My seventeen-year-old sister suffers from an eating disorder, and we have just discovered that she has been cutting herself. Our father survived a heart attack in the fall of 2009, and that event was a wake-up call to our family to better attend to our health. My parents, my youngest sister (of two younger sisters) and I were all significantly overweight. We made a commitment to eat healthier, exercise more regularly, and in general live a healthier lifestyle. We all lost weight, but in the autumn of 2010, when my youngest sister was sixteen, we began to notice that was perhaps overdoing it. We didn't want to admit to ourselves how unwell she had become, so we talked to her a few times and took her word for it that she was okay. As the autumn continued, she lost more and more weight, and we noticed that she ate very little and exercised obsessively. She often complained of headaches, slept irregularly, and became moody and withdrawn. One evening in late November we all sat down as a family and talked, and she eventually admitted that she had been hiding some very dark thought patterns and beliefs, and that she had been acting on them. She had been deliberately eating very little, drinking very little, and exercising far more than would be healthy even for a person with adequate nutrition. A physician confirmed that my sister was at a dangerously low weight (just over ninety pounds) and that she was experiencing serious and potentially dangerous physical conditions as a result of her eating disorder. My mother kept my sister close for the next few months, and prepared all of her food for all meals, and watched that she ate it. By the spring, she had gained weight and was nearing a healthy weight. He mental state seemed slightly improved, but not much. Left to her own devices, she would not eat. If my mother told her to prepare food and eat, she would do so. She would eat a small amount of the food she had prepared and then stop, and then after further prompting from my mother she would finish her food. Things went on this way for a few months before we began to notice a gnat problem in our home. Gnats swarmed around our kitchen and bathroom sinks and around garbage cans and wastebaskets. We began to notice old food in the trash, and worse, what seemed to be vomit. We asked my sister about this until she admitted that she had been purging. My mother had initially been reluctant to get my sister professional help for fear of the label of mental illness and the accompanying social stigmas, but she now turned to counseling. My mother is deeply religious and so sought mental health professionals who had a Christian philosophy and who approached their profession from a Christian perspective. My sister began keeping a weekly appointment with a Christian counselor from a counseling practice in a nearby city. I do not know the level of accreditation of the counselor, nor do I know whether or not the Christian perspective of the counselor negatively impacted the quality of care she provided. I know that the service seemed reputable from what little I know of it. My sister talked to the counselor for one hour each week, but did
not seem to improve very much in her outlook. After fourteen weeks of appointments, my mother felt that the counseling was not sufficiently effective to be continued. My sister had learned some techniques for gauging the rationality of her own thought, and for attempting to prevent herself from thinking in unhealthy ways, but her unhealthy behavior persisted and she openly told my mother that while she was aware that she was not thinking in normal, healthy ways, she was not ready to take steps to get better. The counseling was discontinued and we decided that we would approach her disorder as a family, offering support and positive encouragement when we could, and promoting healthy eating habits in any way possible. My sister seemed to get better, if very gradually. She has now achieved marginal independence. She takes classes at a nearby community college for dual high school and college credit, and packs and eats her own meals. She has maintained a healthy weight and we have not found evidence of purging in months. Unfortunately, things again seem to be getting worse. Lately she has relapsed into irregular sleeping
patterns and sometimes spends long periods of time locked in the bathroom. A few nights ago she awoke my mother in the middle of the night because she was very concerned that she was fat. She has begun to eat strangely again. For example, she recently ate an entire box of cracker chips over the course of several hours while she worked on her homework, but did not eat again for the rest of the day. Today on a shopping excursion, my mother discovered cut wounds on my sister's arms. We are all very worried. What can be done to help my sister out of the darkness of her thoughts, and how can we help her to live a normal and happy life?