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toothfairy

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Reply with quote  #1 
Hi all,
This came up in my normal search to get on this site today
, I just typed in "aroundthedinnertable" & it was on the list with the other😬 MPA ones.



https://kiwifarms.net/threads/around-the-dinner-table-atdt-forums.29083/

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Son,DX with AN, (purging type) age 13 in October 2015 ,  (4 months immediate inpatient) , Then FBT at home since.and making progress every day. He is now in good recovery, and Living life to the full like a normal teen. We are not completely out of the woods yet, but we can see the light at the end of the tunnel, thanks to ATDT. Hoping to get him into full recovery and remission one day at a time.
Foodsupport_AUS

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Reply with quote  #2 
Oh well. Having seen what Kiwifarms is I am not surprised that we have rated a mention there. The whole site seems to be devoted to trolling and ridiculing things that they don't seem to understand. 
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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.
meadow

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Reply with quote  #3 
Makes me really sad. This site has without doubt been the single most helpful thing for us as a family.
mjkz

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Reply with quote  #4 
I was over on kiwifarms and then the proana website.  It was gratifying to see for just about person who raked us over the coals for being overcontrolling, etc. there was another saying gee, I wish my parents had cared enough to do something.  There were quite a few who recognized that we as parents and loved ones who were supporting someone with an ED needed a place to vent and get support too.  It was also very interesting to see that the posts that we often thought were trolls or sufferers posting over here-it was and the mods caught them at it.  I had to laugh at how often we were talked about over on the proana web site.
iHateED

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Reply with quote  #5 
It is so scary what you can find on the internet.  You can clearly see that those posters are still suffering severely with their ED's and it breaks my heart for them.  I know my D had the same feelings about FBT when we first started down the path several years ago, but now she knows it saved her life!

berry75

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Reply with quote  #6 
Ok just looked at the site,I can see why the comments were made.There is no way any research was undertaken before bagging this site.I personally would not have gotten through the last year without the advice from this forum.I did do research hours and hours days and months of research into the best most effective treatments.Under the advice of doctors we started this process.I am not a doctor or an expert and I never claimed to be.I just want my daughter back
aboncosk

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Reply with quote  #7 
Wow!  Had no idea this type of "hate" is out there.  Our family has gone the traditional medical/treatment approach - it didn't work.  They excluded us as parents and who better to know the child than the parents? And who is the person that will be in the home caring for the child (if not in residential/inpatient care) than the parents. 

These sites anger me.  They are entitled to their opinions just as we are entitled to ours.  I can attest to Maudsley working for our daughter.  It's only been seven weeks of using this approach but she's achieved 1/3 of her weight gain to her restoration weight.  All the PHP/IOP treatment facility did was exclude us and cause anxiety over foods that they fed her and from there it was months of losing a pound here and a pound there.  Coming from the week long Intensive Family Treatment program at UCSD - we are doing this under the advise of medical professionals and those who support and back research for eating disorders. 

What's that saying - haters gonna hate...we can't change that but we can continue to support one another and help our children beat this insidious illness.  Rant over.

iwanttohelp

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Reply with quote  #8 
Hello (i wanted to start a new post where i introduced myself, but i was told from the system i have no permission for that).

So i am a learning psychologist from Europe, Germany and want to specialize in ED treatment. I volunteered already in 3 clinics here in G. The approach is VERY different to what i find here and its for me interesting to read from the view of a parent/caregiver. Here its very usual to put sufferes in treatment for several months, actually i have never heard of a family doing FBT or magic plate at home. Personal i am not sure what to think of this way bc its so different from what i see and learn about this illness.

So i did a bit of research into a group of recovered and semi recovered sufferers from one clinic (they all are young adults now and their treatment lies at least 1 year back), asking them if they could imagine their parents having done this approach and if they would have found it helpful or not. The answers were pretty much the same like on this pro ana site: nearly every girl (most of them were girls/women) said that they would have found it more harmful than helpful and a big problem for the further relationship with their parents.

