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Adult Daughter Has an Eating Disorder – How to Help?

By January 29, 2013

My 25-year-old daughter recently came to live with us after a break-up with her boyfriend. She had been refusing to eat or drink water (more than a couple mouthfuls – if that) for 53 days. I finally coaxed her to go to the ER to check for dehydration and low potassium levels and they admitted her for 6 days, but she needs a place that specializes in eating disorders. She is resistant to going. In the meantime, when she was home she was on the computer, the phone, or texting all day long. We want to avoid this happening again. She is being discharged today from the hospital and I want to set limits and encourage her to agree to a schedule of some kind if she doesn’t want to go to ED treatment. In recent past, she has had D&A issues and is being treated for depression and we are paying for her medical insurance, car insurance. We are being stretched to the max-(because my husband raises support as full-time ministry). What are your suggestions? – Sandra

Sandra,

This must be extremely difficult for you emotionally and in simply living your day-to-day life.  I hope you can find ways to get support for yourself.   Here are some thoughts — I pray these will help and that God will be close as you deal with this complex and emotional situation.

Before I get into this any further – I want to address medical issues because much of what I have to say doesn’t apply if she becomes medically unstable.

Medical Concerns

If her weight is okay and she is reasonably stable you can begin to deal with these issues in a more gradual/stair step manner. On the other hand, if she is currently medically unstable and/or may very quickly become medically unstable you should be more direct with her and assume more control. For example, require her to have regular appointments with a medical doctor who can monitor her physically. This doctor could become an ally in getting her into treatment in the future.  It would be good, if possible, to find a doctor who has experience with ED patients.  When it comes to significant medical concerns, it is okay to be very direct.  If she becomes significantly unstable, you can seek consultation with state agencies in terms of your options.

Turning now to your question: “…she was home she was on the computer, the phone, or texting all day long. We want to avoid this happening again.”

In addition to what I have written here I strongly recommend:

  • Obtaining a copy of a book called Peacemakers. You can learn more about the book and the ministry at http://www.peacemaker.net/.  This book has a lot of biblical ideas about how to deal with conflicts and problems such as the one you are facing.
  •  Seeing a family counselor for three sessions or more to learn directly how to deal with this difficult situation. Ideally this would be with your daughter, so that the therapist could begin to do some family therapy helping all of you work through this difficult time.
  •  If this does not work out, it would be good for you and your husband to go to talk through and plan how to deal with this crisis.

Setting Limits

I understand your dilemma, but it is very complex in some ways.  Your daughter is an adult. Treating her and monitoring her as if she were still 15 (even if she is acting that way) can create as many problems as it solves.  She needs to become a responsible adult, and although I clearly understand your not wanting her to text and email all day, that will not move her towards responsibility.  Directly setting limits on how much time she spends on the computer, texting, or talking on the phone will create power struggles that ultimately will not change her and will likely cause you a great deal of stress.

I suggest that instead of focusing on what you don’t want her to do, focus on what you want her to do as an adult member of the family.  Be specific about what you expect.  For example telling her to “Help around the house” is too ambiguous and you and she can argue whether or not she helped around the house.  Telling her you want her to vacuum daily is specific – it happened or it didn’t happen.

If she is sufficiently carrying her share of duties – she will have less time to text, be on the computer, etc.  You have every right to decide the atmosphere you want to your home to have and what you expect from people who live there.  But I highly suggest that you focus on what you want her to do and not what you don’t want her to do.  If she doesn’t do what you want (e.g., laundry) because she is constantly on the computer, let the not doing the laundry become the issue.

Because she is an adult it would be unwise to monitor everything she does (how much time she spends on the computer), but also because she is an adult – you have no obligation to pay for her internet usage, cell phone bill, etc.  You also don’t have to pay for her car insurance or to use your car, especially if she is not keeping up her end of the bargain.

The other area where I would clearly state some expectation is progress on her ED.  If she believes she doesn’t need inpatient care, then see if she will agree that if she doesn’t gain X number of pounds by such and such a date – or she begins to lose weight and move towards medical instability – she will admit she needs help and seek treatment.

Another key is good communication. I would suggest the following although, again, it would be best if it could be done in the context of family therapy.

