Helping a 22 year old niece with anorexia

In less than a week, I will be seeing my niece whom I only see once a year at max, given that she lives in France with the rest of her family.

She has been anorexic--at least has had all the behavior and physical appearances of it--for many years but her condition is now severe. Her mother, father, and grand parents are unable to help her: they make remarks, try to talk about it, recommend that she sees specialists about it but she seems in total denial. I doubt very much I can change anything to the situation but I have a couple of small advantages over the rest of the family in that:

1. I live far from her and therefore can be seen as an outsider to the situation

2. I am much calmer than the rest of my overly stressed family

I am wondering if anyone has any advice as to what I can do/say, if anything.

My instinct would be to have a frank conversation with her, one on one, and try to help her face the reality of the situation and help her accept that she needs professional help, right now. But I also know what seems obvious to our eyes isn't what anorexic individuals see about themselves, and I don't want to waste the trust she might have in me by following a path known to fail from the start.

Is there a better approach? From the last pictures I saw, the situation seems dire enough that just acting as if there was nothing would not feel right.

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Regarding eating disorders, such as anorexia, you can try reaching out to Janice Bremis.   She is the founder of the Eating Disorders Resource Center in Los Gatos.

I contacted Janice when I had a concern about BDD and found her to be calm and compassionate. Her contact information can be found at

Otherwise she can be reached at (408) 356-1212. Best wishes to you and your niece.

Please look at There is a hotline and a Q&A forum. My daughter has suffered with anorexia since she was 13 and is now 34. She is no longer anorexic and is healthy but still somewhat eating disordered. Please check out the website and best of luch

Sorry about your niece.

I have no idea about anorexia, but I know that when we were having difficulties with our 20 year old son, my sister, who lives away from us, came to visit, talk to him about seeing a therapist, that she had already found and was able to convinced him to go see this person for 3 sessions. She told him this would make us, the parents to feel better. The therapist was great and my son understood that it was to his benefit to keep seeing this person. I understand anorexia is very very difficult, more if your niece is denial, but maybe if you say is something good she would  for her parents, she will be willing to see a specialist.. 

Wishing you the best.

Firstly she needs a medical evaluation to see if she is stable from a cardiac standpoint. Many severe health issues related to starvation. Sounds like she may really need a good stay in an inpatient program. Stanford or UCSF.Check out they're eating disorder cites.  Family Based Therapy is the standard of care for anorexics. It's an approach where family members or relatives re-feed usually teens but also young adults. It's a very intense program  but only clinically based program with high success rates. My daughter has an eating disorder which she is currently recovering from with the help of a Family Based Therapist named Suzannah Neufeld, MFT in Oakland. Her practice i think is full but you can contact her and she maybe able to refer you to someone else. Suzannah [at] By the way, the hallmark of anorexia is not thinking you have a problem thus making it very difficult to treat until the patient is able to get over this major hump. Look on line at around the  or FEAST website for lots of good advise and support.  Alta Bates Berkeley also has inpatient program. 

My daughter is anorexia, and we have been doing family based treatment for close to a year.  I’m so sorry your niece is suffering and you are right to be concerned and brave tostep up to try to help her. Your niece needs to be medically evaluated ASAP. There are many serious health conditions associated with anorexia, the most serious being low heart rate which can devolve to heart failure. People with anorexia are often in denial about their condition and need to be “forced” into treatment. Let your niece know how much you love and care about her, and offer to go with her to seek help. This is a scary mental illness, which takes over the mind and refuses to let go. She will likely downplay it, but she needs a lot of support to get better.

Resources- FEAST, national eating disorders websites. You can ask the moderator for my info to contact me directly.

Good luck to you, and best to your family.