Marnie is a 16 year old girl (an only child) who attends a local private girls school in the city. Marnie is always at the top of her class and her report cards are exemplary. Marnie is actively involved with music, drama and dancing in and out of school all of which she excels at. Over the past couple of years Marnie has taken a much greater interest in her looks and how she dresses. She has started to wear lots of make-up, has her hair dyed regularly, reads lots of glossy fashion magazines and wears the latest skimpy clothes.

Marnie has also lost quite a bit of weight according to her mum as all she eats each day is a few small vegetable portions, some sultanas and she drinks litres of fat-free soya milk. She had gone from being a vegetarian about a year ago to being a vegan to this extreme or radical diet and will not listen at all to her parents about her eating problem and refuses to see her doctor. Marnie hangs out with her school and arty friends who all behave in a similar way. Marnie does not eat anything at school except for some sugar free gum and when she goes on excursions she eats nothing and drinks only water.

Marnie’s mum (aged 45) is now a manager in a large business firm having recently changed jobs and has much more work responsibility and stress than previously. She is also conscious of her own weight for health reasons and goes to fitness classes a few times each week and is on her third or fourth fad diet this year.

Marnie’s dad (aged 57) is a bank manager who is soon to lose his job as his branch office is closing. Marnie’s mum complains that he is not fit, does little exercise and does not get involved in family activities except for driving Marnie to school and to drama, music or dance classes. Marnie’s dad finds it difficult to talk to her and often berates her about her not eating, losing weight, not cleaning her room and being cruel to her parents.

Marnie’s parents continually run around to shop for her to make sure that she has what she needs to eat. Marnie’s mum had secretly tricked Marnie into seeing her doctor about her not eating and losing weight and seeing a dietician. Marnie was extremely angry and although she told the doctor she would see the dietician, she completely refused once she came home.

Marnie’s mum is always buying Marnie new clothes and jewellery. Marnie also jogs twice a day and gets on the exercise bike as well. Marnie has her own television, DVD player, computer and weighing scales in her room and tries to eat in isolation to when her mum and dad eat. In fact her mum and dad work long hours and often bring work home as well. If they do get together it is only to watch a favourite television show or to go on an annual holiday to a resort or to visit Marnie’s grandparents.

Money is becoming tighter in the family though as they have bought a large house in an expensive neighbourhood and have large mortgage. Marnie’s teachers and some of Marnie’s friend’s parents have told Marnie’s mother that they are concerned about Marnie not eating at school and that she is scaring their kids. One of Marnie’s friends who has suffered from anorexia had recently attempted suicide, and Marnie has been worried about her a lot.

Marnie’s dad suspects that Marnie may be secretly taking laxatives as a friend at his work said that is what her daughter had done. Marnie’s mum told him not to say anything and that this was just being silly and to confront her would just make things worse. Marnie’s dad and mum are very scared about what is happening to their daughter and are frightened to do or say anything that will upset Marnie. Marnie’s mum has read up on eating disorders in girls, and has noted that Marnie probably is still menstruating normally (checking underwear for signs of bleeding on clothesline).

What is problematic here?

Again stress and workload of the parents appear to be interfering with the functioning of the family unit to some extent. There seems to be little time or commitment allocated for meaningful relationships to develop properly within the family unit. The relationship centres on the work commitments of the parents, trying to satisfy Marnie’s immediate needs for gratification which may be a compensation for a lack of parental closeness, love, caring, guidance and intimacy, all of which seems lacking in Marnie’s life.

Marnie too is also busy and it seems like a rollercoaster ride where everyone is replacing work and business and material needs and success for emotional needs. Marnie gains satisfaction by focusing on her looks and by being fashionably thin. It is difficult to know if this is designed to attract the attention of boys or to conform to the perceived norms of her friends at school and elsewhere. This seems to be a compensation for something, perhaps lack of confidence in herself, or lack of intimacy and love or closeness to others such as her parents in her life.

Marnie’s dad, who like her mum is a bit of a workaholic, has even greater stress looming as his job, which was not anticipated, will soon disappear. This and a large mortgage, private school fees, rising cost of fuel and so on are creating lots of stress for Marnie’s parents and for Marnie’s own perception of her future as well. Marnie may well be asking herself — will she still continue to be able to go to her school? How will this affect her studies and her major exams? Will they have to move house yet again? What will her friends think of her?

The case example illustrates a dilemma comprising lots of stressful events which appear to be having an impact on the mental health or wellness of the family and on Marnie. Marnie refuses to acknowledge that she has a problem and denies a need to seek help. Marnie has lost some trust and respect for her mother after being tricked into seeing her doctor. Ironically, Marnie’s mother may be acting as a role model for Marnie’s eating patterns, given that her mum has been on lots of fad diets recently and exercises a lot.

Marnie is rude and demeaning to her dad, and refuses to go near him or even kiss or hug him goodnight. Marnie tells him to mind his own business and to stop trying to control her life and that she can do what she likes and he can’t stop her. This upsets Marnie’s dad a lot. She will kiss and cuddle her mum sometimes when she needs consoling (always on Marnie’s terms though). Marnie’s mum may be unconsciously trying to compensate for lack of intimacy by buying Marnie lots of clothes and jewellery — feeding Marnie’s obsession. Marnie also does not need to commit to any family rituals such as sitting down at the family table for an evening meal, or watching television with the family or engaging in group family activities. She has everything she needs materially in her room.

Communication in the family is currently just a system for accomplishing basic tasks and again there is little closeness or sharing of ideas, feelings and so on beyond expressions of frustration, boredom or anger. The suicide attempt of Marnie’s close friend is also cause for concern, especially given that her friend has anorexia. The closeness of the relationship with her friend and the concurrent problem of having an eating disorder as well may place Marnie at high risk for a copy cat suicide attempt according to recent research literature.

This situation therefore is becoming potentially serious. Undoubtedly Marnie and her family could do with professional help and counselling, and possibly the school could take a lead role in at least confronting the issue (sensitively of course) and ensuring that Marnie agrees to undertake some action regarding her eating problems. Family therapy and counselling would seem to be appropriate in this particular case.

Marnie’s parents need an opportunity to express their fears and concerns to someone external to the family, to gain some understanding of the issues, develop some parenting skills to help deal with Marnie’s problems more effectively, and to reflect on what changes they may need to make in their own lives and work situations in order to improve open and honest family communication and interaction and to cope with stress and change.

It is important not to undermine Marnie’s confidence and strengths of which she appears to have many, but to build on her strengths, to enable her some independence, but to also require her to commit to improving her attitudes, her diet and involvement in family rituals (dining and talking together about their day and how they feel, sharing household chores together) and to being part of the family again.