Also, most of them critized the way of considering their ED as only a nutritional problem. They mentioned severe causes and reasons for their Ed, what no food in the world would have been able to fix. But they also agreed that being at a healthy weight and not malnourished is the base to start working on their problems.

Maybe this can be helpful?


Please be kind with my language problems....:-)
Foodsupport_AUS

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Reply with quote  #9 
Iwanttohelp this is a forum primarily for caregivers. Although professionals are able to read they may not start a thread. 

Your information is not new, however perhaps in your professional reading you may choose to read about FBT further and look at the numerous papers which have been produced showing that this method works. No one with an eating disorder likes being treated by FBT however it is associated with the good results, fuller recovery and faster, hence its adoption as the primary treatment in most of the English speaking world. Long inpatient admissions have not in studies been shown to be particularly helpful, nor has psychotherapy. 

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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.
Kali

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Reply with quote  #10 
Hi iwanttohelp,

Welcome!

Quote:
said that they would have found it more harmful than helpful and a big problem for the further relationship with their parents.


Yes this would probably be the response of someone with an ED who doesn't want to eat! However as parents most of us have found that we are able to help our children and that without food and nourishment and maintaining an adequate weight AND therapy and or medication as needed, that recovery is not possible. Certainly the sufferer has feelings and can benefit from therapy but Ed is a biological brain illness and not the result of bad parenting or trauma or underlying problems and restoring the brain as best as possible by eating enough is the first line of defense against anorexia.

Read around the site and especially read the stories of parents who have helped their children reach full recovery and you will see that many of them have something in common: they never gave up on their child and they made sure their child received appropriate treatment and food and was weight restored. And the patients you spoke with also seem to realize that being at a healthy weight is the start of recovery.

Quote:
But they also agreed that being at a healthy weight and not malnourished is the base to start working on their problems.



best wishes

Kali

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Torie

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Reply with quote  #11 
Quote:
Originally Posted by iwanttohelp
So i did a bit of research into a group of recovered and semi recovered sufferers from one clinic (they all are young adults now and their treatment lies at least 1 year back)


Hi iwanttohelp,  I'm interested to know more about your research project.  Can you please tell us more?  For example, is the relapse rate there similar to what we see with FBT?  

I'm also interested to learn how it is decided that a sufferer will receive treatment - for example, do they need to get down to a certain BMI to qualify?

Thanks for dropping in.  xx

-Torie

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iwanttohelp

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Reply with quote  #12 
Good morning and thanks for your responses.

I am not totally new to the subject of FBT ;-) bc if you want to come to a reasonable conclusion of sth you have to inform yourself about it!

I know that FBT has good succes rates esp in young patients who live at home or will return home after an inpatient stay.
Its not true, that psychotherapy does not help! As i am going to be a therapist soon my own, i want to make this point very clear!
What is true: a very malnourished brain does not work properly, therefore it is needed to restore weight before therapy may work best.
Esp CBT has been evaluated and there are enough studies who show their efficience.

In Germany their are National Treatment Guidelines for ED, and there are two recommandation to all clinicans and other professionals:
1. evidence based psychotherapy
2. normalizing of eating and weight

In Germany there are 3 therapy options which insurances will pay for: CBT, PA and depth analysis.
FBT is very uncommon, even if there are good studies prooving the effect.

Different to the English speaking countries we have several very qualified treatment centers which are paied by the insurances as they belong to the health system. Sufferers dont have to be at a certain BMI, but below 15 it is advised. Goal BMI is mostly a BMI of 18 or higher. The whole system is based on semi voluntary: patients get a meal plan and supervised meals, but normally they also have the freedom to leave the clinic in their free time and enjoy themselves. If a sufferer does not gain enough, he will either be tube fed or discharged or transferred to a psychiatric ward. Different as in other countries it is not very common to put patients inpatient against their will by law. This may be heritage of the last century, i guess.


The group i did my research with were about 50 patients. 18 of them were in solid remission. 7 were relapsing and already waiting for a new hospital stay. 11 were wr but struggling and the rest was something in between.

