DEAR AMY: I am a 14-year-old girl, and I have a 20-year-old sister who has anorexia. She was officially diagnosed when she was 15. When she was in high school, she was in and out of the hospital. Since then, she has gone to college and is now a junior.
Although she is not as bad as she used to be, she has not recovered and probably never fully will. The issue is that she refuses to go to a general care doctor. Not a specialist, just a general doctor.
My parents and I are at a loss as to how to convince her to see a doctor. She refuses and argues every time it is brought up. Is there anything we can do?
— Worried Sister
DEAR SISTER: Anorexia affects the entire family. I assume you worry about your sister, and I hope you don't feel you need to shoulder this burden for your family.
I shared your letter with Dr. Claire McCarthy, a primary care pediatrician and medical communications editor at Boston Children's Hospital. She answered: "Eating disorders can be so devastating, not just for the person who suffers from them but for everyone who loves them. I know this not only as a doctor, but as a survivor of an eating disorder.
"It is wonderful that your sister is doing better and that she is able to be in college. These are achievements that aren't to be taken for granted when it comes to eating disorders, which can be lifelong.
"Your sister is legally an adult now, and unless you think that she is a danger to herself or incapable of making decisions for herself (in which case your family should talk to both her doctor and a lawyer), the frustrating fact is that you can't force her.
"It might help to give her as much control as possible by letting her choose the doctor and set the agenda. Your folks could also reach out to people in her anorexia care team, especially if there is someone she likes and trusts. This person might give your family insight."
Dr. McCarthy and I wish you all well as you continue to cope with this challenge. Your sister has a lot going for her already: She has you and your family.
DEAR AMY: I love my sister, but she has huge problems. As a child, she ran away, bullied others, tried to commit suicide and was hospitalized. In her 20s she was diagnosed with borderline personality disorder. She eats therapists and drug rehab like Halloween candy. She lies, steals, begs for money and is verbally abusive.
After years of trying to help her, for my own sanity I ceased contact with her last spring.
Now it is holiday time. What do I say to my mother who says she just wants to have a happy Christmas together? I feel like the bad guy.
— Sad Sam
DEAR SAM: Here's a script for a possible dialogue:
Mom: Sigh. I really want to have a happy Christmas with all of us together.
You: Sigh. I know you do, Mom. That would be nice. I'm so sorry it's not possible. Can you help me think of something you and I could do together that would be different but fun?
If you don't want to have any contact, you'll have to restate that in a respectful and calm way: "I've decided to keep my distance from Sis, but I don't want you to worry about that. That's my choice."
Protecting yourself from a toxic person does not make you a bad guy. It makes you a guy who's taking care of himself.
DEAR AMY: I was moved by the letter from "Sad Dad," whose 14-year-old daughter was refusing weekend visitation. Teens need stability at home and the knowledge that their parents are there, no matter what.
He needs to just keep trying. Keep checking in with her, invite her to a picnic or a bike ride or to do something together that they enjoyed when she was a child.
DEAR MARY-JEANNE: Many readers wrote notes of encouragement that this dad should not give up on his daughter.
Send questions via e-mail to firstname.lastname@example.org. Amy Dickinson's memoir, The Mighty Queens of Freeville: A Mother, a Daughter and the Town that Raised Them (Hyperion), is available in bookstores.