Anxiety/Depression-turned-eating disorder?

January 10, 2014

There was a discussion here back in Sept. about a couple of our kids (mine and MadeofStars, if I remember correctly) asking if our kids sounded like they had depression or was it just symptoms of attachment disorder (which mine also has). If I remember correctly, it sounded more like ODD to some of you, maybe a bit of depression, and typical RAD.

Fast forward to the past few months and now my 14-yr-old is talking weight...and her desire to LOSE it (she's already tiny, wearing a size 4 juniors, 5' tall, 94 lbs).

She's also homeschooled, so not around alot of peer pressure other than what she sees on TV or magazines in the checkout lane. I monitor/censor TV and movies, music, etc. Her homeschool peer group runs the gamut from tiny/waif-like kiddos to the curvier gals, but they are all very supportive of each other and the "weight" talk doesn't come up (from what I can see). BUT...she has a newer friend who was also adopted with a very traumatic history and my kiddo is VERY competitive with her. They're "friends," but more like frienemies in that mine constantly challenges the other girl to races, will blurt out questions asked of the other so she can answer them first, etc. (Mine is VERY jealous of the other girl. Granted, the other girl has her own attachment issues, but she's doing better than mine now that she's on an anti-anxiety med and in attachment thearpy.)

Anyway, mine has been talking weight in the past month or so, calling her healthy weight sisters "fat," etc. She's an angry, mean, self-loathing kid, so this is par for the course. (Yes, she gets in trouble every single time. I also just learned she had been blackmailing her OLDER sister to get her to do whatever she wanted her to! Threatened to tell on slower sis for saying a cuss word ("pi$$ed" or similar...certaily not worth allowing her younger sis to blackmail her for months! Jeez.) See? Just meanness, manipulative, angry, nasty....And now this weight obsession (desire to be "smaller/thinner/weigh less" than everyone else).

So today she had her annual Dr. appt. and I brought up the weight talk, her peer/social struggles, and recent journaling (mom/daughter journal) of wanting to "hurt" herself sometimes. Dr. asked her when it is that she feels like hurting herself..."When I've done something bad." (?) I explained that she said it in her journal to me AFTER her friend said "We're through if you can't stop this insane competition with me!" (NOTE: My kiddo hid an article of clothing of her own at the Y, had us all looking for it, then in the car on way home suggested that maybe frienemy had taken/hidden it. I went back and found it in another locker, told the girls' mom. She confronted her daughter, and that girl blew a gasket and said she was done with the friendship...sick and tired of the competition and being blamed for stuff.) (I wasn't sure who was telling the truth, though, because the other kiddo has AD, too, and so has been caught in lies, too.)

Anyway, long story short, dr. today suggested mine see a DIETICIAN when I asked about an anti-anxiety med or anti-depressant. Dr. was stuck on her weight hangups and worried that this was the start of an eating disorder. Dr. wouldn't hear what I was saying--that this is just one symptom of many that stems from poor self-esteem, feelings of abandonment, attachment disorder, etc. (Dr. did say at this age everything gets blown out of proportion, that the dietician is also a therapist and this could be a door into therapy since mine refuses to talk/work with our attachment therapist.)

So now I'm stuck. This seems like a waste of time/$. She KNOWS that protein is necessary for muscles and carbs/glucose for brain power. She knows that people die when they don't get enough nutrition. She knows that she's "underweight." Heck, she can't pass up a brownie or ice cream, so she clearly isn't too concerned about weight. I personally believe it's just talk/attention-seeking. She's also jealous of little sis who gets more Mom lap time (because she'll climb into my lap unlike 14-yr-old. If I pull 14-yr-old into my lap she gets angry, will pull away. If I hug her, she'll demand "What are you doing?!" and pull away. Ugh. ...Anyway, little sis weighs 76.5 lbs, so get this, 14-yr-old apparently told little sis that she wants to get "down to 75." Hmm...Could it be that she wants to be smaller than 12-yr-old thinking she'll be treated as the baby of the family then? You just never know with their warped thinking what the heck motivates them! :eek:

I'm tempted to go back and see the previous attachment therapist who couldn't get anywhere with my daughter just to see if she'll talk to the dr. and recommend a med instead. (The dr. won't do it unless kid is already in therapy and monitored.) Grr. Just frustrated that we seem to be getting nowhere! Thought for sure that dr. would see the anger, contrariness, meanness, self-hatred and recommend a med to take the edge off so she'd be willing to speak to a therapist! (As of now she'll only glare at therapist with arms folded.) Instead, she recommends seeing a dietician!:confused:

