Dr. Barbara Greenberg

Whenever my grandson’s girlfriend eats at my house, she bolts down a lot of food very quickly and then excuses herself to go to the bathroom right away. Should I be concerned ?

Dear Barbara,

My 18-year-old grandson is dating the same age girl with a history of being hospitalized for severe anorexia nervosa. This hospitalization occurred several years ago. Presently she is somewhat overweight. We have shared many meals together, and I have observed that she eats very large portions of food, and eats very quickly. She says she has stomach problems which require her to go into the bathroom immediately after eating. As a retired nurse, I have a concern for her well-being. Am I overreacting?

Dear retired nurse,

You are right to have concerns about your grandson’s girlfriend. With her history of severe anorexia nervosa, her pattern of overeating quickly and then making excuses to visit the bathroom right after each meal is worrisome. Since you were a nurse, you likely suspect that she may be suffering from the eating disorder known as bulimia nervosa. Bulimia is commonly characterized by uncontrolled episodes of overeating, called bingeing, following by purging (vomiting or using laxatives).

Like anorexia, bulimia is a dangerous illness. According to the Mayo Clinic, bulimia is associated with negative self-esteem and problems with relationships, as well as self-injury. anxiety and depression, misuse of alcohol or drugs and thoughts of suicide. It can also cause a host of serious and even life-threatening problems, such as irregular heartbeat or heart failure, severe tooth decay and gum disease, anxiety and depression, dangerous electrolyte imbalances and dehydration leading to kidney failure.

One problem in trying to help people who struggle with eating issues is that they tend to spurn treatment. During my time spent either working on an eating disorder unit, an inpatient unit with those with a variety of diagnoses, or on an outpatient basis, I have noticed certain themes. As parents, therapists, other family members and those who have struggled with eating disorders are painfully aware, once eating disorders have gripped one’s psyche, they are very difficult to address. Somehow, they dig roots, and once planted, seem to grow and flourish and sprout new buds over time. They are like weeds, and they are largely resistant to all sorts of treatment.

However, I am grateful that a more recent approach to eating disorders seems to be much more successful than past approaches focusing on family dynamics. I am now convinced that the relentless pursuit of a lower body weight is much more about an attempt to deal with one’s mood. When someone falls into a depression, for example, focusing on eating seems to provide a sort of numbness. It distracts the struggling person from having to feel the depths of their depression. It becomes obsessional and distracting. The focus on the scale is easier to deal with than the underlying mood issues.

So, solving an eating disorder may mean recommending more intense therapy or even psychotropic medication. Patients need to develop an understanding of how to deal with difficult emotions. If they do not, then their eating issues, even if they recede temporarily, can follow them throughout their lives—and sneak up on them whenever times get tough.

The question is how to help your grandson’s girlfriend, if she is indeed bulimic, find a treatment that works. Since he and his girlfriend are frequently over for dinner, it sounds like you have a strong relationship with your grandson, and it’s important to maintain that. Would it be possible for you to have a talk with him by himself? You could share your observations and fears about his girlfriend’s eating pattern, which you associate with bulimia, and ask what he thinks about it. You might ask him if he would feel comfortable talking with her about seeing her primary care provider for a screening and a referral to a therapist. Let him know not to talk about her weight, and to emphasize that he cares about her and wants to support her in any way he can.

If your grandson feels uncomfortable discussing this with his girlfriend, offer to talk with her yourself if you feel comfortable doing so. Let her know you care about her and so wanted to share what you had observed. You might tell her that as a retired nurse, it seemed that she might be suffering from bulimia, which her primary care doctor could talk about with her and suggest a referral. Stress that you are there for her and want to support her however you can. 

She may react with anger, shame or denial, all common reactions in people with eating disorders. Try not to take this personally. Some experts have suggested saying, “I might not understand, but if you need someone to talk to, I will help as much as I can.” If she does open up, tell her that you know it is difficult, but you are proud of her. Offer to go with her to a medical appointment if she’d like that. Let her know you believe in her and you are there for her.