Anorexia question: prognosis / what works

A question about a relative of mine. She is mid-30s, anorexic, alcoholic (at least in the past), and with other major psychological issues underlying and contributing.

She is self-diagnosed, so it’s hard to say exactly what she has, but most people describe her thinness as “Auschwitz victim,” so it’s clearly both real and serious. She will obviously die if she continues her current plan of not getting help, which we’re working on: how do you get someone to seek professional help when one of the symptoms of the condition is avoiding treatment? What if they (quite legitimately) plead poverty and no insurance? This is in California if it matters.

About anorexia itself, online sources are helpful in some ways but really cagey about prognosis. She is about 5’3" (she says 5’4") and 95 pounds at the moment. It sounds like she’s already endangering organs, but how long does this process take? How long to do irreversible damage? What is the survival rate in general? Is it different in women of her age vs. teens?

I appreciate any information, but dark humor is also welcome. I told her sister that I was getting her Karen Carpenter’s Greatest Hits for Christmas (though obviously I didn’t). And I have to run now, but I’ll come back and share her plan for seeking treatment, which is both hilarious and tragic.

Check out [](Something Fishy).

She sounds like me. I have struggled with ED’s and alcoholism for years (I’m all better now, and 9 months sober) and it took pretty much an intervention to help me. I knew there was a problem, but I liked how it made me feel, and I liked the attention.

I was very depressed and had super low self esteem. Now that that is being taken care of, I have my life back.

You might want to talk to your local social services department to see what kind of professional assistance she’s eligible for. I think that if you get the drinking under control, the weight might come back to some degree on it’s own. Heavy drinkers sometimes forget to eat (or are too sick to eat). Good luck.

Thanks, that’s great. I’m exploring it now. And we are looking into community resources. She’s reaching out for help, but right now that largely consists of gathering an audience to watch the destruction. I am trying to steer her toward professionals. What she has told me is that she will seek counselling, but here’s how.

  • She is going to enroll in college. Normally I would encourage this as a real positive but right now I think the added stress alone would be a deal-breaker.

  • Two courses, at a community college, though she is doing this in part to get insurance. I suggested gently that you often needed to be a full-time student for benefits.

  • She is commuting to campus with her ex-boyfriend, who at the time was (a) married to someone else and (b) her boss at the bar. Even if she finds a support group open to the community (which we’ve also encouraged), it will be dependent on his schedule, and though he’s evidently involved he’s not exactly Mr. Selfless.

  • She wants to take geography and a gymnastics class, because “the gymnastics teacher will take one look at me and send me to the hospital.” Community college gym teachers, even if so motivated, do not actually have the power to commit students.

I think this is simultaneously engineered to put off dealing with the problem but also a cry for a grown-up who will just take over and make all the hard decisions for her.

I have had anorexia for about 14 years and really struggled to find anything that helped, but recently have started have CAT therapy (Cognitive Analytical Therapy) which seems to be really helping. I can say it is impossible to make a diagnosis online, she needs to want to see a doctor. And also, giving the problem a label doesn’t help a great deal.

It is almost impossible to make someone have treatment when they don’t want it…I didn’t for so long and it took a whooping kick up the arse to finally start even acknowledging my problem. It is harder when the person is older and has very rigid routines and habits…the older they get the less willing they are to change it seems.

Have a look at I know you are in the US but it is a good website with lots of information for patients and carers and lots of people from outside the UK use it. There are people from Sweda who you can email for advice.

What did it take for me to wake up and smell the coffee? Well, a mixture of things. My physical health was deteriorating so rapidly it seriously affected (or maybe I should still say affects) my day to day life…and part of that is going to the gym…im addicted to the gym and so beginning to not be able to go made me want to eat better.

I saw how much it is hurting my family and so I want to get better for them. I felt left behind by life…i want to have more of a life than I have right now. I realised that it is either live or die and if i had carried on I would have died. But she needs to realise that for herself. I have done a psychology degree and my diseratation was on the motivation of people with anorexia to recover. It takes a lot for them to realise what they are doing to themselves.

How much contact do you have with her? Does she talk about her problems? Does she have friends and other relatives who are worried? How long has she been like this?

IANAD, but at some point during my anorexia I have got osteoporosis (i was diagnosed with that at age 18 and i’m 24 now…not good), very bad anaemia, kidney problems and other problems caused by things I have done to myself. Anorexia has the highest death rate of any mental health problem, so it is very serious. Some things are reversible (like the anaemia), others are not so much.

Goodluck, it is horrible to see someone go through something like this. Feel free to contact me if you want any more information.

Thank you for your post. No one has much contact with her, but this is mostly because she “hides” (our word) when she’s on a self-destructive kick, which can go for months or years at a time. She has a brother, a sister, and parents about 3000 miles away, one aunt in town, and me (a cousin) about three hours away. Other relatives, including my parents (also thousands of miles away), have essentially written her off a lost cause.

She has a network of friends, but the family barely knows them. She lives with a boyfriend who, like most of her friend-group, is in his 60s. He’s nice enough but not very clueful about mental health issues, and not very proactive.

I’m very sorry about your relative - anorexia is a real bitch of a thing to try to overcome. Doubly so when it’s co-morbid with something like alcoholism.

Some basic facts - generally, the prognosis for anorexia becomes worse with both:
a) the age of the patient (older is worse)
b) length of illness (longer is worse)

Honestly, becasue of the co-morbidity it’s quite hard to even make a guess - I would expect that any therapist/treatment program would want your reletive to get off the booze before a serious treatment program for the anorexia was begin. As Kalhoun mentioned, it’s possible that the anorexia will resolve itself if the alcoholism is addressed.

I know almost nothing about health coverage in the US - I hope that if your relative is destitute there would be some sort of government assistance available to her - I’ll leave it to other, wiser posters to offer suggestions.

Finally, please take care of yourself. It is very difficult and very draining to deal with a sick family member, particularly when the illness is psychiatric in nature. You need to make sure you take care of your own emotional health, and recognize that this isn’t your fault, and other than being supportive and finding resources, there’s nothing you can do that will make your relative get better.