Fighting anorexia

By Dr Jan Reeves

She slid to the floor fainting for the second time during our first consultation. Her parents had begun to notice how thin she was after their friends and schoolteachers had expressed their concern.

"We thought she'd get over it," they said, as I looked at the white face of Annabelle. Her bones were protruding from her cheeks and her arms hung like matchsticks from the sleeves of her sweatshirt. She was wearing five layers of clothing on a hot afternoon to hide her emaciated body from me and she refused to be weighed.

Annabelle, a fictional character but typical of the girls who present with the problem, insisted that her stomach and thighs were fat and she was exercising more than 90 minutes daily to lose more "fat." She had taken over the kitchen to bake cakes and gourmet delights for the family, but never touched any herself.

Her parents had observed her eating a large meal at night, but when they thought about it they realised it was mainly rice and vegetables. This was immediately followed by vigorous exercise.

Until now she had been the perfect child, popular, hardworking and obedient. They were aware she had started a diet some months ago, although she had never been overweight.

Annabelle's friends did this too, so they initially had passed it off as typical of adolescent girls. She then announced she was vegetarian, but this soon progressed to avoiding dairy products.

Annabelle's parents were at the end of their tether trying to get her to eat. They had cajoled and enticed her with treats. Her mother had begged, cried and eventually screamed at her to no avail. Her father was bewildered and lost as to how to help. The parents were now fighting with each other as to which was the best technique to use.

Annabelle is typical of the girls who present with anorexia nervosa. Their prognosis is often very good if they are brought or "dragged" to treatment early, for they usually will not come voluntarily. The longer the illness continues, the harder it is to treat. Treatment includes insistence on weight gain, medication, family therapy and individual psychotherapy.

If the parents can be helped to join forces, even if they live apart, and insist on their daughter eating, considerable progress can be made. The father's involvement is essential and can have a dramatic impact on the daughter's return to health.

The girl herself needs to learn how to solve conflict within herself, and between herself and others, without resorting to starvation. Therapy includes challenging the negative and distorted views she holds about herself, food and fat.

Anorexia nervosa is a battle. The sufferer is fighting herself, her family and the world, but her weapon is food rather than reason and open communication. She needs to learn to value herself, to articulate her feelings and gain appropriate control of her environment, rather than expressing her distress through focusing exclusively on the relentless pursuit of thinness.

Anorexia nervosa is a complex, serious, and mystifying illness about which there is still frustratingly little known. Available treatments are effective for some, but there are many who - together with their families - suffer and endure years of sadness and pain.

About 15 per cent of sufferers still die, either by suicide or malnutrition.

* Dr Jan Reeves is an adult and child psychiatrist in private practice in Remuera. She is a patron of the Eating Disorders Association.