There has also been a very large study in Germany (ANTOP) which showed good results with psychotherapy:

http://thelancet.com/journals/lancet/article/PIIS0140-6736(13)61746-8/abstract


I am not aganst FBT and i am impressed from what i read here in the forum. Esp the conditional love is heart warming and i deeply respect the efford every single parent here takes to help his or her child. Its just that i started to wonder why treatment guidelines and science seems to be so different over the countries. I read some papers which seem to proove the evidence of FBT and i think its sad that we dont have more clinicals here trying this!

The rate of relapses is not small, tho. A lot of sufferers need more than one stay.
iwanttohelp

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Reply with quote  #13 
Hi toothfairy, thanks for your reply.

I already know this video and the blog from Prof. Treasure. Her books were one of the very first i studied about ED!

Therefor i also asked the partipiants of my research if they felt a significant difference, when they reached a certain weight. Like: was there anything better/changing, when you reached BMI 18 or BMI 20?
The answers tho differed a lot. I remember one girl saying, she even wished it would be that simple: just getting at a higher weight and all the OCD and mood changes would get better. This girl was at a healthy weight for over 2 years, but the BMi changed during that time. So she experienced herself at a BMI of 23 and 20 and she said that the OCd and mood and depression wasnt effected or even in a bad way bc her mood dropped a lot with a higher BMI.

I know, you will probably say that she was not long enough at this weight ( i dont know how long and she does not either exactly). But i doubt this.

I discussed the idea, that fat and more weight gain will help, if a patient is at a bad state at BMI 18, with one of my profs, who is also the medical leader of one of these treatment centers. He told me, that ED are as long about food as somebody is undernourished (more important than being underweight) but that you cant feed the soul of the sufferers to healing. He said, the base is nutrition but its not the key to remission, but psychotherapy and helping the sufferers with their emotions, wishes, fears and so on, is.

Greets!
Torie

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Reply with quote  #14 
Thank you for the information.  It's really interesting to hear about treatment in Germany as we don't often hear from people who live there.  (BTW, my mom is German.).  I will intersperse my comments below:

Quote:
Originally Posted by iwanttohelp
Its not true, that psychotherapy does not help! As i am going to be a therapist soon my own, i want to make this point very clear!  What is true: a very malnourished brain does not work properly, therefore it is needed to restore weight before therapy may work best.


I think everyone here would agree with that or at least something very similar.

Quote:
Originally Posted by iwanttohelp
Esp CBT has been evaluated and there are enough studies who show their efficience.


CBT has been popular here on the forum, but my impression is that many here have been even more pleased with DBT.

Quote:
Originally Posted by iwanttohelp
In Germany ... Goal BMI is mostly a BMI of 18 or higher. 


Many here have found that their Ed-kid was still very ill at a BMI of 18.  Actually, my own d never got below a BMI of 18 at all.  And yet, she was very ill and (so lucky!) was diagnosed with AN by a physician at CHOP (Childrens Hospital of Philadelphia), one of the top-rated children's hospitals in the USA. 

Quote:
Originally Posted by iwanttohelp
The group i did my research with were about 50 patients. 18 of them were in solid remission. 7 were relapsing and already waiting for a new hospital stay. 11 were wr but struggling and the rest was something in between.


Wow! It must have been fascinating to speak with them!

Quote:
Originally Posted by iwanttohelp
There has also been a very large study in Germany (ANTOP) which showed good results with psychotherapy:

http://thelancet.com/journals/lancet/article/PIIS0140-6736(13)61746-8/abstract


THanks.  I will have a look.

Quote:
Originally Posted by iwanttohelp
i started to wonder why treatment guidelines and science seems to be so different over the countries. 


As you may know, the treatment guidelines in the US changed a few years ago (DSSM or something like that.) I suppose this is normal and they will change again as the science of EDs advances.

