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Leema
07-10-2015, 05:31 AM
I am writing a YA novel where my MC's best friend (BF) has anorexia. Both girls are 14 years old.

This is a minor sub plot, but I still want to make it factually 'right'.

Over several months, we've seen the BF go from skinny to skinnier, and now looking sickly-thin.

I was thinking the first time that we see something seriously wrong would be the BF being admitted to hospital for dehydration. She'd spend a few days there on a drip, and comes home, for the whole process to just repeat over...

Is this believable?

Any suggestions appreciated.

WriteMinded
07-10-2015, 05:49 PM
Uhmm. I think it comes on more slowly than that. Not an expert, but have known several anorexic women quite well. None of them suddenly started dropping weight. It took years before anyone noted their "skinniness" as being exceptional. I guess what I'm saying is that they didn't wake up one morning with full-blown anorexia. There were some years in there dieting and obsessing about weight that is pretty "normal" for young women in our irrational times, so they did not stand out. As for the hospital process, it varies, but a few days on a drip is a long time. Then comes the treatment center route. In. Out. In. Out. - - very sad.

I'm sure an expert will come along and answer your question soon. In the meantime, I hope that helps a little bit.

Priene
07-10-2015, 08:27 PM
I have experience of this first-hand. It can happen very quickly and be deadly serious when you're still wondering if there's a problem at all.

MDSchafer
07-11-2015, 05:22 AM
I am writing a YA novel where my MC's best friend (BF) has anorexia. Both girls are 14 years old.

This is a minor sub plot, but I still want to make it factually 'right'.

Over several months, we've seen the BF go from skinny to skinnier, and now looking sickly-thin.

I was thinking the first time that we see something seriously wrong would be the BF being admitted to hospital for dehydration. She'd spend a few days there on a drip, and comes home, for the whole process to just repeat over...

Is this believable?

Any suggestions appreciated.

Obviously every experience is different, but some anorexics tend to drink plenty of water, particularly hot or warm water because it can take the edge off of hunger pains. Still, constipation and dehydration happens, so it's realistic. Where they get into dehydration trouble is more manic moments where they want to lose weight as quickly as possible, which is also common. As priene said, it can get deadly serious very quickly.

Medically speaking the first signs are in the blood work, typically anorexic boys and girls tend low electrolyte levels because typically you have to eat potassium, salt and iron. If someone is admitted to the hospital they're going to draw blood work and typically if your pre-albumin levels are low and your serum electrolytes are low and combined with a low BMI and/or delayed sexual maturity a good MD or RN is going to suspect an eating disorder in a teenager.

Leema
07-11-2015, 07:09 AM
Thanks for the comments so far!

This novel series has been tracking both girls for several months, and it's clear that 'BF' character has had issues for a long time - but I'm looking for a sudden dramatic incident, which I thought would be dehydration and hospitalisation, but I am open to other ideas.

Roxxsmom
07-11-2015, 07:18 AM
I believe heart arrhythmia (http://www.psychiatrictimes.com/eating-disorders/young-woman-cardiac-complications-anorexia-nervosa) can happen with anorexia (http://www.mayoclinic.org/diseases-conditions/anorexia/basics/complications/con-20033002) and bulimia (http://www.mayoclinic.org/diseases-conditions/bulimia/basics/complications/con-20033050), because of the electrolyte imbalances. This is certainly something that can land a kid in the hospital, even if her weight is not dangerously low by itself (bulimics often have normal weight, but they still can have heart problems), and lead to testing. It's possible for extreme purging behavior to lead to dehydration and ion imbalances as well.

lastlittlebird
07-11-2015, 01:01 PM
I remember a girl in my dorm (who I didn't know well) being taken away in an ambulance because she passed out, and it turned out she had an eating disorder.
Maybe your character could faint and then, when they do blood-work on her at the hospital, they realize there's something going on? That way it's not a severe enough situation to justify keeping her in the hospital indefinitely, but will still get her a few days and maybe a referral to a psychiatrist?

bombergirl69
07-11-2015, 03:29 PM
I don't specialize in eating disorders, although I've had a few, but have been there myself, got the tiny tee shirt when I was a teen. That was back before people really knew what it was.

