Disordered eating can affect an entire family – the individual suffering from it, as well as parents and siblings. Here is one family’s experience with their daughter’s anorexia, as well as an expert’s advice on treating disordered eating.
PARENT | Meghan McGuan
There were mistakes. When Anabel was 10, we argued over replacing a pair of jeans. In a fit of exasperation, I declared, “They are too small! They give you a muffin top!”
There were warning signs. The first was a list of rules about eating—or more accurately, not eating—that fell from a Mickey Mouse diary tucked between her mattress and box spring with a title bearing the word “Ana.” (Spoiler alert: Ana is not a nickname for Anabel.)
Around the same time, I allowed Anabel to switch from the male pediatrician who had cared for her since birth to a female pediatrician in the same practice in whom I had less confidence. Anabel voiced discomfort with a male doctor, and I felt compelled to accommodate her.
In retrospect, I believe Anabel sensed that our pediatrician trusted my instincts, while this other pediatrician found me a bit overprotective, even silly, in my worries. At the time, I didn’t know the push to change doctors was a manipulation. Eating disorders are powerful masters. The disorder controlled Anabel’s thinking, and she in turn manipulated us to protect her secret.
We got lucky. An anonymous student brought a secret Instagram account documenting Anabel’s pro-ana (pro-anorexic) behavior to the attention of her guidance counselor. Faced with photos of my daughter proudly displaying her protruding hip bones, thigh gap, and concave abdomen, the pediatrician referred Anabel for counseling, despite her own skepticism. “Her weight has dropped, but I’m not sure if this is an eating disorder or just attention-seeking behavior,” the doctor offered.
Each week, Anabel saw a psychologist with a focus on disordered eating, and she seemed to improve. She joined the crew team, which worked out six days a week for hours at a time. Soon she became strong—solid muscle. “She must be healthy,” we thought, or so it seemed.
Then, Anabel went to Spain on a school trip. When she returned, something had changed, and our anxiety about her health returned. Soon, her psychologist and a psychiatrist suggested The Emily Program, a national program treating eating disorders. For the first time, we were told that our daughter has anorexia. Anabel was 17.
The Emily Program follows the Maudsley approach, which is “an intensive outpatient treatment where parents play an active and positive role in order to … help restore their child’s weight, … hand the control over eating back to the adolescent, … and encourage normal adolescent development.”
To make this work, my husband took family leave from work to supervise her lunch and after-school snack. In addition to family sessions, Anabel attended individual and group therapy as she progressed from supervised to independent eating.
Anabel was born with clenched fists, an intense gaze, and a mighty wail. In grade school, her first teachers dubbed her “Skipper” because she literally skipped into school with glee. But for much of her adolescence, she faded into the background, as her anorexia threatened to make her literally disappear.
At 18, Anabel is coming into herself. She is kind, determined, opinionated, silly, and brave. She won’t disappear. She’s just getting started.
Meghan McGuan is married to Marty and is the mother of Anabel, Patrick, and Moira. She works for Catholic Charities, Diocese of Cleveland.
TEEN | Anabel McGuan
I’ve always been a perfectionist. I have a distinct memory of a kindergarten playdate. We were playing with glitter glue, and I was globbing it on like there was no tomorrow. My mom innocently suggested that I try using the glitter glue like my friend. “See how she’s just using a little, and smoothing it into nice lines?” I felt inadequate.
The summer before fifth grade, I attended camp. I remember sitting on a fence with two friends. One was worried that the plank would break under us. “Don’t worry,” the other responded, “It won’t break. None of us are over 100 pounds—then we’d be fat!” I weighed 106.
After that, I started counting calories. I recorded everything in a journal I kept under my mattress. The pages overflowed with tips for avoiding food, meticulous logs of calories consumed and burned, and daily weigh-ins.
My dad found the journal one day when he was changing my sheets. My mom confronted me, but I blew it off, telling her it was old, I was over it, not to worry.
For most of sixth, seventh, and eighth grades, I only ate dinner. My friend and I were competing to see who could eat and weigh less. We’d share daily numbers and body checks and watch each other try to wrap our hands around our thighs. That was the ultimate goal.
