I'm not a mental health professional. My medical specialty is obstetrics and gynecology. But as a physician who sees hundreds and hundreds of patients each year, I've always considered it my professional responsibility to guide women, both young and old, so that they will seek the emotional, psychological, or psychiatric treatment or counseling they may need. As a mother, it's vitally important for you to also assume this role when it comes to your daughter.

As you well know, the adolescent years for your daughter are likely to be filled with excitement, fun, turmoil, angst, and melodrama. That's perfectly normal. Hormones can go on a rampage at that point in a girl's life, and you may serve as a hapless bystander to their emotional mugging of your daughter. And yet, as she grows into adulthood, you're also likely to see that she has emerged relatively unscathed from this exasperating and exhilarating period of her life.

But at times, there are deeper and more powerful issues at work. When that's the case, we owe it to our daughters to do our best in ensuring that they receive whatever assistance or treatment they need, and that they get it as soon as possible.

I realize that this fact places a significant burden on you. When it comes to mental health issues, you're probably not an expert. However, when it comes to your daughter, there is no greater expert in the world. Therefore, as a mom, if you keep your eyes open, your mind open, and your heart open, you're likely to recognize when something is not quite right. Nonetheless, sometimes girls will be very diligent and effective at hiding these types of problems, particularly from those closest to them. As a result, sometimes a mother is the last person to know. But if you think there may be a problem, you need to get involved.

If you begin to believe that your daughter is experiencing emotional problems, talk to a school counselor; your daughter's pediatrician; your own doctor; or your local, city, county, or state mental health service. Tell them what you've observed and what your concerns are. They either will provide you with the reassurance you need that your daughter is perfectly fine, or they will help you find the help your daughter needs.

Unfortunately, even in the twenty-first century, there is an unfair stigma attached to mental health problems. But please don't let that fact stop you, or even delay you, from seeking assistance. Although not as visible as cuts and bruises, emotional problems can be even more harmful and debilitating to your daughter. If there is any point in a girl's life when she needs your help, this is it. Counselors and other mental health professionals can do wonders with young people. Don't hesitate to seek their assistance.

I've written this chapter to help you identify when your daughter may need psychological help. In doing so, I haven't prepared an exhaustive list of emotional issues and warning signs. I'm not sure anyone could. However, my hope is that the following pages will provide you with the information you need so that you can be alert to some of the most common problems that may arise. What you do with this information could make all the difference in the life of your daughter.

What should I know about eating disorders?

Although they can arise in either gender and at any age, eating disorders most commonly appear in females between the ages of 12 and 25. In fact, millions

Eating disorders most commonly appear in females between the ages of12 and 25.

of young women suffer from anorexia and bulimia each year.

Parents often think that their daughter will grow out of the problem, or that they can independently help their daughter get past it. However, don't be tricked into inaction. The most effective way to treat an eating disorder is by getting a trained medical professional involved.

An eating disorder is typically caused by deep, underlying psychological problems that need to be addressed in order for a girl to recover from this affliction. And the seriousness and effects of such a problem shouldn't be minimized. Eating disorders can cause serious health complications, and even death, as we all saw with the singer Karen Carpenter.

Anorexia nervosa[1] is a specific eating disorder that involves an obsessive preoccupation with dieting and thinness that causes a girl to literally starve herself. Girls who are particularly susceptible to anorexia are those who have low self-esteem and negative feelings about their bodies, those who enter puberty early, and those who participate in activities such as gymnastics or dancing where size and weight are important factors to success, and where others constantly emphasize that fact.

There are a number of warning signs for anorexia:

• An obsession with one's body weight;

• A distorted and baseless perception that one is overweight;

• An irrational desire to lose weight;

• Becoming anxious at mealtime;

• Secretly disposing of food rather than eating it, or only pretending to eat food in the presence of others;

• Avoiding social activities that involve food;

• Less regular menstrual periods;

• Exercising excessively;

• Binging on food and then purging it (see bulimia).

Chronic starvation of this nature can be highly dangerous. A girl's body can become malnourished, and then as it searches for calories and nutrients, organs begin to shut down and muscles begin to break down, including the heart muscle.

Bulimia nervosa[2] is a different type of eating disorder. It typically involves frequent binging and purging, but the young woman who has this disorder may not be unusually thin. Oftentimes a girl who has bulimia has intense feelings of guilt or shame about food. A person with bulimia feels out of control but recognizes that her behavior isn't normal. It's estimated that up to 5% of all college women in the United States are bulimic.

The warning signs for bulimia include:

• Eating large amounts of food, usually in secret (binging);

• Vomiting or using laxatives excessively to rid the body of the increased calories (purging);

• Spending long periods of time in the bathroom after meals;

• Obsessing over one's weight;

• Having irregular periods;

• Suffering from mood swings; and

• Experiencing an erosion of tooth enamel caused by the acid in vomit.

I personally witnessed someone with bulimia when I worked near a beach after my first year of medical school. I rented a room in a house with several other people. One of the renters was a beautiful, blonde, normal-weight young woman who was working at the shore for the summer like me. She was very friendly, but she always seemed to avoid eating with the rest of us. She also spent a long time in the bathroom, but no one gave it much notice.

As the summer went on, her behavior became more erratic with bouts of moodiness. One day she just disappeared, without paying her share of that month's rent. When her family was contacted, they disclosed that the young woman had a history of bulimia. Further, when we cleaned out her room, we discovered trash bags full of empty jars of peanut butter and mayonnaise. (High-fat foods like these are used by bulimics to coat their GI tract so that when they vomit, the acid from their stomachs won't irritate their esophagus and throat.) We were all shocked by our discovery. My housemates just kept on commenting on how "normal" the young woman seemed. But I knew that this woman was desperately in need of help.

When it comes to eating disorders, the key to recovery is early diagnosis and professional help.

When it comes to eating disorders, the key to recovery is early diagnosis and professional help. There are many Internet sources that can guide you in finding the necessary assistance. A few include the National Association of Anorexia Nervosa and Associated Disorders, the National Eating Disorders Association, the Academy for Eating Disorders, and the National Institute of Mental Health.

Kama says:

While seeking professional help is the best course of action, once a young person shows signs of self-abuse, there may be some preventive measures that can be taken. As a former anorexic, I am only too familiar with its devastating effects, and it has been my fervent mission to protect my own children from this insidious affliction.

Usually, anorexia starts as a plan to diet. Women are bombarded on a daily basis with the social belief that in order to be of value, one must be young, thin, and beautiful on the outside. Therefore, even children, at a young age, learn about dieting as a means to achieve "perfection." We owe it to our daughters to help dispel this erroneous social expectation.

While I am not proposing that you deviate from a healthy lifestyle, I ask you to remember that you are your daughter's role model. Make it a point to never discuss your own weight or comment on the weight of others. Go one further. Toss out the bathroom scale. That single act will help demonstrate to our daughters that we judge ourselves and others by the beauty within.

  • [1] An eating disorder where the patient has an abnormal perception of her body as being too fat. Extremely low body weight, self-starvation, and excessive exercise are commonly seen in patients with this disease. Professional psychiatric help is essential for treatment of this disorder.
  • [2] An eating disorder characterized by consuming large amounts of food, known as binging, and then getting rid of the food, or purging, through vomiting, laxative use, or with diuretics. Those affected are usually of normal weight. Professional psychiatric help is essential for treatment of this disorder.
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