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Dr. Weltzin: What parents should expect is that their child and the family knows what it takes to recover from the illness. With an illness, where denial is a major problem, often times the current treatment can be done but if the patient does not want to apply what they have learned, then it will not work. No matter how frustrating it is, it is important to keep in mind that patients often refer to their attitude during a previous treatment and say that "now I am ready to get better." While it can be costly and frustrating that a second or even third treatment is needed, if it is effective, parents will say it was worth it to have their child healthy.

David: That's a very straight answer, Dr. Weltzin. And I guess you are right. If the patient isn't ready to get better, or doesn't want to get better, it doesn't matter how much money you spend, you won't see great results if little or no effort is put into the treatment by the patient.

Here's the next question:

CAS284: Dr. Weltzin, my daughter has been free of bulimia for over a year now, but after the bulimia ended, Obsessive Compulsive Disorder (OCD) has became evident. We are now struggling with this and depression. Is this common and how would you suggest we treat these disorders? Thank you.

Dr. Weltzin: There is a strong link between Obsessive Compulsive Disorder and eating disorders and depression. It also does happen that, as the eating disorder gets better, some of these other problems become more noticeable or, at times, more severe. Depression and OCD are very treatable. Treatment for both OCD and Depression require a combination of therapy and medication (if severe). If moderate to mild, then therapy or medication can be used. Because of the specialized nature of OCD, you may want to seek out a specialist. YOU may want to access our web site to ask for a specialist near you. With depression, if this is still present after the eating disorder is improved, then it should be treated as a separate problem.

David: For those of you who want more info on OCD, please visit the HealthyPlace.com OCD Community.

I know that you have done research on the relationship between eating disorders and OCD. Could you explain how that relationship between eating disorders and OCD works?

Dr. Weltzin: What is more likely the case is that OCD or perfectionism (what we call OCD related symptoms) likely increase the risk for eating disorders. Often there is a family history of OCD or perfectionism in patients with anorexia. There also seems to be a link between bulimia and OCD. This is not surprising as serotonin, a brain chemical linked to appetite and eating disorders, is also a major factor in OCD.

alexand1972: What should someone who has been in and out of hospitals do differently to attempt recovery? What are the chances of that person's niece living in the same household and going through the same thing getting better? Or is it too unhealthy for her to be in that sort of situation?

Dr. Weltzin: Depending on how long the hospital stays are, you may want to consider a residential program that is longer and can help you develop and practice the changes you need to make in your eating, problem solving, and approach to recovery that will allow you to be able to implement these changes in an effective way at home. This often works, although (as I stated above) it requires a significant sacrifice. If you are not doing well, it will likely not help your niece.

David: I just want to post this comment from an audience member who has an eating disorder. I'm posting it to give the parents some insight into what your children may be thinking and I hope Dr. Weltzin might speak to that:

waterlilly: My mom, who is an RN, flipped out when she knew I was making myself vomit. She began hitting me and sent me to my Dad's. I don't understand why she didn't support me.

Dr. Weltzin: The stress that this problem puts on parents is quite intense and often times they say or do things that are quite shocking. It would appear that, at that moment, your mom was not able to support you. This is unfortunate, however, she may feel quite bad about what she did and be able to support you now in your recovery. You need to work through your feelings about this with your therapist, then have family sessions with your mom to express to her how this made your feel and to determine if you want her as a resource for your recovery and if she is willing.

David: Rogers is in what part of Wisconsin, Dr. Weltzin?

Dr. Weltzin: Rogers is in Oconomowoc, which is about 30 minutes from Milwaukee on I94 between Madison and Milwaukee.

muddog: My daughter started at 16 and is now 23. She is seeing a therapist. Do you feel she can get well without being in an eating disorder treatment center? Also, my daughter is considering marriage. He knows about her Bulimia. Is the marriage doomed if she doesn't get well first?

Dr. Weltzin: It really depends on how she is doing with her illness. Often times, the therapist can be of help in this - if your daughter is willing to invite you to a session. It is important to mention that the longer an eating disorder goes on the more difficult it is to recover. People begin to have the eating disorder define their way of life and this is hard to break. If she is not better, then a treatment program should be considered.

As to the marriage, an important part of recovery at our program at Rogers is responsibility. It would seem to me that starting out in a life long relationship should be done with it having the best chance of success. If she is not doing better, then this would likely be a very significant stress on this relationship - one that may be too much. Might it not be better to get her eating under control first?