I have decided to share some case histories from my files for several reasons: to introduce the secret language of eating disorders to those who do not speak it, to lay to rest the image of only “one kind of family” and “one kind of person” who suffers from this illness called anorexia nervosa and finally, to tell readers of my blog about some pretty wonderful kids. 

I have been seeing patients with eating disorders for a very long time. Some days it seems longer than others. At our clinic we have seen nearly two thousand patients between the ages of 4 years and 24 years. So if you think you recognize a patient in these case histories—even yourself—you probably don’t. Many stories share similar features. We are all human, we resemble one another far more than not. 

Peter

Peter  was a super-smart, good-looking boy of parents who were both engineers.  He was the oldest son in the family and fluent in English, as well as in the language of his parents’ country of birth.  Peter’s parents had immigrated to the US for economic opportunity and both had good jobs with a prestigious engineering firm.  Although they both worked long hours, Peter’s mother was largely responsible for running the household. Peter had a younger brother, Vincent, and both boys attended parochial school.  Their household was organized, structured, with clear inter-generational boundaries and dinner together every night.

The first thing that Peter’s mother noticed was a change in his conversation.  Suddenly all table talk was about health and fitness.  Peter began refusing their weekly trip to Baskin Robbins and sat and stared at his brother while Vincent ate his ice cream.  Eventually Peter was persuaded to try fat-free yogurt, but always ate less dinner on the nights he knew they would go for this treat.  His mother was puzzled, but said nothing.

Frugality was a trait that had always been valued in Peter’s family’s culture, but Peter began to excel in this quality.  He became obsessed with how the family could save money, drew up elaborate plans for college savings accounts and studied scholarships he and his brother could get.  He refused to go bowling with friends because of the cost and adamantly refused new school clothes, since his old ones were “just fine”.  Amused, his father agreed with him.

Education had always been a family priority, but now Peter was obsessed with his school work. He had always been a good student — straight As in fact — but now began to insist that he be allowed to sign up for all advanced courses and extra credit projects.  He had to get higher grades than anyone else in his already competitive school, he told his mother.

Peter’s friends tried to get him to join their clubs and teams, but he turned them down saying what they did was “not enough exercise,” what they ate was “junk” and the miniscule fees their parents paid to participate were “a waste.”

Peter’s mother was silent until the day she took the boys to the doctor for their school checkups.  She was shocked to discover that Peter had lost 10 pounds.  Her pediatrician told her not to “overreact” since Peter was “doing well in school, increasing his exercise and eating very healthy.”  He counseled her to “avoid being the food police and let him learn to self-regulate.”  This went deeply against her cultural training as a mother, and she did not do it.  Instead, she cooked all of Peter’s favorite things and sat at the table long enough to be sure he could eat it.  While she sat with him he did eat, but then his younger brother told her that Peter gave away his lunch at school every day and spent the noon hour walking briskly around the track.  For the previous two weeks he had insisted on walking the mile and a half to school and back instead of taking the bus.  

Peter’s mother searched his room and found a petrifying bag of all the snacks she had prepared for him to eat after school, as well as a long list of what appeared to be a calorie count of the dinners she had so lovingly made.  When he got home from school she grabbed him and made him stand on her bathroom scales.  His weight was down now a total of 17 lbs, and she realized how thin and drawn he had become.  She also realized he had had no real social interaction with his friends for nearly a month.

That evening as she was trying to talk to her disbelieving husband, they heard crying from the kitchen.  They rushed in to find Peter standing next to his brother with a very large chocolate milkshake, which he was trying to force on the younger boy.  “Drink it, dammit!”  Peter yelled, “It’s delicious! I made it for you!”

Over the objections of her pediatrician, who felt she should consult a psychiatrist, Peter’s mother brought him to Kartini Clinic.  His weight was fully 20 lbs below his normal weight, his heart rate 40 BPM, and he was too weak to protest.  Likely the first ten pounds loss had been more or less gradual and the last 10 more acute.

Peter was hospitalized for about two weeks before he could begin to gain sufficient weight and return his heart rate to a number above 50 BPM during the day.  He exercised under the sheets of his hospital bed, filled with fear that we would “turn him into a fat couch potato.” He required a week’s worth of naso-gastric feeds before he would let himself accept oral food.  This was scary to his parents as it seemed “a step backwards, as if he had given up.” Peter’s mother took a leave of absence from work and stayed with him every day.  She spoke patiently and quietly to him.  They worked puzzles, they watched movies, they read books.

Gradually Peter’s relentless urge to exercise abated.  He was able to be stepped down to the Kartini’s day treatment unit, where he could learn about balanced eating and be returned to his social life.  Very slowly his obsession with money and savings disappeared into the normal range for his family;  he was still unable to allow himself anything except an “A”, but he gave up talking about it day and night.

Six months later, back at school, weight restored for many months, Peter told me he looked back on “his anorexia” as a dream.  “It is as if it happened to someone else,” he told me.  And when I asked him if it was over, he replied “Maybe it will never be over, but I will learn to live with it.”  And when I asked him what had helped him the most, he replied without hesitation:

“My Mom,” he said, “My Mom.”