Freshman year, I created an Instagram account for my eating disorder. My feed was filled with pictures of my protruding bones, accompanied with self-loathing captions expressing my disgust with my body.
Switching between my eating disorder account and my main account was confusing, and I accidentally followed a friend on the eating disorder account. She told my guidance counselor, who alerted my parents. They promptly took me to the doctor. My mom held my hand and cried.
Overcoming An Eating Disorder
That was the first time I saw a therapist. She specialized in adolescent eating disorders. On the outside, things seemed to look up for a while. I was eating enough to satisfy my parents, maintaining my weight, and I even joined the crew team.
The intense exercise caused me to gain about 10 pounds of muscle. When I saw the number on the scale shoot up, I panicked. I started to restrict again, and I weaseled my way out of therapy.
Then, I flew to Spain for ten days with marching band. Instead of indulging in the exciting regional dishes, I avoided calories like the plague. I fainted during a concert in a public square, but I played it off as heat exhaustion.
When I came home, my parents noticed the change. They sent me back to my therapist, and she and my psychiatrist referred me to The Emily Program. There, I finally dedicated myself to recovery. After eight months of family, individual, and group therapy, I graduated from the program.
Every day I continue to work on recovery. Every day is a choice—recovery or relapse. Sometimes, though the choice should seem obvious, it’s incredibly difficult, but I have an incredible support network to keep me on track. No matter how strong my disordered eating may be, I am stronger.
Anabel is a 2017 graduate of Shaker Heights High School and will attend Duquesne University in the fall.
EXPERT | Lucene Wisniewski
Anabel’s experience with disordered eating is not uncommon: The disorder takes hold well before anyone notices. By the time parents see the signs, the disorder has been infiltrating their daughter insidiously for some time. When she is confronted, the disease compels the teen to lie and hide her symptoms.
Meghan’s experience is not uncommon either: She seems to partly blame herself. For many years, parents—particularly moms—were faulted for all the mental health problems their kids suffered, including eating disorders (EDs).
Parents should take heart that there is no one thing that causes a child to develop an ED. People sometimes remember a comment from a coach, an experience at school, a love interest’s rejection, a peer’s judgmental look, or a traumatic event as the tipping point for the development of their struggle, but the science suggests it is much more complicated than that.
Anabel identified herself as a “perfectionist.” This, we know from multiple studies, does tend to place kids at higher risk. Perfectionist kids, who tend to be aware and sensitive, may hear what peers and our culture are saying about weight and think, “I am not perfect. I need to fix this.”
Families often wonder when symptoms require intervention, and it cannot be stressed enough: Any sign of disordered eating is enough to warrant a discussion with a professional since it is common that parents see only a small portion of what is secretly going on.
Treatment for an ED is often disorienting and daunting for parents because their child, who has historically been a good student, a rule-follower, and conscientious, is now sneaking and lying to protect his illness. Parents can sometimes miss the signs and, if they see the signs, can be fooled because they think their child would never lie to them. Even small signs, though, warrant parent action. (Even a parent who does not feel ready to include her child in a discussion with a professional can go by herself to discuss her concerns.)
Anabel’s parents brought her to an ED expert, an important step in this story’s happy ending. We know from research that there are specific treatments that are effective in the treatment of kids with EDs. Individual therapy can be helpful, but for Anabel and many other teens, this was not successful in fully improving her symptoms. Eventually, she received the family-based treatment Meghan mentions, which is the treatment method of choice for kids with anorexia nervosa who are under the age of 18 and living at home.
Parents do not cause EDs, but the steps they take can affect success in recovery. Once parents find out about the problem, time is of the essence because early assessment and treatment are key. Anabel’s family should be commended for their tenacity in getting her the care she needed. The good news is that with effective treatment Anabel and other teens with ED have a renewed chance to live a long, healthy life.
Lucene Wisniewski, Ph.D., FAED, is an adjunct assistant professor of psychological sciences at Case Western Reserve University and maintains a private clinical practice. She has over 20 years of experience treating eating disorders.