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Signs of Anorexia?

March 30, 2008

Question:

My 14 year old daughter used to be a little overweight. She never seemed to mind before, but now she is obsessed with losing weight. In the last two months she's lost a significant amount of weight (I don't know how much exactly because she won't tell me) and she looks great. However, I think she has lost enough and should just maintain her new, healthy body. I can see, however, that she has become fanatical about weight loss; she isn't showing any signs of letting up on her diet. How can I be sure that she has not developed anorexia nervosa? My friend's daughter used to be very heavy and when this young lady lost weight she went way too far, becoming so thin that she had to be hospitalized. I don't want this to happen to my child. How do I know if she is in danger of doing the same thing?

Answer:

You are asking an excellent question. Sometimes teenagers do overcompensate for a previous weight problem by becoming anorexic. Their original intent, of course, was to lose a few pounds. However, the weight loss can occasionally take on a life of its own and the youngster becomes obsessed with her body image (the way she looks) and with being thin. There are also many girls, and some boys as well, who become anorexic as a response to stresses other than being overweight.

As a parent, you may not be able to fully distinguish between normal dieting and the disease of anorexia nervosa. However, if you see the following symptoms in your child, you should definitely talk to her. Let her know that you are worried about what is happening and that you want to set up a meeting with a professional (mental health provider, dietician or doctor) in order to ascertain that all is well or to treat a condition if one is assessed. Here is what to look out for:

· Child has lost a significant amount of weight. The official criteria is 15% of normal weight. However anorexics often wear layers of clothing to help hide excessive weight loss (as well as to maintain their body heat). The unusual amount of baggy clothing can, in itself, be a warning sign.

· Skipping meals (as a new behavior).

· Showing excessive concern about weight loss by constantly weighing herself, examining herself in the mirror, talking about how fat she is (when she isn't), talking about how many calories foods have – beyond what normal dieters do.

· Lying about having eaten or how much she has eaten.

· Restricting her diet to low fat foods and empty calorie foods (i.e. removing all grains, meats, dairy products even though she used to enjoy these).

· Cutting her food into tiny little pieces, pushing them around the plate and barely eating them.

· Shows disgust toward calorie-laden foods such as meat, pastries, cakes and cookies (anorexics may still eat candy).

· Exercises excessively (i.e. for 2 hours a day).

· Leaves "evidence" of purging such as wrappers and packaging from diet pills or laxatives.

· Leaves "evidence" of lack of menstruation by failing to request a new supply of menstrual products (if she used to give you that shopping list previously) or by failing to show whatever other signs of menstruation she used to show.

· Fainting or complaining of dizziness.

· Developing a layer of soft hair on her skin (called lanugo); developing dry or yellowish skin.

· Developing uncharacteristic fatigue and moodiness.

If you do notice one or more of the possible symptoms of anorexia nervosa, don't panic. It is more important to be effective now, than dramatic. Gently let your daughter know that you want to have a little chat with her later in the day. When you have that chat, tell her that you have been concerned. Let her know that you know the symptoms of anorexia and that even though she probably doesn't have it, you are feeling anxious (people with anorexia, like alcoholics, are generally in denial about their condition). Let her know that you want someone knowledgeable to put your mind at rest. Be gentle but firm. The assessment, if you feel you need one, is not an option. Your daughter's health is still your responsibility. If you have reason to be concerned, then definitely carry through until the matter is satisfactorily put to rest.

How to Say "NO" with a "Yes"

March 20, 2008

A parent can easily say "no" 200-300 times a day to a young child. After a barrage of "no's," a child can become so inured to the pain that he stops listening. Obviously, a parent must set limits, but it is also essential to show empathy as you do so. Teaching children to face life's endless disappointments, losses and frustrations with determination and discipline is what helps them build ego-strengths! Even if they rant and rave and accuse you of being the meanest parent on earth, they will – one day - appreciate the fact that you cared enough to protect them. Furthermore, upholding your principles in the face of their threats and bargaining skills will help them to resist the temptations and bullying which they will inevitably encounter.

Here are some suggestions to use with young children:

1. Say a partial "yes"—Agree to some part of what he wants, as in:

  • "Yes, you can have that cookie - after you eat."
  • "Yes, you can go barefoot - when the weather becomes warmer; but now it's cold and you need to keep your feet warm with socks and shoes."
  • "Yes, you can go out - as soon as the room is orderly."
  • "You can roll the ball on the floor, but throwing the ball is for outdoors."
  • "You can hit/pinch/squeeze the pillow - not the baby."

2. Give a brief explanation of your feelings--Some children take longer to develop empathy. Without a lot of dramatics, let them know:

  • "I want to hear you, but it hurts my ears when you talk like that. Please use your grown-up voice and say again what you want to tell me."
  • "I would love to go, but my legs are so tired. It feels like my batteries need to be recharged. If I go to rest, then we can go out."
  • "I used to love junk food too and giving it up was hard, but I love you enough to want you to eat healthy food."

