When I met her she was attending a very reputable boarding school in Connecticut and doing quite well, that is quite well grade-wise… On the surface it appeared like all was well. But it didn’t take long to tell that there was a tidal wave of worry behind those eyes that belied the dissonant chords of complete collapse at any moment.
The ostensible reason for our online session was to work on an essay for her English class on The Odyssey. She already had a rough draft completed and it was in very good shape. Her style was elegant, her understanding of structure impressive, and she fluidly integrated evidence. The one flaw in her game was an incomplete understanding of the text, though hers was not defunct, it just needed a little more polish really, which is really sort of the case with all students. When I challenged her point on Telemachus and his motivations, her mouth tightened up and her eyes began to dart around the page frantically. It was then that I knew what I was dealing with.
There is a blend of student I encountered often in teaching that is typically the head of the class. They sit as close to you as possible; their eyes are typically wide open and movements tend to be jerky, like an overstretched rubber band suddenly given some slack then reset again like loading an arrow on to a bow. For these individuals, failure is not an option. And ‘failure’ to them equates to anything below a 100, quite literally. If there is any red there, they will slip into that frantic mode of hyper-operation: their seas are pretty much always choppy, and no ship rests in a storm before it reaches shore. If this sounds unsustainable,that’s because it is. In state of immeasurable vigilance, they must by definition get exhausted, though the ugliness of this manifests in different ways for each individual: depressive states, prescription drug use, isolationism, paralysis. In Kelly’s case, it was an eating disorder as I came to discover later on.
Though she wasn’t exactly head of the cheerleaders, she had a reasonable social life with some friends in the dorm. She was on the lacrosse team and played some club hockey, and was oddly really into weight-lifting, though mostly to impress a boyfriend that she had at the time. But food was a problem. She would load up on sugary carbohydrates at the cafeteria, and supplement with deliveries to her dorm room, then pick a strategic time to go in the common bathroom, stick a finger down her throat and throw it all up. It was highly ritualistic and patterned behavior, sharing some characteristics with Obessessive-Compulsive Disorder. There were certain numbers that needed to be involved, eating foods in sets of threes, throwing up in sets of threes, etc.
Bulimia is a type of eating disorder characterized by recurring episodes of binge eating followed by purging, either through self-induced vomiting, the use of laxatives or diuretics, or excessive exercise. This disorder commonly affects teenagers, especially adolescent girls. According to statistics from the National Eating Disorders Association, 1 in 5 women struggle with an eating disorder at some point in their lives, and approximately 90% of those affected are adolescent and young adult women. Additionally, 1 in 10 cases of eating disorders occur in men. In teenagers, the prevalence of bulimia ranges from 1% to 2%, although this number may be underreported due to the secrecy and shame associated with the disorder. Bulimia can have serious health consequences, including electrolyte imbalances, digestive problems, dental issues, and depression. Early detection and treatment are essential for successful recovery.
While Bulimia and OCD (Obsessive-Compulsive Disorder) are two distinct mental health disorders, there is often a connection between them. Teenagers with bulimia may experience obsessive thoughts and compulsive behaviors related to food, weight, and body image. These thoughts and behaviors can be similar to those experienced by individuals with OCD, who may have intrusive thoughts or obsessions about cleanliness, symmetry, or order, and engage in compulsive behaviors to try to alleviate the anxiety caused by these thoughts. In some cases, people with bulimia may also have OCD, or vice versa. Both disorders can be complex and difficult to manage on their own, but with proper diagnosis and treatment, individuals can learn to manage their symptoms. Therapy, medication, and support groups can all be effective treatment options for both bulimia and OCD.
But teens, Kelly included, wanted nothing to do with admitting that she had an eating disorder, much less seeking any sort of treatment for it. As with many private struggles, the secrecy involved in Bulimia is often part of its psychosis. Bringing it to the surface would have taken her 90% of the way towards solving it, but like hell was she doing that. She compartmentalized her eating struggles and all of of its symptomatology, moving between purges and lacrosse practice, between binges and pre-calculus. It look predestined to continue in that spiral down the drain… until she cracked.
