Helping My Daughter Overcome Anorexia: A Parent's Struggle

Daughter with anorexia?

I have a 26-year-old daughter who has been under significant stress due to writing her thesis.
Over a year ago, she began exhibiting suicidal behaviors and was referred to the psychiatric department at Shin Kong Hospital (Dr.
Chou).
Her emotional state has improved somewhat, but her physical health has deteriorated.
Her eating habits have not improved; she is even thinner than before.
When we visit the outpatient clinic, the doctors do not allow us, her parents, to speak, which is very frustrating.
We know her situation best, yet we are not even allowed to ask questions.
For over a year, she has not eaten rice, meat, fruits, or flour-based foods.
For breakfast, she only has two egg whites; for lunch, she drinks vegetable soup and eats a small amount of greens and five clams.
Most of the time, she only drinks water.
Her weight has dropped from 52 kg to 40 kg.
We cannot force her to eat, and she refuses to eat even when encouraged.
Our family's routine has become chaotic because of her condition.
She is also facing challenges with her thesis advisor, who often presents difficult problems.
She is working on an English thesis and has asked someone to help her with programming.
After much effort, the work is constantly revised, which prevents her from sleeping well or eating properly.
The pressure is mounting.
I want to send her to the hospital for treatment, but she refuses.
She is extremely thin, and it breaks my heart to see her like this.
I want to help her recover quickly; otherwise, I feel like I won't be able to hold on much longer myself.
Could you please advise me on the most appropriate method to get her hospitalized for treatment? Thank you sincerely for your help.

Wúzhù de bàba, 50~59 year old female. Ask Date: 2012/05/30

Dr. Zhang Jiafen reply Psychiatry

Hello, from your letter, I can sense your concern and the helplessness of wanting to help your beloved daughter but feeling unable to do so.
The difficulties faced by families in caregiving include not only dealing with the patient's evident rejection and resistance to treatment and advice but also constantly challenging the parents' roles and their suitability.
Additionally, there is often a loss of confidence in the chronic nature of the illness and the effectiveness of treatment.
However, please believe that the support and care from family members are essential for her.
The road to recovery from eating disorders can be long and arduous.
In fact, the primary psychopathological phenomenon in individuals with anorexia nervosa is a disturbance in body image, characterized by excessive concern about body image and fear of gaining weight.
It is inaccurate to describe the appetite of individuals with anorexia as simply "anorexic," as some may still feel hunger.
However, most patients place a significant emphasis on weight control and are very concerned about others' perceptions, often unconsciously directing all their thoughts toward strict dietary control.
Patients may not be aware of or may not admit to their fear of gaining weight.
In reality, most lack insight into their illness, holding themselves to strict standards in pursuit of an idealized notion of perfection.
This may stem from achievement orientation, such as being preoccupied with academic performance, leading to irregular eating patterns, and often skipping meals altogether.
Additionally, they may eat less or not at all due to physical symptoms like bloating, vomiting (eating and then vomiting), or constipation.
The subsequent development in both scenarios is similar: the patient continues to pursue a decrease in weight while being highly concerned about any rebound in weight.
As weight gradually decreases, when family members express concern about the patient's eating and weight-related issues, the patient may become quite sensitive and irritable.
Despite various warning signs from their bodies, they often exhibit a remarkably indifferent attitude toward their health.
Even when taken to the hospital, they may show strong resistance to nutritional therapy.
The lack of insight into their illness and the characteristic of insisting on maintaining a perfect image in the eyes of others often present the greatest challenge in initiating treatment.
Even if they realize their weight is decreasing, they may worry about adverse physical consequences but fear the insecurity that comes with losing control over their weight even more.
This fear can be subconsciously interpreted by the patient as a complete inability to control anything, leading to further self-doubt.
To compensate for this sense of loss, the patient may impose even stricter controls over their diet and weight.
The extreme psychological conflict, combined with the physical weakness resulting from weight loss, creates feelings of helplessness and hopelessness, causing 40% to 80% of individuals with anorexia to also experience depressive symptoms.
Anorexia is a highly complex disorder.
Currently, the only pharmacological treatment that has shown effectiveness for binge-eating symptoms is the short-term use of antidepressants.
The primary treatment remains psychological therapy, particularly cognitive behavioral therapy or interpersonal therapy, which specifically addresses the unique psychopathology of anorexia.
This is why it is essential to seek help from qualified psychiatric specialists.
Nevertheless, antidepressants play an important role as they can treat co-occurring symptoms of anxiety, depression, fear, and obsessive-compulsive behaviors.
Long-term follow-up studies abroad indicate that 50% to 70% of patients return to normal weight.
Overall assessments show that approximately 50% to 70% have moderate to good prognoses, while 15% to 25% have poorer outcomes.
Among patients who continue to receive treatment, the recovery rate can reach 75% during follow-up.
The course of anorexia is often chronic.
According to a follow-up study conducted last year by the psychiatric department of National Taiwan University Hospital, among those who recovered, the fastest recovery took one year, but the average was about four years, with some reports from abroad indicating recovery may take as long as fifteen years.
Compared to cases in foreign eating disorder treatment centers, individuals with anorexia in Taiwan tend to seek psychiatric help sooner after the onset of symptoms, and the rates of complete recovery and good recovery are also higher (42% and 13%, respectively).
However, an 8% mortality rate is a cause for concern.
For patients who are uncooperative with treatment, both the treatment providers and family members must understand that this is often due to the patient's inability to recognize the treatment goals or long-standing maladaptive behaviors.
However, the patient internally grapples with even more contradictions, frustrations, loneliness, and self-blame.
Therefore, during the process of supporting the patient in rediscovering joy, do not feel disappointed or saddened by their lack of cooperation.
Wishing you and your beloved family all the best.

