NZ Eating Disorder Specialists

Case history: Amy

Patient Profile:

Name: Amy

Age: 17

Eating Disorder: Anorexia, Bulimia

Anorexia condition: 18 months

Started treatment: July 2005

Symptoms:

• Very particular about food
• Withdrew from family
• Weight loss of 10kgs over 2 months

Referral: From GP

Past history: None. Treatment began soon after condition discovered

Medical history: Healthy

Treatment:

• Intensive Structural Family Therapy (IST)
• Family therapy for four months involving parents and sister in sessions
• Treatment one hour sessions, bi-weekly for the first half of treatment, weekly for the second half

Amy’s story

The following account is by Amy’s mother and shares her experience with Amy’s treatment through NZ Eating Disorder Specialists.

School ball triggers changes

Amy is a bright girl. She’s strong willed, reasonably competitive, but not overly, and she’s a perfectionist who always works late on projects and turns out a fantastic presentation every time.

For whatever reason, she had a difficult year 13. It just didn’t go as well as previous years.

I think it was the school ball that triggered her eating disorder, with all the organising, trying to find a partner, getting a dress, and all that palaver. Most of her friends had boyfriends and she didn’t. Like so many excited girls she “toned up” and dropped some weight for this special occasion, and on the night of the ball, she looked beautiful and received many compliments…and I think these were all contributing factors to her anorexia.

She lost 10 kilos at that time. It was quite a subtle thing. As the weeks went by, she tipped over that fine line and suddenly she was just too thin! At this point, she was becoming quite particular about the kind of food she would eat – not the quantity, exactly, but the food specifically. For example, she’d eat lots of vegetables ice cream and sweets, but was still completely avoiding the carbs in bread, pasta, or rice.

When she got to the stage when she started to be dishonest about her eating habits and I started finding toast thrown away in the bin, the alarm bells went off.

These bells just kept ringing as we spent a holiday in the mountains soon afterwards. During the holiday, which we spent with friends, Amy withdrew, wouldn’t mix easily with others as she once had. She felt the cold terribly. Of course, Amy was wearing her thick winter gear all the time, so nobody could notice her weight loss, but when we ate our meals together, it became very obvious that she wasn’t eating properly.

After we returned from our holiday, a parent of one of Amy’s friends rang to report that her daughter and her other girlfriends at school were concerned that Amy wasn’t eating well.

That was the last straw for my husband and me. We took Amy straight to our GP. It turned out we would only get into the eating disorder clinic if Amy’s condition was critical and child psychologist’s we contacted seemed unable to see us. We were left feeling desperate until our GP referred us to Dr. Charles Fishman.

Resisting specialist help

Amy was defiant about needing help. Whenever we approached the issue of her eating habits, she didn’t react well at all. She vehemently denied having any problem, saying, “I’m fine”, “don’t be ridiculous.” So, it was not easy to get Amy to her appointment with Dr Fishman. We had to be very firm.

In our initial visits, there were tears before, distress during, and disappearances into her room afterwards. I can understand that she didn’t like what Dr Fishman made her face up to, but he did understand eating disorders and knew that her avoidance of certain issues was part of her problem. He took her sometimes awful behaviour in the sessions in his stride.

As I now understand it, anorexia is about avoiding confrontation and conflict, which was exactly what Amy was doing. So the therapy was critical to her overcoming it.

We all participated in the therapy. My husband and I spoke with Dr Fishman together and Amy and her sister met with him separately. Amy’s relationship with her younger sister was also quite strained at the time and often antagonistic and heated.

Dr Fishman didn’t say a lot during the initial sessions, but sat and let us talk. This was uncomfortable at the beginning, a very unusual situation for all of us. Over time, we were all more at ease.

Our discussions were very empowering. Dr Fishman is a very committed and principled man and didn’t hesitate to tell Amy she was being rude or provide her father and me with clear suggestions of what to do to help Amy at home. If we had a bad week with Amy, a half-hour meeting with Charles would leave us with a solid grip on the situation.

