Dear Dr. Garner,

I am writing to you about a problem that has me heartbroken.

My beautiful 20-year-old daughter has a very bad problem. She cannot eat properly and is down to skin and bones.

I believe she is bulimic, but she won’t listen to me and tells me it is none of my business.

It has affected her school work, and she has lost most of her friends. She has no social life.

Where should I turn?

Broken-hearted Mom in Brooklyn Heights

Dear Broken-hearted Mom,

Before I discuss your very serious topic, I would like to give a special hello to Andrea Grasso and Mary V. Gallagher, who are loyal Tablet readers as well as friends from New York Methodist Hospital.

I am very sorry to hear about your daughter and your situation. Eating disorders can be devastating and often fatal. Over 10 million Americans have eating disorders. The majority are young females, ages 15 to 25.

About 50% of young women and men with eating disorders have coexisting depression. It is sad that only one in 10 people with the disorder receive treatment, and those who do get treatment do not get care in facilities that specialize in this problem.

Unfortunately, eating disorders have the highest death rate of any of the mental illnesses, about 20%.

An eating disorder is a serious condition in which a person is so preoccupied with food and weight that this becomes the prime focus of her or his life.

The three main types of eating disorders are anorexia, bulimia and binge eating. When someone has an eating disorder, the body does not get the proper nutrients, and as a result, severe physical problems can develop and become life threatening.

Let’s review each of the three types:

Anorexia

Anorexia is a condition in which a person is obsessed with being thin. This can be carried to the point of deadly starvation. The signs and symptoms include: preoccupation with food, social withdrawal, intense fear of weight gain, refusing to eat, denying hunger and menstrual irregularities.

Bulimia

In bulimia, there are episodes of binge eating, followed by forced vomiting or excessive exercise. The signs include: self-induced laxative use, vomiting and visiting the bathroom after eating or during meals.

Binge Eating

In binge eating disorder, a person eats large amounts of food, even when he or she is not hungry. This often leads to severe dieting, which is then followed by binge eating. The signs include: eating to the point where it becomes painful, feeling depressed about overeating and eating much more food than a normal meal.

An eating disorder is difficult to manage by oneself. It basically rules a person’s life and causes her or him to think about food all the time. There is often a feeling of shame and depression. The problem, as with your daughter, is that many people with eating disorders refuse treatment. It’s important to arrange an appointment with a doctor who is trained in this specialized area.

I would be happy to provide a referral if you do not already have a physician who can help.

For parents and other families out there, there are certain red flags that should be an alarm for early signs of eating disorders. They are: making excuses for not eating, skipping meals, withdrawal from normal social activities and irrational thoughts where one thinks that he or she is overweight when this is not true.

The causes of eating disorders are not well known. Some people believe it is due to genetics, as it is more common in certain families. Chemical imbalances in the brain are also thought to be a cause. People with eating disorders often have mental health conditions. They may be perfectionists who are impulsive and have low self-esteem. Our culture, which glorifies thin models and exerts peer pressure, may increase the desire to be thin, particularly among girls.

Certain factors predispose individuals to the disease. They are:

1. Being a young woman in her teens or early 20s

2. Having a family history of eating disorders

3. Constantly dieting

4. Being an athlete, or one who relies on his or her appearance, such as actors or models.

In general, treatment involves psychotherapy, education, medication and nutrition. This is a serious disorder, and I cannot overstate the need to have your daughter evaluated.

Some scary facts regarding eating disorders include:

1. 40% of Americans either have suffered from or have known someone who has suffered from an eating disorder.

2. More than 80% of women are dissatisfied with their weight.

3. 13% of high school girls “purge.”

Eating disorders are life-threatening diseases, which are often accompanied by depression and other mental illness. Patients should get treatment as soon as possible to increase the chances of success.

[hr] Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on The NET, Tuesdays at 8 p.m. on Channel 97 Time Warner and Channel 30 Cablevision.