Eating disorder at college - looking for advice from other parents

Parents Forum
21

I am not a mental health professional- and my heart goes out to this family- but I have seen a lot of families go through similar stuff and I will put three things out there:

1- Hallucinogenics is “a bridge too far”. This is not a kid borrowing her roommates Ritalin before finals (not that I’m condoning this). This is not a kid borrowing an Ambien from a GF after a stressful week when the dorm is loud and hectic on a Friday night and she needs to sleep (again, not condoning).
2- Eating disorders are a Jekyll/Hyde situation. The kid is fine until she’s not, and the difference can be a few days, not several months. As I’m sure your local nutritionist and therapist have told you- it doesn’t take much to throw off the body chemistry- the flu, a few all-nighters, a few glasses of wine and what started as mild dehydration can escalate pretty quickly. I think it’s terrific that she did so well so quickly at home- but the evidence (and your mild panic, evident in your posting) seem to suggest that you realize that she’s relapsed. Not just a one-off event, but that she’s relapsed.
3- Every single family I know who have gone through both the drugs and the eating disorders have said that if they had their “do-over”, they’d abandon the denial sooner rather than later. In many cases, they were outpatient much longer than they should have been- and once they went in-patient, they regretted not having stepped in earlier. In other cases, they trusted an adolescent to manage an incredibly complex and sometimes subtle disease- and they’ve stated that if their kid had lymphoma or a serious kidney disease, in no way would they have allowed the kid to manage her own symptoms and treatment. But somehow- the eating disorder? Sure, let a teenager handle the reins. Even if she’s shown that she’s not completely forthcoming with her health care team and her parents. Kid looks great, how can she be ill? Eating disorders are worrisome when the kids teeth rot and her hair falls out, not when someone looks as great as my daughter, right?

Big hug. Can’t be easy. But better a semester at home in recovery taking classes online then leaving her in her dorm to battle her demons, no???

22

I understand those who say to bring her home. But I also understand your concerns about doing so. It is not going to necessarily help to take away the thing that is actually keeping her ED under control - with the caveat being that it is in fact under control. If you don’t think having her come home is the right answer, you need a way to monitor her behavior in a more proactive way. That is, at least bi-weekly visits so you can see for yourself how she is doing and a perhaps a joint counseling session. You don’t want to be in denial about what is going on, but you also want to give her a chance to prove that she is in control of her disease. At the very least, she MUST sign the HIPA form so you can be informed. I would probably set some conditions on her staying in college.

23

If the OPs daughter is far away visiting a couple time a week could be impossible, even once a week if a student is 5 hours away can be difficult. The OP’s D “could” be a "normal"range weight and still have very serious purge issues that can cause serious health issues so just “looking” at her or eating with her might not tell the OP anything (or anyone that she lives or is friends with unless they know what she is doing.) i’ve only known one “purger” and she wasn’t anorexic…she looked totally normal unless you knew what she was doing in secret.

24

When it comes to people with addiction, you have to trust your gut, not what the addict says. Always. You know she is a master at manipulating you. This is part of her illness. So don’t second guess yourself when your gut is telling you something is very wrong. It is.

I would make treatment a condition of her staying in college, but not treatment by the college health services. They can be good for short term things like stress and anxiety, but for serious chronic mental illness, you need someone who specializes in treating people with addiction and eating disorders. Health services may have a list of outside providers, but be prepared to do some digging on your own.

Have her sign the HIPAA waver. No excuses. If she doesn’t sign, she comes home. This is the tough love part.

Then, start searching for qualified doctors in her area. She should help with this. If she doesn’t have a car to get to treatment and there is no public transportation available, have her sign up for a ZIP car account, if her school offers these. The minimum age is 18, and she’ll be able to rent a car for $18 an hour to get to and from therapy. My daughter does this to get to her therapist and psychiatrist (she is in treatment for depression and anxiety and is a recovering cutter) every week. The money we spend on the car service and the treatment has allowed her not only to stay in school, but to thrive there.

Finally, even though a doctor cannot share anything with you, you can certainly share your concerns with her treatment providers. Concerned family members do this all the time for their loved ones. You won’t get a reply, but they will hear what you say.

