I nearly screamed when I entered the exam room: sitting on the exam table was a skeleton staring at me with solemn, intelligent, tearful eyes.

I agreed to take a look…good grief, what a look. She was at residential treatment, her mother said, and doing pretty well, but preferred to come to us on completion as it was near their home. Her mother called to beg me to take her back as a patient. By age 15 she was engaging in self-mutilation.Įnter Kartini Clinic (again). Once she crossed the legal threshold of 18 years, her parents obtained custodial guardianship, but it was a fiction, as they had neither the energy nor desire to “make her do anything she didn’t want to.” This much Lorna knew, of course. Much of the time Lorna was grossly underweight and had thoroughly deranged electrolytes and constant chest pain. She eventually landed a full-ride scholarship to a fine university, despite the extremely sketchy formal schooling caused by her repeated absences due to her illness. It is amazing that some of the treatments didn’t kill her.ĭid I mention how intelligent this girl was? She was lovely and delicately featured, spoke with a soft voice and was whip smart. She was re-fed with and without regard to re-feeding syndrome, depending on the experience of the physicians and where she was at the time. Once she landed on an adult service she was placed on Cymbalta, Seroquel, Neurontin and Trazadone, all at once, and all with virtually no follow-up. She saw psychiatrists, therapists, family therapists, massage therapists, doctors, etc. Lorna spent all those years going from place to place, from inpatient to residential to outpatient, back to inpatient, back to residential, on to drug and alcohol related residential, back to outpatient. They were the only family she had.įrom the age of 12 to the age of 18 Lorna began a long, involved trip through one treatment program after another, usually culminating in either her insurance benefits running out or her parents pulling her out of treatment, including ours-twice-because it was “too demanding of the parents.” Sometime during that time her parents separated and Lorna’s mother was able to begin to repair her own life. We involved her family, of course, because that is what we have always done, even though we were aware that her father was himself affected and that her mother constantly dieted to lose the weight her husband insisted she must “if she loved him”. We began Lorna’s pediatric treatment so long ago that Maudsley and similar protocols lay far in the future. When I first met him, when his daughter was 12, he told me he was “terrified that we (doctors) would take away his own eating disorder.” He loved his daughter, but he loved his eating disorder as well. And who knows? We don’t know what causes eating disorders, so we will take her guess at face value and tell you that her father was physically and emotionally abusive to her mother. She also told us-many years later-that she felt that the purging was a response to her chaotic family life. Purging is rare in very young patients with AN (under 13). She told us years later that she began her first attempts at purging then, too, although that certainly would be publishable were we able to substantiate it. Lorna was only 11 when she became aware of her urges to restrict her food intake. We are all human, we resemble one another far more than not. So if you think you recognize a patient in these case histories-even yourself-you probably don’t. At our clinic we have seen nearly two thousand patients between the ages of 4 years and 24 years. I have been seeing patients with eating disorders for a very long time. 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.

Anorexia success story