How can I help a loved one who is abusing laxatives?

July 25, 2013 10:26 AM

A family member I am very close to has been abusing laxatives, probably for a very long time (maybe a decade or even more, possibly to the point that it's a miracle she is still alive). She is now gravely ill. It's all very complicated, I'll try to hit the major points without being too lengthy.

She has a lot of emotional issues, all related to abusive parents, but she's pretty self-aware about most of it. She also has a LOT of health problems that she talks about all the time. Lots of digestive issues, irritable bowel, food allergies, chronic pain, she's always cold, her hair falls out, arthritis, a heart problem, it's a long list, and most of it she just claims she has, but has received no diagnosis for from her doctors. She's in her early 40s. She admits she uses large doses of laxatives (daily or nearly so), but somehow believes they are a necessary evil to cope with her "real" illness. She is skillfully vague about her "real" illness, focusing instead on the awful problems it causes for her. She's been to doctors and been admitted to the hospital for various problems (sometimes for severe dehydration, electrolyte imbalance, severe deficiencies in things like potassium and magnesium), but they never find any underlying reason for whatever she's there for, and around the time they tell her they want a psych consult, she will check herself out or stomp out of an office. I don't know if she tells her doctors that she takes laxatives, could be that when she mentions the laxatives is when they call for the psych consult. I've been reading about laxative abuse for the last week and every single thing she's ever told me about her health is listed as either a sign or a consequence of laxative abuse. And then I read that laxative abuse might be a form of Munchausens and it was a big ding ding! moment. At this point, I really believe she is going to die from this if she doesn't get help very soon.

She currently won't speak to me because I've stopped taking her crazy word about her health issues. I don't live near her, and I think our remoteness has allowed that she can complain about all her pains while still hiding just how bad things have been. She is married to one of my immediate family members, and I've had one frank conversation with him about her health, but that was before I started reading about laxative abuse. One thing I gather is that the denial can be so strong, it can be really tough to treat. I am planning to have another, even more frank, conversation with her husband, and confront him with my suspicion about the laxatives. He knows that she takes them, but has accepted her word that they are necessary.

Any advice about how I might best get through to him/them about this? I feel like if no one does something soon, she's going to die because we were afraid to upset her. She gets increasingly hysterical if anyone tries to call her on any of this, effectively shutting down any meaningful conversation. There are a lot of layers to this shit, I could write a book. Despite all the crazy, I care about her, and her husband, deeply and hope that by bringing all of this stuff out in the open, she might get some help.

posted by upatree to Human Relations (16 answers total)

First of all, not your business.

Second of all, while laxative abuse does exist, there also real medical problems that can be so severe that they require the use of laxatives daily in order to have bowel movements. Colonic inertia is one of the big ones. It can be so severe that even with huge quantities of laxatives the sufferers end up requiring removal of the intestine and/or a permanent ostomy in order to actually void waste from the body.

Third of all, see first of all.
posted by telegraph at 10:30 AM on July 25, 2013 [7 favorites]

Yeah, you can't fix this and it's not your job to try. Also, it would be such a kindness if you wouldn't discuss her situation with other family members.

What if she did have one of those rare and weird illnesses? You playing at being House just piles onto the already frustrating experience of going to doctor after doctor and getting NO help or relief.

Sure, she may be an abuser, or she may be really sick and suffering.

Be supportive, suggest to her that she should see a shrink to help her deal with the depression and frustration of having a chronic illness. But that's IT.

Keep the rest to yourself.
posted by Ruthless Bunny at 10:36 AM on July 25, 2013 [6 favorites]

You don't live near her and your family member, so you're interpreting her reported symptoms. You might not be the best person to get through to them about this. You can voice your concerns about the choices you think she's making, but it sounds like you've already done that.

She is most likely not going to die of Munchasens. It sounds more like she's trying to manage her chronic illness, which may be the cause or effect of her laxative use.
posted by RainyJay at 10:41 AM on July 25, 2013

Best answer: Wow, what a terrible situation for all involved.

If you're asking how do you force her to get help? The answer is you can't.

If you're insistent on this, possibly the only way I know would be an intervention. Unfortunately, this can backfire tremendously, may cause gigantic rift in your relationship with both her and your relative, not to mention it may not work -- relapse rates on interventions are super high, and it requires the support of most of the immediate family to even accomplish, which it appears you absolutely don't have. Not to mention, it's really not your place.

I totally understand your heart is in the right place and you care about her, but the bottom line is, it's really tough to help someone who just... doesn't want help. Ultimately, people are responsible for whatever they want to do or not do to their body, providing they're only hurting themselves, and you can't really convince them or nag them or shame them into changing-- it just doesn't work. I can't stress this enough: It doesn't work. If it worked, all those government PSAs about the obesity epidemic and smoking would, you know, have some effect.

