One of my goals at TTT is to share encouraging content with you, and that is certainly my goal for today’s post. This wasn’t an easy post for me to prepare because it involves the death of a young woman due to a severe eating disorder. However, her mom, Dr. Lisa L. Billings, demonstrates great courage in transparently discussing her daughter’s eating disorder and the sadness that she has experienced as a result of it. Not only do I want this post to be an encouraging reminder to unconditionally love those in your life who are battling an eating disorder, but I also want this post to be an encouraging reminder that because of Jesus’ suffering and death, we can find purpose in our deepest sadness. He wants to draw us near, friends.
Surely our griefs He Himself bore, and our sorrows He carried; yet we ourselves esteemed Him stricken, smitten of God, and afflicted. But He was pierced through for our transgressions, He was crushed for our iniquities; the chastening for our well-being fell upon Him, and by His scourging we are healed. All of us like sheep have gone astray, each of us has turned to his own way; but the Lord has caused the iniquity of us all to fall on Him. (Isaiah 53:4-6 NASB1995)
Here’s my interview with Dr. Billings.
Tell readers a little bit about yourself—your background, family, career, hobbies, etc.
I grew up in Chicago in a very academic family. My father was a professor at the University of Chicago. I got my BA in psychology at Dartmouth College and went on to get my PhD in Clinical Psychology at the University of Virginia. Maddie’s (my daughter’s) father and I met and in college and married right before we started graduate school at the University of Virginia. We had Maddie and her sister, Emma, while in graduate school. In graduate school, I focused on how traumatic childhood experiences affect developmental trajectories and looked at what factors help mitigate these negative effects. I came to Denver, Colorado in 2000 to do my clinical internship at the Children’s Hospital Colorado and fell in love with the people and beauty of Colorado, and we’ve never left. While in Denver, we had two sons, so we now have four kids, ranging in age from 16 to 23. Maddie was our oldest.
The way I found out about you was actually through Daily Mail.com. Can you summarize that article for readers?
I’ll be honest—the Daily Mail didn’t interview us, nor did they call us to check their quotes. We were interviewed by a wonderful local Denver anchor for the NBC News, Kim Christiansen, and the news piece aired in mid-June. The Today Show picked up the story and interviewed us further. I purposely didn’t read the Daily Mail article because I so was offended by the headline. It called Maddie “brilliant but psychotic” and took something Maddie’s father, Nick, said out of context. Maddie was never “psychotic.” During the last few months before she died, her incredibly intense Ed (eating disorder) thoughts became more and more removed from reality, and her desire to check them out with us increased. She began obsessively worrying about her bodily functions. Nick commented that her thinking sometimes seemed psychotic because her thoughts were so repetitive and unrelated to what she had always held important in her reality.
At any rate, the original story focused on Maddie’s relentless struggle with her anorexia that began to develop the summer she turned 12 and continued relentlessly until her death by starvation and multiple organ failure at age 23. I first noticed that Maddie had lost significant weight when I picked her up from a sleepaway camp the summer before she started eighth grade. Given my clinical training, we swiftly took action. We took her to her pediatrician immediately, set up a weight restoration program with a dietitian, and got her set up with one of the best outpatient Ed therapists in Denver. While she quickly recovered from her initial bout of anorexia and had a good eighth grade year, the behaviors came back with a vengeance her freshman year of high school. At that point, we put her into her first of a long series of inpatient treatment programs here in Denver. Between high school and last December, she went to almost a dozen programs—many of which were in Colorado, but there were also some in Massachusetts, Utah, Oklahoma, and Arizona. While she had periods of recovery during high school and college, she never fully experienced respite from the hounding, obsessive Ed thoughts, driving her to be thinner and to exercise harder.
How did you find out that your daughter was struggling with anorexia? What was your initial reaction—especially as her mom but also as a licensed clinical psychologist?
During the summer that Maddie turned 12, she insisted on having a busy summer with lots of travel and time away from home. I picked her up from the final three-week sleepaway camp of the summer, and she was just a fraction of the girl I had dropped off. I was very aware of the devastating effects of serious eating disorders, as I had done a six-month clinical rotation at the Children’s Hospital Colorado in the inpatient Ed unit while doing my clinical internship for my doctorate in psychology. I vividly remember one of my first patients there. She was 19 years old and weighed 78 pounds. Her head looked too big for her body, and she had downy fur all over her body. The hair on her head had mostly fallen out. She had been an incredibly beautiful, bright, athletic soccer player who had developed anorexia in early high school and subsequently spent more time in the hospital than out of it. I thought of my daughter Maddie (who was two years old at the time) and my daughter Emma (who was eight months old at the time) and prayed daily that this disorder would never terrorize my daughters. It was chilling to end up in that same unit 10 years later with Maddie as a patient.
What steps did you and your husband take throughout your daughter’s journey through anorexia to help her find healing?
