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annabanana

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Reply with quote  #1 
Hi all, we are waiting to start FBT at a local hospital because we were told they don't have therapists available for us at this time.  We are seeking private help.  I am wondering though, what would the FBT approach have been for my girls if we had started? 

They told me to continue doing what I'm doing, since the twins' BMI's are 22 and 25.   What else would we be asked to do?  Can someone shine light on that for me?  I don't want to wait another 8 months without doing anything on my part and most books and articles don't go into the specifics of 'hows.'

Thank you!
mjkz

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So you decided against UCSD?  What issues are you still dealing with?  Last time you checked in, we were talking about camp for T2 to get her some time away from T1 and also giving them different meals so they couldn't compare.  Where are things now?
tina72

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Reply with quote  #3 
Hi annabanana,
you seem to do everything right because the BMI´s of the girls seem to be o.k. at the moment. What have they been 6 months ago? A year ago? What is their "normal" BMI?
Very helpful is the book of Eva Musby: Anorexia and other eating disorders. How to help your childs eat well and be well. There you get a lot of answers to every question, it helped us a lot because you get all the "hows" you may need.
Try to get a routine about meals at home. Try to introduce "forbidden" food again. Try to get rid of ED behaviours (cutting into small pieces etc.) What are your problems right now? Can you tell us a bit more about the state of your twins? Age, kind of ED, behaviours... Here are a lot of people who can help you, but we need some information.
Tina72
annabanana

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mjkz--We decided against UCSD after speaking with several people who had attended the program.  Even the 'poster lady' who was in the promotional video indicated to me that we need the next step after UCSD.  I spoke with another mom whose daughter went through the program 6 months ago and they are still struggling with eating fear foods.  We don't have that issue at all.  They eat everything except onions and mushrooms. It's the comparison demon that we are fighting, especially T1.

I was so hopeful to send them to a camp but 99% camps for 17 year olds are overnight camps for a week, which is out of the question.  I found one but the separation, if there's one, is only for lunch.  I don't think a week is going to do anything.  Might as well do it at home where T1 can cry freely. 

We just moved last week so implementing a complete separation was too much during this time and T1 just cried about everything for a week.  I thought I was going to kill someone as she followed me from room to room crying as I'm packing and unpacking.   She's calmed down now a bit and I'm still considering a complete separation at home but I want to make sure there are other things I can do that will not increase her anxiety level too much.  Right now, they eat with a barrier and yesterday, she cried because she counted the number of 'crunchies' of her sister's and after matching them, she had 6 more chips left on her plate.  She's sure I'm trying to make her the 'fat' twin.

We thought about sending T2 away to her aunt, but T2 was having a lot of depression episodes--crying about her weight, her looks, etc (maybe stress of the move as well) and I felt uneasy sending her at this time.  Also, her aunt is a health nut (an ex-aerobics instructor) so even though she's understanding about where the girls are, she might trigger her unwittingly.  Recently they told her that they had an ice cream pint party a few months ago, she chided them for being so unhealthy.  So there you go.....

Tina72, I hope some of what I wrote explains a bit more. I know that T2 is much bigger than she ever was--she looks like she's 4 months pregnant.   They are 5'2" (BMI 22)and 5' (BMI 25) and small-boned Asian girls.  They are tiny.  I'm trying to keep raising T1's BMI, but her built is not that heavy to start with, although she's steadily gaining weight each week, it's very slow.

My main problem is T1's anxiety is directly related to eating--high anxiety, she can't eat (or do anything for that matter).  2 wks ago, I took away her ability to check her twin's plates and that was tough--taking a break before the separation. But is there anything else I can do?   Again, there's no fear foods.  Thank you.




tina72

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Reply with quote  #5 
Hi annabanana,
that sounds difficult and I hope you will get some help from the people here who are fighting against ED with two patients in the family, I have no experience with that. Do they compare with everything or only eating/foods?
Can you separate them while eating (different times/rooms) so they cannot compare plates? Are they able to compare weight or are you weighing them blind?
It´s great that they eat everything. Crying about weight and look is quite normal with ED I think, they will get used to the weight and the look will get better when the weight spreads out a bit and doesn´t concentrate on the belly, which takes some time.
If the comparison demon is only with eating, try to separate them for meals. Another idea is cooking totally different meals for each of them so they cannot compare the plates. If you serve nearly the same amount of calories, you could make it a game which d will get which plate (with a dice for example) so they can see that you serve the same amount on the plates and will not make anyone "fat".
Hope I can help you get ideas...
Tina72
mjkz