All you can do is control your reaction to the situation-- part of Munchausens as I understand it is the need for attention. Don't give it to her. You're fueling her fire. Disengage. If she insists, just re-iterate that you hope she gets the help she needs. If stating this upsets her, just don't interact with her.

Regardless, people need to want to change. She doesn't want to change.

So the answer is you can't fix it. You can only fix your reactions to it. And lastly, she may well be legitimately sick-- you don't really know. It would be terrible to be legitimately ill, with no one to believe you. Yeah she may be exaggerating or faking, but there's always a chance she may not be.
posted by Dimes at 10:45 AM on July 25, 2013 [6 favorites]

What do you have to lose by taking her crazy word on her health issues? (Seriously- is she asking for money?)

If you have nothing to lose, just support her and nevermind if you think she's delusional or not. From my point of view, as someone who's not her MD or spouse or kid, your job is to tell her you have her back, emotionally. The end.
posted by small_ruminant at 10:53 AM on July 25, 2013 [2 favorites]

She is now gravely ill...
...they never find any underlying reason for whatever she's there for, and around the time they tell her they want a psych consult...
...At this point, I really believe she is going to die
...confront him with my suspicion about the laxatives

Check your own crazy first. You are pretty engaged in a drama here, some of which is just from your own mind, and you are having this drama with a person who doesn't even want to speak with you. Dial it way back. "Miracle she is still alive" -- really...?

This comes off as a lot of "I want to insert myself in the middle of a thing and I am excited by: big thing," not, "How can I respond compassionately." By "excited" I don't mean to imply that you're somehow enjoying her distress -- clearly you care -- just: you sound far too involved, without consent, in another person's personal life. Emphasis on "personal." Shut down conversations you don't wish to have, offer compassion, butt out when appropriate, abandon the idea that a person who regularly sees a variety of physicians is about to drop dead and only you are privy to that fact.
posted by kmennie at 10:59 AM on July 25, 2013 [10 favorites]

I'm sorry, but having internet access does not make you a doctor. Back off and mind your own business.

You are diagnosing both her mental and physical condition (which even a real doctor wouldn't do from a distance!) based only on: She frequently uses laxatives and she has multiple medical issues; therefore internet medical searches prove she's a laxative abuser in need of a psych consult.
posted by easily confused at 11:02 AM on July 25, 2013 [2 favorites]

I would also point out that even if she didn't need the laxatives originally, after several years of constant use, she is likely totally dependent on them now. As in, she probably can't have a bowl movement with out them. Whether she did this to herself, or it is to treat a condition, the end result is the same.

Unless you're advocating for a medically supervised stepping down of dosage of laxative, taking any hard line, cold-turkey kind of intervention/addiction approach would not be advised.
posted by fontophilic at 11:03 AM on July 25, 2013 [1 favorite]

Response by poster: Thank you all for your frank answers, I appreciate your calling me out. Although I think I have maybe not explained some things as fully as I could, given a few zillion extra words, I don't think you're wrong about me needing to just butt out. It's very distressing, all of this, but I do need to just step back.
posted by upatree at 11:04 AM on July 25, 2013 [3 favorites]

Best answer: The most intensive (expensive) therapy in the world has abysmal success rates with deep-rooted, multifaceted problems and behaviors like the ones you describe. It's not just about butting out, it also won't work. Try not to feel guilty.
posted by headnsouth at 11:11 AM on July 25, 2013 [3 favorites]

Best answer: Although I haven't been in your shoes, I did have an alcoholic mother. As we grew up and became teenagers and young adults, my slightly older sister would regularly freak out at my mother and the two of them would have a big scene and a big cry that would end up with my sister pouring all the alcohol in the house down the kitchen drain. The next day, my mother would go to the store and replenish her supply.

During all this time, my sister would periodically berate me for not being more upset by my mother's actions and addiction. I always kind of took the position that I needed to do what I needed to do to survive and as long as she wasn't actively harming me or my sister, my mother's actions were her own responsibility.

My sister never brought about any meaningful change in my mother's actions.

However, I believe in large part because I was relatively emotionally detached from the whole business, a few months after I graduated from college and just as I was preparing to move out of the family home into an apartment with my boyfriend, I gently asked my mother whether she thought she might be happier if she weren't drinking all the time. She said yes but that she didn't know how to stop.

I had already done all the groundwork and we checked her in to a residential rehab program that night.

Obviously my timing was lucky and perfect. Obviously she was the one who had to be motivated to do it and I happened to present the right option at the right moment and then she did all the work. But she did quit drinking and that meant that the remainder of her life was much better. I also told her that she should never feel ashamed to tell me anything and that I cared way more about her health than I did about any other outcome, so if she started drinking again, she should feel free to let me know. I wouldn't judge but I would do whatever she wanted to help her or not help her.