I often think how lucky we are to be living in the current century, as my d would not have qualified for treatment under the old guidelines.  We were able to get her weight restored at home, relatively quickly, as she received such a prompt diagnosis.  I shudder to think what would have happened had we waited until her BMI was down to 15.

Quote:
Originally Posted by iwanttohelp
The rate of relapses is not small, tho. A lot of sufferers need more than one stay.


I think all of us live in fear of relapse.  Well, maybe that's too strong, but yes, the relapse rate is sobering.  I think it is improving, though, with modern treatment.

THank you again for taking the time to converse with us.  Your English is great!  (So much (!) better than my German!) xx

-Torie

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Kali

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Reply with quote  #15 
Hi iwanttohelp

I think this is a really interesting discussion and that you will become an excellent therapist because you are curious and open to learning and as your name says, you want to help.

IMHO I always wonder why in some countries sufferers need to be at a very low bmi...15..13...etc. before they are admitted to residential/inpatient treatment. A person can be very ill at a bmi of 17... or 18......and research has shown that the sooner they get help, the better the outcome. One analogy is to compare it to cancer; why would someone start treating cancer at stage 4 instead of stage 1? My d. for example went to residential treatment at a bmi of 17 and was still very very ill when she reached a bmi of 18. So sometimes I wonder why treatment centers want to refeed someone to a bmi of 18 and why they think that is ok? The treatment center our d. was in went higher, she was released after maintaining a bmi of 20.5 for 6 weeks which research has also shown to be associated with better outcomes. When she came home we followed many of the fbt principles and had very structured mealtimes, supervision, etc. I did find that when d. was critically ill and at the bmi of 17 that therapy did not really help until she was restored to a higher weight. At a low bmi we were only engaging with the eating disorder in therapy and she really had limited insight into her situation. When she reached a higher bmi she was better able to understand what had happened to her. I'm not saying that the person should not be in therapy but just what I noticed during the process with my d. She has been in therapy continuously since we discovered she had AN.

I also think that a younger child does not engage in therapy the way a young adult might...so there are differences there.

Also, my opinion as a parent is that all the best therapists consider the family as part of the team and try to facilitate open communication and support for the family as well as the patient, so that the family can be well educated in how to best help the sufferer.My understanding is that research has also shown that the best recovery rates are when the sufferer has a supportive family. I hope that you will do that with your patients and their families in your practice. Families can really benefit from being coached about how to refeed their child and how to work out the conflicts in the family brought by the AN (lying, anxiety, etc); that was helpful for me for example. If you can harness the power of the family to really help your patients, you will be helping your patients get well because we are on the front lines with the disorder at home.

Here is a study they did at Columbia U. that I find interesting if you want to take a look: 
https://www.eurekalert.org/pub_releases/2015-10/zmbb-nsr100715.php

Essentially their research showed that when patients with AN make food choices, a different part of their brain is activated compared to people who do not have AN. it is pretty recent, from late 2015. Your professor is right when he says
Quote:
you cannot feed their souls to healing
because it is not about their souls it is about their brains.

Also there is a therapy called DBT here which has been helpful to many sufferers AFTER weight restoration, my d. did that also, as well as CBT. I wonder if you have that in Germany?

best wishes,

Kali

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mjkz

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Reply with quote  #16 
Quote:
I know, you will probably say that she was not long enough at this weight ( i dont know how long and she does not either exactly). But i doubt this.


Things don't magically improve but the longer the person is at a healthy BMI for that person, the more brain healing will happen and things will get better.  For some people like my daughter the thoughts never go away but we have done a lot of work on realizing that emotions are just feelings and they won't kill her whereas starving herself will.  The thoughts haven't lessened but her ability to fight them has grown in strength the longer she is at a healthy weight for her.

Quote:
Its not true, that psychotherapy does not help!


My daughter has been in therapy since diagnosis and refeeding started.  She has comorbid conditions so I felt it was necessary as long as she was also gaining weight.  Does it work as well as if she was a healthy weight?  No, but we have to work with where we are at and keep moving forward.  That doesn't mean she doesn't get anything from it and as she gained weight, her trauma issues got worse.  Her therapist has been amazing at helping her cope with the trauma issues and her own emotional dysregulation as she gained weight.  They focus on DBT and CBT along with EMDR and talk therapy so focus on where we are at now and how to move forward rather than digging in the past for reasons why she is the way she is, etc.

