Tens of thousands of parents have turned to this compassionate guide for support and practical advice grounded in cutting-edge scientific knowledge. Top experts James Lock and Daniel Le Grange explain what you need to know about eating disorders, which treatments work, and why it is absolutely essential to play an active role in your teen's recovery--even though parents have often been told to take a back seat. Learn how to monitor your teen's eating and exercise, manage mealtimes, end weight-related power struggles, and partner successfully with health care providers. When families work together to get the most out of treatment and prevent relapse, eating disorders can be beat. This book is your essential roadmap. Featuring the latest research, resources, and diagnostic information, the second edition has been expanded to cover binge-eating disorder.
|Publisher:||Guilford Publications, Inc.|
|Edition description:||Second Edition|
|Product dimensions:||5.90(w) x 8.90(h) x 0.90(d)|
About the Author
James Lock, MD, PhD, is Professor of Child Psychiatry and Pediatrics at Stanford University and Director of the Stanford Child and Adolescent Eating Disorders Program. Dr. Lock has received numerous awards for his research on eating disorders and has published several books for professionals in collaboration with Daniel Le Grange. He is committed to providing evidence-based treatments to children, adolescents, and their families. Daniel Le Grange, PhD, FAED, is Benioff UCSF Professor in Children’s Health in the Department of Psychiatry and UCSF Weill Institute for Neurosciences and Director of the Eating Disorders Program at the University of California, San Francisco. He is Emeritus Professor at the University of Chicago, where he was Director of the Eating Disorders Program until 2014. Dr. Le Grange was a member of the team at the Maudsley Hospital in London that developed family-based treatment for anorexia nervosa. Over his career, he has treated numerous adolescents and families struggling with eating disorders. He is a past recipient of the Leadership Award in Research from the Academy of Eating Disorders and an Early Career Development Award from the National Institute of Mental Health. The author of over 500 articles, books, book chapters, and published abstracts, Dr. Le Grange has published several books for professionals and parents in collaboration with James Lock, including Help Your Teenager Beat an Eating Disorder, Second Edition.
Read an Excerpt
Help Your Teenager Beat an Eating Disorder
By James Lock, Daniel Le Grange
The Guilford PressCopyright © 2015 The Guilford Press
All rights reserved.
You don't know what to do.
Thirteen-year-old Sheila has been losing weight for 6 months. At first you thought it was normal teenage dieting. But she's too thin now. She has stopped eating with you but insists on cooking everything for the whole household. Last week she made four desserts but wouldn't eat any of them. She has a book with a list of the calories in everything most of us eat, but she doesn't need it anymore because she knows it by heart. Besides, at present, she eats only three things: raw vegetables, tofu, and dry cereal. She's still doing well in school. Her straight As, though, seem more of a burden than a source of accomplishment to her. When she isn't studying, she's going for a run or doing sit-ups. She ignores calls from her friends and seems more and more depressed. When you try to encourage her to eat, she fumes and says it's none of your business. She insists she's fine.
You don't know what to do.
You caught 17-year-old Donna throwing up. She said she was sick. But it wasn't the first time. You have heard her before. Always heading off to the bathroom after every meal. She says it was nothing—she only had an upset stomach. You've noticed she hardly eats breakfast or lunch, but when you come home in the evening, lots of food is gone from the pantry, especially cookies, potato chips, and bread. You've had to go to the store midweek to restock. One of her friends told you she was worried about Donna. You are too.
You don't know what to do.
Tom used to be a great high school diver. He's too weak now to perform his toughest dives. He eats only protein bars and fruit drinks. He is constantly exercising to get perfect abdominal muscles, but you can see his ribs. He says he's still too fat. Where there used to be muscle, there's mostly bone and skin now. At first his coach complimented Tom on his weight loss because it had improved his dive entries. Now the coach has called you and suggested Tom take a leave from the team. Tom's best friend called him "skeleton" to tease him, but you know he's worried too.
You don't know what to do. Should you do something?
This is the first problem you face if you're concerned that your son or daughter may have an eating disorder. You know most eating problems in children are transient. You remember lots of struggles over junk food and sweets with your other children, or you've seen it in other families. Many children commonly go through periods of being picky eaters, eating more than usual, eating less than usual, and even complaining about upset stomachs or having periods of mild digestive problems and constipation. You've asked other parents and relatives about these types of behaviors and learned that, although usually short-lived, eating problems are nearly universal. As children enter puberty, many, especially girls, are very much interested in their appearance and weight and may try dieting or other weight-loss strategies. You expect this because you know it's normal to become more concerned about appearance in the teenage years and because you've known your son's or daughter's friends to express similar thoughts and engage in the same types of behavior. You don't want to create a problem where there isn't one.