Over the course of years, I've thought a lot about why my strategy worked and my sister's strategy didn't. A big part of it is timing, of course. But I think that it was at least as important that I didn't turn it into a big drama of any kind. I never reacted to her drinking. I never participated in the love/hate fests that my sister and mother threw regularly.

With this in my past, the first steps I would take in your shoes would be to let my loved one know that I am too reactive to her medical issues to be able to discuss them rationally with her, and stop all conversations about them. It could take a really long time, but once you and she are no longer having the conversations that have such a charge on them for both of you, you two may ultimately be able to have a conversation about her health that isn't fraught with emotion. I think when you reach that point, you'll have gained her trust enough so that you might be able to provide guidance or suggestions that won't be seen as intrusive or upsetting.

It's a long haul. And I can tell you that living in a household with an alcoholic mother was difficult, and I expect your relationship with your loved one will be equally difficult and won't get better for a while. But I really don't believe that you can change someone who doesn't want to change.

Also, I have ulcerative colitis, a form of inflammatory bowel disease, and I therefore have way more information about digestive disorders than I would like. While I agree with you that self-medicating with laxatives is generally a really really bad idea, constipation-presenting IBS and chronic constipation do exist. If you come from a place of utter disbelief in her symptoms, I can pretty much guarantee you that she will not listen to you.
posted by janey47 at 11:16 AM on July 25, 2013 [5 favorites]

Laxative abuse can be a symptom of an eating disorder. Having said that, I should emphasize that there is no evidence here that she has an eating disorder, and you shouldn't jump to conclusions about it. All you know is she takes a lot of laxatives. You don't know why.

I think you can tell her "that sounds like a lot; have you talked to a doctor about it?" And you can tell her husband something like "hey, I know it's not my business, but I'm worried about your wife because it sounds like she's taking a large amount of laxatives and that doesn't seem healthy." But that's about the extent of it. The more you push or plead, the more likely it is to backfire.
posted by Metroid Baby at 11:18 AM on July 25, 2013

Best answer: Considering she's married to an immediate family member, it is partly "your business," but only to bring up your suspicions in a loving and honest manner directly to your relative in a face to face conversation.

However, whether or not they heed what you say is none of your business. As this is a one-time conversation you hope to have, don't hedge the issue. Use full disclosure. Let them know that you have some observations about their spouse, what these are, and that you are only mentioning this out of love for the both of them. Close by saying that you'll do whatever you can to help if it becomes necessary. Then butt out and let it lie for good or until someone asks you for help.

If at some point your hunch is right and it progresses into a known problem, your relative will know that you're available to turn to for support.

If you're wrong, it's a one-time private conversation with your immediate family member who is their spouse. That's it.

If it remains an issue not determinable, you've said your peace, your side of the street is clear, and you can move on and continue your relationship with at least your immediate family member without feeling you're silently and helplessly watching a tragedy unfold.

Additionally, as with all addiction or compulsive damaging behavior, it is the biggest bullshit addict cop out to say "Well, I'm only hurting me" completely disregarding the distraught and destroyed mothers, fathers, spouses, siblings, children, extended family, friends, co-workers, employers, etc. ....the list can be expanded ad infinitum.
posted by Debaser626 at 12:32 PM on July 25, 2013 [1 favorite]

FYI, it's not uncommon for people, especially women, to have their mystery illnesses be diagnosed as a Psychiatric condition.

When I started having weird movement issues, I had doctor after doctor tell me it was all in my head - until I saw a Movement Disorder Specialist. He also thought it was all in my head. Turns out that my Basal Ganglia is misfiring, and I have Spastic Paraparesis. I didn't need psychotherapy, I needed Baclofen. Now that I have it, I'm some 90% better.

So, her 'mystery illness' may be something genuine, but undiagnosed. I wouldn't discount it.
posted by spinifex23 at 12:49 AM on July 26, 2013 [5 favorites]

Came back to say what spiniflex23 said: all too often, a lot of women get told their pain isn't real, it's all in their head. For example, I used to work with a woman who --- after trying for YEARS to get a diagnosis --- was finally told she had an ulcer.... her doctor was shocked: "only MEN get ulcers!" (Heck, a higher percentage of women than men die of heart attacks every year, because they get blown off like that.) So it's very possible that your relative IS suffering, IS trying to get help, but is being told her pain isn't real.
posted by easily confused at 5:01 AM on July 26, 2013 [3 favorites]

Oh, and the great ironic thing about this? I actually went a therapist and Psychiatrist for this originally, who both disagreed that it was Psychiatric. Yet, when future doctors suggested is was mental in origin, I'd mention that my Psychiatrist disagreed, and they had my explicitly permission to contact him to discuss the diagnosis. They never took me up on it.

Maybe the one thing I'd mention that maybe it'd be worth for them to see a mental health professional about this, to either definitively rule it out, and/or get it treated if it indeed is psychiatric in origin.
posted by spinifex23 at 6:32 AM on July 26, 2013