My stepsister (S) is 21, in her second year at a uni 4 hours away. I’ve posted previously about our background so I won’t go into details now. Just before Christmas I’d posted about her relapsing into AN at university since being there from September, having gained weight to near WR over the summer.
She has continued to lose weight, and pretty much refused to even engage with me over Christmas break. Whenever I tried to approach her or encourage her to eat more she would completely ignore me, leave the room, or walk out. She spent a lot of time avoiding me and my H, especially at meal times. S was thoroughly miserable the entire holidays. Fortunately, she did eventually begin to open up to me about how difficult she has found managing the anorexia and her studies at uni, and I was able to persuade her to increase her intake by a few hundred calories – nowhere near enough to gain weight, but it was progress. It was only in the last couple of days of her being home that I think I saw the real S, not the S controlled totally by anorexia.
She’s barely been back at uni for a few days, but she had a GP appointment and the doctor is very concerned about her continued weight loss – she has reached a low of 37kg at 5ft 3in. Her obs are all fine which is a relief, but given her low weight and ongoing restriction (which improved slightly while she was home, and has worsened again at uni), S agrees that she needs to be home. If she continues to stay at uni much longer, even for her exams at the end of the month, she could seriously jeopardise her health. As a result, she will be taking medical leave and is moving home soon.
I am frantically trying to prepare to help her to refeed. She has agreed to let me be involved in meal planning and feeding her, but I do not want to get into negotiations with anorexia.
I have a few questions about refeeding…
She has been eating very little for the last few months, around 600 calories a day. How do I increase this? I would like her to be getting to a minimum of 3000 calories for weight gain, but I’m aware of refeeding syndrome and the risks… How slowly do we increase calories in the early days?
S is also petrified of binge eating. This is something that she told me she struggled with over the summer when she gained weight of her own accord – she ate a very controlled diet during the day and binged every evening and into the night. I often heard her sneak into the kitchen after we went to bed in the evenings… Is this common?
I don’t know if I should try and stop her or not – I believe that once she’s eating sufficiently throughout the day the urge to binge will lessen, but is this right? And should I try and stop her from bingeing? If she is in the early stages of refeeding and she binges on thousands of calories does this put her at risk of refeeding syndrome? I know it’s quite rare, but I am so concerned about her… I just want her to be safe and healthy, goodness please that would be a dream come true.
Anyway, I’m so sorry for having so many questions! Any help would be truly appreciated.