Question: Our adolescent daughter has lost a great deal of weight over the past few months. At this point she’s so alarmingly thin that I’m beginning to worry that she may be anorexic or bulimic. How can I be sure? What should I do if this is indeed her condition?


Let’s begin with a couple of definitions. Anorexia nervosa is a condition of self-imposed starvation that eventually leads to a body weight at least fifteen per cent below the expected level for an individual’s age and height. Affecting as many as one in one hundred girls and young women, it is characterized by an extreme fear of – or antagonism to – gaining weight and a strikingly distorted body image. As more weight is lost, the fear of gaining weight intensifies rather than diminishes. Not surprisingly, this leads to a number of medical consequences, including the interruption of the woman’s monthly cycle, loss of bone density, decrease in body temperature, reduced capacity of the stomach, dry skin, thinning of scalp hair and the development of a fine hair growth on the body called lanugo. Anorexia nervosa is a serious condition with lethal risks: at least five per cent – some sources say as high as twenty percent – of anorexics die from starvation, cardiac arrest or suicide.

Bulimia nervosa is characterized by a behaviour known as bingeing and purging. During a binge, an individual quickly consumes an enormous amount of food, often without even chewing or tasting it. The resulting physical and emotional discomfort will provoke a purge, usually involving self-induced vomiting. The bingeing and purging cycles may occur a few times a week or, in severe cases, several times daily. Bulimia is more common than anorexia, affecting an estimated one to three per cent of women in Western countries at some time in life. Among the serious medical consequences of bulimia we should cite are the decay of teeth and inflammation of the throat and salivary glands due to repeated exposure to stomach acid; severe constipation; and potentially dangerous disturbances in heart rhythm attributable to loss of potassium from vomiting. Other equally serious (but fortunately uncommon) events include bleeding and even rupture of the esophagus or stomach, and choking or pneumonia resulting from food aspirated into airways.

Underlying causes

While each case is unique, there are a number of contributing factors that may be considered underlying causes of anorexia and bulimia. Personality traits such as perfectionism, obsessive-compulsive tendencies and a desire for total control are typical of young females with eating disorders. Biochemical issues, particularly imbalances of chemical messengers in the brain known as neurotransmitters, may also play a key role. Cultural factors are also important: in developed countries, advertisements, films, videos and TV consistently associate thinness with the ideas of bodily perfection and personal success. And over the past several years, a number of websites have emerged – so-called "pro-ana" or "pro-mia" sites – that actively promote anorexia and bulimia as "positive lifestyles" rather than eating disorders.

Get professional help

Because eating disorders can put health and even life in serious jeopardy, they should be taken very seriously. In order to be effective, treatment must address a variety of issues and will often require a team approach. A thorough medical examination is extremely important, and counselling, involving the entire family, will be needed on a long-term basis. If you need help finding a qualified Christian therapist, Focus on the Family Canada’s counselling department can provide you with referrals. You can reach us Monday through Friday between 8 a.m. and 4 p.m. Pacific time at 1.800.661.9800.

How you can help your daughter now

In the meantime, you can help your teenage daughter in the following ways:

  • Beware of perfectionism, especially in regard to your child’s weight or physical appearance. She must understand that her worth and your acceptance of her are not based on physical beauty or perfect performance, but are, in fact, unconditional.

  • Beware of demands on an adolescent to "make weight" for an athletic team, slim down for a cheerleading or dance team or in some other way subject the body to stringent dietary restrictions for any reason.

  • Help your daughter understand that body shape and build have a strong genetic basis and that few women are capable of attaining cover-girl status, even with intense effort.

  • Eliminate from your own and your family’s conversations jokes or demeaning comments about the appearance of others.

  • Point out to your children how advertising and other media put forth misleading images of beauty and body image.

  • Be a good role model in your own eating and exercise habits, and be careful about openly criticizing your own body appearance.

  • Focus on relationships and building emotional intimacy in your family rather than on food-related issues.

Excerpted from The Complete Book of Baby and Child Care published by Tyndale House Publishers. © 1997, 2007 Focus on the Family U.S. All rights reserved. Used with permission.

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