help! my anorexic daughter won't eat!

Question:

We really don't know what to do about Amanda’s anorexia at this point.  We saw the nutritionist on Tuesday and Amanda participated reluctantly.  She tells me she’s been eating everything but her sister told me privately that Amanda barely eats when I am not around and that this morning she didn’t have breakfast.

We know she's lied to us plenty in the past few months.  I can tell her that I think she's not being truthful with me but, if she denies it (she can really put on an act), I'm not sure what else to do.  I can't put her sister in the middle of this but I feel like we have to tell Amanda that we know that she has lied. 

At this point, she's decided not to take anti-depressants, she isn't complying with the eating plan, and I’m worried she’s going to end up right back in the hospital.  Basically, she has to choose to start trying to actually get better. 

Do you think I should confront her with her behavior?

Answer:

It’s really hard to know what to do sometimes...

Why don't you tell Amanda that you have doubts about her commitment to getting better and that you need to know where she stands on her own treatment and recovery.  If she says she's committed to the process, don’t try to confront her with any lies or hearsay.  Encourage her to continue trying; and let it go.  If Amanda is lying, the truth will eventually emerge because she will be weighed during her medical appointments and any weight loss will become apparent over time.  If Amanda responds that she is not committed to getting better or is struggling, let her know that she may be hospitalized again if she loses more weight, and that this will merely postpone her recovery.  

Either way, you have to let Amanda face the consequences of her choices and behavior.  Ambivalence around autonomy is a major struggle for anorexics and Amanda has to work it out in order to move forward.  If you take it upon yourself to get her to eat, you will perpetuate an unhealthy dependency on you.  I know it’s tricky because her behavior is irresponsible and, as her mom, your instinct is to step in; but she has to own her life.  

In terms of her sister, you are right to not involve her.  Amanda may be baiting you by telling her sister “secrets” that will make it back to you, and it is best not to encourage any indirect communication. What Amanda says is less important than what she actually does. 

What if I DON’T have OCD?

It's not time to worry yet.
~ Harper Lee; To Kill a Mockingbird

Question: 

I've been doing great, but I'm writing again because I stumbled upon a very tricky obsession, and it's a very tricky one indeed and I can't get seem to get my mind around it: "What if I DON’T  have OCD?"

I have OCD but still doubt that I have OCD even though I know I had compulsions that started in childhood.  I used to go up and down the stairs a lot, and had trouble with light switches at a pretty young age! Heck, I remember seeing the episode from Scrubs starring Michael J Fox as an OCD surgeon only 4 years ago and I could identify with him! I didn't' doubt my compulsions or memories then like I do now!  Now my thoughts seem to compulsively doubt themselves, including the thought that I have OCD.  It's ridiculous!  Why is this happening to me?

I did a bit of a "brief" online research about obsessive thinking.  Mistrusting the diagnosis seems to be part of the pathology. Am I right?  If not, I don't know what the [bleep!] I have.  Would it mean that all my concerns are founded?  Sheesh!

Basically, it all boils down to this: "Why can't I believe I have OCD when I clearly remember having struggled with so many compulsions?"

Answer:

Sorry to hear that you are struggling. 

Is there a pattern?  Do you find yourself doubting yourself more at night, on the weekend, when?  Are you possibly more tired, bored, hungry or lonely at these times?  Any compromised state will make it harder for you to step away from the vortex of obsessive thoughts.  Try to keep that in mind.  If, like most of us, you tend to be more broody in the wee hours, do not trust the counsels of the night and instead encourage yourself, à la Scarlett O'Hara to "think about that tomorrow; tomorrow is another day". 

Now to answer your question:

I think mistrust of a diagnosis is part of the pathology.  Am I right?

Yes.  You are right.  That can happen!  And I think that this is exactly what is going on in your case. 

The suffering as a result of your kind of OCD is really intense, precisely because of the inability of obsessive thoughts to let go their grip so you can come to a place of rest, and think and feel "Ah!  Everything’s fine".  When thoughts compulsively gravitate to doubts including doubts about your own thoughts, they'll trip up your thinking with knots that you can't undo by worrying them like a string of beads.  You'll just get caught in the loop.

There is no way to stop yourself from having thoughts, but you can manage compulsive worrying by stepping away from the vortex of doubt, avoid the worry loop and reinforce a few simple truths:

You are sane.  

You are okay. 

You "just" have OCD.

blame it on the limbic system

Question:

John’s business trip abroad has been extended.  This news really devastated me – I am not sure why.  I am really angry, disappointed, and frustrated with it all.  I have no choice though and I guess that is why I am so angry.  Yesterday, I cried all the way home from work – sobbed along the highway, came into the house and continued the sobbing, along with some screams and some “I can’t do this” and “I won’t do this, again”.  Why am I having such a hard time with the knowledge that he'll be gone for another month?  Why am I acting like such a baby?  Is this normal?

Answer:

Though you may feel like there is something terribly wrong with you, this kind of reaction is really quite normal.  Why do we regress like children upon pain of separation from our loved ones?   

Blame it on the limbic system, our primitive reptilian brain. 

This limbic system is responsible for emotional regulation and depends on how securely we are attached to our loved ones and how attuned they are to us.  Since the limbic system stores templates of the emotional attachments we formed in early childhood, adult love relationships can trip primitive neurobiological wiring and trigger early childhood responses that cause us to “act like babies”.

Even in healthy adult relationships, separation from our partners can trigger the same distress that we experienced as children upon pain of separation from our mothers.  Those of us with insecure attachments inscribed in our primitive templates experience even higher levels of distress.  Those of us who are repeatedly exposed to unforeseen or extended periods of separations that are not of our choosing (as you seem to be), even higher still.

The cure lies in relationship, i.e. in developing a secure attachment that effectively contains  dysregulated states like the ones you are describing so that early childhood wounds are healed, and trust and comfort are restored.  John Gottman recently wrote a book called The Science of Trust on this subject which you may be interested in exploring. 

I also encourage you and John to use Harville Hendrix’s famous mirror listening technique. Thanks to Oprah, here is a link that will explain to you how to do that.

teach your children well

Teacher don't teach me no nonsense
~ Fela Kuti 
                      

What!  My foot, my tutor?
~ Shakespeare

When my daughter was born, I thought I had to teach her everything.  I remember the overwhelming sense of responsibility that came with that belief, not to mention the overwhelming self-doubt.   I hardly knew how to look after myself, how was I going to teach someone else how to do it?

I soon realized that my daughter was not a very cooperative student.  I had no control over when she would eat or sleep or get fussy.   I had no control over when I would eat or sleep or get fussy, let alone when the lessons of life would begin.  But that was all right because it turned out she already knew everything she needed to know.  In fact, it turned out she was the one doing the teaching, not me, and my humble job was to learn from her and adapt to her.  I was the student.  That was way harder than being the teacher!

As parents wanting to do right by our children, we think we have to teach them way more than we have to.  We think of them as empty vessels into which we have to pour our wisdom, or as formless clay in need of shaping by our hands, delusions that can persist long into our parenting career and distress our tender charge.

Unless we allow ourselves to be humbled by our ignorance.

Rather than think of your children as empty and amorphous, think of them as seeds that already have the fruit built into them, and make it your job to find and cultivate the optimal conditions for their fruition.