The Repeat ‘Customers’ That I Don’t Want

As an event planner, I love repeat customers. It’s so gratifying when satisfied clients keep coming back and requesting help in planning additional events for family members.

In contrast, when it comes to parents of kids with eating disorders who come to me for advice on treatment, I pray that they only come to me once. Generally speaking, this is the case. They call me when their child is diagnosed with an eating disorder, or when treatment is at an impasse, to ask for help or advice. As the mother of someone who has been living with an eating disorder for the past 13 years, I am more than willing to offer the benefit of my experience, and the knowledge that I have gained during this journey, with other parents. We have a long conversation, I offer them some guidance and suggestions, and I don’t usually hear from them again. I hope this means that they all find their way and experience positive outcomes. Though the statistics suggest otherwise, I prefer to pretend that all of their kids recover from their eating disorders.

However, recently, I have noticed a developing trend, and it makes me profoundly sad and concerned. I am getting “repeat customers” coming back to me asking for help for a second child who has been diagnosed with an eating disorder. These parents, who have been through hell already, have to go back there with another child. And what makes it even worse is that they know what they are facing; they know how enormously difficult the struggle is, they know how hard they are going to have to fight, and they know the energy that this is going to require and the toll that it is going to take on their family. They know all of this, and more. And though the mere thought of repeating the worst experience of their lives is inducing intense anxiety, severe dread, and acute pain, like a knife through the heart, they are willing to withstand this awful journey through hell again with another child, because this is what parents do when their child is sick. They do anything and everything to help them get better, no matter what.

Though it is tragic, it is not surprising that there are parents who have more than one child with an eating disorder. Eating disorders are influenced by genetic factors, and they run in families. I know more than a fair share of families with both parents and children who are affected by an eating disorder. This doesn’t mean that if you have an eating disorder then you are going to pass it down to your children, or that if you have one child with an eating disorder that your other children will develop one. But it means that a genetic predisposition to eating disorders exists, and that carries a degree of risk. You need to have that on your radar if someone in your family has an eating disorder.

Practically speaking, to me, this means several things. First and foremost, it means being vigilant. It’s easy to miss an eating disorder the first time around, because eating disorders are cunning and deceitful. They know how to convince you that you are not seeing what you think you are seeing.

Most parents who call me about a second child with an eating disorder intuitively know that there is a problem early on. They are recognizing a pattern of behavior that is disturbingly familiar.  They know what they are seeing, they know the tricks and the subterfuge and the manipulations that are characteristic of an eating disorder. They are not easily convinced that they are not seeing what they think they are seeing. They know exactly what they are seeing, and it scares the hell out of them, because they know what is coming. These parents know what they need to do, they have done it before, but they are so shaken by having another child affected by an eating disorder that they panic, and they call me for support. They need so much support.

Early intervention is a predictor of a better outcome, and it’s reasonable (and yes, hopeful) to think that vigilant parents may be able to catch an eating disorder the second time around early enough to limit the damage . The advantage of the benefit of experience is knowing the danger of waiting; waiting for a diagnosis, waiting for treatment, waiting for some sort of confirmation that this is a bona fide eating disorder and not some sort of phase. Unfortunately, doctors don’t seem to understand that time is the enemy, and that waiting to start treatment resolves nothing and exacerbates everything. But a parent who has been through this before has paid too high of a price not to have learned this lesson.

Another way to identify family members who are at risk for developing an eating disorder is through personality profiling. This is particularly relevant for anorexia nervosa. Individuals with anorexia nervosa tend to be self-driven perfectionists with unrealistically high standards. They are black and white, rigid thinkers. If you have a family genetic predisposition toward eating disorders and you have a child who fits this profile, take action at the first sign of any concerning eating behaviors. Trust your parental intuition; if you think that there is something wrong, don’t hesitate to have your child evaluated.

In my very non-scientific opinion, anxiety is a precursor to an eating disorder. If a genetic predisposition to eating disorders runs in your family, and you have a family member with high anxiety, keep an eye on him/her.

I wrote him/her because males get eating disorders too. This happens in all populations; no one is immune. Bear that in mind while being vigilant.

Last thought here—restricting is a component of all eating disorders. Adolescents should not be on diets that are not medically supervised, period. This applies even more if the genetic gun is already loaded.

When parents contact me for help, I end each call by telling them that they are welcome to call me at any time in the future if they need additional advice or support. I hope that they don’t; I hope that they find their footing and have no need for further guidance. I especially hope that they don’t end up contacting me again about an additional child who has developed an eating disorder. But if they do, I’m here.