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ac24

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Reply with quote  #1 
Hello I am new to the forum. D 15 yrs diagnosed with An in March 2017 restrictive eating, anxiety etc. We caught it early and have been refeeding (3 snacks and 3 meals daily) with success, along with doing FBT. Now back at prior weight as of this week and medically stable. D has been attending an outpatient day program full time for the past few weeks and has been doing really well with her eating. She is trying challenging food, last night ate a cookie, will eat out in a range of restaurants relatively stress free and is coming along both with her eating and how happy she is inside. She now feels that she is in recovery and that she isn't getting anything out of the day program. She says she feels positive and is happier than she has been in months and that the program is no longer helping her and she can't relate to the other program participants who are all really struggling with food. She says she is open to treatment and wants to continue seeing her psychologist and dietician privately but not completing the program. I am really torn. While I am delighted she is doing so well, I am also cautious about pulling her out of a 3 month program 4 weeks in. It was only a few weeks ago that she was in a very dark place. Part of me hopes that was her hitting rock bottom before achieving her weight recovery and we are truly on a bright path, but another part of me worries that this is ED showing us a happy outlook and that things will go backwards if we let up and say yes. While we have banned all exercise for the past few months I have recently started taking D to a gentle Pilates class and allowing some gradual exercise which she is loving and also she is not trying to do more which I am also very happy about. I would really appreciate any advice or guidance others more experienced than me can offer.
toothfairy

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Reply with quote  #2 
Hi there,
A warm welcome from Dublin!
Well done on getting so far in a short space of time.
First her weight, she probably needs to be brought to her original growth curve including extra for any inches grown since, plus about 10lbs.
She will also need to keep gaining into her 20's.
It is a common error in treatment that the clinician sets the target weight too low, therefore impeding recovery.
It is common to put up a level of resistance to treatment, & I would definitely not allow her ( ED) to manipulate you into letting her stop treatment.
It is common for the sufferer nott to realise that they are ill or still ill, it is called anosognosia.This is a symptom of the illness.

Whilst your D has done great in the last couple of months, this illness sadly does not normally just go away, treating it is a marathon & not a sprint, normally taking at best a couple of years to get to full remission.
Many of us , my hand is up , had a short course of illness & caught this horrible illness early, but often our kids need treatment & supervision for a long time to keep them in recovery.
Of course I don't know, but I would also be nervous that ED is trying to throw you off the scent by seeming like all is well. ED can be very sneaky & cunning.

I am not a fan of exercise in recovery.
Exercise can be a form of purging, & can feed into the anorexia. I would definitely not allow her exercise for the forseeable future.
It is great that you stopped it.
This is all just my opinion, & Kudos to you for doing so well in this battle to date.
Best wishes
TF

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Son,DX with AN, (purging type) in 2015 ,had 4 months immediate inpatient,then FBT at home since. He is now in strong recovery, (Phase 3 ) and Living life to the full, like a "normal"[biggrin] teen. This is with thanks to ATDT. Hoping to get him into full recovery and remission one day at a time. Getting him to a much higher weight, and with a much higher calorie plan than his clinicians gave him as a target, was instrumental to getting him to the strong recovery that he is in now. Food is the medicine.
Foodsupport_AUS

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Reply with quote  #3 
Welcome to the forum. Sorry that you have had to find your way here. You have made some amazing progress with weight restoration and in getting D back to trying new things. 

At the same time like you I am nervous about withdrawing from a 3 month program one month in. 
It is possible your D does find it difficult, and if she is doing much better in her recovery than the others she may truly find it unhelpful. Many who are recovering find it easier to avoid listening to those who are still suffering finding it tends to increase their ED thoughts.  It does however sound like a dramatic turnaround and this is atypical for AN. 

Is is worth suggesting continuing for a little longer and you assessing how you feel she is coping? You could perhaps set up further reviews with others in the meantime to get some further measurement of how she is truly coping. 

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D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
toothfairy

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Son,DX with AN, (purging type) in 2015 ,had 4 months immediate inpatient,then FBT at home since. He is now in strong recovery, (Phase 3 ) and Living life to the full, like a "normal"[biggrin] teen. This is with thanks to ATDT. Hoping to get him into full recovery and remission one day at a time. Getting him to a much higher weight, and with a much higher calorie plan than his clinicians gave him as a target, was instrumental to getting him to the strong recovery that he is in now. Food is the medicine.
toothfairy

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Reply with quote  #5 

http://tabithafarrar.com/2016/12/anosognosia-eating-disorders-dont-know-sick/

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Son,DX with AN, (purging type) in 2015 ,had 4 months immediate inpatient,then FBT at home since. He is now in strong recovery, (Phase 3 ) and Living life to the full, like a "normal"[biggrin] teen. This is with thanks to ATDT. Hoping to get him into full recovery and remission one day at a time. Getting him to a much higher weight, and with a much higher calorie plan than his clinicians gave him as a target, was instrumental to getting him to the strong recovery that he is in now. Food is the medicine.
Kali

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Reply with quote  #6 

Dear ac24,

Welcome to ATDT! It is really great that you have helped your d. with an early intervention, and she has regained what she lost and her state has improved! [smile] You are right to be concerned about pulling your daughter out of the program at this stage. 

Quote:
Now back at prior weight as of this week and medically stable. 

Quote:
It was only a few weeks ago that she was in a very dark place.