How do you know if there's a real problem?
If you think your child's thoughts and behaviors resemble those of Sheila, Donna, or Tom, however, it's time to take action to help. Left untreated, eating disorders can lead to chronic health problems, depression, and even death. With the severe weight loss associated with anorexia nervosa, for example, starvation leads to lower body temperatures, decreased blood pressure, and decreased heart rate, as well as rough and dry skin, loss of hair, cessation of menstruation in young women, and osteoporosis. Because the body isn't being fed, it turns to muscle for fuel. This causes weakness, fatigue, and, in particular, decreased cardiac mass (the heart being a large muscle in the body), which can prompt dangerous changes in heart rhythm and may thereby cause cardiac failure and death. Over time, the risk of death as a result of the complications of anorexia is estimated at 6–15%. This mortality rate is the highest for any psychiatric disease.
For bulimia nervosa, the risk for death appears to be lower, but there still are risks of severe medical complications. One of the most common of these complications is depletion of potassium (hypokalemia), which results from loss of body stores of this essential electrolyte due to purging stomach contents. Without potassium, which is required for many basic physical processes but is very important for muscle contraction, cardiac arrhythmias are possible, leading to cardiac arrest and death. In addition, with chronic vomiting, the linings of the esophagus and stomach can become eroded, causing bleeding, ulcers, erosion of tooth enamel, and even death if the bleeding cannot be stopped. Chronic use of laxatives and purgatives leads to intestinal problems, including pain and severe and unremitting constipation. Both vomiting and the use of laxatives lead to severe depletion of water from the body (dehydration), which can cause low and changing blood pressure, increasing the likelihood of fainting and falls. For binge-eating disorder, the medical risks include obesity, hypertension, and diabetes. The specific medical risks associated with avoidant/restrictive food intake disorder are not known, but in cases of severe weight loss accompanying this disorder, the risks of malnutrition are similar to those found in anorexia nervosa.
We discuss these complications in more detail in Chapter 4. By now, though, you can undoubtedly see that eating disorders have serious health consequences. To be complacent in the face of a possible eating disorder is the greatest risk a parent can take in the battle to prevent such serious problems from developing.
WHAT DOES AN EATING DISORDER LOOK LIKE AS IT DEVELOPS?
If you're to catch a problem before it becomes an eating disorder, you have to know what to look for over time. Sheila, Donna, and Tom's problems did not develop in a day. Like most eating disorders, their problems developed gradually and sometimes in secret. If you understand the path by which more typical, temporary eating problems and weight concerns can become real eating disorders, you can get a sense of where your own child is on that trajectory.
Extreme Dieting: The Path to Anorexia Nervosa
Fourteen-year-old Rosa has always been a terrific child. Her parents said she had spoiled them because she was always so easy, independent, reliable, and mature. That's why they were so shocked by her recent weight loss. She had never shown the slightest sign of emotional problems. She was an honor student, swim team champ, and popular at school. She had never been overweight; in fact, she'd always been on the thin side.
The problems seemed to begin during the summer before ninth grade. Rosa had been on the summer swim team. It was the first time her parents noticed that she wanted to stay longer to swim after practice. She wanted to get fitter, she said, so she could be a starter on both the breaststroke and freestyle teams. At the same time, she started a vegetarian diet. She felt it was cruel to eat animals, and besides, she didn't need fat in her diet when she was trying to be healthier. At first her parents understood and supported her efforts at self-improvement as Rosa seemed happy and confident.
Then Rosa attended the special 3-week swim camp for the summer team located in another part of the state. She left in the middle of July and returned at the end of the first week of August. When her parents picked her up at the bus, they were startled, almost frightened by how thin Rosa had become. They didn't say anything right away. They were just glad to have their daughter home. They surmised that the food hadn't been too good at the camp, and Rosa implied as much. They didn't have good vegetarian choices, she said, and she was very active. She had made both teams as a starter.