Communication

  • Start out with affirmation of your love for her, your concern about her well-being and you wanting things to work out for her.
  • Ask her open ended questions in an empathetic manner as opposed to confrontational manner. For example: “Help us understand the feelings and thoughts you have that make you want to not eat?” versus, “Why won’t you eat?
  • Offer support – “What can we do to make it easier?”
  • Don’t try to be her therapist or fix her in these types of communications. The goal is to genuinely let her know that you love her and care about her.  Although this can set the stage for confronting some of her behaviors – it needs to be real and cannot be rushed.
  • Don’t invalidate her perceptions or feelings. If she says, “I’m worthless.”  Don’t say, “No your not!” or “How can you say that, when we’ve tried so hard to be loving and supportive of you.” Instead you can say something like, “How long have you felt that way?” or “What happened to make you feel like that way.”  Or even “When I hear you say that, I feel so sad, but I want you to be able to talk about it.”
  • Another example is if she were to say something negative about you or her past. “No one ever spent time with me.”  “Why do you say you care now, you never showed that before.”  “You always loved my brother/sister more.” Again, don’t say:  “Of course we spent time with you don’t your remember…:  “How can you say I never showed love for you before, after all I…..”  “No I don’t love her more.  I love you every bit as much.”
  •  If you do become defensive about statements like these (if she makes them) you will – in her mind –be proving her point.  “See even now they won’t take what I am saying seriously.” Responses like – “I feel very badly that you feel that way. Help me understand why you feel that way.” – will likely be more helpful in the long run.
  • At some point it’s okay to say that your recollection of the past is different, however, you respect how she feels and you want to have more conversation so you can understand and try and work things out.
  • Ask her how she feels about how things are going at home. Listen – again validate that this is her perception — without necessarily agreeing.
  • Share you concerns and how you feel things are going. Use “I” statements. “When I see you losing weight and need to be hospitalized, I feel extremely frightened. I want to control you.” – if that’s how you feel. Or “When you don’t do the laundry, because you are too tired, I get angry because I feel ….   Part of the anger is that, when I get up in the middle of the night, you are still awake using the computer and the next day you don’t do the laundry because you are too tired.  What I want you to do is the laundry, vacuum, etc. and if you are too tired to do that because you were up late, then I want you to go to bed earlier and get up earlier.”

Having an adult child at home is not healthy for anyone except in crisis situations. Crisis situations by definition are somewhat short-term.  You might want to sit down with her and develop a step-by-step plan where she can get back on her feet and become independent again; not because you don’t love her, but because it is best for her.

Create, with her, a list of what would need to happen for her to be able to be independent and then put those in order of what needs to happen first, along with a rough timeline.  If she isn’t moving towards the goal, she obviously needs help, such as more intensive ED treatment.

Setting the Limits 

Here are some other ideas if you sit down with her to set limits:

  • Take time and plan ahead, don’t just do this off the cuff.
  • Know which issues are essential limits (if any) and which ones are less important.  Rank them in relative priority.
  • Decide wisely.
  • Don’t create a hill to die on, unless it really is a hill to die on.
  • Don’t compromise if you really cannot live with something.
  • Talk with your husband and work out any disagreements about what you want to say before you say it to her!
  • Be ready to listen openly and reconsider something – IF she has a valid point that you had not thought about, but don’t commit to any changes in the moment. Instead, just let her know that you hadn’t thought about what she said and that you need some time to think about it. Then give her a specific time – Wednesday by 5 p.m. – when you will let her know.
  • Be specific in what you want her to do.
  • Get her feedback and ask for commitment.

Again, I don’t know your daughter or how she might respond when you sit down to talk to her about these limits. Therefore, plan what you will say and do to the various ways she might respond.  Know what you will say and do if — she…

… Says, “Fine, I’m leaving.”

… “You never loved me anyway.”

… “I might as well kill myself.”

… Gets up and walks out.

… Cries and says “I cannot do that, I just can’t.”

… Starts screaming or some other severe reaction.

… She simply says – “no.”

You probably have a good idea of how she will respond, but it is important for you not to make an emotional response in the stress of the moment one way or the other. It is okay to say, “We are all pretty upset.  We love you, so let’s talk about this again tomorrow evening.” (Be specific about the time, if possible). If possible, try to end on a positive note, even if there isn’t any resolution.

Consequences

  • If therapy is possible you and your husband need to sit down and decide what you are going to do if things don’t change and how long you are willing to wait.
  • Recognize that this is your choice.
  • As a Christian psychologist it is my opinion that you are not obligated to take care of her – that would be something you could choose or not choose – especially if she will not cooperate.
  • However, think about your options if she doesn’t change, taking into account the impact that choice will have on you.

As a father I can definitely empathize.  I pray God will give you wisdom and that your daughter will be motivated for recovery and move towards the abundant life God would have for her.

David Wall, PhD