Quote: Since the time that things have gone awry in our R, my W has dropped weight to an alarming degree. Today, she is 5 foot 6 inches and weighs a mere 98lbs. She doesn't eat any meals and only snacks on low fat, low calorie items (e.g., pretzel sticks). She is overly concerned with calories and fat intake. Sadly, she still thinks she isn't quite "there" yet in terms of weight, but from what I can gather she is "okay" with where she is at. She refuses to seek help because it likely would require her to take medication which, you guessed it, would likely cause her to gain weight. I know that typically eating disorders are a manifestation of an underlying personality disorder characterized by issues of control and perfection, and that the thing she is going through is the impetus for the weight loss (i.e., the only "thing" she has control of in this world of hers is weight loss...striving for a "perfect" body image that is unattainable).
Oh honey - you are up against a real bear of a problem. Let me share some things with you. I'm a family physician and the mother of a daughter who developed anorexia/bulimia with some OCD and depression components when she was 13. She is now 15 and doing well, but it required a full court press to get her here (she was 5'4" and went down to 90 lbs., btw, so i have a pretty good idea of what your poor wife looks like right now).
First of all - let me say - forget all that psychobabble stuff about her doing this because she wants to control something. Anorexia is a biological disorder, genetically predisposed, closely related to obsessive-compulsive disorder, Tourette's syndrome (which my son has), and/or a family history of clinical depression. Social or psychological factors may trigger the initial diet, but the downward spiral into obsessive behavior that occurs afterwards is a biological problem with the basal ganglia in the brain.
Right now, your wife is not controlling things - the eating disorder is controlling her. She is having repetitive, intrusive thoughts that will not leave her alone, insisting that she cannot eat normally, that she is not worthy, etc. etc. My D was even able to see and be frightened by how gaunt her face and arms were, but the persistent thoughts that she had to have "flat abs" drove her to continue to restrict and purge. It was terrifying for her and for us. And make no mistake, this is a life-threatening illness with a high mortality rate. This is NOT something your wife CHOOSES to do. And it is going to take great strength and perseverance on your part to keep her alive.
It is a lot harder, I know, for a spouse than a parent - you don't have the same kind of leverage over her behavior as we did. Still, I'd like to recommend a few things:
- first, some reading for you. The better you can understand what is really going on in her mind, the better you can deal with her. I recommend The Boy Who Wouldn't Stop Washing by Rappoport - a book about OCD, not ED, but you will recognize the close similarities in the thinking process (plus it sounds like your wife probably has a significant oCD component, from the manner in which she is restricting). Also read The Secret Language of Eating Disorders - while I don't agree with some of her psychological explanations for cause, I think this book gives you an excellent insight into the mental processes of someone with an ED.
I had some success with my daughter by sharing the medical research with her - research about autoantibodies to the basal ganglia being associated with EDs, about rare cases of tumors or aneurysms in the area causing EDs, about twin studies showing that identical twinds have a 70% concordance rate (risk that if one twin has an ED, the other will get one) while fraternal twins have only a 5-9% concordance rate. Even though she was young, she is smart and was eventually able to absorb some of this information, and start to mentally separate herself from the eating disorder. It also took away the shame and guilt, for her to be able to understand the disease process a bit.
Your wife right now is at risk of dying from a heart arrhythmia. She needs to have her potassium levels checked and probably should be hospitalized, although that's obviously difficult to do. What support do you think you can get from her family? How was her ED treated when she was a teen?
