I have caught my daughter throwing up in the shower several times. I don’t know how to approach this with her. I am terrified that she has bulimia.

- User Submitted

Such an important question and I think that it is so valuable in situations like this when we, as parents are really conflicted, we have a significant concern, but we really don't know how to raise it with our child.

It can be very helpful to recognize that we all have many different parts of ourselves and to actually speak for those parts. What that might sound like, let's say I'm a mom in this context, it doesn't specify mom or dad. What that might sound like is "sweetheart, I love you so much and a part of me is really afraid and uncertain of how to bring up this particular topic with you. I don't want you to feel put off and I don't want to scare you, but another part of me is really concerned. Would you be open to letting me just ask a question? I overheard you throwing up in the shower and I have a worry that you are inducing vomiting, that you're having some issues around food relating to weight or anything else. Would you be willing to tell me if that's something that's coming up for you? And, if you're really trying to hide that, if you have any fears about what it might be like if I knew about it or we knew about it, is there any way that we could support you in that?"

One of the valuable things for our kiddos is to be able to hear our own hesitance and different parts of us and not knowing how to respond, because for sure, if we do have a child who is struggling with bulimia or binging and purging, they have parts as well. One part of them may be trying to help them with pain by binging on food and another part of them might be trying to help them stay in an idealized body image state by purging and a third part of them might be very ashamed and afraid of that cycle, which is, perhaps, why it's happening in a shower or in a hidden context.

So that's very, very helpful for us as parents if we can speak for our many different parts. It also empowers our children to speak for their parts and recognize that the bulimic part of your daughter, if in fact, she is struggling with bulimia, is not all of who she is. And that's very helpful for you to know as a parent and also for your child to know. It's going to be a very difficult situation. And if in fact she is getting into the arena of an eating disorder, it will be so important, mom or dad, to gently help to guide that child to clinical support because eating disorders are very, very deadly. We want to surround a child who's struggling in that way with professional support, with people who specialize in treating eating disorders. Just like if I have a heart attack, I want to go to a doctor who specializes in cardiac care, not just a general practitioner. Similarly, if I have a child who's struggling with a specialized issue, like an eating disorder, I don't want to go to a generalist, I want to go to a specialist. Dr. Skinner, anything you would add?

You know, I often say there's always a story. You said in your question that it's several times, which means it's a pattern. So I think it is really important to follow up and to talk about it. If we don't talk about it, the pattern doesn't disappear.

So there's a story. What's driving your daughter? There's a lot of possibilities, but usually it's an escape away from something. I'm turning to this to get away from something. As a parent, you might use that as a question. "Is there something that you're trying to get away from?" Maybe it's a numbing, I don't want to feel emotion, I don't want to feel pain, I don't want to feel rejection or loneliness. As a parent, just recognize that you might see the behavior, but there's often something beneath that behavior that we would want to understand.

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Dr. Kevin Skinner