“I’d always made a point of serving my children balanced meals, including lean meats, salads, veggies, and starches. Sometimes, however, I’d be watching my carbs, and that might have had an effect on Holly. It’s not that I broadcast my intention to lose weight to my children. On the contrary, I barely mentioned it. Still, Holly was at an age where she may have picked up on my personal weight concerns and developed similar ones about her own body.”

In talking about what has helped her improve her health, Holly focuses on her friendships. “Some of the girls from that group acted so mean to me that I wasn’t sure I wanted their friendship back,” she admits. “But there were a couple I still liked. My therapists were on my side, and we discussed how to go about ending the fight. One day, I sort of cornered one girl, Alexa, and spoke my mind. I told her how a fight I’d never wanted in the first place had gone on far too long, how we’d both been in tough spots, and how I wanted us to like each other again. To my surprise, she felt badly about everything that had happened too. So we ended up hugging and staying friends. It was scary to approach Alexa, but it was worth it.”

During treatment, Holly’s parents and therapists helped her modify the extreme stand she took in response to her girlfriend crisis. They guided her as she changed approaches to the problem from those that didn’t work (locking horns with the aggressors) and were actually harmful (starving herself) to those that proved productive (reevaluating the friendships, talking to Alexa). Now doing well in recovery, Holly acknowledges the pain of last year’s girlfriend crisis and feels good about the steps she took to resolve it.

Of her stoicism, she says, “I wouldn’t do the same thing again.”

Marianne and Jordan are heartened that Holly has gained some weight and that her natural vibrancy and sociability-which waned with the illness-are starting to return. Between dance rehearsals, academic requirements, and social activities, Holly’s days are busy, and, like many individuals in recovery from anorexia, she continues to demand a lot of herself. In addition, she sometimes has trouble going with the flow. Switching gears-moving from one train of thought or plan of action to another-comes more naturally to some people than to others. For many individuals with past or present anorexia, adjusting to unexpected changes-going from one mind-set to another-is not always easy. On the bright side, Holly is gradually realizing that she doesn’t have to do everything to the max. In addition to learning less extreme ways to cope with problems, she is trying to be kinder to herself, a skill that will help her throughout adolescence and long after.

Is She a Perfectionist?
As we mentioned in Chapter 3, perfectionism often occurs with an eating disorder, sometimes predating the illness. Although compliance is commendable, some children take it too far. These are children who obey everything requested of them to the nth degree and make painstaking efforts to stay out of trouble. Eager for approval, they aim to be model children, sometimes at the expense of their own needs. If they mostly operate based on what others tell them to do, it may become hard for them to chart their own course. Rather than making every decision for your child or expecting her to make them in isolation, work with her, allowing her to make the final choices.

Perfectionists typically expect themselves to perform flawlessly-in school, in extracurricular activities, on the athletic field, and on the job-in order to earn and keep approval. In addition to setting high standards for everything they do, these individuals have difficulty bending their self-imposed rules to take their personal needs into account. For example, a pupil who continually overstudies in her quest for the perfect A is not necessarily doing herself a favor. Suppose she insists on doing homework until midnight Monday through Friday. Some nights she’s sleepy by 10:30 or 11:00. Her drowsiness is a signal that it’s time to quit working. But that’s not what happens. Instead, she strains to stay awake until the stroke of midnight. As the semester progresses, sleep deprivation prevents her from performing as well as she’d like. In addition, working many hours every evening keeps her from participating in other activities. Yet she resists reevaluating and possibly modifying her study habits.

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David B. Herzog, M.D., Debra L. Franko, Ph.D., Pat Cable, RN

David B. Herzog, M.D., is the Harvard Medical School Endowed Professor of psychiatry in the field of eating disorders at Massachusetts General Hospital and the director of the Harris Center at Massachusetts General Hospital.
Debra L. Franko, Ph.D., is a professor in the Department of Counseling and Applied Educational Psychology at Northeastern University and the associate director of the Harris Center at Massachusetts General Hospital
Pat Cable, RN, is the director of publications at the Harris Center.