She was at hockey practice in the late winter when she collapsed on the ice and began vomiting blood. She was taken by ambulance to the hospital and treated for severe dehydration and diagnosed with Bulimia Nervosa. Her parents were absolutely stunned. She had been at boarding school and were a bit distant from her to begin with, so they hadn’t noticed any of the warning signs, minus that Kelly seemed a bit nervous on an ongoing basis. She stayed at school on weekends almost universally, and on breaks, she had typically kept to herself. She went on medical school from her boarding school and remained at the hospital for treatment for a couple of weeks before being released to spend time at home.
I directed the family to The Anxiety Institute, an Intensive Outpatient Program that we work with in Greenwich. She began attending the program and meeting with her primary therapist and engaging group therapy for four hours every day. But now she was behind in school… The several weeks she had been in the hospital and transitioning to AI had left her with incompletes in all subjects and in danger of losing her status in her honors and AP classes, perhaps even having to stay back a year, or even withdraw, if things continued down that route. However, the parents didn’t want to risk pressing her on the academics yet, as they rightly suspected that they may have been the trigger to her anxieties in the first place. In other words, they were stuck in the ugly Catch-22 of not wanting her to fall further behind in school but also not wanting to trigger her into backsliding.
Fortunately, we at Alliance specialize in this exact type of circumstance. After allowing her a few days to settle into her IOP, we began working with her for a couple of hours after her therapy at the institute in Greenwich. We collected her work from her boarding school via her school counselor, guided her through the materials, proctored tests & quizzes and helped her with her papers. But it needed to start slowly. The exposure therapy model utilized at AI posited a slow ramping up of engagement with the sources of anxiety, beginning at the very lightest of doses. That meant that we needed to collaborate with her primary therapist at the institute, to provide the right ‘dosage’ of academic pressure, or else she would likely backslide into her bulimic rituals.
This was difficult, as it was clear early on that Kelly urgently wanted to get back to her schoolwork, recognizing its importance, and feeling anxious that it was piling up while she was in recovery. There was the backstock of assessments she had missed and the ongoing work that her classes continued to accumulate, which was quite overwhelming when combined. We had to sort the work based on what was most critical not to miss (STEM subjects generally, or subjects where material builds on bases of accumulated knowledge as it goes), what could be glossed over, and what teachers were expecting of Kelly. Some teachers, as is common, were more understanding than others, so that had to be factored in as well. In taking over this sorting, which should never fall on the student in my opinion, we did offer some relief to her, knowing that a plan was in the works to complete her work.
The first week or two were rough. She missed a couple of days with an illness and showed up late to one or two more as she struggled to attend the IOP, but she began to build some momentum as time went on. She fell into a regular schedule, meeting with our tutors for two hours every day 1-3PM after the therapy. All at once, she began to complete large chunks of work: essays, a couple of tests. After a month of this process, she had caught up with her classes and hadn’t had to drop a single one. She graduated from the IOP and was able to return to school following their March break. The parents were perhaps more relieved than thrilled, but she was back on track and happier than she had ever been.
Kelly’s is a far more common narrative in the post-pandemic era, unfortunately. The pandemic has brought about unprecedented levels of anxiety and stress for people of all ages, but teenagers have been particularly hard hit. According to a recent survey by the Centers for Disease Control and Prevention (CDC), over 70% of adolescents reported experiencing symptoms of anxiety and depression during the pandemic. Another survey by the American Psychological Association found that almost half of teenagers (45%) reported feeling more anxious than usual in the past year. Many of the results have been invisible, as teens tends to keep their suffering to themselves before it becomes unmanageable and causes catastrophe. It is incumbent on educators to be mindful of this trend and to develop a keener vision of students that may be teetering towards the edge. For every Kelly success story, there are a dozen with far more tragic endings. Detecting these struggles earlier and addressing them before they spiral is going to be key to treating this entire post-pandemic generation.