Coming to terms with my 9-year-old’s eating disorder

Young girl overcomes eating disorder

I didn’t think my 9-year-old daughter was at risk for developing an eating disorder. She was not involved in any of the known “risk” sports like gymnastics, dance or ice skating. She wasn’t a child preoccupied with looks or thinness. In fact, she is kind of a tomboy, preferring sweats and t-shirts. And she did not consume a lot of pop culture.

But what I learned during our Family-Based Treatment (FBT) sessions with Dr. Melissa Freizinger at Boston Children’s Hospital, is that children who develop eating disorders often have an underlying (and possibly undiagnosed) mental health issue — commonly anxiety or obsessive-compulsive disorder (OCD).

Family-Based Treatment (FBT) is an intensive outpatient treatment for adolescent eating disorders including anorexia nervosa and bulimia nervosa. FBT does not blame families for the disorder and believes that parents are the best resource to help their child fight the eating disorder and restore weight.

While our daughter was not a gymnast participating in intense competitions, she was a child who had been dealing with anxiety, which was brought to our attention by her first-grade teacher who was concerned it was impacting her ability to perform in the classroom. At that time, she started seeing a school psychologist, and I continued her therapy when we moved from that school district because it always seemed like she had very strong emotions, often difficult for her to regulate or understand.

Do you remember the arcade game whack-a-mole, where you pound down a mole with a mallet but he pops up somewhere else? That is the analogy that Dr. Freizinger used to describe what can happen with mental health issues. Just when you think you may have made progress dealing with an issue, watch out, because it might pop-up again in a different place.

During third grade, my daughter was struggling with extreme anxiety surrounding being late for school, activities or anything with set start times. I mentioned it to her counselor and over the next few months it got better. She seemed to be developing strategies to cope with her feelings of helplessness when we were in charge of getting her places. I thought we were headed in the right direction.

But remember that pesky mole? What nobody in her life recognized (unfortunately until she was already very much consumed by the disorder) is that she had begun to control what she ate and restrict her calorie intake. My hunch is that she was trying to exert control on her life where she felt she didn’t have any. She couldn’t control what time we would all manage to get into the car in the morning to head to school, but she could control how much she ate. It is thought that when someone restricts their food intake, the state of starvation also manages their anxiety.

And here is where our story gets more complicated to tell. When I was 18, I also had an eating disorder. I channeled my fear of leaving home for the first time to attend college into controlling my diet, until I became dangerously thin.

And here is where our story gets more complicated to tell. When I was 18, I also had an eating disorder. I channeled my fear of leaving home for the first time to attend college into controlling my diet, until I became dangerously thin. Last year, when my husband and I began to understand our daughter had an eating disorder, he discovered through online research that genetics do play a role in whether or not a person is at risk for developing an eating disorder. I was bewildered. I couldn’t understand how my “diet that went too far” in college could possibly be handed down to her. Specifically because of my experience, I had worked hard to foster healthy body images and eating habits in my daughters. It was an area of parenting where I thought I excelled.

As most of us do know, however, mental health issues can be hereditary. I know people who struggle with depression worry it may present in one of their kids. While it seemed incomprehensible to me that I “passed down” an eating disorder to my daughter (particularly because I was very careful in this arena) it was not as hard to believe I passed on issues with anxiety. And while I had never really put all the pieces together until this experience, I now realize I also struggle with anxiety and have throughout my life.

Thanks to our team at Boston Children’s, our daughter’s eating disorder appears to be in the rear-view mirror, and we are moving forward. FBT works to break the bad eating behavior and re-nourish the body as quickly as possible. The process felt a bit like exorcising a demon, but we were able to get the eating disorder ‘out of her,’ and we have our daughter back.

While my husband and I are still quite vigilant about her daily calorie intake and activity (we will probably worry about that for the rest of her life), I am also particularly aware of that pesky mental health mole. It will be critical that we give our daughter the tools she needs to deal with her anxiety and whatever mental health challenges she may have in her life. I would like to whack the mole for good, but unfortunately that’s not how the game works.

For more information about Boston Children’s Eating Disorder Program in the Division of Adolescent Medicine, call 617-355-7178.