Q. My teenage granddaughter spent some time with me recently. She eats very little, and is extremely thin. I have also heard her throwing up after she has eaten a small meal. Could you tell me more about bulimia and anorexia and what causes it? Should I confront her? Should I try to get her help?

Q. My teenage granddaughter spent some time with me recently. She eats very little, and is extremely thin. I have also heard her throwing up after she has eaten a small meal. Could you tell me more about bulimia and anorexia and what causes it? Should I confront her? Should I try to get her help?


A. From the description, it sounds as if your granddaughter is probably anorexic and not bulimic. According to Helpguide.org, there are two types of anorexics. The restrictive type will fast, follow strict diets, and even exercise excessively. The purging type will eat small meals, but control weight through vomiting and use of laxatives or diuretics. Conversely, bulimics usually regurgitate after a large meal, and maintain an average body mass.


Pay attention to your granddaughter’s food behaviors. Anorexics usually follow a severely restrictive diet, become obsessed with calorie counting and portion sizes, make excuses to avoid eating, and display unusual food rituals such as cutting meat into very small pieces. At the same time, anorexics can be so obsessed with food that they read cooking magazines, collect recipes and prepare elaborate meals for others.


Anorexics also have many noticeable signs in their appearance. These can include sudden weight loss, feeling fat in certain areas such as the thighs or stomach, becoming fixated on body shape, constantly weighing, denying that one is too thin and wearing baggy clothes that hide the body shape.


Although experts are uncertain of the exact cause of anorexia, there are several theories. According to the website WebMD, risk is increased if one has a family member who has had an eating disorder. Also, anorexics usually display traits such as perfectionism, perseverance and anxiety. Additionally, they are likely to feel more pressure to achieve high goals set by their parents, themselves or their social group.


Your granddaughter is likely a "good girl" who focuses on pleasing others. To the outside world, she probably appears to be "together," but inside she likely feels she does not live up to her own standards or those set by others.


You should definitely address this issue with your granddaughter and her mother. Anorexia is not just a passing phase; it is a life threatening condition. Between 5 and 20 percent of adolescents who become anorexic will eventually die from the disease. As the body loses muscle mass from not eating, it also loses heart muscle. When an anorexic exercises, the pulse and blood pressure fall and collapse or death can follow quickly. In fact, heart damage is the number one reason that most anorexics are hospitalized.


Please take your granddaughter to her physician, who will likely refer her to an eating disorders program. You can also contact the National Eating Disorders Association and read more about the condition on numerous websites and in hundreds of books.


Adolescents can overcome anorexia, but it is not easy, and she will need the support of you and her mother. Too many girls have died or been near death because the family has been in denial.


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Nancy Ryburn holds a doctorate degree in psychology from Yeshiva University in New York City. She teaches psychology at Southeast Arkansas College in Pine Bluff and maintains a private practice.