Q: "When my daughter came home from college for the summer, I couldn't believe how much weight she'd lost. I'm worried. Could she have an eating disorder? What should I do before she heads back?"
Answer from Jason Stone, M.D., psychiatrist, Providence Adult Eating Disorders Program and Providence Behavioral Health Services, and Barbara Oyler, RN, MN, PMHNP, clinical team leader, Providence Behavioral Health Services:
We would need to evaluate your daughter to confirm a diagnosis, but your concerns are not unusual or unfounded. The college years are a very common time for eating disorders to emerge. Some students struggle with the transition from all that is familiar – home, family and friends – to a new school, new friends, new responsibilities and new expectations. A change in eating patterns may begin simply as an effort to stay on an even keel through a time of huge transition. Or it may start as a defensive strategy against the dreaded "freshman 15," the highly exaggerated rumor that students will gain an average of 15 pounds in their first year of college ("freshman five" would be more accurate). Whatever the impetus, a new dietary routine can provide a comforting structure to a student's life before the routine spins out of control and takes on a life of its own.
We see a huge influx of patients every June and December, when college students are home on break. Many come home knowing that they need help; some tell us they've just been holding things together until they had a long enough break to enter treatment. Others don't realize that they have a problem, or don't understand the extent of the problem, until someone encourages them to talk about it. That's where parents play a crucial role.
We recommend taking the following steps to investigate your daughter's situation further and to help her get treatment, if appropriate:
Learn: Don't try to diagnose your daughter yourself, but do learn more about anorexia and bulimia so you can approach the next steps as an informed parent.
Talk: We urge you to talk with your daughter about your concerns. Be kind, supportive and respectful. Ask questions; don't make accusations. Ask how she is doing, and whether she thinks she might have a problem. Let her know that she can talk openly with you, and that you are on the same team: You both want her to be healthy.
Guide: Your daughter may be feeling the stress of knowing there is something wrong but not knowing what to do about it. Let her know that you want to help, and offer her your guidance. Form an alliance with her and decide together to make an appointment for an evaluation with a specialist in eating disorders so you both can learn more. Then follow through: Make the appointment, and offer to drive her there. (If your daughter is resistant to being evaluated, you may need to gently insist - eating disorders can be life threatening and should not be ignored.)
Treat: If the evaluation reveals that your daughter does have an eating disorder, enroll her in an appropriate treatment program. Reassure her that this doesn't necessarily mean that she needs to put her education on hold. During the course of a summer or winter break, programs like ours can provide a great deal of treatment and can get many patients stabilized without much disruption to their academic pursuits.
Support: Throughout your daughter's treatment and recovery, offer her your full support. One of the most important factors in a patient's success is the involvement of her family members or chosen support system in the healing process.
Take care: Many parents wonder if they are to blame in some way for their child's eating disorder. The answer, nearly universally, is no. Don't blame yourself or worry that you did something wrong as a parent. Instead, focus your energy on taking care of your family. And be sure to take care of yourself as well.
Learn more about eating disorders treatment and recovery at Providence's free informational meetings, every Wednesday from 4:30 to 5:15 p.m. at Providence St. Vincent Medical Center in Portland. If you live outside of Portland, feel free to give us a call at 503-216-2025.