EtA: Dr. noted with me privately that my kid's answers seemed "very simplistic, immature. Very concrete thinker" and asked if I'd considered getting her on Medicaid Waiver/SSI benefits! (My older one is on the waiting list, but I thought this one was too advanced for that. Her IQ isn't low enough (81-ish, though would probably test higher now. That was when she first came to us and she's much more secure now. And she's way more socially aware than her 73 IQ sis.) Not sure what she asked my kid or what my kid's answers were, but Dr. told me to keep homeschooling her and worried that we're running out of time to intertervene...that she'll need services to help her make the transition to adulthood. Wonder if my kid talked about her boy obsession and how mean her mom is for not letting her date yet?! eek! Dr worried that kiddo is at "high risk for being taken advantage of." Well, duh....Dr. also asked if kiddo had ever been diagnosed with ADHD!!! (My guess is my kid was anxious and couldn't sit still while being questioned with me outside of room.) I told her yes, she had, but it was a tentative dx and thought to be anxiety-related. Sure enough, we brought her home to homeschool and the hypervigilance reduced and she's able to concentrate for 2 hours at a time now. (But again, why, if dr. knows that she has prior anxiety disorder and depressive disorder dx's wouldn't she Rx an anti-anxiety med?!)

Advertisements

Sharon Kaufman

July 29, 2016

I am aware of a child, about the age of your daughter, who has an eating disorder combined with anxiety and depression. She's in high school, has attempted suicide twice, and has had both psych and medical hospitalizations -- the latter because she lost so much weight that her heart and other organs were being affected.

In this particular case, the extremely bright chlld does NOT have weight/body image issues. She's "girly", in that she likes makeup and jewelry, but she has never been fat and her friends don't make a big deal about weight. And she's not interested in wearing stylish clothing or going on dates. I'm no expert, but it seems that one issue is that she doesn't want to grow up. Not eating stops menstrual periods, which she hates, and reduces the appearance of a bustline. She acts a little young for her age, though her intellectual ability is quite advanced.

Another issue is control. She is a strict vegan, in a household of non-vegans, which means that her Mom has to buy and make special foods for her -- and winds up making them for everyone else, too, frequently. And she won't even eat most vegan foods, just a limited selection. I think that the veganism started as a healthy interest in animal well-being, but soon became a way in which she could control her life and that of others.

Still another issue is discomfort with change -- something that goes hand in hand with the need to control. She was terrified of starting high school, and beginning to think about going away to college. In fact, she wound up missing a good bit of her first year of high school, but being bright, she made up what she missed easily, and her family moved her to an alternative school with smaller classes and more flexibility.

And finally, she was adopted internationally, and her birthparents were unknown. There is no way of knowing whether there was depression in her birth family. And to the extent that depression is part of what's going on, it has to be remembered that depression is a disorder of brain chemistry, and can be familial. It may be triggered, but not caused, by a circumstance like adoption. Moreover, she doesn't like to talk about adoption much, so it's hard to tell if there are abandonment issues and so on.

The first thing I'd suggest to you is to take action very quickly, before your child damages her heart and other organs through insufficient intake, and before she attempts suicide. Suicide attempts are pretty common among kids with problems like hers, and with young teens, in general.

Find an eating disorders program to evaluate your child. Look especially for one that deals with eating disorder along with anxiety and depression issues. Your daughter's type of eating disorder is actually common enough that most eating disorders programs will work with her. The child I've mentioned has a type that is relatively uncommon, and when an inpatient program was needed, the family actually needed to put her into a program far from home -- like an airplane flight away; the mother flew to see her every weekend, and participated in family therapy by video conference call during the week.

Some eating disorders programs feature outpatient-only programs. Others feature residential-only programs. And others have a spectrum of services, which can be accessed as needed. Most won't provide medical testing and treatment for damage done by not eating; however, they will work with your doctors or your acute care/children's hospital on what's needed. They will have psychiatrists and other professionals who can diagnose your child's illness and prescribe a course of treatment that may involve medication, therapy, nutritional counseling, and so on. If residential care is needed, the programs will work with her school to provide instructional services.