Many of us here have found that weight restoration was only the beginning of recovery. 
Research has shown that if a sufferer goes through a maintenance stage (maintaining their recovery weight for at least 6 weeks or so before being discharged to a lower level of care) they have a higher chance of ongoing recovery than if they are discharged right at the point where they become weight restored. Many of us have also found that our kids needed to continue to consume a fairly high-calorie diet for the months after initial weight restoration and that they still needed to be eating their meals with a support person for a long time after weight restoration.

Warmly,

Kali


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mjkz

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Reply with quote  #7 
Wow!!  Your daughter has made amazing progress and in a very short time.  I can see why you are torn about what to do.  One thing I can say is I've never regretted requiring my daughter to finish a treatment program she started.  I have always regretted the ones I let her quit prematurely.

Can you meet with the program staff and have a discussion about how she is doing and where they think she is at?  They may be able to give you valuable insights into where she is struggling that your daughter can't see at the moment.  They might agree that she has done all she can in the program and is ready to stop.  Either way, your daughter can see that you heard what she was saying and listened to her, took her seriously.  There may be ways too that the staff can tweak the program for her to help her move farther into recovery and help her prepare for being home full-time without their support.  I would never pull (again) my daughter from a program without taking to the staff and getting their opinion.
tina72

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Reply with quote  #8 
Welcome! Thats great so hear that your d is doing so well. Just to throw another position in here:
I can understand when your d says that she has a problem with the other patients there struggling with food. My d had one point in recovery when she felt she was the biggest and most eating person in IP and every body else was more anorexic than she was and she felt bad about that (that is ED, I know). At that moment she was better being together with healthy friends that eat normally and not to see anorexic behaviour every day.
We took her out of IP at that point ad for us that was the right decision. There is a point when they are ready to get into that normal life again and we should be alert, but you must take that chance to get back into normal life, I think.
I would talk to the staff there, as mjkz said. Maybe she is at that point, but maybe she just doesn´t see what problems are still there.
You´ve done a great job! Congratulations!
Tina72
ac24

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Reply with quote  #9 
Thankyou so much for your advice and support. I can't tell you how much it means to me right now. Since I last posted we have met with D's private psychologist and also had a family session at the outpatient day program. D is headstrong and believes the program is not helping her any longer to the point where the level of distress each morning before going and each evening when she comes home is causing us concern that she will start self harming again. It's also exhausting to rehash it every night over dinner. She says she can do this food thing (and to my delight she has been even through this stressful period) and now wants to work on her anxiiety and other underlying issues which are causing her more distress than the ED and which he program is not geared to support. She acknowledges she's still got anorexia, but feels she has the tools to manage this with our support outside of the formal treatment program. We got her to agree to doing two more weeks - so that we could set up the necessary support from her psych, dietician and school to enable her to continue to progress her recovery outside of the formal program and transition back to her school. I called it a checkpoint meeting in 2 weeks while she is calling it a discharge meeting. Nonetheless she is reluctantly going for two more weeks and boy are we hearing about it. While I am hoping for a miracle and that her attitude changes and she sees the rest of the program through, my husband and I have agreed we need to get plan B in place and ready to action. D also knows that she needs to maintain her weight otherwise all negotiations are off the table and she will be forced to complete the day program. I think if I push any harder she will shut down and completely refuse to participate or try to get anything out of the program at all. On the positive side she is eating 3 meals, self monitoring her snacks including "this yoghurt isn't big enough so I need to eat 8 almonds as well'" and even had a chai latte with me when we took the dog for a walk yesterday morning. She's also finally happy again (except when we talk about continuing in the day program) so while I am terrified a part of me feels like we have to trust her and see where this goes. I know we still have a long road ahead of us so I am just taking it a day at a time.
mjkz

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Reply with quote  #10 
Quote:
D is headstrong and believes the program is not helping her any longer to the point where the level of distress each morning before going and each evening when she comes home is causing us concern that she will start self harming again. It's also exhausting to rehash it every night over dinner.


I wouldn't rehash it with her anymore.  She has agreed to do two more weeks and reevaluate.  It is a done deal and I would not discuss it with her.  If she starts rehashing it, I'd just do what I do with my daughter when she started arguing food.  I'm not going to have this conversation with you. You agreed to do two weeks and reevaluate.  End of discussion.

A very good clue as to how far into recovery she truly is will be how long she continues the conversation.  As my daughter got better and farther in recovery, I didn't have to remind her at all.  At the beginning she used to follow me to argue to the point I would put my ipod headphones on just to make the point that I was not going to listen to her ED arguing.

If she is starting to self-harm again, I don't think I'd pull her from the program. She can still work on her anxiety by continuing to go and working through the feelings being there causes.  I only let my daughter leave treatment once and I regretted it for a very long time.  No one ever said treatment was fun or would not cause distress or other feelings.  The point is to learn to work through them and finish.
Torie

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Reply with quote  #11 
Hi ac24 - It sounds like you and your d have made great progress so far - kudos to you both!

It also sounds like you have a tricky decision to make regarding the next stretch of treatment.  As you probably know, anxiety tends to ramp up at various points in treatment - one of the classic patterns is an anxiety spike at or shortly before weight restoration.  Weird.  

The main thing, of course, is that she MUST continue with full nutrition.  Any "deals" you make about changes in treatment should include provisions for possible backsliding - for example, if she loses weight or starts rejecting food items or missing meals or whatever, then she will have to go back in the program.  (Maybe allow one week to reverse the slide and if she doesn't, then back in she goes.)

It's so unfortunate that the difficulties tend to ramp up just as you're seeing the light at the end of the tunnel.  Like so many here, we experienced that, too, and had to find creative ways to press onward through the final hurdles.

Please be sure to keep us posted. xx

-Torie

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"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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