Quote:
Its just that i started to wonder why treatment guidelines and science seems to be so different over the countries.


History, cost, age.  No every family can do FBT and be successful.  My daughter has required numerous hospital stays and gotten to single digit BMI at one point so for us anyway it has been a combination of FBT at home, hospital stays as needed and tube feeding along with therapy in every form she found helpful.
iwanttohelp

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Reply with quote  #17 
Wow thank you so much for your input! I really love this discurs and i am happy for your kindness. Tbh i was a bit fearful to come here bc i am not a parent and i may have a different view on this topic.

We have DBT here! My Alma mater etablished one of the first ward with that therapy in Germany! But over here it is mostly used for BPD and/or PTSD, not Ed. I know a bit of this approach, but not enough to get deeper in it :-(

Its very interesting how treatment options have changed over the last 10 years in Germany. Back in the 90ys/00s the treatment centers would take patients above 16 ore even 18 only. So for the younger sufferers there was only the psychiatric children ward left. Today the leading and most polular clinics have special wards for the younger ones, where the approach is a bit different (more family therapy e.g. and more support from specialised nurses).

Its fascinating to work with them and i loved it! But there are still things i dont agree with, so in Germany the patients will never be blind weighted or only exceptionel. I think this puts an enormous pressure on them to be confronted with the numbers sometimes every day. I read that else where it is very common that the sufferers dont know even their target weight!

Of course its a brain based disease but this counts for other affective disorders like depression or mania or alcohol abusus aswell. You have these biological triggers and the neurological and the environmental triggers.


So, thanks for letting me know all your experiences, i will go on reading here and hopefully learn more about this cruel illness. For you all the best (now i have to go and do my studies about personality disorders bc this will be my next exam!)

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Reply with quote  #18 
Quote:
There has also been a very large study in Germany (ANTOP) which showed good results with psychotherapy:

http://thelancet.com/journals/lancet/article/PIIS0140-6736(13)61746-8/abstract



My reading of this is not seeing good results from psychotherapy. 
There was a small increase in BMI at the end of treatment and over 12 months (average of around 1.5kg/m2). There was no statistical difference between the study groups and there was no control. This supports psychotherapy as probably not making things worse, but as a study it would appear to have limited benefit. The high drop out also makes it difficult to know what is happening. 

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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.
Mamaroo

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Reply with quote  #19 
Hi Iwantothelp

It's great that you found this site. Reading through a lot of the posts will give you an idea how this illness affects the child and their family. Your English is also very good!

Have you heard of the Minnesota Semi Starvation Project?  A summary is given below, which I just grabbed from Wikipedia:

"The Minnesota Starvation Experiment, was a clinical study performed at the University of Minnesota between November 19, 1944 and December 20, 1945. The investigation was designed to determine the physiological and psychological effects of severe and prolonged dietary restriction and the effectiveness of dietary rehabilitation strategies.

The study was developed in coordination with the Civilian Public Service (CPS) and the Selective Service System and used 36 men selected from a pool of over 200 CPS volunteers.

The study was divided into three phases: A twelve-week control phase, where physiological and psychological observations were collected to establish a baseline for each subject; a 24-week starvation phase, during which the caloric intake of each subject was drastically reduced—causing each participant to lose an average of 25% of their pre-starvation body weight; and finally a recovery phase, in which various rehabilitative diets were tried to re-nourish the volunteers. Two subjects were dismissed for failing to maintain the dietary restrictions imposed during the starvation phase of the experiment, and the data for two others were not used in the analysis of the results.

In 1950, Ancel Keys and his colleagues published the results of the Minnesota Starvation Experiment in a two-volume, 1,385 page text entitled The Biology of Human Starvation (University of Minnesota Press).

