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Ask Dr D; ‘Nothing seems to help my bulimic child’

Q: My 17-year-old daughter has bulimia and she’s been receiving outpatient treatment for three years. She was admitted to a clinic for a week last year in an attempt to get to the root of the problem, but nothing seems to work and we are desperate. What should we do next?

Feelings of desperation,impotence, anger and despair are just a few emotions that are prevalent in parents with a bulimic child. Bulimia is a common eating disorder, particularly among adolescent girls in cultures where value is placed on being thin. It’s characterised by excessive binge eating and then purging in the form of vomiting or laxative abuse. It’s a dangerous illness and may affect renal and cardiac function over time, even in cases when weight is more or less maintained. Other physiological symptoms include dental decay, thinning of hair, compromised menstrual cycles, dry skin and electrolyte disturbances. Of course, bulimics may also be extremely underweight (like anorexics).

 Behaviourally and emotionally, your daughter may experience mood swings and see the world in extreme terms – such as black or white, good or bad, right or wrong. She’s likely to sometimes appear withdrawn and oversensitive, and her social relationships may be impaired. It’s unlikely that she’ll be treated successfully as an outpatient. You’ve tried this for three years and it’s simply too difficult to deal with the behaviour, the precipitating and maintaining factors, her severe guilt and fear at home. The effect on her family is enormous. One week as an inpatient is a waste of time. She needs inpatient admission in a highly specialised unit where manipulative behaviour is controlled and understood as part of the desperation which characterises the illness. The professional teams in such a unit are specifically trained to initially support and reassure the patient while the bulimic behaviour is being dealt with.

This will require at least a sixweek admission, during which your daughter will begin to deal with her fear of loss of control and of weight gain and learn to eat properly. After discharge, ongoing outpatient therapy is important and may involve the family. This is where issues such as self-esteem, relationships, personal control and challenging false beliefs and ideas are focused on. My advice is to not put off her admission as an inpatient any longer, even if you see some slight improvement in her behaviour. It’s probably the most difficult thing a parent can do – to admit a child to hospital when they’re desperate to convince you they can get better at home. As a parent, you experience a sense of personal failure and heartbreak for your child.

 With bulimia, there’s sometimes secondary gain in the illness in that it may serve to keep parents together when there is dissension. It may also result in an alliance between a child and one parent, or other specific familial or personal payoffs. These would come to the fore and can be dealt with by the professionals. With supportive yet firm professional care, your daughter will settle down and – as hard as it may be – you can offer her the way to a healthy and fulfilled life.