Brief Answer: More details are needed for proper answer. thanks Detailed Answer: Hello XXXX, Welcome to HCM! I have read your question carefully and from that it is apparent that the person in question is a young female, to be married. She had an accident in past with head injury and now is on lamictal daily. Firstly, please donot loose hope, you have ample amount of time before you send her to England, I think with proper treatment she will get improvement. You have mentioned that she has eating disorder, but to tell anything related to its managment, the doctor needs to know what kind of eating disorder she has? moreover she has been on lamictal for epilepsy, which should have increased her appetite! as almost all anti-epileptic drugs do that. So, tell me - 1. is she underweight or normal weight? 2. dose she not eat enough and does not feel that there is anything wrong in that OR eats enough and then vomits and feels guilt? 3. her current weight and if there are any other metabolic problems or not?, like. her thyroid status , etc. 4. are there episodes of aggressive, irritable / depressed behavior? 5. was she ever treated for her eating problem? The above said information is necessary to diagnose the type of eating disorder and give any relevant and useful suggestion. I would also like to tell you that along with medicines, these patients need regular sessions of therapy. Family members try to make them understand that there is a problem without any significant benefit. Only a trained psychiatrist can do her cognitive therapy/ behaviour therapy along with drugs and help her get out from poor eating habits. I can understand that she is not cooperative for treatment, as this is the case with almost all eating disorder patients. Please provide further details and I will try to give best possible suggestion. thanks Dr. Manisha Gopal

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Brief Answer: Explained below. Detailed Answer: Hello XXXX, Welcome to HCM! Hope you are doing fine. I have read the question and from the information you gave, I can say that your daughter appers to have bulimia nervous a like eating disorder. I can say this as -her weight is fine as per her age, - she eats but the think that she has eaten more - and feels sick after eating. In this disorder the patient--1. likes to eat, 2. takes lot of food, tasty food items, 3. start eating normally , but soon the guilt takes over and they stop eating. 4. have almost normal weight and donot look weak or very unhealthy It is a usual finding that these patients use toilet more than normal. (As you have also mentioned in your question) --they do so because they want to vomit out the food which they eat. They fear gaining weight, and so they purge, ( induce vomiting). They may use more laxatives. The basis of all this is a disturbed body image, which may occur because of some psychological trauma early in life or some continuos stress. But many times the precipitating factor is not recognised. The treatment involves both medicine and counselling form a trained therapist. I have seen the results of treatment is fair to good in most of the cases of bulimia in my practice. ####-At home, you may begin with giving her appreciative remarks on how well she looks and that she is not fat. : You may give her example of girls ( who are known celebrities, who are either of her shape or even fat compared to her). : This has to be done very delicately, may be indirectly. : When you try to talk to the patients directly, then she feels offended and also thinks that no one understands her. : You must also try to stop her to eat junk foods. --- the most important part is stopping her from going to toilet after every time she eats. she would only go there to vomit most of the times. This can be done by 1. either stopping her directly OR 2. occupying the loo/ bathroom by some one else before she does and keeping it so for about half an hour or more. ( difficult but one can try). By this much time, the food crosses the stomach and then it is difficult to vomit. --- you can also stop her by starting some interesting talk : OR getting her involved in some important work, just after eating food. This will help to keep her away from toilet for some time and then it is seen that patient dosent try to induce vomiting. The distraction technique also helps in handling nausea. You have to think of these distractions before hand. --- The regular counselling session, done by therapist help in removing the distorted body image and help person appreciate her own real self. --- I also find that when some one close to the patient, may be of her age, tries to discuss the literature of such disorders and kindly suggest the patients about her illness, then slowly, there is some behavior change. #### Regarding medicine: I have seen fluoxetine 20-40 mg, or sertraline (25-100mg) working good in such cases. The results improve when it is given with therapy. Medicines help in reducing the anxiety, guilt and sadness associated with eating conflicts. Please donot loose Hope, I know that there is a problem, but I can assure you that by trying the above methods you will find some change. It is seen that once these people start recognizing the problem, then with time they become good. You must also understand that they are also not happy with their behaviour but they do so to help their anxiety and fear. So, putting up heated discussions will not help, rather indirect, intelligent and smartly handling the situation will bring needed change. Hope the reply is useful and your daughter gets well soon. Please feel free to ask more questions if you need further clarifications. If you are satisfied, then kindly rate the answer. Dr. Manisha Gopal, MD psychiatry

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