Among the conclusions from the study was the confirmation that prolonged semi-starvation produces significant increases in depression, hysteria and hypochondriasis as measured using the Minnesota Multiphasic Personality Inventory. Indeed, most of the subjects experienced periods of severe emotional distress and depression. There were extreme reactions to the psychological effects during the experiment including self-mutilation (one subject amputated three fingers of his hand with an axe, though the subject was unsure if he had done so intentionally or accidentally). Participants exhibited a preoccupation with food, both during the starvation period and the rehabilitation phase. Sexual interest was drastically reduced, and the volunteers showed signs of social withdrawal and isolation. The participants reported a decline in concentration, comprehension and judgment capabilities, although the standardized tests administered showed no actual signs of diminished capacity. This ought not, however, to be taken as an indication that capacity to work, study and learn will not be affected by starvation or intensive dieting. There were marked declines in physiological processes indicative of decreases in each subject's basal metabolic rate (the energy required by the body in a state of rest), reflected in reduced body temperature, respiration and heart rate. Some of the subjects exhibited edema in their extremities, presumably due to decreased levels of plasma proteins given that the body's ability to construct key proteins like albumin is based on available energy sources.

One of the crucial observations of the Minnesota Starvation Experiment discussed by a number of researchers in the nutritional sciences—including Ancel Keys—is that the physical effects of the induced semi-starvation during the study closely approximate the conditions experienced by people with a range of eating disorders such as anorexia nervosa and bulimia nervosa. As a result of the study it has been postulated that many of the profound social and psychological effects of these disorders may result from undernutrition, and recovery depends on physical re-nourishment as well as psychological treatment."

That last paragraph is very crucial to understand. Psychological healing can only begin after physical healing.

Here is a link to a summary of the results, published as an aid to relief workers: https://archive.org/stream/MenAndHunger#page/n5/mode/2up

Good luck with your research work!


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D became obsessed with exercise at age 9. Started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for a year and WR at age 11. Challenging fear foods now.
iwanttohelp

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Reply with quote  #20 
Hello Mamaroo,

thanks for your input. Yes, of course i know the MSS and have read about it. Its very impressing.

As i told you before, i have been volunteering at treatment centers. One of them is known to take sufferers even at a very low weight. I always found it hard and heart breaking to watch, how the starvation has infected the whole appearance including the capability to think or st even speak (!) streight. And the miracle (well, kind of), nutrition can do! When they checked in, they often looked like zombies. Within the weeks of feeding, you could watch their personality come back. Its flashing!

But i think, nevertheless, there is one big difference between the men of the MSS and Anorexia: the mindset.
I dont think, that there are always traumatic experiences like abuse or violance. But there is something we call: microtrauma. It means, that if a person in very vulnerable and/or in certain circumstances like growing up/puberty or experincing changes in their lifes, they will feel more hurt by things or feel them with higher intensity. There is no checklist for this, some will be able to deal with things, others not.
And if a person with high vulnerability experiences too much of these microtraumas, it infects her view of themselves and the world. Like every person they will likely try to find a way of dealing with issues. And for some, its about control and weight and body appearance.
ED are a language you have to understand, if you want to help them.

Of course, there are other triggers like mentioned before. But someone with genetic praeposition ANd these triggers but instead having a solit self esteem and social net and support ist less likely to develop an ED.

Have you ever heard of Christian Bale, an artist? He lost a tremendous amount of weight for his role in "the machinist".
He never developed AN, tho.
http://www.dailymail.co.uk/news/article-2788520/typo-led-christian-bale-dropping-dizzying-60-pounds-skeletal-role-machinist.html

What i strongly oppose to, is, that there are no other or deeper issues for someone developing an ED. Its a multiple causes thing - genetics, environment effects, personal issues and finally nutrition.

Greez!!!



Kali

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Reply with quote  #21 
Hi I want to help,

Thanks for this very interesting discussion! 
I wanted to share a webinar presentation with you that I watched a few weeks ago given by the Center for Balanced Living where they discuss the neurobiology of eating disorders.



