Telephone consult on bulemic young woman

All names have been changed.

Gerri and I spoke for 20 minutes and came up with a plan to help a friend of hers who is temporarily housing her bulemic niece.

Bulemia is an eating disorder where the individual, usually a woman, binges and then purges. Eventually you harm your body by doing so. It is not natural to make yourself vomit after you feed yourself.

Karen was recently asked to leave college b/c of her severe eating disorder. She returned home to live with her folks. That didn't work out so she went to live with Aunt Ada and Uncle Phil. Good people. They live in a three-bedroom house. The only room Karen could possibly live in is the living room. And there she stays, 24 hours a day. Doing nothing. Nothing at all except watching TV and sleeping. If you try to tell her anything, she'll say, Leave me alone or I'll kill myself.

Needless to say her behavior is affecting the whole household including two older children who live there. What to do?

Firstly, it's important to know that Karen is extremely intelligent but has the emotional intelligence of a 2-year-old. She is stuck in the 'terrible two's,' the phase where she always says, No! and is defiant. It's an issue of control. Your average two-year-old finally sees the error of her ways and finally goes on the potty.

Here's my suggestion.

Call a meeting between Aunt Ada, Uncle Phil and Karen. Tell her You must abide by our ground-rules or else we'll put you out on the street.

Be aware that Karen excels in the art of manipulation. It is the only thing she can do well other than binge and purge. She thoroughly enjoys terrorizing the whole family and particularly her parents who live nearby.

Realize that Karen will doubtlessly not kill herself. And if she does, it is her own decision, not anyone's fault. Should the relatives wish, they may attend a 12-Step Family Member Group to appease their guilt.

The agreement must be signed by Karen.

1. You are not to threaten us by saying you will kill yourself. You'll be put out on the street.

2. You will choose one household task to help us with and do this daily. Wash dishes, shovel snow, fold clothes, etc.

3. You will immediately get into treatment. (Karen has been in treatment numerous times including the Renfrew Center for Eating Disorders but always drops out. She has not hit bottom since no one has ever challenged her or given her boundaries like the aunt and uncle are now doing.)

4. Uncle Phil will find you an apartment and pay for it until you can find a job.

She will read the contract and sign it.