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Section 8
Anorexia Nervosa in Children

Question 8 | Test | Table of Contents | Eating Disorders CEU Courses
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On the last track, we discussed three components of the anorexic member’s effect on the family dynamic.  These components of the anorexic member’s family dynamic effect included:  negative familial reactions; polarization; and sibling rivalry.

On this track, we will examine three different exceptional situations with anorexic clients.  By exceptional situation, I am referring to anorexic circumstances that go beyond the norm and are exceptions to the rule so to speak.  These exceptional situations include:  the chronic adult client; stressors and enablers; and very young clients.

3 Exceptional Situations

Situation #1 - The Chronic Adult Client
The first exceptional situation is the chronic adult client. This is a client who, for five years or longer, has experienced strong anorexic symptoms. In my experience, these clients can be some of the most difficult to treat. This is because this type of client is very rarely in conflict with themselves and their illness. The anorexia has become more of a natural way of thinking and acting for them and those around them may have adapted the same attitude.

As a result, the client develops a new identity that becomes inextricably linked to the illness. As you are aware when a client is no longer a minor, he or she cannot be coerced by family members or school officials to commit to therapy against her will. 

Darcy, age 28, had developed anorexia at 18. During her freshman year at college, her father had suffered a massive business failure, and he was forced to sell the family horses, including Darcy’s. Being an avid rider, Darcy began to lose weight a month after her horse was sold. She left college during finals and since had been living by herself without supervision. 

When I asked her about her own sense of femininity, Darcy stated, "Other women are in couples or single.  But most of them are interested in becoming couples, involved, or at least hooking up with someone of the opposite sex or same sex. I feel neuter, nothing about it. I’m not a lesbian, but I can’t see myself with a guy either! I guess I’m literally out of it!" As you can see, Darcy’s identity had become so absorbed into her anorexia, she had lost all sense of another self.

Situation #2 - Stressors and Enablers
The second exceptional situation occurs when there are several stressors as well as enablers. If there are extra stressors involved in the client’s life, obviously this will exacerbate the client’s condition. More importantly, enablers can further instill the idea of anorexia into the mind of the client. While stressors may increase a client’s anxiety, an enabler can reinforce the identity of anorexia in the mind of the client. 

Kyleen, age 20, like Darcy, was the daughter of affluent parents. Her father, Jim, was a powerful executive of a large communication conglomerate. Kyleen’s mother had died when Kyleen was only eight, so she never had a female role model and Jim had neither the time nor the capacity to play both father and mother. To compensate, Jim provided Kyleen with as much material comfort as possible.  When she left for college, her father gave in when she wanted her own private room. She does not require a steady income as Jim consistently supplies her a weekly allowance. 

Because her standard of living allowed Kyleen to live in a state of complete isolation apart from attending class every so often, she quickly lost weight without any resistance. At five foot three, she weighed 85 pounds. Even when Jim was notified of his daughter’s condition, he could not pull himself away from his work. Through his absence and constant financial support, Jim was unknowingly enabling his daughter’s condition.  I called Jim and recommended that he cut off the steady stream of money to Kyleen so that she is forced to find a job and interact with others.

In addition, I asked that he take more time off from his work to give his daughter the needed amount of emotional support as well.  Think of your Kyleen.  Is his or her parent an enabler?  Is the mother or father, like Jim, a distant enabler?

Situation #3 - Very Young Clients
In addition to the chronic adult client and stressors and enablers, the third exceptional situation is very young clients.  This includes those clients age 12 and younger.  These clients are still trying to develop their identity and anorexia provides a means to form an identity.  Because of this, many of these very young clients fear adolescence because it represents a new identity that could interfere with their anorexic identity.  The inevitability of adolescence can cause anxiety and fear in many clients. 

Ginny, age 11 was 70 pounds, and afraid of becoming a teenager.  Ginny stated, "I don’t know why, I just don’t want to go through all that!"  I ask, "Are you afraid of changes in your body shape?  By that I mean the development of your hips and thighs?  Are you afraid of having menstrual periods or of other people’s expectations of you to act ‘older’ than you act now?" 

Ginny stated, "I think things are expected of teenagers and I don’t want any more expected of me!  I think that a lot of things are expected, or will be expected of me, and I don’t want to have to do them.  I don’t even want to look like one of them!"  I asked Ginny, "Is your dramatic weight loss due to the fact that you want to stay a child and don’t want to leave your childhood behind?"  Ginny responded, "I just don’t want to have to rely on myself.  If I keep losing weight, my parents have to help me." 

Think of your Ginny.  Does he or she wish to remain a pre-adolescent and is using anorexia to do so?

On this track, we discussed three different exceptional situations with anorexic clients.  These exceptional situations included:  the chronic adult client; stressors and enablers; and very young clients.

On the next track, we will examine three concepts of dissociative behavior in an anorexic client.  These three concepts of dissociative behavior in an anorexic client include:  bizarre behavior; trances; and manipulative strategies.

Peer-Reviewed Journal Article References:
Darcy, A. M., Fitzpatrick, K. K., & Lock, J. (2016). Cognitive remediation therapy and cognitive behavioral therapy with an older adult with anorexia nervosa: A brief case report. Psychotherapy, 53(2), 232–240. 

Goetz, P. L., Succop, R. A., Reinhart, J. B., & Miller, A. (1977). Anorexia nervosa in children: A follow-up study. American Journal of Orthopsychiatry, 47(4), 597–603.

Haynos, A. F., Berg, K. C., Cao, L., Crosby, R. D., Lavender, J. M., Utzinger, L. M., Wonderlich, S. A., Engel, S. G., Mitchell, J. E., Le Grange, D., Peterson, C. B., & Crow, S. J. (2017). Trajectories of higher- and lower-order dimensions of negative and positive affect relative to restrictive eating in anorexia nervosa. Journal of Abnormal Psychology, 126(5), 495–505. 

What are three different exceptional situations regarding anorexic clients? To select and enter your answer go to Test.

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