Even though she is holding on now, I can almost guarantee that finals will make things much, much worse. My daughter was okay most of her first year, but during reading week, all of the mental health stuff came back with a vengeance. It was every bit as awful as when she was first diagnosed her sophomore year in high school. She–and we, her parents–know now that while she is dealing with the pressures of school, she needs to be on medication and in therapy.

25

OP, you are definitely between a rock and a hard place. IMO, the drug use is not as much of an issue, as that behavior is unfortunately pretty common (yes, even at that frequency of use of weed/hallucinogens). The bigger issue is the ED. If I were a parent, I would want to pull her out ASAP because if she’s engaging in behaviors, she likely won’t be able to stop without intervention. But then you have to counterbalance that with the positive influence of school and doing well in classes, which may be keeping her from spiraling further into her ED. I agree with what others have said. I would tell her that if she wants to stay at school, she needs to sign HIPAA/FERPA paperwork and agree to seeing a counselor/nutritionist/whatever other professionals are necessary on a regular basis.

ETA: Would definitely recommend seeing an outside counselor over a student health center counselor. The student health counselors also have to worry about liability for the school, and may not always act in your D’s best interest

26

First of all, I recommend the Maudsley technique for dealing with an ED. My daughter’s best friend was diagnosed with anorexia at age 12, and her parents found a Maudsley therapist, followed the program, and she has been doing just fine for years. They did a lot of research and found that Maudsley gives the best results. I do think it may be necessary to bring your daughter home, as the Maudsley technique involves daily, hands-on involvement from parents. There is nothing more important than her health, which she IS jeopardizing if she is purging regularly and/or using drugs. If it were my child, it wouldn’t matter if she was 18, 28, or 38–I would do whatever I had to in order to help her. I feel for you. It is not easy, but you can do it.

27

Thanks you guys. @Massmom your post really resonated with me. I’m so sorry you also went through this and your last paragraph was heart wrenching.

I’ve called and left a voicemail for her local psychiatrist, but she wont be in the office until Tuesday. First thing tomorrow I will call the school and see if they have any input. I will have D go to the counseling office and sign the HIPAA waiver so that we can converse with them about possible local options.

She is 3.5 hours away, and she does not want us to show up, so I don’t think we will do so unless it seems necessary and the phone calls get us nowhere. She is at a small LAC.

28

“even though a doctor cannot share anything with you”

Sure they can. She can sign a HIPAA waiver with an independent doctor, too.

29

To give you hope, I also know kids that had serious mental health challenges in HS that overcame these and went on to do well in college and beyond.

By the way, I was suggesting every other week visits not twice a week (biweekly means either so it is confusing). If you are paying for college, you can request a twice a month check in meeting.

Even if she were home, however, would parents necessarily know if a child were purging if her weight were not affected? I think they are probably pretty good at hiding it.

30

Bulimics can go thru a lot of food. They spend a lot of time in a bathroom. They can also engage in a lot of exercise or self-harm behavior. At home, the parents would likely be aware of such activities, at least some of the time.

In residential facilities, we did phone sessions with parents. Many would come for IRL sessions at least 1x a month.

31

My heart goes out to you. I’ve thought about these issues a lot, since my hs senior d is struggling with depression and anxiety and I’m wondering if she’ll be ready to go off next year. In googling around about colleges and mental health, I read this about ‘psychiatric advance directives’, enacted in a number of states, whereby your d would grant you the authority to make treatment decisions for her:

http://www.nami.org/Content/ContentGroups/Legal/Advance_Directives.htm

32

I am a clinical psychologist who specializes in treating folks with eating disorders. I primarily work with college students . I cannot give you specific advice about your daughter , but I can tell you that there comes a time when students must take a leave of absence , return home to their support system and treatment team , and regroup to restart recovery . This is not a punitive process but one that may lead to a deeper recovery and better chance of happiness once the student returns to school . Eating disorders are tricky and folks who are suffering from them lack insight into the depth of their problems , by definition.