One of the treatment modalities that is available here in the US for families is a one-week program designed for eating disorder sufferers and their families, to help them better help their child. Many families have found that to be very helpful but it doesn't seem to exist outside the US. They have programs at the University of San Diego and the Center for Balanced Living, in Ohio. So I'm mentioning it to you as a future therapist in case you want to learn more about it. We haven't done one of them but would if we needed to.

There are so many different theories about how EDs start or what they are caused by but it is the treatment results that is the most important. I can only talk from our experience about what worked for our d. and what the different providers theories about Ed were and how they informed d's treatment:

So here goes:

Therapist Number 1: told us that she would look for the underlying causes and then the eating would come. D. only got worse under her care.

Therapist Number 2:
D became suicidal after 5 sessions with her. She uses pscho drama and is trained in internal family systems.

IOP: Spent time investigating whether d. had experienced trauma and telling her "she needed to reflect on her motivation for the ED". We had one family session which I think was only them checking in to see whether we were a dysfunctional family. D. only got worse under their care. I pulled her from this group of therapists because I was appalled.

Residential Treatment: They believed that ED was a brain-based biological illness and their treatment was based on evidence-based care. D. made great progress in this program and gained insight into her illness and was fully weight restored. They also focused on self-care and tried to help her take ownership of her health. They provided excellent family therapy and focused on her aftercare and how we could help her at home. They also addressed her self harm issues.

Step down PHP and IOP: This was a DBT based treatment and the DBT itself was helpful. D. made some progress but did not like being in the program and was still experiencing strong urges to lose weight. 

3rd Therapist: Practices CBT and didn't seem to deal much with the weight issue. In the family sessions the therapist seemed to spend a lot of time dissecting how d. and I communicated. Considering how much we have been through I think that our communication is pretty good under the circumstances. D. lost weight working with her. 

Nutritionist: At this point a nutritionist was helpful although we had a different point of view about independent eating. She thought d. needed more independent eating but I thought that the loopholes needed to be closed up because each time we gave d. more opportunity to eat independently she lost weight. So I let the nutritionist reinforce good eating habits with d. and then I closed up the loopholes at home and focused on getting her weight back up. 

4th therapist: FBT therapist: Daughter ran out after 3 sessions and refused to go back after the therapist confronted her head on about the weight loss, but I continued to work with the FBT without d. and was coached in how to bring d's weight up at home. D. gained 8 lbs during this time and progressed enough to continue with her college education. D. was still working with therapist 3 and the nutritionist during this period and on a low dose of prozac.

So this is where we currently are. D. is doing much better and she is continuing her studies, is interested in the things she is doing and has an active social life. She is still continuing with therapy and working on her independent eating.

best wishes,

Kali



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Torie

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Reply with quote  #22 
Quote:
Originally Posted by iwanttohelp
What i strongly oppose to, is, that there are no other or deeper issues for someone developing an ED. 


I can't remember where I saw the quote (maybe someone can help me out with that), but one of the providers said something like:  "We see a great many families that are dysfunctional in some way.  We also see a great many families that would make excellent models for future parents.  And we see even more that are in between.  In short, what we see is a cross-section of society, much like you would find in the local shopping center."

Some clinicians have developed excellent methods of re-feeding, and supporting families with that.  These centers have good results.

The ones that focus on underlying trauma and such what-not ... not so much.  

We know how to re-feed.  We know it's needed.  Let's get on with that.

And once weight has been restored, if more work is needed, let's address that, too.

But first, the food.  xx

-Torie

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Reply with quote  #23 
Kali, thank you so much for sharing this!

There are studies which examined the effects of psychotherapy and it was seen that the relationship between the pro and the sufferer was the most important thing! More important than the approach. So i wish one day soon to be that kind of person, the patients dare to trust and share their thoughts, wishes and fears with. I want to stand up for their right of beeing seen and heard and give them space to open up and heal and grow.



