For families
You suspect something, you are not sure, and you do not want to make it worse by asking badly.
This page is for the moment before there is a diagnosis. What can be observed without policing, what separates a phase from a problem, and how to open a conversation that does not close on the first attempt.
Observing
What you can see without policing.
Observing and policing are not the same thing. Policing is following someone to the bathroom. Observing is noticing what is already happening in front of you, and holding it for a few days before drawing conclusions.
Around the table
- She eats alone, or waits until everyone else has finished.
- She has stopped eating in front of others, though at home she says she already ate.
- She cuts food into very small pieces, spreads it around the plate, eats very slowly.
- She goes to the bathroom as soon as she leaves the table, repeatedly.
Around food
- She has cut out whole food groups, for reasons that sound healthy.
- She knows the calorie count of almost everything in the house.
- She cooks for everyone else and does not eat what she cooked.
- Wrappers or quantities appear that do not match what you see her eat.
Around the body
- She changes clothes several times and ends up choosing the loosest thing.
- She weighs herself daily, or has stopped letting anyone see her weigh herself.
- She talks about her body in a level of detail she did not use before.
- She trains even when she is ill, exhausted or injured.
It happens to sons as well. It is caught later, because almost nobody is looking for it there.
False positives
What is not a sign.
This part matters as much as the previous one. A list of warning signs without this section frightens families whose children are fine.
- Counting calories because she trains, without distress when the count slips.
- Loose clothing because it is the trend, not to cover up.
- Becoming vegetarian out of conviction, and eating normally within that decision.
- Eating less on some days and more on others. Appetite is not stable and does not have to be.
- Closing her bedroom door, answering rudely, wanting privacy. That is the age.
What changes the picture is not the isolated behavior, it is the pattern. Rigidity counts, meaning the rule cannot be broken. Secrecy counts, so do escalation, withdrawal, and the thing holding over time. If you recognized a single behavior and otherwise she eats, goes out and gets annoyed like anyone else when her plans change, you are more likely looking at a phase.
Talking
How to open the conversation.
The principle is short. Talk about what you see, not about what you think it means. Without diagnosing, without talking about weight and without talking about food.
Naming a behavior invites an explanation. Naming a diagnosis invites a defense. And choose a moment that is not the table, because at the table any subject becomes the same subject.
Closes it
“You have to eat, you are worrying me.”
Opens it
“You have seemed quieter these past few days. How have you been?”
There is a whole article on this, with more phrasing and with what is better avoided. What to say and what not to say.
Avoid
Four things done with good intentions that go wrong.
Watching the plate
It turns every meal into an exam and you into the person administering it. The behavior hides better, it does not stop.
Commenting on bodies, hers or your own
Compliments included. "You look great" said to someone who is restricting confirms that the restriction is working.
Negotiating with food
Rewards, punishments and deals put the conflict where it is not. The conflict is not the food.
Asking for a promise
Promising to eat does not produce eating. It produces a broken promise and a conversation that is less available next time.
If she says no
When she refuses to consult.
It is the most common response, and it does not mean the process has stopped. The refusal is usually to the label, not to the help.
You can come without her. A session with the family serves to order what is being seen, decide whether it is worth insisting, and above all to stop you improvising every conversation. Working with the family while the person is still unwilling to come in is part of treatment, not a second-best option.
If she is a minor and there is physical risk, the decision to consult is not hers. There the route is medical first.
Urgent
When this stops being a psychological consultation.
Fainting, dizziness on standing, repeated vomiting, palpitations or chest pain, dehydration, confusion, or rapid and sustained weight loss. None of that is resolved in a psychological session and it is not worth waiting for an appointment with me. That is a medical evaluation, and it is now.
Psychological support comes after, and remains available.
You too
Families wear down, and that is not selfishness.
The question that is almost always underneath all the others is whether you caused this. It is not the question that helps, and it has no clean answer either. Eating disorders are multicausal, and no family produces one on its own.
The family does have a role, and that role is the part that can be worked on. It is different from guilt and it is far more useful.
Recovery holds or collapses depending on whether the family and the people around the patient are involved alongside them.
The first session
What happens when you book.
- You message the appointments number on WhatsApp to arrange a time. You do not need to say anything about your daughter there.
- At the first session you tell me what you noticed and since when. You do not need to know the name for any of it. I ask concrete questions and tell you whether it warrants clinical attention.
- If it does not, I say so, and you leave clear about what to watch and when to worry again.
- If it does, we decide whether she comes in, you come in, or both, and in what order.