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Odd Eating Behavior

Question:

I’m recently married and have a new 14 year old stepdaughter who has a diagnosis of ADHD for which she takes medication. She is extremely thin which we attribute to the ADHD medication. She doesn’t have much of a normal appetite but does eat at meal times, sometimes more than others. While her weight is concerning us, some rather odd behavior is even more puzzling. During visitations we find that she has eaten, not chewed, whole packs of gum, several at a time, and large amounts of candy and cookies will be gone from one night until the next morning. We really suspect she is getting up in the middle of the night because we find all sorts of items chewed up. Most recently she tore up a microwave popcorn bag and chewed big pieces into little wads! She tends to “hide” when doing these things and will deny or lie when confronted even with evidence right in front of her. She tends to lie frequently, such as, denying she has done something all the way to stating untruths. For example, she said that she is in an honors class when she isn’t.  She makes up outrageous, such as, “I had a friend who had a baby and she died.” She said that, “My best friend went to visit her grandparents and was abducted and raped and murdered.” I’ve tried to track when she exhibits the behaviors and I notice a trend that it may be happening after she has been scolded or not gotten her way. Could these be some impulse control issues stemming from the ADHD? Is it a way for her to have some control in a new unfamiliar environment? Is it possibly a more serious condition?

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Answer:

What you present is a very complicated situation with your step daughter. She has ADHD but presents with behaviors that are symptoms of other disorders as well.

First, let me state that I doubt that her being extremely thin is a result of her medication. However, I am not an MD and cannot make this statement with any authority. I hope that she is being seen by a Psychiatrist who is prescribing her medication and following her case.

In addition to ADHD, at age 14, she is being influenced by the larger culture with regard to how females are supposed to look attractive. Many girls at this age begin experimenting with weight loss. Some of them develop Anorexia Nervosa. It is possible that she falls into this catergory and that would explain what appears to be her lack of appetite.

She is also displaying symptoms that are typical of Bulimia Nervosa. The fact that candy and cookies are disappearing during the night hours and that she lies about having eaten them is the type of thing you see with Bulimia. Bulimia carries with it poor impulse control, telling lies and spending time in the bathroom to purge.

Even when we speak of eating disorders with this young girl, we must remember that she is diagnosed with ADHD and that it can all be connected to that, including her lies, manipulations and distortions.

You are the step mom and that puts you into a very difficult and even precarious situation in terms of your relationship with this young teenager and with her mother and your husband. Therefore, it is important that you speak with your husband about his daughter’s behavior and allow him to take it up with her mother. If you attempt to handle it yourself, you run the risk of becoming another “evil stepmother,” (Cinderella, etc) and of the this girl being able to cause a split between you and your husband. So, here is what I suggest:

1. Ask your husband to discuss all of these behaviors with his ex.

2. Have him suggest suggest to his ex that they both speak to the psychiatrist about these worrisome behaviors. In the event that she does not have a psychiatrist, both parents should have her seen immediately because it is only one of those who should be handling the case and not a family physician.

3. It is the treating psychiatrist who then needs to handle the situation.

4. This youngster really should be in psychotherapy. Medication, by itself, is not enough. Now, especially, when she is displaying these symptoms, she needs to be in treatment.

Again, I want to emphasize that there is little or nothing you can or should do because you are the step mom. Your only course of action is to mobilize your husband, her father, to go into action.

I wish you the very best of luck

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