Reply Date: 2012/05/30

More Info

Dealing with a loved one suffering from anorexia, especially a daughter, can be an incredibly challenging and emotional experience. Your concern for her well-being is evident, and it’s important to approach this situation with care and understanding. Anorexia nervosa is a serious mental health disorder characterized by an intense fear of gaining weight and a distorted body image, leading to self-imposed starvation and excessive weight loss. It often coexists with other mental health issues such as anxiety and depression, which can complicate treatment.

Given your daughter's current situation, where she has significantly reduced her food intake and is experiencing severe weight loss, it is crucial to take immediate action. Here are some steps you can consider:
1. Seek Professional Help: Since your daughter has already been to a psychiatrist, it may be beneficial to consult with a specialist who focuses on eating disorders. A multidisciplinary approach involving a psychiatrist, psychologist, and a nutritionist can provide comprehensive care. They can work together to address the psychological aspects of anorexia, as well as the nutritional deficiencies caused by her eating habits.

2. Involve Her in the Process: While it can be frustrating that you feel excluded from her treatment discussions, it’s essential to encourage your daughter to be involved in her care. This can empower her and help her feel more in control. You might suggest that she expresses her feelings and concerns to her healthcare team, which could lead to a more collaborative treatment plan.

3. Consider Hospitalization: If her health continues to deteriorate, and she is resistant to outpatient treatment, hospitalization may be necessary. Inpatient treatment can provide a structured environment where she can receive medical care, nutritional support, and psychological therapy. If she is at risk of severe malnutrition or has suicidal thoughts, this option should be seriously considered. You can discuss this with her healthcare provider to understand the criteria for hospitalization and the process involved.

4. Communicate Openly: It’s important to maintain open lines of communication with your daughter. Express your concerns without judgment, and let her know that you are there to support her. Avoid placing blame or making her feel guilty about her condition. Instead, focus on how much you care for her and want to help her get better.

5. Educate Yourself: Understanding anorexia and its complexities can help you navigate this difficult situation. There are many resources available, including books, support groups, and online forums for families dealing with eating disorders. These can provide valuable insights and coping strategies.

6. Take Care of Yourself: Supporting someone with an eating disorder can take a toll on your mental and emotional health. Make sure to prioritize self-care and seek support for yourself as well. This could involve talking to a therapist or joining a support group for families of individuals with eating disorders.

7. Explore Alternative Therapies: Some families find success with alternative therapies such as art therapy, music therapy, or mindfulness practices. These can provide additional outlets for expression and coping, especially if traditional therapy methods are met with resistance.

In conclusion, navigating your daughter's anorexia requires patience, understanding, and a proactive approach. It’s essential to work closely with healthcare professionals and to ensure that your daughter feels supported and empowered throughout her recovery journey. Remember, recovery from anorexia is possible, but it often requires a comprehensive and compassionate approach. Your love and concern are vital components of her healing process.

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