.P. or threatening them with a psychiatrist may only make them more determined to protect their lifestyle 'choice'. However there may come a point where medical help becomes essential and, as a parent, you should not feel that you have somehow 'failed' if you decide to seek professional help. In most cases, sufferers will be offered therapy and counselling so that thoughts and feelings about food and body-image can be addressed. Family therapy may also be an option as may anti-depression medication. Hospital admission is usually reserved only for the most serious cases where body weight has fallen at least 25% below normal.
Preventing Anorexia
There are never any guarantees for this sort of thing but there are a few things that may help:
- Avoid making food a battleground - try not to panic about a 'faddy' eater and don't equate an empty plate with 'good behaviour'. If food is too much of an issue in a family, it may be the 'stick' that your children unconsciously choose to beat you with in adolescence.
- Do everything that you can to encourage self-esteem and self-worth in your children. Notice their efforts and their small successes. Tell them how loved they are.
- Be careful of the language you use and the values that you may inadvertently pass on - e.g. 'fat people are stupid'. Be careful, too, of the example that you set - a girl who sees her mother endlessly fretting about calories is likely to end up doing the same herself.