And then school began. The ninth grade was a transitional year for Rosa. Students from three middle schools were combined in a single high school, so there were many new kids in her class. Her parents noticed that Rosa seemed more preoccupied and worried about schoolwork, but they thought this was to be expected when starting high school. Rosa's day began at 5:00 A.M. with swim practice for 2 hours before school. She then attended classes for the day and reported for another swim practice from 5:00 to 7:00 P.M. Rosa arrived home after the family had already eaten. She studied until 11:00 P.M.
Out of sight of her parents, Rosa had developed a highly limited eating pattern. She allowed herself one cup of orange juice before morning practice. She told her mother she had a bagel and cream cheese at school with milk after practice, but in reality, she ate half a dry bagel and water. The lunch her mother carefully prepared for her was thrown away each day. Again before afternoon practice, she would drink a glass of orange juice. Because she came home after the family had eaten, her parents didn't know how much she had for dinner. Usually she had a carefully weighed slice of tofu, a few carrots, and an apple.
Her parents grew increasingly alarmed at Rosa's continued weight loss. The coach of the swim team called to ask what was wrong with Rosa. She was afraid that Rosa might have an eating disorder. Her parents made an appointment with her pediatrician, which took some time to set up. When they arrived, the pediatrician said that Rosa was too thin, and Rosa promised to eat more. Unfortunately, she did not. Her parents tried to intervene, but she easily became angry when they talked to her about eating, and they hated to confront her.
Although anorexia nervosa usually starts in early adolescence, typically at 13–14 years, it is not uncommon to see children between the ages of 8 and 11 develop this eating disorder. Anorexia usually begins with an episode of dieting that gradually leads to life-threatening starvation. At times some identifiable precipitating event triggers the dieting process. Maybe the child is teased about her weight, or her friends start dieting. Or perhaps she sees her parents dieting. Some girls start dieting at the onset of menses, when they make the transition to a new school or level in school, or when they begin dating. The illness of a parent may also trigger dieting. It's important to understand that these events often start the dieting process, but that does not mean these triggers are the causes of anorexia nervosa. It is dieting that usually appears to be the starting point for anorexia nervosa.
Teens diet for a number of reasons. Sheila says she began dieting to become a healthier person, whereas Tom's dieting was initially designed to improve his diving. Most teenagers report that dieting began because of a wish to lose weight, eat healthier, or improve performance in a sport. A few adolescents begin consuming fewer calories in the service of being "good," as they define it, using an ascetic formulation along the lines of "The less you consume, the better you are."
All of these motivations to diet share some features. For example, each implies some notion of self-improvement, in particular improvements that are concrete and outward and thus noticeable by others—to look better, perform better, be healthier. However, there are differences among these motivations for dieting as well. The emphasis on a thin appearance suggests a connection with social norms of beauty, whereas improvement in performance of a sport, in health, or in morality is related more directly to perfectionism, drive, and ambition. These latter qualities appear to be common personality features in children who develop eating disorders.
Regardless of motivation, dieting usually begins informally. The child may start by cutting out desserts and snacks, but over time, meats and other proteins, fats, and sugars are eliminated too. Once food choices are narrowed, dieting efforts are typically focused on lowering the quantities of food consumed even within this limited range of options. Often detailed calorie counting, exact measuring, and elaborate preparation of foods become the rule. At this point, adolescents may attempt to remove themselves from the company of others while eating, prepare meals independently of others, and sometimes cook elaborate meals and desserts for others without eating the food themselves.
Alongside this extreme food restriction, a schedule of increased exercise is often employed to ensure continued weight loss. At this point, whatever weight goals might have been set initially have typically been long surpassed, and the goal of weight loss in itself is firmly established. Sometimes self-induced vomiting or diet pill and laxative use may begin in an attempt to purge the small portions consumed.
For a child on the path to an eating disorder, on the one hand, eating is often associated with guilt, anxiety, and anger. Not eating, on the other hand, is associated with feelings of accomplishment, power, and strength. Paradoxically, with increased weight loss, hunger cues are diminished, making the process of continued food restriction easier. Nonetheless, most teens with anorexia are still extraordinarily preoccupied with food. Some will visit supermarkets and bakeries to look at and smell the food, but abstain from eating it. Parents may notice unusual food rituals beginning to develop, such as eating only out of certain bowls or plates, weighing and measuring foods precisely, using chopsticks, and so forth. The period of time over which this cascade of events takes place is variable, but it can be as short as 4–6 weeks or as long as a year or more. At some point during this process, in girls who have begun menses, menstruation likely ceases.
