Q. My 19-year-old daughter was diagnosed with an eating disorder about nine months ago, and has been attending a clinic on an outpatient basis ever since. Although she has made some progress, my husband and I are increasingly worried about her as she refuses to eat the required amount of food the clinic recommends, and is very underweight. I have made several attempts to encourage her but, although sometimes it seems I am getting the message across about how important it is for her to look after herself properly, ultimately she is really struggling to consume normal amounts of food. I am at the end of my tether. I would be very obliged, if you have any advice. I feel this is an important issue which needs to be faced more openly by society. I do not wish any other parent to have to endure what I and my husband do.

A. Unfortunately, eating disorders such as anorexia or bulimia are common in western countries, with between 1 per cent and 3 per cent of young women meeting the criteria for diagnosis and up to 10 per cent having some form of eating problem. Such disorders are particularly worrying due to their serious physical health implications. The sufferer can be dangerously underweight, which leads to an increased risk of a whole range of illnesses and complications.

Your question highlights the plight of families of those with eating disorders, who are very worried about their loved one, yet struggle with knowing how best to help.

In helping your daughter, it is important to understand what is going on for her and how the disorder affects her. An eating disorder can start out innocently as a diet, as the young person begins to control and restrict their eating. Over time, however, this habit becomes all consuming, with the person constantly obsessing about food and their body shape. Their compulsion to restrict their eating becomes fixed and less within their control.

Frequently, sufferers get into the habit of controlling their eating as a means of managing stress or difficult feelings – they control their eating as other things in their life are less easy to control.

For many, an eating disorder is a like an addiction. Though the person knows on one level that restricting their eating is harmful, they are literally addicted to their compulsive habits. It is very hard for them to break the habit of constantly ruminating about food and restricting their eating. Overcoming an addiction can present many challenges but it can be done with support and a willingness to try.

The first step to helping your daughter is to get her co-operation and to make sure you are working together to tackle her eating disorder.

As a parent it is easy to get into a battle with her as you encourage her to eat the correct amount of food. The disorder can make her resist these attempts, thwart your plans and increase the conflict between you.

It can help if you view the disorder as external to your daughter, much like a disease that you are working together to overcome.

Your conflict is with the disorder and not with your daughter. In concrete terms, this means trying to agree with her goals about when, how and what she will eat, and to see yourselves working as a team to achieve this.

The key is to make goals very small and to build on any signs of progress. If the simple goal of eating an apple for breakfast is progress, then this should be marked and celebrated.

Attending the outpatient clinic can help with this, as the staff can be outside arbitrators to give your daughter feedback on the seriousness of her problem and motivate her to set goals that you can both work on.

A range of individual, family and group therapies might help, depending on your daughter’s specific needs. A cognitive-behavioural approach, for example, would focus on helping your daughter challenge her distorted beliefs about body shape and her unhelpful eating habits, while setting positive concrete behavioural goals to overcome them. This can help, but the most important thing is to find empathic mental professionals you can work with.

There are also a number of voluntary sector services such as BodyWhys ( www.bodywhys.ie), which offers helpline and group support for individuals and their families, or Overeaters Anonymous ( www.overeatersanonymous.ie), which follows a 12-step group approach to recovery. Through these organisations, try to make contact with other parents dealing with similar issues as this can be a crucial source of support and information.

Be careful to monitor your daughter’s weight and health, and continue to work closely with health professionals as needed: if things deteriorate, be prepared to step up her level of care as needed.

Many people with eating disorders can benefit from inpatient treatment, especially if their weight becomes dangerously low. A residential stay can be used as a time to kick-start a period of recovery.

In addition, make sure to consider alternative therapies such as relaxation, yoga or mindfulness, all of which could contribute to improving her health.

As well as focusing on tackling the eating disorder and setting small goals around healthy eating, it is important to support your daughter in getting on with her life, whether this is in pursuing study or employment, making friends, having relationships and doing what you would expect other 19-year-old girls to be doing.

When you have an eating disorder, it can take centre stage and prevent you from getting on with your life – which can make things much worse.

Indeed, what often helps a young person overcome their disorder in the long term is achieving in other areas of their lives, whether this be working in a satisfying career, establishing quality friendships and relationships, making a contribution in voluntary work or taking up interesting leisure or pastimes.

Dr. John Sharry, Irish Times Newspaper,October 2012.  John writes in The Irish Times Health+ every Tuesday.
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