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Expert Q&A

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My son's girlfriend is starving herself; what can we do?

Asked by Ed Beattie, Chappell, Nebraska

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My son's 21-year-old girlfriend seems to be starving herself. When we first met her a couple of years ago, she was a beautiful, athletic, vibrant young woman. She started to do some part-time modeling about a year ago and that seems to be when the obsession with weight control began. We hadn't seen her in quite some time, as they both are enrolled in an out-of-state university. She recently stayed at our home for a few days over Christmas break and her appearance is shocking! She was always trim and fit, but now she looks like a skeleton. Her hair seems to be falling out and she doesn't look at all healthy. I asked my son if he has tried to get her to seek professional help, but he said she just gets very angry whenever he raises the subject and then won't talk to him for a week or more. Her own family doesn't seem to be concerned, but my wife and I certainly are. Do you have any suggestions as to how we might be able to help?

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Ed,

I am sorry to hear of your son and his girlfriend's situation (and your problem by extension). As always, I can't make specific recommendations the way a physician who had evaluated your son's girlfriend could, but I do want to make general comments about what you describe.

When young people lose a lot of weight it is always very serious. A first possibility is that the person is sick. Many illnesses, from cancer to hyperthyroidism, can cause weight loss. But the most likely cause of your son's girlfriend's problem, based on your description, is a truly devastating psychiatric condition known as anorexia nervosa.

Anorexia nervosa is typically a younger person's illness. It is much more frequent in women than in men and is especially common in professions such as modeling where emaciation is at a premium. (Other high-risk careers for this include ballet and show business.) The symptoms are much as you describe. First comes an obsessive concern with thinness and an absolute conviction that one is too fat, even though this conviction is often completely unrealistic. When a skeletally thin person with anorexia sees herself in the mirror, she sees herself as grossly overweight. Sometimes if she can see herself from the outside perspective of a video recording she will get a glimpse of how others see her, and this can be helpful.

In Western countries it is this nearly psychotic misperception that is really the root of anorexia, and when it becomes entrenched it can sometimes never be removed. More often than I care to remember I have stood in the intensive care unit at the bedside of a young person dying from self-imposed starvation. Even when patients don't starve themselves to death, they not infrequently die from complications such as cardiac failure (as happened to singer Karen Carpenter).

As anorexia progresses and the food restriction worsens, young women lose their menstrual periods; they develop significant body and facial hair while the hair on their head turns brittle and falls out. Their body temperatures drop and their heart rate slows. Worst of all, their personalities change and they frequently become extremely guarded, irritable and remarkably rigid, especially around anything having to do with food.

I'm afraid your son is in for a very tough go no matter what he decides to do. When anorexia reaches the stage you describe, it very rarely goes away on its own, especially when a person has the violent denial you describe in your son's girlfriend. People can recover, but it usually takes very intensive treatment, often on an inpatient basis. I spent a number of years working with eating disordered patients on such an inpatient unit so I know of which I speak.

If he wants to help, he is almost certainly going to enact what would be called "an intervention" in the substance-abuse world. Such a decisive demand that she receive treatment will most likely run a great risk of leading to a breakup, but what is the alternative? It's not much of a life to have to endure the tragedy of an untreated and potentially lethal eating disorder and pretend it isn't happening. If fate smiles on him and she does agree to get treatment, it is of tremendous importance that she gets plugged in to adequate treatment immediately. If they are in college, a reasonable first place to start would be the counseling center, not as a treatment venue but as a resource for where the type of intense treatment she'll need can be obtained.

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