Lucinda remembers those quarrels about the appointments all too well. “As hard as I tried to avoid arguing with Anita, I could not let her skip her visits to her doctor,” she says. “His diligence in sharing his findings and reasons for recommendations with me-as well as with Anita-helped equip me to reinforce his suggestions at home. Early in his treatment, the doctor observed that Anita often looked chilled in the examining room. ‘I’m cold a lot,’ she admitted. He gently explained that when the body does not get sufficient nutrients, fuel that would normally heat the skin is used to sustain the heart and other vital organs. In addition, a body that is too low in fat has difficulty retaining heat, thus leaving the person feeling cold. Improving Anita’s nutrition would help keep her warm. Aware that she had probably tuned out, I figured that, for the time being, I’d be satisfied if she could begin to absorb the doctor’s compassion and understanding. As for the information per se, I’d have it to call on whenever she grew ready to hear it.”

“That readiness didn’t happen for quite some time,” notes Anita. “I came away from the discussion convinced that the doctor was out to make me fat. He told my coach that swim practice was off-limits for a while. He spoke to my school nurse as well. I snuck in some laps one weekend during the pool’s family hours; I shivered too much in the water to enjoy myself, but that didn’t matter. Neither did my jitters nor the trouble I had falling asleep at night. I’d missed several menstrual periods but was only marginally aware of that; what’s more, I didn’t care. As my illness progressed, I grew proud that I didn’t have periods; losing them felt like a real accomplishment.”

Many individuals who have recovered from an eating disorder have told us that their drive to be thin was so overpowering that they’d resort to anything to meet that goal, even if it meant tricking a parent or health professional into thinking they’d gained weight when they really hadn’t. One young woman recalled arriving at her first appointment with a paperweight deep within each side pocket of her baggy jeans, only to learn that her physician wanted her weighed in an examining room gown. It is not unusual for a patient to secretly drink large amounts of water prior to a weigh-in so as to tip the scale upward. This is worrisome from a medical standpoint because water overload, combined with a low level of sodium in the individual’s blood serum, can place her at risk for seizures. Physicians monitor for water misuse by testing the patient’s urine for specific gravity.

Due to the nature of eating disorders, it may sometimes be hard-for you and even for the doctor-to know how your child is doing with her eating behaviors. Moreover, a person struggling with an eating disorder tends to experiment with a variety of behaviors throughout the course of her illness. For instance, someone who deprives herself of food may become so hungry that she eats and then panics that the food she has ingested will result in weight gain; in an attempt to rid herself of unwanted calories, she may induce vomiting. A person with bulimia who is stuck in a vicious binge-purge cycle often retains some of this behavior well into treatment. If her doctor has laboratory evidence (such as abnormal electrolytes and chemistries, especially potassium and bicarbonate) suggesting that she is vomiting, she is likely to retort, “I am not.”

Whether or not there’s clarity regarding your child’s behaviors, the idea is for you to strive to understand why she hides them and to avoid putting on your detective’s hat to prove her wrong.

Perhaps she is ashamed of her eating disorder or unable to admit that she has one. It’s possible that she’s concealing her behaviors because she is worried about the impact on you and is trying to safeguard you from becoming frightened or distressed. Maybe she’s dishonest about purging because she fears it means that she’s “failing treatment” or that you will view it as such. Instead of turning her possible vomiting into a “gotcha” mission, you are better off keeping the lines of communication between the two of you open. In talking to her primary care doctor or pediatrician, let safety be your guide; if she is medically safe, you may have to tolerate occasional purging episodes.