I have twin daughters. From the time they were little, they have been extremely competitive in everything they do. As such, they have also excelled in everything they have attempted. If I were to put any tag on them, I would call them overachievers. They are both in college in the honors curriculum with triple majors, anticipating to go into medicine.
Recently, one of them decided that she was going to be skinnier than the other, and purposefully lost weight. They were skinny to begin with. We did begin to notice, and it finally got to a point where we stepped in to put a halt to it. We took her to the campus health center for evaluation. When my daughter got on their scale, she gasped at her own weight ... she had not weighed herself, so she didn''t know that she had gone that far. The doctor who saw her immediately tagged her as anorexic and told us we needed to get her into an eating disorder clinic. The doctor indicated that she had to be delusional (she wasn''t) and that her blood chemistry had to be messed up (results were normal). But we trusted the doctor, so we had her take medical leave from the college and entered her into an eating disorder clinic.
She immediately began gaining weight under the care of the dietician at the clinic. But when she went to therapy sessions at the clinic, she was asked if she was fat, if life was horrible, if her future was dark, etc. She only responded positively, that she was anxious to get back to a proper weight (which she was), and her future looked good, life doesn''t suck, etc. The clinic told us she was being uncooperative and was not going to get better until she admitted that she thought she was fat, etc. We withdrew her from the clinic.
She is now at home and has continued to gain weight based on the plan given her by the dietician at the clinic. But her university has now tagged her as anorexic and has refused her re-entry unless she goes to and stays in a clinic (due to liability issues). I''m extremely hesitant to do so, because our experience so far has been that doctors see her as being skinny and automatically assume she has an emotional problem. We''ve been extremely communicative with her, and fully believe that this was only an attempt to be skinnier than her twin sister, but now that she realizes she made a mistake she is working to restore herself. Unfortunately, she now has this tag following her wherever she goes.
Is it possible to be skinny and not be anorexic? Is it not possible for a doctor to see that she is engaged in achieving a healthy weight and understand that there isn''t an emotional scar underneath it?
Understand that I am concerned for my daughter, and we have been working to get her better. But I don''t see that the doctors she''s seen so far are willing to even consider that her weight loss was not the result of emotional trauma.
What a difficult situation for you to be in. I'm sure you must be out of your mind with worry. I preface this next post with saying I am not a doctor -- this is just my opinion. But I have been unwell with various EDs for many years and I think I understand them.
The awful irony of this situation (and of this illness) is that everyone says "oh, it's not about weight" but they still base ALL their diagnoses on it. For example:
CASE A: A girl of healthy weight who obseses about food to the point she can't eat in public and will only eat at certain times. She drops out of college because she thinks she too fat to be able to achieve anything and withdraws from all her relationships. She only eats certain foods and feels extreme anxiety every time she eats. She is a healthy BMI, she doesn't purge every meal. Is she anorexic? No. Is she bulimic? No. Does she have an eating disorder? Definitely! If thoughts of food and shape and size are that dominant that they interrupt important aspects of someone's life, there's a problem.
CASE B: Your daughter: psychologically healthy (although maybe competitive), has a normal relationship with food, but used thinness as a way to gain leverage over her sister. I don't think it sounds any different to trying to beat her in a maths exam or get the sports prize. But she is underweight. Therefore she is (inappropriately) diagnosed as anorexic.
I want to acknowledge that there are many girls who ARE in denial and say many of the things your daughter is saying. But you know your daughter better than a doctor does. I think you need to ask, if her weight was normal would we be asking questions? I know for me, I've been underweight, I've been obese and I've been everything in between, but the torturous thoughts and obsessions with food are exactly the same -- no matter what size I am.
Like any illness, anorexia has a multitude of symptoms. Thinness is only one of them and for your daughter to be diagnosed on that alone is very frightening.
And you were worried about your post being long! I guess I am passionate about this and the fact is the profession still diagnoses according to weight. I've been at the other end of the spectrum, where, because I'm above a healthy weight, I have been denied treatment that may have helped me. Similarly, I've had doctors etc. ignore that part of my medical history. It's really not about the weight. It's about the thoughts and emotions. Trust your instincts, and as long as your are SURE your daughter has not been co-opted by ED, trust her too.