Battling Anorexia: When Parents Take Control

Initially, Harriet Brown didn't understand why her once happy, sociable and above all reasonable 14-year-old daughter Kitty Brown had become an anxious "crying mess."

The answer came when Kitty Brown was diagnosed with anorexia nervosa, an eating disorder that affects an estimated 1 in 100 adolescent and teen girls in the United States.

Brown, a journalism professor at Syracuse University, chronicles her family's battle with anorexia in a new book, "Brave Girl Eating." She spoke at the in White Plains Tuesday night, along with Dr. Evelyn Attia, the director of Columbia's Center for Eating Disorders.

The turning point in Kitty Brown's illness came when she started experiencing heart problems. She was put in intensive care and a doctor ordered a feeding tube, which she protested.

Brown bargained with the doctor not to give her daughter the tube, and in exchange, promised she would get her daughter to eat, even if just a tiny bit.

"Watching her eat that night, I really got it on an emotional level," Brown said. "It wasn't a refusal to eat, it was inability to eat. It was terror."

Traditionally, treatment for anorexia has focused on individual therapy and trying to root out the psychological causes behind the disease. Parents are often excluded from the treatment process, since they are often thought of as part of the problem.  

Family-based treatment (FBT) actually puts parents at the center of the recovery.

"Our job is to stand up to the voices in her head," Brown said. "You are not choosing to eat; we are forcing you to eat. This helped her sidestep the guilt and fear of eating."

A new study suggests that anorexic teens in family-based treatment have better long-term recovery rates than teens who receive individual therapy. The study, conducted by the Stanford University and the University of Chicago, compared 121 anorexic adolescents ages 12 to 18.

Forty percent of the adolescents in FBT were in remission at the six-month mark, compared to 18 percent in individual therapy. After a year, the remission rate was 49 percent for FBT patients versus 23 percent.

Malnutrition itself causes most of the psychological symptoms of anorexia, said Attia. The first part of treatment is addressing the physical problem, "re-feeding" a patient to get them to a relatively healthy weight. In family-based treatment, the parents take control of their child's eating.

"The first few weeks were very, very hard," Brown said. "We sat at the table all day."

Eventually, as her daughter got stronger physically—Brown and her husband slowly transferred control back their daughter, a process that took several months. Kitty Brown, now 19, has been healthy ever since, except for a brief relapse when she went away to college.

"She's fighting the good fight," said Brown.

What Are the Signs?

Brown said she missed some of the signs that her daughter was developing anorexia. An early, aggressive intervention can often head off a more serious situation. Rapid weight loss is an obvious signal something is wrong, but it's not always the first sign.  Some other warning signs include:

▪ Cutting out certain foods or restricting certain foods, especially a favorite food, like pizza or ice cream. Attia said if your child suddenly decides to become a vegetarian, it could be a red flag, but not always.

▪ A sudden preoccupation with cooking, food, nutrition, or calories. For example, Brown said her daughter never had any interest in cooking and then one day asked for a subscription to Gourmet magazine.

▪  An obsession with exercise and weight. Female athletes are more likely to develop anorexia than non-athletes. Kitty Brown was a competitive gymnast.

▪ Physical signs can include thinning or loss of hair, feeling cold when it's warm outside, or stopping menstruation.

What Can Parents Do?

▪ Make a point of eating dinner as a family and take note of what your kids are eating. Brown believes her daughter's anorexia began when she was eating an early dinner alone before gymnastics practice.

▪ Model positive eating habits and send a positive message about body image and weight range. If mom's always dieting, why shouldn't your daughter?

▪ If you suspect something's wrong, don't wait to visit a doctor.

For more information, visit the National Association of Anorexia Nervosa and Associated Disorders website – www.anad.org.