QUESTION: I have a daughter-in-law who has bulimia.  She has had this illness for as long as I've known her, which is 6 years.  She has never discussed this with me but her husband, my son, has.  My son says she wants to talk to me about this on an upcoming visit.  I think she realizes she needs help.  How can I help her?  Are there support groups she can contact?  Should she see a doctor first and go from there?  Should she keep a journal of her feelings/eating/vomiting?  Any advice would be greatly appreciated.  She looks to me as a mother figure and does not have a good relationship with her own mother.  She is average build and has 3 young children.  The children presently eat normally and healthy but I'm afraid soon they are going to realize what mom is doing.  Thank you for your help. 

ANSWER: I appreciate your heartfelt concern for your daughter-in-law and am moved by your deep desire to support her. Eating disorders are serious, serious business, and she is lucky to have you in her life to see so clearly what she needs and be so willing to be there for her!

You are also right to be concerned for her children – children can easily pick up their parents’ thought and food habits without even realizing what they are doing, and having a parent with an eating disorder automatically increases the child’s risk of developing a similar condition.

In your email I read three excellent suggestions you have thought of on your own that would be great to implement – sounds to me like you already have the building blocks of a plan. In addition, in most cases, I recommend a comprehensive six-step plan to take immediate action against the effects of an eating disorder:

  1. Recognize and admit that the problem exists and reach out for help – this is the communication/intervention stage, which for many is problematic, but it sounds like your daughter in law may have already moved past this step and is ready to ask for and accept help.
  2. Immediately schedule a thorough physical evaluation with a qualified medical doctor who is very familiar with eating disorders. In this evaluation the doctor will identify any medical concerns (electrolyte imbalance is a particularly dangerous element of bulimia and should be promptly addressed) and take action to alleviate any critical medical needs.
  3. Schedule a psychological evaluation with a qualified psychologist, social worker or eating disorders counselor. This is a ‘checkup for the mind’, and the goal is the same – to identify immediate mental health needs, and also longer-term mental health goals, and formulate a plan for the best way to meet those needs and goals.
  4. (Optional based on the results of Step 3) Schedule a psychiatric evaluation and obtain prescriptions for short or long-term medication necessary for the management of mental and emotional conditions arising from the eating disorder. Depression, panic, anxiety disorder, obsessive-compulsive disorder and others are all commonly present in individuals suffering from an eating disorder, and often are successfully alleviated with medication.
  5. Schedule an initial consultation with a Registered Dietician or Nutritional Counselor. This step is necessary to begin the process of dietary re-education where food is once again seen and consumed for what it is – and ONLY for what it is – as fuel for the body.
  6. Attend available eating disorder support groups, and identify one or more individuals who have recovered from an eating disorder and are willing to serve as mentors or ‘recovery coaches’ throughout the healing process. This step is critical – it is the missing link in many treatment teams, and the most reassuring thing a person in an active recovery process can ever have is the presence of someone who speaks the ‘secret language of eating disorders’ without the need for translation.

My website has many excellent web resources and suggestions for reading material that can also help. Please let your daughter-in-law know that she is welcome to join this ezine, and also to join my daily moderated online support community, Behind This Mask: there is someone real. All the best to you and your family – please keep in touch and let me know how we can support you!

Shannon

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