33

^ Thank you. I know it’s true and we are certainly keeping it in mind. I’ve already contacted several local therapists who specialize in EDs (from the PhyschologyToday.com database) and I think we will try this route first, but with very open eyes and keeping the possibility of more drastic measures in mind. FWIW she has been, in the past, very aware and thoughtful about EDs, drug abuse, etc. As I watch her I can see that when she is doing well, she truly understands the dangers and speaks on social media about it. But it’s like, once on that slippery slope, she becomes blind. I visualize it as a pair of horse blinders that start growing and getting bigger and bigger so that what she KNOWS is finally blotted out and invisible. Not sure that makes sense. But the point is that she is extremely intelligent and aware and when she’s doing well, advocates for other people. We just need to help her get back to that place again, and to remember and strengthen her coping skills to try to be stronger in the future.

34

Please don’t underestimate the dangers of an eating disorder and drug abuse. These are very serious issues. Your top priority should be getting this young lady the help she needs. Maybe she needs a residential treatment program. I would seriously discuss this with your doctors who have treated her in the past.

There is another poster on this forum who thought her daughter could work through an ED issue, and really wanted to believe it wasn’t as critical as it was. She now knows she should have acted sooner.

Please consider this whole situation. Your daughter is in a potentially dangerous situation. Please help her. She is not going to help herself.

With the roght treatment, your daughter should be able to return to school. But in my opinion…rift now…school is a low priority,

35

My step-daughter developed bulimia post-college. Recovery has become her full-time job. After a residential program she has been in a 5-day a week local program. She’s now able to work part-time but therapy remains her primary focus. Many of those who were in her residential program have relapsed and returned there 1 or more times (very common) but so far she has not.

At the very least, to stay at her college your daughter needs to sign HIPPA and FERPA forms allowing you to talk to people at her school and her doctors/therapists to make sure she’s doing what she needs to be doing. The school’s Dean of Students office is a good place to start. If she refuses to sign the forms, she comes home. I agree with others, do not rely on the school’s health center. Find good ED therapists in the school’s area. If they don’t exist, bring her home to work with An ED team near your home. Her primary focus must be getting better. School CAN wait, if need be.

Until my step-daughter developed this problem, I had no idea what was involved. H and I are still grappling with it. My step-daughter is devoted to getting better, but it’s such a slow and painful process.

Best of luck to you and your daughter.

36

Daughters of three friends of mine had eating disorders in college. I have a few things to add:

First, you should look into your school’s policy about eating disorders. Some schools are very strict about this – if they learn a student has an eating disorder, they make them visit health services once a week for a weigh in, and if the student loses weight, or doesn’t gain weight, they make them go home. Some schools are even stricter, and send the student home the moment they learn of an eating disorder. That happened to one of the students I knew.

In another student’s case, she and her parents felt very strongly that she not come home. This was not the advice I gave them, but they were very insistent. This girl spent at least one summer in a residential program, which did help her tremendously and brought the ED under some control.

None of the three girls I knew used drugs, so I can’t comment on that. But the eating disorders were very serious, and the students had a “team” to help them. (Unfortunately, only one of them has turned out OK.)

37

I haven’t read all the replies, so this may have come up already. I strongly advise that you seek care outside of the school health services. Many people have learned the hard way (and my family too has personal experience with this) that educational institutions have an interest in protecting their reputations over the welfare of any particular student. In other words, they are NOT experts in mental health issues - they tend to be either not-that-responsive, or at the other end of the spectrum, they overreact and remove a student with minimal reason - they just don’t want the responsibility, and, in fact, aren’t usually very good at dealing with mental health issues.

And at the same time, they have control over your child’s standing at school. It is better to keep them separate. If there is a serious medical or legal issue involving a college student, it’s better to go straight to the real medical experts and the real police.

There is a Newsweek article called “How Colleges Flunk Mental Health,” which I really recommend reading.

38

For some kids, signing these forms threatens their nascent sense of autonomy and they just won’t do it. It is not a battle worth fighting: getting past the student’s expressed desire for privacy and independence would mean going to court for guardianship- unlikely course in this situation. It is best to rely on a good relationship with the daughter to establish parental rights to know, and punitive approaches won’t work for that. Overall, I don’t think the parent should insist on the paperwork or on any level of communication. That needs to stay in the student’s hands. If things are bad enough to require parental knowledge and involvement, perhaps she should leave.