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Quote:
We just moved last week so implementing a complete separation was too much during this time and T1 just cried about everything for a week.  I thought I was going to kill someone as she followed me from room to room crying as I'm packing and unpacking.   She's calmed down now a bit and I'm still considering a complete separation at home but I want to make sure there are other things I can do that will not increase her anxiety level too much.  Right now, they eat with a barrier and yesterday, she cried because she counted the number of 'crunchies' of her sister's and after matching them, she had 6 more chips left on her plate.  She's sure I'm trying to make her the 'fat' twin.


I totally agree actually that UCSD was not what you need and that you are a step beyond what they can provide.  I think you made the right decision.

You are not going to be able to get T1's anxiety down other than just doing it and getting her through.  The longer you stretch it out, the more suffering for both twins and the entire family.  You are getting ED talk still from T1 and I would just ignore it or tell her that you are not going to talk to her ED.  I would send T2 to camp even if it is just for a week.  It's not only the separation that you are looking for but also some way to give T2 a break.  I think you will find that a week of even only lunches will give you a great chance to deal with T1's anxiety and not trap T2 in it.  I also wouldn't be letting either see the other's plate.  Counting things and comparing is only going to prolong T1's suffering and anxiety.

I think you are at the point now where you have to push T1 into the deep end of the pool so to speak to get her through the anxiety.  You have waded in from the shallow end with both and got pretty amazing results in getting them weight restored but you can't really do much more trying to wade in from the shallow end.  They both need challenges and the camp would do that for T2 and her absence for that meal would challenge T1.  I'd keep the barrier between them and allow no seeing what the other is eating with no comparing.  You are at the point where you get her through the anxiety or live for months bogged down in it until one goes off to school and you get the separation naturally.  I'd do it now rather than later.
toothfairy

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Reply with quote  #7 
Hi Annabanana, 
Kudos to you, take a bow!

Have you considered anti anxiety meds for T1

Have you considered an FBT Private T for T1  starting now, and letting T2 go with the other team that have the waitlist, ( and maybe going to camp without T1).

Is this list any good Canada FBT Maudsley Therapists

CANADA 

McMaster Children's Hospital 
Pediatric Eating Disorders Program
1200 Main Street 
W. Hamilton, Ontario
Canada
(905) 521-2100 x 73497
(Cheryl Webb, the Clinical Coordinator, was trained by Dr. James Lock and Dr. Daniel le Grange and is currently involved with doing Multifamily Therapy in addition to Maudsley therapy.)

Dr. Sherry Van Blyderveen, C. Psych.
Halton Psychological Services
14A Martin Street, Milton, Ontario, L9T 2P9
Phone: (905) 878-6650
Fax: (905) 905-878-2205

http://www.haltonpsychologists.ca

Children's Hospital of Eastern Ontario
401 Smyth Road
Ottawa, Ontario
K1H 8L1
(613) 737-7600
http://www.cheo.on.ca/english/1072i.html

 


Eating Disorders Clinic

Toronto General Hospital 

7 Eaton South, Room 425 

200 Elizabeth Street

Toronto, ON M5G 2C4
Telephone: (416) 340-3749 
website
★ D. Blake Woodside, MD FRCPC
★ Gina Dimitropoulos, PhD, RSW

Ahmed Boachie, M.D. MRC(Psych), FRCP(C)
Karin Jasper, Ph.D., M.Ed. Eating Disorder Program
Southlake Regional Health Centre
596 Davis Drive
Newmarket, Ontario  
L3Y 2P9
Ph: 905-895-4521 ext. 2322
Drs. Boachie and Jasper are co-authors of A Parent’s Guide to Defeating Eating Disorders: Spotting the Stealth Bomber and Other Symbolic Approaches. This book is based on the Maudsley model of treatment.