3. Talk to the body part--Children often get into an obsessive loop and have difficulty stopping whatever they are doing. Since they like to give orders, tell them to order the body part that is "acting up" to stop. Tell the child:

  • Tell your mouth: "Stop biting!" Or, "Stop talking!"
  • Tell your hand: "Stop hitting." Or, "Stop banging."
  • Tell your leg: "Stop kicking."
  • Tell your hand to: "Don't hit! Be gentle!"

Teenagers:

Saying NO to a teenager can arouse a storm of reactions and test your own ego strengths to the hilt. Most teens hate feeling dependent on their parents and think they are much smarter and "cooler" than them. Teens who are terrified of being rejected, scorned and ostracized may not care what you think; all that matters is not feeling like an outsider among their peers. To establish their own individual identity (and often score points with their peers), they rebel against their parents, argue with them about everything and shut them out. Stubbornness often takes the place of intelligence. Nastiness gives them the illusion of power and independence, as if, "I don't need my parents."

During this painful time, parents are also going through their own crises – financially, emotionally and often physically as well. You may not have the patience or strength to set limits. It might seem easier to just give in. Remember, your ability to stand firm will be respected – later on! – and actually shows how much you care.

When you need to set limits, avoid sarcasm and name-calling, especially, "selfish, egotistical, brat, lazy, slob, crazy, idiot," etc. Even if you think these names reflect the truth, keep your opinions to yourself, as expressing them will cause severe damage later. If you talk when angry, you are likely to indulge in exaggerated threats, such as, "You're grounded until you get married!" And punishment may be harder on you than it is on them, as they sulk, stomp, threaten and generate negative energy like a nuclear reactor. When you talk, avoid condescending looks or gestures (such as eye-rolling, hands on hips or crossed arms. Your task is to be like a protective policeman, stating the rules and giving appropriate "fines" in the most dispassionate, emotionally neutral manner:

#1 Teen: "Everyone's going to this event. I can't believe you won't let me go."

Parent: "I understand how you feel, but it is my job to keep you safe." Or, "I know how much you want to be independent and I know how exciting these events are. However, this is my decision and it is final."

(Not: "Are you crazy! I don't care what your friends are doing! Anyway, that's a lie. Not everyone is going!")

#2 Teen: "I have to do everything in this house! I'm not your slave. I never have any free time. Why don't you ask anyone else to do these stupid chores?"

Parent: "I definitely want to discuss this with you. When you are ready to talk without screaming at me, let me know." "The rule is that your clothes must be in the hamper, or they do not get washed." Or, "I see that you are upset, but I will not listen unless you find a more respectful way to talk to me." "I realize how pressured you are with all these tests, but it is good preparation for adulthood to know how to make a meal (get up on time, iron your clothes and clean your own room).

(Not: "You selfish, lazy brat. I hardly ask you to do a thing!")

#3 Teen: "I hate you! Everyone has ________ (diamond earrings, expensive suits, etc.) I'll look like a freak if I don't have ______. You don't care! You're always trying to control me! Why do you have to make every little decision for me?"

Parent: "I know how frustrating it is not to be able to do/buy what you want, but these are the rules."

(Not: "All you think of is yourself! You are wasteful and materialistic! Money doesn't grow on trees!" "You're grounded until you get married for talking to me like that!")

#4 Teen: "It was nothing. Just a one-day suspension from school. You're so hysterical. You get so stressed out about everything. That's why I can't talk to you."

Parent: "I'd feel more secure and safe if you would tell me the truth."

#5 Teen: "I got a lousy mark. Now I'll never get into university. I'll never live up to your standards! I'm a total failure."

Parent: "I'm so sorry that you are in so much pain. Let's put our heads together and come up with some creative solutions."

#6 Teen: "You went through my personal belongings! You had no right to do that! I can't trust you!"

Parent: "I blew it. I don't blame you for being upset. I'm sorry. I didn't realize how much this would upset you. But you still have to speak to me respectfully."

It takes enormous spiritual strength to stay in control during these times and not take their tantrums and nastiness personally. You may need a therapist to help you deal with your own feelings of grief, rejection and abandonment, so that your own pain does not spill over on your children. If you maintain your own equanimity, your child will eventually calm down and your relationship will gradually improve. Even if it takes ten or twenty years for that teen to "grow up," the strengths you display will strengthen you. However, if your child is acting in a destructive manner toward others or himself, if he is up all night and sleeping all day, or showing signs of being addicted (to food, internet, shopping, etc.), not eating, or too anxiety-ridden to function, these are clear signs that he needs outside help.

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