Anorexia in the face of trauma

MCH Eating Disorders Clinic helps free one young teen of her anorexia 

Every Sunday from the age of nine to 14 Sara* was sexually abused by her grandfather. “I would always black out what was going on,” she says. “And I would think about something that made me happy, like playing Barbies with my little sister.”

Five years into her sexual abuse, Sara decided that she’d had enough of her chaotic young life that was also scarred by unstable and neglectful parents. Sitting on the floor of a closed closet she decided that she would stop eating. In two months she went from 180 to 90 pounds.

“For most patients, anorexia is a very complex physiological and psychological disorder,” says Sue Mylonopoulos, social worker in the Montreal Children’s Hospital Adolescent and Eating Disorders (ED) Clinics at the MUHC. “No etiology of an eating disorder can be generalized or simplified by one problem. This is a multilayered complex illness, which can represent maladaptive coping mechanism for some.”

When Sara was finally brought to the MCH Emergency Department, her skin was almost grey, her electrolytes were completely off balance, and her blood pressure was dangerously low. The doctors told her that if she waited another day, she could have died from cardiac arrest.

“When Sara came through Emergency she looked like an emaciated 80-year-old lady,” says Dr. Franziska Baltzer, director of the MCH Adolescent and Eating Disorders Clinics. “She was only 14.”

When a young person comes to the MCH with anorexia the staff do one of three things: immediate hospitalization because of danger of dying from instable vital signs; follow the patient at home; or, after consultation, give another appointment in a week or two.

“If the parents and teen/child are agreeable,” says Dr. Baltzer, “we engage in a long-term journey with a multidisciplinary team, including medical monitoring, nutritionists, psychiatric consultation if indicated, and individual and family therapy (social work, art therapy, psychology, psychiatry). Physicians in the ED Clinic see about 80 to 100 new patients a year and on average they follow them for three years.”

Short-term success for Sue and Dr. Baltzer is measured by strong parental involvement and by patients not being repeatedly hospitalized. Long-term success is measured by an individual’s capacity to resume normal adolescent life, achieving improved parent-child communication, to better cope in stressful situations and overall, to have a more fulfilled life that is not based on thinness.

Sara was immediately hospitalized when she first arrived at the MCH. Due to the trauma in her life she underwent much therapy and consultation before she was able to overcome her anorexia. At nearly 18, she is still being followed, but she is at a healthy weight, she has started to date, she is making positive and concrete plans for her future and she now lives with extended family who are very supportive. She credits the ED team’s services for her recovery. And in her spare time she focuses on her passion: writing songs. In one song she tells others who have been sexually abused to let it go—to just tell someone so you can be freed of the suffering.

“It is such a privilege to help people in their journey to reaching their emotional and psychosocial potential and in helping them to not be held hostage by their eating disorder,” says Sue. “I believe in Sara’s growth and her capacity for recovery. I am confident she will heal from her wounds.”

*To protect the identity of the patient we are not using her real name.