• The first thing I noticed about Anna… History of an Eating Disorder in Dubai

    By Jared Alden,
    Psychologist, American Board Certified,
    GNC German Neuroscience Center, DHCC, Dubai

    The first thing I noticed about Anna was what an attractive and nice girl she was.  She came into my office with her parents.  I had heard from my receptionist that her parents had made a big fuss about booking the appointment.  It was either the wrong time or the wrong day and it had taken them four attempts before they finally got into my office.  When I looked more closely at Anna I could see that she was very thin and had dark circles under her eyes that she concealed with makeup.  Her parents reported that she started dieting when she was 11 years old and she has had trouble with food ever since.  Anna had just turned 15.

    Anna’s parents presented as anxious and concerned.  They told me how the felt helpless and not know what to do with their daughter.  Dad was very involved in his business and he was quick to tell me how successful he has been over the years.  He was tall, forceful and friendly.  Mom was 45 but looked and dressed like a woman of 30 years.  She was thin and perfectly presented.  She had a great personality and talked openly.  Anna was the oldest of their three girls.  She was a perfect student and she presented no behavioural problems at school or with her friends.  The only problem was that Anna would not eat and she was slowly dying of starvation before everyone’s eyes.

    Anna is representative of so many young women that I have met over the years.  I started working with eating disorders in 1991.  I have worked in many cities around the world and met with people from every conceivable background.  Anna represents what they have taught me.

    You might have heard that having an eating disorder is about control and you would be correct in that.  Control is an essential part of an eating disorder.  From Anna’s point of view she was under a great deal of pressure.  She was the oldest child in the family.  That means she was the first one to confront her parents with each and every stage of her development.  Anna was the first to walk, the first to talk and the first to go to school, the first to grow up.  All her families expectations were focused on her.  It would be fair to say that by the time Anna’s younger sisters got to these stages her parents were more relaxed.  Anna benefited from all the attention and being the first but she also ended up holding a great deal of the family’s anxieties and expectations.  In most ways she flourished under this attention.  Like her parents, Anna was sophisticated, intelligent and very capable in many areas of life.  She had a wisdom beyond her years and by all accounts she was the perfect daughter in a perfect family.

    Now please don’t misunderstand me.  I am not criticizing this family.  They where good people, who worked hard, did everything they could for their kids and in fact where doing everything they could think of to help their daughter by bringing her to me.  The problem being or course is THAT was the problem. Eating disorders are about control, that is the one thing in Anna’s gifted and loving life she did not have, control.

    That statement would be a surprise to almost everyone including Anna herself.  She could buy what she wanted, go where she wanted and in a sense she lived an adult life.  This distracted her from the fact she did not feel she had freedom and choice.  Being the oldest, Anna felt a tremendous responsibility to do things the correct way. After all she had two siblings watching everything she did.  Anna was also the first grandchild in the family as well. The result was she felt she lived her life in a public spotlight. When it came to grades and academic achievement how could she not work hard, look how hard her parents work and look how much they gave her.  Anna would often think of how could she possibly come close to what her parents had achieved in their lives.  Anna felt like a loser at the young age of fifteen.

    Many kids her age blow off steam with their friends.  They go to the mall, act silly, have friends over etc.  Not in Anna’s life.  She has always been… serious, older and responsible.  She was even that way when her parents did not expect her to be.  When it came to socializing Anna did not put pressure on her parents like her friends did to their parents.  Her parents considered themselves lucky and did not mention the issue.  They thought of Anna as not really ready and they did not mind that she did not push the topic.

    When Anna came into therapy with her parents she would not really talk.  She would look over at her parents with an angry face, as if they where stupid, and she gave the impression she could not wait to get away from them.  She talked openly when they left the room and it was clear that she was very angry with them but she could not say why.  She also really thought her parents where perfect and lived the perfect life and had given her everything.

    Primarily, this is best viewed as a family issue.  The person with the eating disorder is expressing a dynamic they feel they have no other way to express.  Remember, eating disorders are about control, the ability to control your own life, feelings, failures and your own body.  Anna had been on a fast track to success from her earliest age.  She always got the best grades, she dressed well and she wore her hair in a way that her parents liked, she made the academic choices her parents wanted.  Anna talked back but she never really rebelled.

    Anna’s caring parents were shocked that their high standards had hurt their daughter.  They never wanted to control their daughter; they only wanted to guide and provide for her.  They had wanted to protect her from the usual pitfalls of life and pass on their wisdom and experiences to all their children.  This loving act meant that Anna never made a mistake, never learned directly about life.  Making mistakes, a natural part of growing up, was engineered out of her life.  Anna contributed to this as well, she wanted to please her parents, she was not a rebel like her youngest sister.  Anna was also a perfectionist and could not stand to make a mistake.  She very much wanted to be like her parents and she believed in their standards.  The only trouble was she could not really do it. In the beginning not eating made Anna feel mature and powerful, it relaxed her and allowed her to focus on school. Now she did not seem to be able to do the most basic things.  She intellectually knew she was underweight, she knew people did not like it and they made comments but when she looked in the mirror she saw someone distorted, ugly and fat.  She could not get those feelings out of her head and she developed and extreme fear that those feelings would take her over and she would become hugely fat.  The thinner she got the worse her mood became, the worse she felt and the less she did.  Her schooling got worse and all her relationships suffered.  She was not able to see that she was actually starving her brain and that her logic and insight where slipping away.  She was proud that she was the thinnest girl in her class and she could barely look at those girls who seemed so big!

    Therapy for this family was much like most families with eating disorders.  It was helping the parents see that they are not bad parents, that they can relax and let their daughter make some of her own choices and ultimately her own mistakes.  It was helping Anna see that much of the pressure she was under was self-imposed.   Her parents did not really expect everything from her.  She did not have to be the perfect child for her siblings and her parents.  Anna also had to learn how to express normal human emotions of sadness and anger. Her parents had to learn to listen to their oldest daughter and not get frightened and overreact.  Anna was so used to getting all the attention in the family.  At first, it was due to her being the oldest and then it was due to her achievements, then it turned into negative attention for not eating.  Now, she had to get used to sharing her parents with her sisters.  In a sense, she had to go back to being a kid again, or in Anna’s case she was doing that for the first time.  With her parents help she was able to be 15, challenge her perfectionism and take some chances in life.  She learned to talk about what she felt and not just present the easy happy feelings.  She learned to manage conflict with others and conflicts within her own feelings.  Her eating did not go back to normal straight away but she started to gain weight.  Her mother and sisters learned not to talk about dieting and how fat they felt.  The whole family learned that all food is good food in moderation.  They put time into family meals and stopped eating the majority of their meals on the go.  They learned to slow down and as a result got more done not less.  They replaced shopping with family sport and more active holidays. Dad was more available.  He was not home every night but he was more approachable when he was home and he made time to talk one on one with each of his daughters. Mom let the house get messy every now and then and seemed to give her daughters a bit more space without giving them too much freedom.  Ultimately, Anna started acting like a typical 16 year old.  Her moods changed regularly, she listened to horrible music, she wore weird clothes and did strange things with her lovely hair and she cried and laughed.  Most of all she started eating and caring for herself, trusting herself and growing up to be a great young woman.

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