His advice and the consequences he set in response to Amy’s behaviour were all quite simple, really, but very effective.

Managing the treatment

Dr Fishman told us that over the course of the therapy, every time Amy did not gain weight, she would go on “bed rest”, and not attend school. She’d be allowed to eat, drink, and go to the toilet, but could have no reading material, no radio, and no phone contact. It was a solid dose of “tough love” that Charles prescribed us. As parents, it was us who had to explain and implement the consequences.

I had been expecting lots of therapy and discussion but as Dr Fishman said, “You could talk for years. What Amy needs to do is to eat.”

It was very hard to cope with initially. Imagine trying to keep a 17-year-old girl in bed, feeding her…it was dreadful. However, it made brilliant sense. She had no contact with the outside world, and her friendships were threatened. All she could do was to think about her life while she was in bed, and about the choices she was making. Also, being in bed helped address her physical condition, as all the energy output from her food was going straight into weight gain.

Once she gained some weight and went back to school, the transition was so extreme that she realised that she was happier at school than at home. However, it wasn’t easy for her to change her behaviour. We managed to get through to her in the home situation, but therapy remained really important.

We treaded water for quite a while, just not getting anywhere. She’d go to school, not eat properly, and make excuses for not eating – “I’ve got to go, I’ve packed my lunch”. At times she would come home having lost weight again. Amy commonly lost weight after a night out or a sleepover. Because this was always a step backwards we had to limit her going out which was really difficult since we did not want her to lose contact with her friends and get isolated. This was all a strain since Amy would make gains and then go backwards.

We were advised to put Amy on a 3000 calories per day diet which had to be managed by us. Previously, Dr Fishman advised us to lay down the law at mealtimes, to put food on the table and make her sit there until the food was gone. However, when we had to set the 3000-calorie diet, we had to monitor her further. But gradually she gained some weight, and this was ‘crisis-averting’ progress.

Parents being fully involved

Early in the treatment, Charles urged my husband to get more involved. We realised the more we were both involved in the treatment, the better progress would be made. We had to be united and be firm, especially on Amy’s bad days which could involve explosive outbursts and very abusive behaviour from her. She would also be manipulative and deceitful, so it was really important that both my husband and I were both fully involved and aware of everything all the time.

When Amy was in bed for days on this 3000-calorie diet, her father would have to come home from work. This was hard for him as responsibilities at work made it difficult for him to take time off. However, I couldn’t do it anymore on my own, and really, on the mornings when he was with us, there was no nonsense. His presence brought a lot home to her, and she made some significant progress.

Throughout the therapy, Charles was always available. He followed through so we never felt isolated. He focused primarily on Amy’s eating but also encouraged her to read books about inspirational women and do empowering, confidence-boosting activity. At the time, she resisted his ideas, but I think they were all ultimately very helpful.

As Amy began to put on weight, the grip that anorexia had on her lifted, and she kept inching the weight on. It was an incredible thing. However, we never stopped having to keep a very close eye on her.

A year on…

It all happened so quickly! It just crept up amidst our busy daily lives.

We are so glad we intervened when we did. Amy had…and has…so much potential. The last thing we wanted was for Amy’s future and her happiness to be lost to this condition.

Amy is studying for a degree at university now and things are going well. She’s very happy, has a boyfriend and is working hard. We are incredibly encouraged by her looking so well and by the fact that she enjoys her studies and her social life.

Now we can ask her about her weight and ask if she’s eating well. She can talk about these things with us much more openly now. This makes it much easier to keep a check on things.

I would have liked to have had more time to help Amy work through her awareness of her problem. Because of her “departure” to university, I feel I haven’t done enough to help Amy learn some life lessons from this whole experience. However, I do think she has structures in place to help her cope, thanks to Dr Fishman and his therapy. I really recommend him and his approach. We always came away from our sessions and thought, “Right. We can cope with this!”

And we have.