Auntie SparkNotes: How Can I Get Treatment for My Eating Disorder?

Dear Auntie,

So, I’ve been struggling with an eating disorder for years now. As in like eight years. And it’s even been in remission before, but it’s reared its ugly head once again, this time worse than ever. Long story short: I haven’t eaten anything at all in days.

The problem is pursuing treatment. It’s bad. It’s seriously bad. I don’t eat and on the rare occasions when I do (aka when I can’t get away with not eating) I almost always purge. Whether I purge or not, even relatively small amounts of food make me feel uncomfortably full and physically ill because my body just isn’t used to food, much less normal amounts of food. I feel shaky and weak upon even slight exertion. Thoughts of food have taken over my life and the feeling of hunger and the exhilaration control brings me have become my friends.

And I know I need treatment, I do. But I’m a broke college student with no financial support from my parents. I can’t afford the kind of intensive therapy I need, which would probably end up being multiple times a week, plus the monthly psychiatry appointments I need. My university’s psychology office has refused me treatment, even just for depression, on the basis that I have other, more difficult to treat, issues.

And as for my parents, back when I needed help for my obsessive-compulsive disorder, they mocked me, refused me treatment, and at one point, my father even dangled treatment over my head just to get me back from my mother when they got divorced. My mother scoffed at the idea of treatment or getting an emotional support animal because “you’re not crazy” and acted like I was stupid. They refused me treatment then, and I don’t expect anything better now. On top of that, my family hasn’t given me any money for college or to support myself when I’m at school, and has delayed or refused treatment of everything from my impaired vision, hearing loss, lumps in my neck, and a torn ACL.

So I’m kind of stuck. I found a psychiatrist but I’m not sure I’ll be able to afford it, and I definitely can’t afford therapy. I actually think I should probably be hospitalized because it’s gotten so severe, but even with insurance, the medical bill would be thousands of dollars that I just don’t have.

I don’t know what to do, Auntie. I’m sick and I need help but I can’t afford it and I don’t have my family to fall back on. I don’t know where I can turn for help or how I can somehow make my parents see the truth.

Well, let’s start there, with a sad but necessary truth regarding the latter question: You can’t.

And I’m so sorry about that, Sparkler. I wish I could tell you that if you just approached your parents in exactly the right way, with exactly the right words, they would magically snap into a whole new perspective vis-a-vis their role in your mental health care. But unfortunately, you have a long and varied history of trying to get your parents to take your concerns seriously, and they have an equally long history of responding by not doing that, ever, no matter what the circumstances. This is who they are. And look: Of course they should take you seriously. In an ideal world, your folks would be responsive and supportive and committed to seeing you get the help you need. The fact that they aren’t is truly unfortunate and unfair.

It is, however, a fact you need to accept. If you wait for your parents to “see the truth” before you move forward with seeking help, you will be waiting forever—and needlessly so. You don’t need their validation or support to take care of your health. They are not gatekeepers standing between you and the Land of Non-Disordered Eating; in fact, given how dismissive they seem to be about your mental health struggles in general, I think it’s safe to say that your road to recovery probably won’t take you past their front door. And that’s too bad, but it is also okay. Family support is a nice thing to have, but it’s not a prerequisite for getting better.

And on that note, here’s the deal: Maybe you can’t afford multiple therapy sessions per week, and maybe you can’t enter inpatient care for your eating disorder just yet. That still leaves a whole wide world of low or no-cost resources that you can lean on, either instead of or in addition to things like a monthly appointment with a psychiatrist. Use the internet to connect with an online support group, or find an IRL one that meets in your area; take advantage of free hotlines and chatlines staffed by trained counselors; find a therapist who offers services via video chat for a lower fee. NEDA is a good place to start; so is a keyword search for “free eating disorder support in [your region].” And while it’s unfortunate that your college’s psych services department isn’t equipped to treat someone with your litany of conditions, that shouldn’t preclude you from sitting down with one of their counselors on a weekly or bi-weekly basis—or from working with them to find a psychiatrist nearby who sees patients on an affordable sliding scale. (Also, if you haven’t called your insurance provider to ask about their mental health coverage, now is the time to do so. Not all insurers have great behavioral health coverage, but some do, and you might be covered for at least some psychiatric treatment at no cost except the copay.)

That’s for you to do right away, okay? I mean it. Grab a beverage, crack your knuckles, and get busy making a list of resources and taking those first steps toward a healthier future.

And while I know this is hard, you’ve gotta try to resist the urge to wallow in despair over the various options that aren’t available to you. Your letter is a great illustration of how easy it is to get discouraged and just keep banging your head against the obstacles in your path, rather than looking for ways around them. From now on, if a given treatment option isn’t manageable for you right now—because you can’t afford it, or because your parents won’t support it, or because it requires a commitment you’re not in a position to make—then discard it and look for one that is. A less-intense course of action may not be perfect, but it isn’t worthless. Any movement in the direction of taking care of yourself is better than none, and taking care of yourself is something you don’t need anyone else’s permission to do.

Which is something you’ll need to remember; in fact, if it continues to be an issue, it may even be something you need to dig into with the guidance of a therapist. One of the most troubling things about your letter is how much of what you’re going through apparently isn’t new. Your eating disorder is just the latest source of pain that you desperately wish your parents would acknowledge; in some cases, it seems like you want their care and sympathy even more than you want a solution to what ails you. And in a perfect world, those two things would go hand in hand; you would get the treatment you need as well as the validation you crave. But in reality, sadly, it doesn’t always work that way. Sometimes, the former has to take precedence. Sometimes you have to answer your own cry for help. So please, don’t let someone else’s indifference to your pain be the cornerstone of your decision to do something about it. You are strong and smart and capable, and you don’t need to wait one second more to take these next important steps forward on your own. Good luck.

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If you or someone you know is struggling with an eating disorder, help and support is available at the National Eating Disorders Association: Call the toll free, confidential Helpline at 1-800-931-2237, click to chat with a NEDA Helpline volunteer, or, for crisis situations, text “NEDA” to 741741 to be connected with a trained volunteer at Crisis Text Line.