Q:I do much of my legal work in a home office, giving me plenty of opportunity to see and interact with my 22-year-old daughter, who has been back at home since finishing college. I know that she's discontented, not having lined up, as yet, the kind of job she hopes for. But lately I've also noticed a kind of secretive behavior that reminds me of my own, pre-recovery, alcoholic behavior of many years ago. I'm pretty sure she's not drinking, but given her nightly bathroom routine and sudden trips to the convenience store, I am actually wondering (despite her normal weight) whether she may have developed an eating disorder. If it is an eating disorder, what kinds of treatment can I direct her to?
A:You're right that this may or may not be an eating disorder. If it is, it might be bulimia, which might well appear alongside a depressed mood. Bulimics typically "discover" various ways to "undo" their binge eating (often of sweet, caloric foods) by means such as self-induced vomiting, abuse of laxatives or fasting. They typically don't become emaciated like anorexics (though many have had both disorders), but it is also true that these "undoing" behaviors are rarely effective in the long run, and can cause medical complications, including dehydration and heart abnormalities.
The typical bulimic is a female who first showed symptoms as an adolescent or young adult. The vomiting and the way it is induced may result in erosion of tooth enamel and/or scarring on the hands, and some bulimics develop "chipmunk"-like swollen salivary glands. We have heard bulimic individuals describe their behavior as addictive, like alcoholism, including that familiar pattern of swearing, "That was the last time," and then finding themselves repeating the pattern. Also, like addictions, the causation seems to be a complex combination of biological and environmental factors, along with a process of conditioned learning.
It is far from easy to put a halt to a bulimic pattern of behavior, but treatment is available. Since bulimia is much less immediately life threatening than anorexia, hospitalization is rarely needed, though for some, it is useful to get away for a while to the supervised setting of a residential program (where support is close by and one is not exposed to the triggering stimuli of home). The intensity of treatment depends on the individual's needs, and, as for chemical addictions, varies greatly in amount of time per week. Scientific studies show that bulimic symptoms often decrease with the use of antidepressant medication, especially the newer ones that target serotonin levels.
Among psychotherapeutic approaches, most studies point to the effectiveness of a cognitive-behavioral approach that focuses on monitoring of bingeing/purging behaviors, as well as related thought patterns, such as perfectionism and preoccupation with one's body. Group therapies are useful for validation, support and strategies, whether professionally led groups (some available, for example, through MEDA Inc., also known as the Massachusetts Eating Disorders Association), or peer support groups like Overeaters Anonymous (OA) or Food Addicts in Recovery Anonymous (FA). A particularly useful adjunct to any of these treatments is consultation with an appropriately experienced nutritional counselor.
As a family member of a lawyer, your daughter is welcome to meet with us, to assess whatever the problem may be and get help in selecting and locating suitable resources. We have noticed that it's hard to find an eating disorder specialist who deals with managed care. You are also welcome to come in yourself, with or without her, to discuss your own reactions to her behavior and your wish to help.
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