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How do you know?
with Karen Danielson, RN

How do you know if your teenage daughter has an eating problem?   (Or your son-- rarer but it happens.)   So many girls and young women have written in to the Sneaky Kitchen with eating disorders, or mothers or other loved ones asking for advice dealing with picky eaters, that I asked Karen Danielson what to look for.   Karen is a Registered Nurse and is in charge of the Student Clinic at a college in Pennsylvania. 

Karen, as I do, feels food is health, food is pleasure and food is love, and while she isn't a specialist in eating disorders, she certainly encounters it frequently while counseling students.   In fact, this problem is so pervasive in our society that their college has a specialist in eating disorders on staff, as many probably do.  I can tell from the tone of Karen's answer that the cases of bulemia, anorexia and other eating disorders she handles grieve and outrage her for the sake of the sufferers, as they do me.  Here's her comments on eating disorders in general and some specific advice:

Most anorexics, for instance, have a control issue.  'You can control what I wear, who I date, where I go, where I go to college, but you can't control what I put in my mouth!!!'.  They are usually in denial, i.e. 'I always eat meals.  I'm not denying myself food in any way'.

People with eating disorders are great at manipulating those who try to intervene.  Girls often are great at telling you what you want to hear; they try to be the perfect daughter; they try to excel in everything they do, especially academics.  They are genuine people pleasers and they please everyone but themselves.  They usually have 'hungry hearts'.  They often work in fast food places, pizza places, anything to do with food, and all the while they won't touch it.  They love to be in the midst of the temptation of food and be able to not eat it.  Again, it's an exercise in control.  And when they succeed they are very pleased with themselves.  They may feel triumphant!!  They may make every excuse in the world as to why they're not eating like, 'I just ate',  'I'm going out for a big dinner and I want to be hungry',  'I'm a really picky eater and I don't eat meat',  'Oh no, I don't eat anything like that, I'm a vegetarian', on and on, ad infinitum.   But it's all a cover-up for the root problem.

Food is basic.  It's life-sustaining, it's comfort, it's enjoyment and pleasure.  People with eating disorders often withhold food from themselves because they think they are undeserving of the pleasure food brings.  

Eating disorders are a fascinating (although distressing) subject to me, because I have this perpetual love affair with food and I just can't even imagine going with out it.  I have a hard time doing a 12 hour fast for blood work for heaven's sake!!

There's an excellent  resource at   But while do-it-yourself help manuals are helpful adjuncts, at times, I would never recommend them as the only source of help.  

An excellent explanation, Karen.  As you mention elsewhere in our correspondence, most colleges and universities have qualified and confidential counselors.  For Junior High and High School girls, a first choice may well be a dietitian who can assess the problem and make recommendations for other counseling if required.   Or visit your family physician first and explain the problem, asking for referral to a specialist, especially if you are are member of an HMO.   Insurance sometimes covers some or all of the cost, but if money is a problem, almost every community has clinics that base their fees on ability to pay.   Karen adds:

"Most professionals who deal with people who have eating disorders are not judgmental and will not think a person is stupid or unlovable.  Depending on what your religion or faith is, of course, I know there are many wonderful Christian counselors out there in our area and many do an especially effective job with this particular problem.  But if you get hooked up with someone that makes you or the person with the disorder feel uncomfortable, or someone who isn't having some kind of positive effect after several sessions, drop him or her immediately and find someone else."

Thank you, Karen, and good advice.  It can happen; sometimes it's simple incompatibility, sometimes incompetence, but don't stick with someone who isn't helping, and don't let a bad experience keep you from trying again. 

Whatever you do, if you strongly suspect a loved one has a problem (or you yourself do), don't let it slide, and don't engage in denial of your own.  Eating disorders can be health- and life-threatening.   If you're in doubt, make an appointment with a specialist yourself; they can either confirm there's a problem or ease your mind!

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