Teen Talk

Oct O ber 29, 2015 | t he Jewish Home

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by rabbi Doniel Drandoff, LMFt

The Conversation Continues

Last week, we responded to a painful letter written by a teen who was ridiculed about her weight when she was younger. Over the course of her high school years, she lost a great deal of weight and developed a complex which led to severe restriction of calories in her diet, as well as an extreme exercise regimen. Though we cannot offer a diagnosis, it was noted that the letter writer, Eliana, presented a story that carries many of the hallmarks of an extremely dangerous eating disorder called anorexia nervosa.

Last week’s article was a direct response to Eliana. However, it is really important that parents understand the nature of this disorder. For this week’s article, I will take the opportunity to explain this further. We will discuss: • Causes • Warning signs • How to talk to your teen and be supportive, rather than harmful • Treatment

Research suggests that while it is often unclear what causes an eating disorder, there can be a number of factors that play into it. In other words, there are some indicators that we can point to and consider.

It seems that genetics are a definite factor. Eating disorders often run in the family. If a family member suffers with an eating disorder, the likelihood of others developing an eating disorder rises. It is far from a guarantee, chas v’shalom. It simply means that the statistics teach us that parents must be more vigilant and aware of their children’s eating habits if there is a family history of eating disorders.

Another statistical fact is that eating disorders are far more common among females. Once again, a little more vigilance with one’s daughter(s) is appropriate.

Other causes can be social pressure to be thin, anxiety, perfectionism, and a history of abuse. Included in this is if a child is bullied or teased due to his/her weight.

Once again, I want to reiterate that this list represents a loose idea of potential indicators. The mere fact that your child fits any of these should not be cause for panic. In fact, as I will explain below, even a clear diagnosis should not result in panic.

When it comes to anorexia warning signs, we can be a little more specific and certain. There are specific behaviors and attitudes that should indicate to a parent that there may be a serious problem.

I will list some of them in bullet form (in no particular order): • Intense fear of gaining weight • Sticking to a strict and restrictive diet, despite being very thin • Emaciated appearance • Refusal to eat or admit when hungry • Discomfort eating in public, and/or refusal to do so • Extremely self-critical of weight and/ or appearance • Changes in mood – depressed, anxious, irritable… • Becoming increasingly less social • Compulsive exercise • Regular female biological cycle has become erratic or has altogether stopped

While this is not a completely exhaustive list of potential symptoms, it is a very good start. As a parent, you should be cognizant and aware so that you can pick up on the warning signs if they do emerge. Some or all of these red flags may be present, so it is important to be tuned in to your child’s world. The earlier an eating disorder is discovered, the better the prognosis.

Until now, we have really only been discussing anorexia of the restricting type, but it is important to note that there are other eating disorders to be aware of: anorexia of the binge-eating/purging type (which was briefly mentioned last week), bulimia nervosa, and binge eating are the most common. It is beyond the scope of this article to go into detail of each, however, the approach to how to speak with your kids is more or less the same for all.

If you suspect that your son or daughter is suffering with anorexia, the first rule is don’t panic. Generally, people who are in a state of panic are not capable of acting in a way that is thoughtful, careful and extremely empathetic and validating. When it comes to approach- ing your teen, you will need heavy doses of all of these. So, step one is to find your inner calm so that you may come to the conversation with your teen in a way that exudes confidence and love. If your teen picks up on your anxiety and frustration it will only further his/her

Teen Talk, a new column in

TJH, is geared towards the teens in our community. Answered by a rotating roster of teachers, rebbeim, clinicians, and peers (!), teens will be hearing answers to many questions they had percolating in their minds and wished they had the answers for.

own feelings of anxiety. That is definitely not helpful. You must communicate in a way that is calming.

So, what exactly are you communicating? It starts with empathetic yet brutal honesty. You must share your observations and concerns. A defensive response, or even outright denial, is extremely likely so be prepared for that and don’t get frustrated. Be very careful not to cast judgments or criticism. This is a lot easier said than done! Just remain calm and reiterate your concerns for his/ her safety. If your teen is adamant, and you are fairly certain that it is denial, then you must make an appointment with your family doctor. At the same time, if he/she actually opens up and your fears are confirmed, then be very liberal with your hugs and kisses and express your unconditional love and support. Then make an appointment with your family doctor.

At that time, a full physical assessment can be done so that other underlying medical conditions can be ruled out. At the same time, maybe you have overreacted, and your teen is fine. The doctor can help clarify a lot.

If your doctor confirms your fears, then he will be able to guide you through your immediate next steps. Next steps will likely include a psychiatric evaluation (preferably with a psychiatrist with experience and expertise in treating eating disorders), nutritional counseling, and psychotherapy. Of course, ongoing medical care will be very important to assess for and treat any health issues that the eating disorder has caused.

In the event that your teen is not responsive to the treatment prescribed, then a more intensive form of treatment can be necessary. Common avenues of higher-level treatment include intensive outpatient treatment (IOP) and in-patient treatment. In very severe cases, hospitalization may be necessary.

You will know that your teen requires higher level treatment if he/she is: • Not keeping to the agreed upon treatment recommendations made by the doctor and/or therapist • Sabotaging any potential progress • Experiencing severe depression • Feeling suicidal, or is threatening suicide

If you are concerned for your teen’s safety, you should immediately contact your family doctor for guidance. If the situation is seriously acute, then call 911. Alternatively, if it can be done safely, you can take your teen

to the nearest hospital. But I can’t reiterate enough that this should only be done if you are certain that it can be done safely. If you are worried, then it is better to be safe and call 911.

The road ahead will be extremely challenging. In order for your teen to recover, he/ she will need you more than ever. The right kind of parental support can be the difference when it comes to a successful outcome. You have to be prepared to actively participate in the treatment. This may involve weekly family therapy sessions. It also means being on top of his/her nutrition.

Take the time to educate yourself about anorexia so that you will have greater insight into your teen’s struggle and so that you will know what to expect. Be extremely patient and non-judgmental. As much as possible use positive regard and reinforcement to help your teen continue moving forward. Maintain constant vigilance with regards to the red flags and warning signs discussed above. As much as possible avoid lecturing.

Beyond all of this, your own self-care will be more important than ever before. Much as the body requires physical fuel to endure, your spirit requires joy and fulfillment to endure. Without it, you are bound to burn out at some point. So spend time learning, take up a hobby, get together with friends, volunteer at a chesed organization, go for a daily walk…do whatever brings you joy and fulfillment.

If you are married, double down on shalom bayis. Make sure that you and your spouse are spending quality time together and connecting deeply. Avoid the common pitfall of blaming each other for how things turned out with your teen.

Most of all, pour your heart out to Avinu Malkeinu, the only real rofei cholim. Iy”H with a lot of hard work and siyata dishmaya you will get through this terrible ordeal and see great nachas from your teen.

Are you a teen with a question? If you have a question or problem you’d like our columnists to address, email your question or insight to editor@fivetownsjewishhome.com, subject line: Teen Talk.

Step one is to find your inner calm so that you may come to the conversation with your teen in a way that exudes confidence and love.

Rabbi Doniel Drandoff is a Marriage and Family Therapist in private practice in the Five Towns/Far Rockaway community, as well as Clinical Director of My Extended Family. He works with teens, young adults, families, and couples. You can reach Rabbi Drandoff at Dndrandoff@gmail.com.