Helping a teen with an eating disorder is among the most difficult challenges that a family can face. Parents should know that, fortunately, there are specialists who can help them help their child, that treatment for eating disorders is available. As with many disorders, there's a better chance of recovery if you recognize the problem and treat it in the early stages.

Research is ongoing into the causes of eating disorders, and the results are a subject of debate. Most experts believe that an eating disorder is a strategy that young people use to cope with problems too painful to talk about. They use their bodies as vehicles to play out the issues they face, usually issues of control, sexuality, separation, and self-esteem.

Of the people with eating disorders, 90 to 95 per cent are female. People with eating disorders may have suffered a trauma such as psychological, physical, or sexual abuse, or be part of a family in which the caregivers are addicted to alcohol or drugs. However, many people with eating disorders have not experienced such traumas. An eating disorder may have no single cause. In someone who is vulnerable, a disorder can be triggered by an event she doesn't know how to handle, which can be as common as being teased or as devastating as rape or incest. An eating disorder often begins when the person is dealing with a difficult transition: puberty, a new school, the breakup of a relationship. Every person's experience is unique, but often the teen who develops an eating disorder feels shame, disgust, and anger about her body. Some feel a need to purify or even punish their bodies. They feet powerless to change anything else in their lives.

There are two main types of eating disorders: anorexia nervosa and bulimia nervosa. Both are characterized by excessive concern about one's weight and shape and a negative, distorted body image. Although a teen may weigh only 32 kg (70 lb.), when she looks in a mirror, she sees herself as obese. She thinks that others also consider her mammoth in size, even if you think she looks skeletal when you see her thin arms and legs.

Anorexia Nervosa

Of the women in Canada between the ages of fourteen and twenty-five, an estimated 2 per cent suffer from anorexia, a condition defined as a drastic weight loss caused by self-induced starvation. It can, however, begin earlier. The child may begin by eliminating desserts from her meals. Then she may also exclude bread. She could go on to deny herself more and more food until she's eating only celery sticks and water. Eventually she may try to exist on water alone. The anorexic may go to the extreme of counting the calories she consumes from the glue after licking a postage stamp.

Behind this potentially fatal illness is a girl's strong desire to control everything and to become thin. Some may already be painfully thin in their parents' eyes; others become anorexic because they were overweight children, were either ostracized or encouraged to diet, and were praised when they lost pounds. Anorexics believe their only problem is being too fat. They have a distorted body image and dorA recognize how underweight they are, which makes it difficult for them to recognize that they need treatment.

Typically the anorexic makes up excuses to miss meals. Most adolescents have voracious appetites, but if your daughter often says that she had a huge lunch and doesn't want dinner, you might well be alert to other indicators of anorexia.

The British Columbia Ministry of Health includes the following as signs of anorexia:

• She develops obsessions about food and recipes. An anorexic may eat vicariously by grocery shopping, by watching cooking shows,or by cooking food for others.

• She develops unusual eating habits. She may cut her food into tiny pieces or eat only the crumbs that others leave behind.

• She always feels cold.

• She shows a noticeable weight loss.

• She involves herself in excessive exercise. As a way of burning
calories, an anorexic may spend hours in the gym or go on day-long walks.

Bulimia Nervosa
Of the women between the ages of fourteen and twenty-five, an estimated I per cent have bulimia nervosa. This disorder is characterized by cycles of binge eating followed by purging or other inappropriate compensatory behaviour to rid the body of calories. Because young girls don't know about or can't execute the methods of purging, this disorder doesn't usually begin until the mid-teens.

For a bulimic, a binge is eating boxes of cookies or litres of ice cream in a short period or time. Methods of purging themselves include selfinduced vomiting or using diuretics, diet pills, or laxatives. Teenagers with bulimia use stimulant laxatives such as Correctol or Ex-Lax most frequently because these cause diarrhea soon after eating. This leads to the loss of fluid, which may give a false sensation that she has lost weight. The abdominal pain, which is a common side effect, serves to make the teen's emotional pain real. The misuse of laxatives has serious complications, including dehydration and electrolyte imbalance. Many anorexics also suffer constipation from a combination of inadequate intake of food bulk and excessive vomiting, as well as the laxative habit, and may go days without having a bowel movement. Seek medical advice for your teen as soon as you become aware of the problem.

To induce vomiting, some teens use syrup of ipecac, an over-the-counter drug intended to induce vomiting in someone who has accidentally swallowed a poison. If used repeatedly, the drug becomes toxic to the muscles and can destroy heart tissue irreversibly, weakening the heart. If your child is using ipecac, she needs immediate medical attention. Unlike anorexics, bulimics know they have a problem. However, they don't want to admit to what they consider shameful and disgusting behaviour.

The British Columbia Ministry of Health includes the following as signs of bulimia:

• She eats large amounts of food, but shows little weight gain.

• She becomes excessively sensitive, secretive, and irritable about food and eating.

• She goes to the bathroom after meals and vomits In secret.

• She has a chronic sore throat and hoarse voice.

• She leaves evidence of vomiting or laxative abuse.

How to Help

Parents may feel helpless watching a child struggle with an eating disorder. Because of their worry, they may vacillate between being too involved or not involved enough. In an attempt to gain control of the situation, some parents revert to parenting techniques they used when their teen was a young child. Trying to force or tempt a child into eating may perpetuate the eating disorder. You may simply want to have your daughter spend more time at home so that you can make sure she's eating regular meals and nutritious food. But if you no longer allow your teen to hang out with her friends or go to the mall, her symptoms may escalate. Support her by letting her continue to spend time with her friends, to do the things other teens her age are doing.

You can help best by maintaining good communication with her, by showing your interest in her activities and her feelings. She needs to know that she's not alone and that you care about her. Talk about things other than food and weight. Let her know that you're concerned about her health and seek help from your family doctor or from an eating disorder clinic that can offera multidisciplinary approach.

Your role is that of a parent or a concerned friend, not a therapist. If your child refuses help, negotiate with her, but don't demand. Offer to go with her to the doctor's. Promise a shopping trip after the appointment. Say "I know you don't think you have an eating disorder, but unless a doctor confirms that, we'll never know for sure." If she's adamant about not seeing a doctor, maybe she'll talk with a school counsellor or a therapist who can help her recognize that she does need medical help. The National Eating Disorder Information Centre in Toronto keeps a national registry of therapists and programs.