Eating disorders are very complex and some of the behaviors occur more on an unconscious level. A sufferer cannot just decide one day to stop (get better). Some people can function quite well for many years with bulimia and/or some level of food restriction. Getting healthier is often a process, not an event. It’s great that the daughter was better for awhile but the stresses of transition to school and leaving home (even positive stresses),and also academic pressure, can retrigger eating disorders. In fact, some develop an ED for the first time during this transitional time. She may continue like this, and gradually improve over the years, or she may become worse and gradually her functioning will suffer.

Many students smoke marijuana daily. Marijuana might help her eating disorder, or help her eat. But the hallucinogenics can be a problem and certainly would suggest a pattern of avoiding feelings in some way. I wonder if she has gotten into drinking as well- not uncommon with an ED. The LSD is troubling, but I would not worry about the marijuana unless it is somehow debilitating her, which is unlikely.

This is not an easy situation to respond to. The parent doesn’t have a full picture and neither do we. In general, holding on to normalcy while in treatment is a good thing, so staying where she is and adding treatment to the scenario would be most helpful. But the treatment needs to be expert in this area, and most likely almost daily, as in a day program. In this case, even once a week would be an improvement. But if she is not ready, she will hide the truth of her behaviors and maybe even believe it herself. It is not uncommon for a person with an ED to go to support groups but still end up in the bathroom after eating, for some years. This is not non-compliance or sneakiness or willfulness: it is an illness.

Another alternative, if things are headed in a more dangerous direction, would be leaving campus for inpatient or outpatient treatment as a focus, followed by a low stress alternative to the academic program she is now maintaining. Some schools will require a student to leave with an ED, but that is often (stupidly in my opinion) weight-based. At any rate, the lower stress follow up period could be at home or elsewhere, could involve part-time work or volunteering, part-time school (online or on a campus), any creative new challenge that she comes up with, and continuing treatment that is fairly intense.

I would suggest the parent meet with an eating disorder specialist herself, to discuss options. Eating disorders are stress-relievers but at the same time are a hellish way to live. A sufferer will tenaciously hold on to the ED behaviors in order to cope, though. I think the only person who can advise about whether to leave the student where she is, with a semblance of normal life, or whether intervention should happen (regardless of the level of severity of the ED) to avoid future progression- is a professional in the field.

If the college knows about the eating disorder, they will intervene if need be. Usually a kid with an ED is being followed in some way by the college. If this is not the case, there is not much the parent can do without releases, other than one-way communication letting the college know of concerns (this is allowed). The only option is to watch for signs things are spiraling and intervene against the daughter’s will if need be, if things get really severe.

Some people truly recover early from an eating disorder, and some have the disorder at some level for many years. The danger of holding on to normalcy while using the ED to cope is that it can become more entrenched and harder to recover. In some ways, the ED can be seen as a progressive disease. However, sometimes staying in normal life provides a structure that some level of health can hang on and things can improve. Disruptions to normal life can worsen the disorder too. It’s hard to tell. Again, I suggest the parent herself meet with an eating disorder specialist to discuss options.

39

@compmom Are you suggesting that we meet with an ED specialist here, on our own, for advice? Or that we meet with whoever she ends up working with in her college town?
Regarding the drugs: it is difficult to know how to feel about the weed. As you say, it’s become such a normal part of students lives these days. And my husband and I both did some drugs at her age and after a year or two we both realized it wasn’t all that, and easily stopped doing them. However, D is a rather extreme person. She goes whole-hog into whatever it is: her studies, her interests, whatever. The reason we know about all of this is that we found a blog she was keeping that was devoted to drugs and eating disorder. One of the posts stated she wanted to smoke but had no money, so she was planning to “do a dance for $200.” That implied to me that she was hiring herself out to do something at least vaguely sexual for money, which of course is VERY scary. When we asked about it, she said, no, in fact she had been dating a drug dealer at that time and did the dance for that person in exchange for $200 worth of drugs. That, too is very scary. $200 worth of drugs on one person is surely enough to get arrested, kicked out of school, and lose her scholarships, right? It blows my mind that she would jeopardize what’s most important to her (being at college) like that! So, while the fact of smoking weed might not be such a big deal, it is the surrounding risky behavior that really, really makes me so scared.

40

As a layman, my impression is that this rather typical of many people with addiction or ED issues - goes with lack of perspective and tendency towards obsession. (Also typical of creative people, btw)