Anorexia, anxiety, depression cycle

[wagtail]

I have slowly figured out that my daughter has been battling anorexia for about 6 years (she is currently 23).  I have been solid in this realization for about 4 years.  I now realize that depression and anxiety have played a significant role in her illness.  She saw one therapist for 2 years, another for  this last year, but has now gone away to school and is seeing no one.  We now realize the stress of school and a strange city cause here to cylce through restricting again, and the depression and anxiety have returned.  She has not been able to break this cycle, so she will soon start seeing another therapist.  All of her therapists have had varying degrees of experience with anorexic patients but most have not had a soecialty in this field  

I feel she should take time off from graduate school and enter a residency program.  She does not want to do this and I'm worried my pushing the issue will trigger even worse symptoms.   She has started to take an anti-depressant but she has tried this before and the medications either hve done nothing or had extremely negative effects (Welbutrin).  

I feel my family is in a holding pattern and I cannot firgure out how to help her. I am willing to do family counseling, residency or whatever it takes to help get her relief from the pain of this disease.   I started reading about the pituitary gland and cortisol production, ACTH and other potential solutions and just feel like I'm starting to consider any path as a possible solution which is, of course, confusing.  Do you have any suggestions?  

[Patricia Pitts, PhD]

Dear wagtail,

Listen to your instincts.  Your daughter is most likely caught up in her eating disorder thinking, she is not able to make the best decision for herself.  Having treated eating disorders for 27 years, I believe it is imperative to seek treatment from an eating disorder professional.  Action is needed.  You cannot be fearful of triggering her to more eating disorder behavior.

Seek an eating disorder professional for a comprehensive consultation.  A professional that is well aware of assessing the criterion for the levels of care, and is equipped to make the appropriate referral.  Treatment levels go from outpatient services to intensive outpatient programs to partial hospitalization programs to transitional living to residential to inpatient.

Anorexia is a biopsychosocial spiritual disorder.  To most successful treat an anorexic, the treatment needs to treat the whole person.  The process can be lengthy.

To learn more about anorexia and different treatment levels of care, visit the bella vita website.

Best,

Dr. Patricia Pitts
The Bella Vita
Los Angeles, CA

[Patricia Pitts, PhD]

Dear wagtail,

For clarification, Cognitive Behavioral Therapy is a type of therapy utilized at all levels of care, including Residential.  The beauty of Residential is that it is 24/7 care.  It affords the opportunity to address issues as they arise to help challenge and treat the eating disorder voice.  Depending on the unique needs of the individual, Residential programs utilize behavioral, cognitive behavioral, dialectical behavioral, experiential, relaxation, yoga, down time techniques, passes, outings, etc.
You probably have more influence than you know.  Are you supporting your daughter financially with school, room and board?  If you have this pull or any other, you can step in and let her know because you care for her you will not continue your support until she graduates from a Residential Treatment Center.  There are also interventionists that are quite effective with eating disorders.  If you contact me through the bella vita website, I can connect you with an interventionist.

To learn more about anorexia and different treatment levels of care, visit the bella vita website.

Best,

Dr. Patricia Pitts

[wagtail]

I appreciate the advice.   My daughter has had full evaluations in the past, but the Cognitive Behavioral Therapy that each of her therapists has used has not been effective.  I have always favored the residential treatment approach but, at this point, haven't been able to get her to cooperate.  This is most likely due to your description, that she is unable to make rational decisions when she is caught up in her eating disorder thinking (my viewpoint as well).  So it has been a viscious cycle for 3 or 4 years.  She is of age, so she must agree to treatment.  

She knows she has serious mental and health issues but, so far, has been unable, even with our support and concern, to change her habits.  I think she should take time off from school and get back on a healthy track.  

Any other thoughts you have in the future, or any comments you have to this response will be greatly appreciated.  I am grateful for the care you have shown my daughter already.