Torie: you speak as a parent, me as a future therapists. This may explain our different viewsand that me, i cant go along with your last post. Patients need and deserve therapy to learn to understand themselves better, to recognize dysfunctional thoughts and behaviours and encourage them to take over responsibility to change. I saw girls and boy facing their fears bc they wanted to gain back their lifes, not so much bc someone told them to eat. This was not in the beginning, more in the middle of treatmment. The effect for self esteem is huge, if they know they did it by themseles with support or they have NOT been forced through all was long. They begin to be proud of themselfes and learn to be get stronger when Ed calls. No way in the world i would want to take away that froM them by simply tell them obyence. But, as i say, different points and situaTIONS. lOVE AND GOOD NIGHT
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Torie: you speak as a parent, me as a future therapists. This may explain our different viewsand that me, i cant go along with your last post.


We also speak to you as people who have lived the actual disease with our children through numerous good and bad providers, multiple different hospital stays, etc.  You speak as one who is learning the theoretical basis but not the practical experience of living with someone day in and day out with an eating disorder.  You are on the outside looking in armed with some information and your own thoughts but not necessarily wisdom gained from experience.  You get to go home at night thinking that you've done this anorexic kid something great while we have to take that kid home and actually get him/her to eat.  When my kid first got sick, I would have totally agreed with you.  However experience and years of keeping my daughter alive has shown me that insight doesn't equal action. My daughter could tell you the ins and outs of her eating disorder, why she had it, did tons of work in therapy but when it came time to actually put the food in her mouth and eat it, all the therapy in the world didn't help.  For some it may follow that insight into their ED leads to weight gain, etc. but after all the programs and things that I've been through with my daughter, I would say that 80% of the time it never happened that way regardless of the skill of the therapist.

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they have NOT been forced through all was long.

I would say most kids with ED have been forced to some degree due to anosognosia.  They don't see themselves as sick and so they have to be forced.  That would like saying don't tube feed a kid who won't eat so that when they can finally eat, they can be proud that they were able to do it.  Great but they could starve to death in that time too.  I didn't let my kid get tube fed at first for just the reason I mention due to a therapist with similar views.  Tube feeding was the easy way out so to speak and it should be her choice.  That was how I ended up with a 5' 7" 64 pound YA that nearly died and is only alive now due to being tube fed.  I don't care how my daughter recovers, as long as she does and is still alive at the of the experience.
Torie

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I think perhaps we are not as far apart as it might appear at first blush.  For example, I agree that most sufferers can really benefit from therapy - especially CBT or DBT.  Where we might differ on that is the timing.  The first thing I did when I realized my d needed help was to find a therapist for her - a kind, experienced, well-meaning therapist.  The problem was that my d was so consumed by her mental illness that her brain couldn't really process much at that time.  Now that she has been weight restored for several years, I think therapy might be very helpful for her.

You said, " I saw girls and boy facing their fears bc they wanted to gain back their lifes, not so much bc someone told them to eat. This was not in the beginning, more in the middle of treatmment. The effect for self esteem is huge, if they know they did it by themseles with support or they have NOT been forced through all was long. They begin to be proud of themselfes and learn to be get stronger when Ed calls. No way in the world i would want to take away that froM them by simply tell them obyence."

Here's the thing, though:  We don't force them to eat (unless they are restrained and tube fed).  Actually what we do is more akin to empowering them to eat during the times that the eating disorder is stronger than they are.  But here's the key point: THEY are the ones who have to do it!!!  It is the hardest, scariest thing they will face in their lives, and they do it.  They are the ones who have to face down the beast - every day, every meal, every snack.

We are so proud of them for that.  And yes - they deserve to take great pride in that, too!  Unfortunately, they feel terrible guilt about eating - it isn't something they can feel proud of in the early days.  Quite the opposite.  If and when they get to the point that they can take pride in their recovery, they still get to own that.  They faced the beast and came out on top -  I think everyone knows that whatever we did along the way is pretty insignificant compared to what they had to do.

Thanks for your interesting posts. xx

-Torie

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