momlogic: Were you surprised by the news about Demi Lovato?
Dr. Paul Hokemeyer: In our image-obsessed culture, our teenage daughters have become victims of a relentless pursuit of thinness. In this world, no one -- not even the celebrities themselves -- are immune from the physical and emotional damage caused by distorted eating. The recent admission of Demi into a treatment facility for her struggles with body image and weight is a painful confirmation of this truth.
ml: How should parents discuss the issue with their children?
PH: The important point here is that parents should discuss Demi's struggle with their teens. Rest assured that your kids will be talking about it with their friends both in person and online. These peer-to-peer discussions need to be counterbalanced with the genuine concern and guidance that can only come from a parent's unconditional love of their child. In my experience in working with both adolescent girls and boys in the field of eating disorders, I've found that the best way to approach the topic is through a sense of curiosity, not judgment.
Rather than preaching down at your child by telling them what's right or wrong, healthy or unhealthy, approach your child as a concerned adult who is trying to understand their world. A good way to start this type of conversation is to ask a question to the effect of, "I understand Demi is seeking help for an eating disorder. What do you think happened?" By opening your discussion on this note, you will give your child the sense of autonomy and self-agency she or he will need to overcome problems of their own.
In addition, because our teens are very impressionable and susceptible to "copycat" behaviors, it's important to discuss the situation as generally as possible and avoid specific details such as the methods Demi used to manage her weight at the time of her admission. Teens are incredibly impressionable and look to role models like Demi for a sense of identity. In this regard, you should shift the focus away from the illness and the details around it to the strength and bravery it took for her to admit she had a problem and to reach out for help.
ml: What are some warning signs of a disorder?
PH: For an eating disorder, the obvious ones are:
- Rapid weight loss or gain.
- Rigidity around eating, either in the types of food eaten (i.e., absolutely no fat or carbohydrates) or the eating rituals (i.e., the person will not eat after or before a certain hour, won't eat around other people, etc.).
- Fluctuations in energy levels (either really low or really high).
- Tooth decay and/or hair loss.
- Excessive amounts of exercise.
- Wearing baggy clothes to hide their body.
- Constantly complaining that they are too fat.
The less obvious ones are:
- Having friends who are weight and image obsessed.
- Spending significant amounts of money on unaccountable items. (This could indicate compulsive binging.)
- Visiting websites and chat rooms that promote weight loss.
- Excusing themselves from the table during and immediately after a meal to go to the bathroom (to purge the food they have eaten).
For self-mutilation, the signs are:
- Cuts, bruises, scratches and burns
- Emotional outbursts
- Lack of impulse control
- Extreme mood swings
- Harshly critical of self
- Diminished sense of self-worth
- Lack of pleasure in activities and an overall sense of joylessness in life
- Changes in peer groups and/or social isolation
While Demi didn't confirm a substance abuse problem, unfortunately, substance abuse and eating disorders can often go hand in hand.
ml: What is the key to prevention?
PH: Families are the greatest resource we have in keeping our kids from veering down the wrong path, be it one of eating disorders, substance abuse or delinquency. Our kids need parents, not friends, who are emotionally and physically available for them and who view them as people they can turn to for comfort, understanding, boundaries and guidance.
ml: How can parents be role models for their kids in terms of personal and mental health?
PH: What parents do influences their kids far more than what they say. Towards that end, parents should be diligent in their own self-care. Parents must also remember that adolescence is a period of time in which their kids are especially impressionable and vulnerable. It is a period of growth, brain development and great emotional conflict. Rather than preaching down at their kids, parents need to demonstrate to their kids that uncomfortable emotions like anger, sadness and disappointment are OK and can be managed by healthy and constructive coping skills.
Parents must also develop the capacity to be honest and accepting of their own imperfections and vulnerabilities. No one lives in a world that is perfect or is possessed of a perfect body. Rather than teaching our kids to strive for perfection, we must show them that love resides in our imperfection.