For an individual with an eating disorder to acknowledge that she is ill and needs help is often very difficult; that’s one of the many reasons some postpone treatment until the disease worsens, perhaps opening the door to medical complications. It is not unusual for a person who suffers from anorexia or bulimia to progress in her thinking from “I’m fine” through various stages of “Maybe I’m not fine” before reaching “I have an eating disorder and need treatment.” Sometimes a person’s intellectual side tells her that she wants to get well, but her emotional side is unsure; it can take a while for the two sides to agree. The process of contemplating change and reconciling ambivalence often continues well after the patient has entered talk therapy.

Some individuals try to avoid treatment by insisting that they are not “sick enough” or not “thin enough” to necessitate professional care. In fact, they tend to compare themselves to other unusually thin people or even to other eating disorder sufferers who appear more underweight. These comparisons can serve to minimize the illness in their minds, thus further delaying treatment.

Motivation for treatment emerges at a different pace for everyone. Many patients who have recovered describe their readiness to change less as a “lightbulb moment” than as glimmers of awareness that grew brighter and steadier over time. For some, the progression toward readiness is not linear but more suggestive of the two-steps-forward-one-step-back principle. Thus, your child’s level of motivation may fluctuate; sometimes she’ll feel able to take on the challenge of change, and other times she’ll feel more vulnerable.

The good news is that you can, through your words and actions, encourage her to become more open to treatment.

Discussing Medical Risks
“Soon after my appointment with the pediatrician,” recalls Serena, “I decided that I did not want talk therapy. The appointment with my medical doctor had been hard enough. Now I had to see a psychiatrist? No way. But then Mom told me about certain health problems that can result from anorexia. One of them was infertility. At the time of the conversation, I acted indifferent. But days later, I started to worry that I’d never be able to have a baby.”

Like Serena, some patients who have recovered recall that learning about the medical risks of eating disorders provided an incentive for them to get better. However, it is not unusual for an individual to dismiss the physical dangers with thoughts such as, “Medical crisis?

That won’t happen to me.” In fact, she may take pride in her ability to do well day after day despite a low weight, almost as if she’s won a bronze medal and will now shoot for the gold. Some patients hit rock bottom before realizing they want to get well.

To approach your child about medical dangers, call on your empathy skills, perhaps opening with an acknowledgment of how uncomfortable it might be for her to talk about her eating disorder. Trying to put yourself in her place will help her feel that you understand. You can then address factors that contribute to her resistance to treatment. For example, you’ll want to recognize how hard it must be for her to believe she’s ill when she doesn’t feel it all the time. She may have had a normal physical exam and lab tests, particularly if she’s in the earlier stages of the illness, and draw the conclusion that nothing’s wrong. We know that potentially life-threatening medical events, such as abnormal heart rhythms, sometimes strike suddenly and that a person can coast for a while without complications only to suffer a catastrophe in the end. However, it is often difficult for those with eating disorders, particularly adolescents, to take these risks seriously.