Maudsley Parents

Our daughter was first diagnosed 2 years ago when she was 16. She has always presented as orthorexic. She’s willing to eat, but only “healthy” foods. She has been through 3 hospitalizations, months of day treatment and even a 2 month residential stay. This all took place before she turned 18. None of the advice worked for her because she didn't like the food choices. In fact her symptoms have gotten worse over time, rather than better.  

Now that she is 18 she won't go to the hospital even though she's lost more weight now. She's 5' 3" and 96 lbs. Orthorexia is confounding because she's eating, just not enough. She avoids fats, proteins and carbs. Her favorite foods are vegetables and fruits. Sometimes she'll eat a salad that weighs 1.5 lbs for dinner. She's in counseling (both individual and family), but there's no talk about her fixation on "healthy" foods. In fact her behavior appears more like OCD, with a food focus. She also doesn't identify as an eating disorder patient, even after all the treatment she's been through. Any recommendations as to how to support her are welcome.

Lauren Muhlheim, PsyD responds

OCD, Anorexia, and Orthorexia share many similarities.  Your daughter is underweight and you’re right that she is not eating enough and is not eating the right foods.  Regardless of diagnosis, she needs to eat more flexibly and needs to gain weight.  I would encourage you to find a Maudsley therapist who will address and support you in helping her with her eating behaviors.  In FBT, we encourage parents to feed their children “according to their severe state of malnutrition and not according to the wishes of the eating disorder.”  In FBT you can use structured family meals to introduce your daughter to foods that her body needs but that she is afraid to eat.  She desperately needs fats, proteins, and carbs. 

In addition to the need to gain weight, I like to think of where we want children to end up after treatment.  Having a very restrictive diet cuts off life opportunities.  My family lived in China for two years.  Not only was the food unfamiliar, it was difficult to even ask what ingredients were in restaurant meals.  If your daughter is only comfortable eating vegetables and fruits, it will be hard for her to have experiences like travel and social occasions with friends.  In addition, some recent studies have associated a positive outcome for eating disorder treatment with higher consumption of fat and greater variety of foods.  In FBT, parents learn to use parental leverage to encourage more flexible eating.