Honestly, we tried everything. Denver happens to have two nationally recognized Ed programs, the Eating Recovery Center and Children’s Hospital’s Eating Disorders Program. Maddie went to both of these programs, all the way through from inpatient to day treatment to intensive outpatient therapy. As a family, we became well-versed in the Maudsley Method (or Family-Based Treatment), which required that we take control of her food intake. Soon, family meals and vacations revolved around Maddie’s eating, which caused a lot of resentment with our other three children. We sent her to a very well-regarded program in Tulsa, Oklahoma for three months during her senior year of high school to help her take more ownership for her eating and exercise management, as she had been relying on me and her dad to impose strict rules and consequences around her food intake and exercise (mostly by restricting her soccer team participation). We knew that if Maddie was going to be successful in college, she would need to learn to take on these responsibilities herself. Despite how strong Maddie’s Ed-related thoughts were during high school, she still excelled academically and athletically. She had an obscenely high GPA and always insisted on taking the most rigorous course load available. As a senior in high school, she captained her high school soccer team to the state championship. She also got into her first-choice college, Dartmouth College, an Ivy League school that both her dad and I had attended.
Dartmouth College had an incredible Ed program as part of their student health services. We met with them before Maddie started her freshman year, and she had to meet with the team weekly to get weighed. If she dropped below her target weight range for longer than a couple weeks, the college forced her into medical leave. Once Maddie went away to college, it became really hard for her to keep her anorexia in the backseat. Without the meal support that we had provided at home, she starved herself and got taken out of college within six weeks. From that time until her death, she was in and out of eating disorder programs of every type.
What was the hardest part of watching your daughter struggle with anorexia?
It’s absolutely heart-wrenching seeing your child struggle. I felt Maddie’s struggle in every cell of my body and only wanted to take away her pain and relentless intrusive thoughts. Her eating disorder caused her to be someone whom she really didn’t like. It created a barrier between her friends and family, whom she adored so much. And her hateful thoughts of Ed pervaded her mind from the time that she woke up until the time that she went to bed. They destroyed her sense of self and self-confidence.
I can’t imagine how difficult it must have been when your daughter passed away last December. Can you share what this experience was like?
Yes, for the year leading up to Maddie’s death, the Maddie we all knew and loved slowly faded away, and her wretched anorexia took over. She hovered at the lowest weight she had ever been. In January 2022, she started a program in Utah that we all felt hopeful about. Unfortunately, almost immediately upon arriving there, Maddie contracted Covid-19, and the program sent her to a regular hospital nearby to isolate in the Covid-19 unit. They wouldn’t let me into the hospital to hold her and support her during the 10 days that she was there. It was excruciating. I rented a room a block away from the hospital and brought over stuff daily to let her know that I was there. But it was a busy training hospital, and they had no idea how to handle Maddie’s eating disorder, despite my many calls and pleas. Ten days later, post-quarantine, she returned to the Ed program utterly defeated and 10 pounds lighter than she had started at. In general, Covid-19 took a huge toll on Maddie. She thrived on learning and friends and social connection, and when all that shut down, so did she.
At the time of her death, she had just been discharged from another inpatient program in Arizona. We were very unhappy with her care there. She actually lost weight while in the program, which was the first time that that had ever happened. Nick went to pick her up from the program and bring her back to Denver. We had planned to put her in a local program for very acute eating disorders patients here in Denver. She was on the waitlist for the program, but like everywhere else, the program was understaffed, and no beds were available for weeks. Her dad and I were desperate because we knew how sick and malnourished Maddie was, but we couldn’t get anyone to help. We brought her to the emergency room three times in the 10 days before she passed away. Maddie was scared too. We talked multiple times the day she died. She complained about how cold she was and how she didn’t have any energy but that she couldn’t make herself eat. When I didn’t hear from her first thing in the morning like I always did, I told Nick to run over to check on her, and he found her, already gone. Getting his call was the worst moment of my life.
How has this tragic experience affected your family, your career, and your life in general? Where do you find comfort and strength as you grieve?
It has brought our family extremely close together. Maddie’s father and I got divorced a little over three years ago, and it was extremely difficult on the kids. There were a lot of hurt feelings, and Nick was really fractured off from our family. However, now he is back and is very involved with our children again. We check in with each other every day. We talk and cry and laugh about Maddie often. I took about a month off from my practice but am now back full-time, and I feel that my purpose right now is to help others. I don’t see primary eating disorder patients because it’s too difficult. I primarily see young adults to help them deal with all the issues that go along with that developmental period.
If you could tell readers one thing about eating disorders and recovery, what would it be?
Eating disorders are ugly, pernicious diseases that need to be taken seriously from the very beginning. They can take on a life of their own and be so relentless. Always remember that your child is separate from his/her eating disorder, and make sure that you keep loving him/her hard. Get angry at the eating disorder, not your child, because he/she is suffering so much already.
Lisa Billings, PhD is a licensed clinical psychologist. She has a private practice in central Denver that focuses on young adulthood and the myriad of issues that accompany this exciting yet perilous time of life.