Well, just got back from an orthodontist appointment with my D to find all your lovely messages - thanks so much, everybody, it sure feels great to have this support.
I am hopeful that since we have caught it early enough that she is still scared of it rather than entrenched in it, that we can turn it around. It's a fine line to walk between letting her know we take it seriously, and are not minimizing it, and at the same time letting her know she's going to be all right, that this doesn't mean she will become someone with a lifelong serious disorder.
She's actually a pretty confident kid, with a pretty good self image. She's always been a bit of a perfectionist, though. I think what happened is, she developed earlier than many of her friends. She was not chubby but maybe 10 lbs. over her ideal weight, and surrounded by skinny prepubertal girls without breasts and hips. I think at first she just wanted to lose those 10 lbs. and have nice flat abs - but somewhere along the line it became a more compulsive thing, and finally she lost enough weight that she lost her appetite.
I was always slender as a teen, and ate pretty much what I wanted, but when I was in college, there was a period of time when I wanted to get just a little thinner, to look more like the models of the day (early 70's, of course now I know that all the figures I admired were fueled by amphetamines or anorexia!). I dieted for a little while, managed to drop from 118 (my usual weight - slight frame and I had NO muscle mass - hadn't discovered weight training yet!) to 113. At that point I completely lost my appetite. Well, I was smart enough to know that wasn't right, and I really didn't have any eating disorder issues, I'd just been stupidly following the fashion, so I promptly resolved to put the weight back on. I do remember that spooky feeling, though, of having no appetite, and of having to say to myself "it's noon, time to eat, I will eat this half a sandwich even though I'm not hungry". Luckily, as soon as I got back up to 115 my appetite returned to normal and I never had any problems with it again.
I have had patients who did really well if they were discovered early and responded well to Prozac or other drugs. I obviously will have to educate myself on the behavioral therapies. Yesterday I had D promise me that she would not vomit for that day, managed to get about 900 calories into her, plus some multivitamins and essential fatty acid capsules. Instituted a "no flushing" rule in the house so I can be sure she's not vomiting when she goes to the bathroom. This morning she ate a half a large bagel with butter - under protest, but she ate it. I told her it was okay with me if she skipped lunch today - I know she's struggling with the urge to vomit, and I would rather she skipped lunch at school and ate when she gets home at 2:15, than to continue the pattern of vomiting there.
H has been great, he went into work early so he could research more about this, I know he feels so badly because he always wanted to raise her to be strong and self-confident. I am so glad to have him here to help deal with this.