In this child's case, she categorically refused to take medication. And professionals, nowadays, will not medicate a child without his/her consent. As a result, she has made extremely slow progress in therapy. And because she is very bright, I suspect that she tried to "game the system", by telling therapists what they want to hear. It's very easy to do, especially with cognitive-behavioral therapy. She does see a dietitian and has a meal plan she must follow, but it tends to work well only when her Mom is with her; left to her own devices, I suspect that she still won't eat properly.

If medication is recommended, I would suggest NOT going with anti-anxiety drugs, without some second opinions. Most anti-anxiety drugs, like Xanax, are HIGHLY addictive and hard to stop using. They should be prescribed mainly on an emergency basis -- for example, if your child is screaming that she wants to die and refuses to go voluntarily to the hospital, when she is dangerously dehydrated and emaciated. In that sort of case, she may need to be sedated.

Many doctors find that certain antidepressants have a good effect on anxiety, as well, so don't be surprised if one is recommended, even if she does not seem all that depressed. Unfortunately, many antidepressants are not recommended for children and teens, because they actually increase the risk of suicide early in their use. However, not all antidepressants work for all people, and it will be a matter of trial and error before the right drug or right combination of drugs, and the right dose is found. Sometimes, it is necessary for a doctor to try an antidepressant that is NOT generally used for kids and teens, in order to find one that is effective. Don't be afraid of that, if you trust the doctor. My daughter had depression, but not an eating disorder, when she was youir daughter's age. The first drug he tried, which WAS approved for kids and teens, had terrible side effects. She developed a terrible social phobia, displayed horrific anger, and so on. The doctor quickly switched her to a drug that was NOT approved for kids, and it worked like a charm. She was on it for a year or two, then stopped voluntarily because she no longer needed it. Stopping was not difficult.

Obviously, if your child is on antidepressants OR if you think there is a risk of suicide, you may have to lock up all sharp objects, medications, liquor, and household cleaners. And you may have to do a thorough check of your daughter's room daily, to make sure she isn't squirreling away dangerous things she finds, gets from friends, buys, or shoplifts. In the case of the child I mentioned above, her product of choice for suicide attempts was Tylenol, which can cause permanent damage to the liver if taken in large doses. If she goes to a psych hospital or a residential program for eating disorders, it will have systems and processes to keep the children safe.

My daughter never attempted suicide, when she was depressed, though she talked about wanting to be dead and once tried a "cry for help" type of slashing her wrist (very superficial). She was also very bright, and very well attached to me, and we developed a verbal contract in which I agreed not to lock things up if she agreed not to attempt suicide. She felt that if I locked things up, she'd feel even more depressed, because she'd know I didn't trust her. Although I was scared, I kept my part, and she kept hers. But we have an unusually strong bond, possibly because I'm a single Mom, and my daughter, despite her depression, really had a strong will to live.

Unfortunately, eating disorders are not really "cured", in most cases. The child will learn to make better food decisions, to realize that she is a lovable and attractive person regardless of her weight, and so on. And, hopefully, those lessons will stick with her, though many children relapse and need repeated stints in a hospital or residential program. Ongoing psychotherapy can reduce the likelihood of relapse.

But, unfortunately, you are probably looking at a "new normal" at home. You are going to need to deal with a lot more doctors and other health professionals than you ever hoped to deal with, and some programs may not be covered by insurance. You are going to need to develop a food plan with your child, and insist that she stick with it, watching her while she eats, at least until she is able and willing to self-monitor. You are going to need to develop an exercise plan, which requires her to eat more if she exercises more, without turning her off from exercise altogether. (Some teens with eating disorders exercise excessively, as part of trying to lose weight.) You are going to need to have a family meeting, in which you set some rules for ALL of your children, with regard to competitions such as those you describe, and ask their cooperation in helping your daughter with an eating disorder to make healthy decisions. As I mentioned, you may need to lock up things that can be used for self-harm. And so on.

Are the issues attachment related? Quite possibly. But first, before you think about that, you need to make sure that your daughter doesn't become ill from not eating enough, and doesn't try to kill herself, because her anxiety and depression are overwhelming. Do that by getting your daughter into a program for kids with eating disorders; let them talk to you about what they see and whether she needs outpatient, inpatient, or residential (example -- 2 week or 28 day program). Let them talk with you about medication. Mention attachment disorder, the fact that it's common in adopted children, and the fact that your child is showing some of the symptoms.

Sharon