Adolescent Anxiety and Disordered Eating

Fay Hamilton’s anxiety and restrictive eating are presented not as isolated symptoms but as difficulties entangled with secrecy, family conflict, and the upheaval surrounding Charlie Hamilton’s disappearance. Therapy notes document her food restriction, fear that her parents are hiding things from her, and uncertainty about whom she can trust; at home, Kathy Hamilton sees the physical changes that Fay’s treatment records describe. The novel leaves her without a diagnosis or a simple recovery arc, instead showing how distress can persist beneath moments of apparent composure.

Anxiety, Secrecy, and Trust

In a confidential therapy progress note, Fay’s therapist records that the tension at home feels unbearable to her. Fay believes her parents are keeping secrets, and the resulting doubt about their trustworthiness is damaging the parent–child relationship. She does not yet entirely trust the therapist either, which the note connects cautiously to the difficulty she has making meaningful connections amid the secrecy at home. Fay says she feels close to neither parent. When the therapist suggests confiding in a close friend, Fay asks whether the two of them are friends; she also asks how to become a therapist and what qualifications the therapist has. The note treats these shifts as possible deflection or an effort to settle her mind, not as a definitive explanation of her behavior.

Fay’s questions also test the boundaries of the therapeutic relationship. When she probes into the therapist’s private life, the therapist redirects the conversation to Fay. The therapist again explains confidentiality, hoping Fay will feel safe enough to disclose more, but records uncertainty about whether she believes her parents will not learn what she says in sessions. The note says the exceptions to confidentiality do not appear relevant in Fay’s case, while also acknowledging that reassurance has not fully resolved her doubts. Trust is therefore both a stated therapeutic aim and an unsettled condition of the work.

Restrictive Eating and Its Visible Signs

The therapist records that Fay is limiting her diet and has declared herself vegetarian, although nobody else in the household avoids meat. Fay wants to show the definition in her abdominal muscles and appears to expect praise. The therapist instead tells her that a healthy weight is more admirable. The note also describes Fay as somewhat disheveled and records that, despite previously saying she wanted to cut her long hair short, she has not done so. These details are observations, not proof of a single cause or diagnosis; together, they show a clinician watching for changes while trying not to reinforce Fay’s focus on thinness or definition.

The concern becomes concrete in Kathy’s observations at home. Kathy notices that Fay’s forearms have grown bony over roughly the past month, that her hands look too large for her, and that she is deliberately wearing baggy clothes. When Fay declines more food, Kathy offers the potato chips she likes, hoping to make eating easier without turning the moment into a confrontation. Fay takes a bag, crunches the cheese-and-onion chips, and reads the calorie count on the packet. Kathy recognizes that the chips are not nutritious but is relieved that Fay is eating something. The small exchange makes the tension plain: the effort to offer food meets Fay’s attention to its calories, while Kathy tries to respond without escalating the situation.

Treatment During the Family Crisis

The pressure on Fay continues as the household faces Charlie’s disappearance and Megan Carter’s stay with the Hamilton family. When Fay comes downstairs, Kathy sees that her hair needs washing and that she looks tired and sweaty; she has arranged another therapy appointment for a couple of hours later because Fay is not coping well. The progress note from a session describes Fay as upset by the tension at home and worried about her parents’ trustworthiness. Therapy is thus shown as a response to distress already affecting daily family life, not a quick resolution to it.

The therapist gives Fay an information pack on nutrition and asks her to educate herself about it, along with practicing meditation techniques. Fay leaves this session feeling more relaxed, but dreading the return home because she expects the conflict to start again. The therapist has also suggested exercises for moments when she feels out of control and encouraged her to focus on schoolwork. The assessment is cautiously hopeful: the therapist believes Fay has coping mechanisms for her current stress, while the note’s record of her continuing dietary restriction indicates that the problem remains under observation.

Concealment, Setbacks, and Uncertain Progress

Mitch Hamilton’s explanation to Chase Cooper reveals another pressure bearing on Fay. Mitch says Fay believes Charlie is adopted; he and Kathy have not told her that Mitch is Charlie’s biological father, because they fear the revelation would add to her anxiety. He points to Fay being too thin and worries that learning about his affair could lead her to hurt herself. This is Mitch’s expressed fear, not evidence that Fay has attempted self-harm. The concealment nevertheless sharpens the conflict already recorded in therapy: her suspicion that her parents are keeping secrets has a basis, even as the adults frame silence as an effort to protect her.

After further revelations leave Fay tearful and despondent, a later therapy note records a marked change in how she describes her dependence on others. She concludes that she can rely only on herself because her parents are capable of letting her down. By the middle of the session she appears stoic and determined to move forward regardless of how hurt she feels. The therapist considers that this apparent improvement may instead be a defense against fresh disappointment, with anxiety only temporarily eased. Fay does not want to discuss her disordered eating, believing it will go away on its own; because the therapist considers her to be at a healthy weight at that point, the therapist does not press the issue. She also refuses, for the first time, to set goals, calling them empty gestures. The note records no safety concerns, but describes her new coping strategy as pretending everything is fine so long as she relies on herself.

Fay’s arc keeps outward signs and inner reassurance in tension: the eating restriction is noticed, discussed, and at times left unaddressed, while her willingness to trust adults rises and falls with what they conceal. The clinical notes supply a second view of the family crisis, recording both practical interventions and the limits of what those interventions can establish. Her distress is not resolved by appearing calmer; the later refusal to discuss eating and to set goals leaves the question of progress open.