Yes to drinking water and also pushing food around on the plate to make it look lie eating more, isolating from friends, particularly avoiding food related events, counting calories over everything and having a "number" like 900 or 1000 as a daily limit, gradually cutting out various foods, bragging to your friends that you don't get your period, exercising (I was running, swimming, playing tennis and fencing daily) being happy when one sees bones start to emerge. I actually started wearing very baggy clothing.

I don't know about dehydration (electrolyte imbalance as I remember, yes) but passing out and falling (and breaking something) because one hasn't eaten can definitely get one a trip to the hospital. And then docs and nurses get suspicious. That might lead to a trip to the shrink but shrinks are easy enough to BS when it comes to food issues.

I don't know what era you're writing about but over the years treatment has been pretty horrendous - all about control ("Start eating, now!") My collleagues do NOT approach it that way at all but it's interesting reading! I credit my own recovery to an outstanding doc who did NOT take that approach either.

Ken
07-11-2015, 04:57 PM
I read several YA novels with protags who were so. From them it'd seem telltale habits and visual clues might also do. That might be a more believable way to go. If it's just a subplot, though, you probably don't wanna spend much time on it. A quick cue as you have might be fine.

Wiskel
07-13-2015, 03:53 PM
There are two parts to your question - and a disclaimer that I work in the UK and different countries may do things differently.

The first is how to get her into hospital. Dehydration is a pretty good way to go. Have her faint and taken to A&E and admitted that way. it's all very plausible.

The second part is harder. It sounds like you want her out again with the anorexia undected or at least not provoking an immediate response from professionals.

If she's admitted, she'll be on a children's ward which will have had plenty of anorexics admitted to its care before. she will be weighed and her BMI calculated. She will be asked how she ended up dehydrated. She will also be monitored regarding food and fluid intake on the ward. Her family will also be asked about the last few months.

Any suspicion of anorexia at the hospital i work for would mean she was asked to see a psychiatrist before discharge. If that psychiatrist was suspicious of anorexia, their response would be dependant on weight. At a very safe weight the girl might be discharged with an outpatient appointment in the next few weeks if all looks well. At a very low weight the girl will be expected to gain enough weight to be medically stable before going home. That might not need to be a lot but the level of scrutiny as an outpatient will be pretty high and pretty immediate - with the family asked to monitor diet and weight and inform us if something isn't working.

So, getting her into hospital is pretty easy. Getting her out again undetected a bit harder, unless she is at a weight very close to normal, gives a very plausible reason for being dehydrated, eats pretty much normally on the ward and her family don't raise any alarm - but if she's eating that well then making sudden dehydration plausible is harder.

We're not easily put off by people refusing to attend appointments either.

Craig

Leema
07-15-2015, 04:15 AM
Thanks heaps for that, Craig! Useful insights for me.

My character is going to faint a couple of times, get admitted when she faints at home and her parents are concerned, have bloods in hospital that indicate issues, be referred to a psychiatrist. As she is in a small country town of 600 people in Australia, she gets discharged and her parents take her to another town where there is a psychiatrist to consult. This seems a conceivable chain of events from the information provided.

lexirose
07-15-2015, 08:47 PM
Looks like this has been answered, but just to put in my two cents. Besides being referred to mental health specialist, due to her age, she would also most likely be referred to a nutritionist who would aim to help her establish a diet that would be helpful during recovery.

kkwalker
07-16-2015, 11:07 PM
One of the things that usually causes a problem is low potassium. Causes weakness, fatigue, heart arrythmia. Actually, I had a friend who decided to go Vegan, and did it wrong, leading to this problem. He wound up in the hospital for a couple days, getting a potassium infusion.

cmhbob
07-17-2015, 12:54 AM
I'll pass on that I had a HS friend who was anorexic for several years. She told me the happiest day of her time in that state was when she got her last period. She was down to about 67 pounds at that point, as a 5'2 teen. Her body was shutting down, and she no longer menstruated.

Leema
07-17-2015, 01:56 PM
Thanks for the continued comments, guys. I will keep checking in and keep things in mind as I polish these scenes.

Twick
07-17-2015, 07:49 PM
Nothing medical to add, but I remember in high school one girl who was sent for treatment when she didn't come home after school one day. She was found trapped inside the building, too weak to push the exit door open. That might be a "we have to do something" moment for your characters.