Rosa became too weak to swim and was taken off the swim team. At school, she was more and more isolated, and her friends stopped talking to her because they were afraid to ask her what was wrong. She became tearful and moody at home. She was so thin now that none of her clothes fit, even though they had been purchased only a month before, when school began. She was always cold; she wore sweaters and was constantly turning up the heat while the rest of the family sweltered. Her worried parents thought she was depressed and sought help from a psychiatrist.
Failed Dieting and Overeating: The Path to Bulimia Nervosa
Sixteen-year-old Jasmine had always set high standards for herself. She wanted to be the best at everything. She worked hard at school and got good grades. She was generally well liked, though she always worried about who her friends were. She had worried about her weight for as long as she could remember and first began trying to lose weight when she went on a liquid diet with her mother when she was in fifth grade. She herself was never teased for being overweight, but she had seen other girls and boys teased when she was a child and was worried that she too would be teased. The diets she tried never made any difference. She lost a few pounds but then gained the weight back.
For the junior prom Jasmine decided she wanted to look great. She had a boyfriend, her first, and she wanted him to find her beautiful. That meant thin. Her boyfriend had never commented on her weight, but Jasmine was sure it was just because he was too nice to say anything. She knew she was too fat. She was determined to lose 15 pounds before the prom.
She began skipping breakfast altogether, and lunch as well. She would then go to the gym after school and exercise for 2 hours. She found some over-the-counter diet pills and drank lots of coffee, all in an effort to keep herself from being so hungry. Still, she woke up at night feeling hungry. But she stuck with her routine and lost 15 pounds for the prom. Everyone told her how wonderful she looked, and her boyfriend seemed happy with her appearance too. All of her friends congratulated her on her diet and wanted to know how she did it.
After the prom Jasmine tried to keep her diet plan going, but it became harder and harder to do. She would come home from school and be too tired to go to the gym. When she missed her workout, she was certain she would gain weight, so she tried to eat even less the next day. However, she began to be so hungry that she couldn't stop herself from eating. One day after school when no one else was home, Jasmine was so hungry that she ate a box of cookies. She went to the gym and tried to "exercise the calories away," but there were too many and she was too tired. The same thing happened the next day. This time Jasmine was so upset she decided to try to throw up the cookies. She had promised herself that she would never do this, but she couldn't stand the worry about gaining weight. She would throw up just this once.
Jasmine tried to follow her own injunction, and sometimes she succeeded, but at least once or twice a week she failed and overate so much that she felt she had to purge. Slowly, week by week, she got into a pattern of eating very little and then binge eating in the afternoon, followed by purging. On days she found she couldn't vomit, she took some of her mother's laxatives to relieve her fears about gaining weight.
During this time, Jasmine's weight had gradually increased despite her efforts to diet, using diet pills and laxatives, and vomiting. Jasmine was increasingly despondent. Her boyfriend broke up with her because she stopped wanting to get together with him. She felt too ashamed of her weight to see him. In addition, she was afraid to go out with him because she might have to eat something and that would start her overeating.
Excerpted from Help Your Teenager Beat an Eating Disorder by James Lock, Daniel Le Grange. Copyright © 2015 The Guilford Press. Excerpted by permission of The Guilford Press.
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Table of Contents
IntroductionI. Getting Started: First Steps Toward Helping Your Child with an Eating Disorder 1. Act Now 2. Get Together 3. Don't Waste Time on "Why?"II. Understanding Eating Disorders 4. Know What You're Dealing With: The Complexity of Eating Disorders 5. Get into Your Child's Head: The Distorted Thinking Behind Your Teenager's Behavior 6. Understand Your Options: What the Research Says about the Best Ways to Treat Anorexia, Bulimia, Binge-Eating Disorder, and Avoidant/Restrictive Food Intake DisorderIII. Making Treatment Work: How to Solve Everyday Problems to Help Your Child Recover 7. Taking Charge of Change: How to Apply Family-Based Treatment to Help with Eating Disorders 8. Playing a Supporting Role: Other Ways You Can Be a Part of Your Child's Recovery 9. Harnessing the Power of Unity: How to Stay on the Same Page in Your Fight against Eating Disorders 10. Staying Empowered and Informed: How to Work with Professionals Who Are Trying to Help Your Child Resources Further Reading Index About the Authors
Parents who are concerned about their teen's eating habits or dieting, or who have already received an eating disorder diagnosis. Also of interest to health care professionals working with 10- to 19-year-olds and their families.