Eating Disorders Eating problems are common in children and teenagers. Yet myths about such problems abound and it can be very difficult to separate the facts from popular beliefs; unusual or disturbed eating patterns can be understandably bewildering and distressing for parents. Whatever aspects of your child’s eating behaviour is causing you concern, this book will help you understand some of the more common reasons why problems arise, and will give you advice on what you and others can do to manage the situation. Written by experienced clinicians, Eating Disorders: A Parents’ Guide provides positive, sensible advice on a range of eating disturbances in children and adolescents—both girls and boys— and answers many of the questions frequently asked by worried parents, including: • Why is my child experiencing eating problems? • What can I do to get her to talk about it? • Where can we seek help and treatment? • How long will it be before my child is better? Complete with a helpful glossary, suggestions for further reading, and a list of useful addresses, Eating Disorders: A Parents’ Guide is a reassuring and practical book that will support and encourage you and your child to obtain appropriate help and successfully deal with those worrying eating problems. Rachel Bryant-Waugh is Consultant Clinical Psychologist and an Honorary Senior Lecturer at the University of Southampton. Bryan Lask is Professor of Child and Adolescent Psychiatry at St George’s Hospital Medical School and Medical Advisor to the Huntercombe Hospitals, UK. Eating Disorders A Parents’ Guide Revised Edition Rachel Bryant-Waugh and Bryan Lask HOVE AND NEW YORK First published in 1999 by Penguin Books Ltd. Revised edition published in 2004 by Brunner-Routledge 27 Church Road, Hove, East Sussex, BN3 2FA Simultaneously published in the USA and Canada by Brunner-Routledge 29 West 35th Street, New York, NY 10001 This edition published in the Taylor & Francis e-Library, 2005. “To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.” Brunner-Routledge is an imprint of the Taylor & Francis Group Copyright © 2004 Rachel Bryant-Waugh and Bryan Lask This publication has been produced with paper manufactured to strict environmental standards and with pulp derived from sustainable forests. Cover design by Terry Foley at Anú Design All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. British Library Catologuing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloguing in Publication Data Bryant-Waugh, Rachel. Eating disorders: a parents’ guide/Rachel Bryant-Waugh and Bryan Lask.—Rev. ed. p. cm. Includes bibliographical references and index. ISBN 1-58391-860-4 (pbk. : alk. paper) 1. Eating disorders in children—Popular works. 2. Eating disorders in adolescence—Popular works. I. Lask, Bryan. II. Title. RJ506.E18879 2004 618.92′8526–dc22 2003024355 ISBN 0-203-44886-3 Master e-book ISBN ISBN 0-203-67903-2 (Adobe eReader Format) ISBN 1-58391-860-4 (Print Edition) Dedication This book is dedicated to the many young people with eating disorders whom we have met over the years, and to their parents. We have sympathized with their suffering, admired their courage, and rejoiced in their recovery. When will I stop seeing food as the enemy? When will my guilt and fear cease? Why can’t I think my thoughts clearly? Why won’t they just leave me in peace? What does it mean to be ‘normal’? I want to have fun and be free. When will the dark turn to daybreak? When can I enjoy being me? How can I kill these small demons? Those monsters that tear up my head. In what way can I finally defeat them? I wish for them to be dead! CW Contents About the authors vii List of figures and tables viii Foreword ix Acknowledgements xii Introduction 1 1 What are eating disorders? 9 2 What causes eating disorders? 23 3 How do I know if my child has an eating disorder? 45 4 What can I do? General principles 57 5 What can I do? Specific problems 67 6 Who should I consult and what will they do? 97 7 What about the future? 131 8 Case vignettes 141 Postscript 161 Glossary 163 Further reading 167 Useful addresses 169 About the authors Rachel Bryant-Waugh was educated in The Netherlands and subsequently studied Human Sciences at the University of Sussex. She went on to obtain her D.Phil., also at Sussex, on the subject of childhood onset anorexia nervosa, while also working at Great Ormond Street Hospital for Children. She completed her clinical psychology training in 1988 and returned to Great Ormond Street to specialize, with Bryan Lask, in the treatment and study of eating disorders in childhood. She has published and taught widely on this subject and is currently a Consultant Clinical Psychologist and an Honorary Senior Lecturer at the University of Southampton. Bryan Lask trained at St Bartholomew’s Hospital Medical School, London, and did postgraduate training at the Maudsley Hospital and Institute of Psychiatry, and Great Ormond Street Hospital for Children. He was Consultant Psychiatrist at Great Ormond Street from 1975 to 1998 and was Director of the Eating Disorders Programme there. He is currently Professor of Child and Adolescent Psychiatry at St George’s Hospital Medical School and Medical Advisor to the Huntercombe Hospitals, UK. The author of eight books and over a hundred and fifty scientific papers, he has lectured throughout the world and has been a visiting professor at a number of universities in Norway, Australia, Canada and the USA. Dr Bryant-Waugh and Professor Lask are the co-editors of Eating Disorders in Childhood and Early Adolescence (Psychology Press 2000). List of figures and tables Figures 1. The development of an eating disorder 44 2. Stages of anorexia nervosa 81 3. No change in weight over time 111 4. Water loading 111 5. Typical example of stepwise weight gain 112 6. Angus’s weight chart 124 7. Angus’s height chart 124 Table 1. Darren’s mealtime plan 70 Foreword When children or teenagers have unusual or disturbed eating patterns, parents are understandably bewildered, distressed and frustrated. They cannot make sense of such intense concerns about eating, often accompanied by seemingly inappropriate worries about weight and shape. This book is for any parent who is worried about their child’s eating. The idea for it arose from a booklet we wrote some years ago addressed to parents of children who attended our eating disorders clinic. The booklet proved so popular that we were encouraged to expand it and this Parents’ Guide is the result. We hope that it will prove to live up to its title and truly act as a guide for parents through the difficult world of eating disorders. The term ‘eating disorder’ can mean many different things to different people. We are all familiar with the tragic stories that hit the headlines: death from anorexia nervosa of promising young people who should have so much to live for. Eating disorders are often featured in magazine and newspaper articles, and a whole range of confusing terms and explanations are offered. Myths abound and it can be difficult to separate the facts from popular beliefs. In this book we try to be clear about what is and what is not known. We will not use terms like ‘slimmer’s disease’ to describe anorexia nervosa, because this term is inaccurate and misleading. We will not be suggesting that you view your child’s eating difficulty as a phase of awkward, stubborn, defiant behaviour that is best ignored until it goes away. We will not be looking to the worlds of fashion and fitness to provide a full explanation for your child’s problems and, finally, we will not be suggesting that you are a bad parent. It is clear that you are a concerned and interested parent because you have picked up this book. So what will we hope to do? Your child might have any of a number of different eating