Dr. Adele Lafrance, C. Psych
Eating Disorder Program
Sudbury Regional Hospital
127 Cedar Street
Sudbury, ON
P3E 1B1
(705) 523-4988

Maria Kostakos, M.A. C.Psych.Assoc
Registered Member of the College of Psychologists of ON
SRHRH Regional Eating Disorders Program
27 Cedar Street Sudbury ON P3E 1B1
Phone: 705 523 4988 ext 4390
mkostakos@hrsrh.on.ca

North York General Hospital 
4001 Leslie Street 
Toronto, Ontario
Canada 
M2K 1E1
(416) 756-6000
http://www.nygh.on.ca
★ Marla J. Engelberg, PhD, CPsych


The Hospital for Sick Children 
555 University Avenue 
Toronto, Ontario 
Canada 
M5G 1X8
(416) 813-1500 
http://www.sickkids.ca/default.asp
★ Lindsay Ross, MSW, RSW

Dr. Ester Wagner
Registered Psychologist
45 Sheppard Ave East, Suite 419
Toronto, Ontario M2N 5W9
Canada
(416) 229-1477 Ext.234
(Works with adolescents and young adults. In addition to her private practice she is on staff at the North York General Hospital in the adolescent eating disorders program.) 

Brad Mac Neil, PhD, C. Psych.
Dr. Brad A. Mac Neil Private Practice
308 Wellington, Street
Kingston, Ontario, Canada
(613) 328 1231
http://www.drmacneilkingstonpsychologist.com

Dr. MacNeil is a licensed Clinical Psychologist in Kingston, Ontario, Canada who provides evidenced based assessment and treatment services to children, adolescents, adults, couples, and families. At Dr. Brad A. Mac Neil Private Practice, he provides FBT for AN, as well as CBT for BN, Acceptance and Committment Therapy for Eating Disorders, and Cognitive Remediation Therapy (CRT). 

 Karina M. O'Brien, Ph.D., R. Psych.
Registered Psychologist
Provincial Specialized Eating Disorders Program for Children and Adolescents
BC Children's Hospital
4500 Oak St. Vancouver, BC, V6H 3N1
(604)-875-2345 x5581
 

Kimberly Sogge, Ph.D., C.Psych.
Sogge & Associates Practice in Psychology
Psychology for Health and Performance
451 Daly Avenue
Ottawa, Ontario K1N 6H6
Canada
Telephone 613-288-0022
Fax 613-691-0589
Web http://www.drsogge.com
Dr. Sogge is a clinical health psychologist with an emphasis on the mind-body relationship, specifically eating disorders.  She is a supervising faculty member in the University of Ottawa Centre for Psychological Services. Dr. Sogge received her doctorate from Texas A&M University. Her predoctoral internship/residency was at the University of Texas at Austin Behavioral Health Service.  Her postdoctoral training was at the Texas A&M College of Medicine and the Olin Teague Veterans' Administration Hospital's PTSD Unit.  She trained in the Maudsley approach/Family Based Treatment through the University of Chicago Medical Center.  Dr. Sogge focuses on mindful evidence based approaches to the treatment of eating, weight and other psychological disorders. She works with families from a Maudsley model, but also provides Mindfulness Based Stress Reduction, Cognitive Behavior Therapy, Acceptance and Commitment Therapy and Dialetical Behavior Therapy for adolescents and adults.

 


 

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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.
AUSSIEedfamily

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Reply with quote  #8 
Dear annabanana,

In conversations with eminent clincians at the recent AED ICED conference in Prague I discussed the topic of BMI and my particular view that it is a very poor indicator of a persons state of health especially mental health. All of the clinicians I spoke with agreed that for those with BMI in the mid to high teens and 20 and above, BMI alone is a poor measurement tool. 

Please use the BMI as measurement with an understanding of its poor indicator capacity at the numbers above the mid teens.

There are a few published studies examining the DSM-5 BMI value showing that BMI is a poor indicator of the severity of illness.

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annabanana

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Reply with quote  #9 
Hi Toothfairy, thanks for the list!   (Where do you get all these links and lists?  You're amazing! [smile] The hospital psychiatrist said she didn't need med because she's doing so well.  But he only spent one hour with her.  (BTW, Southlake hospital you listed is ours.  Unhappy memories there.)  Like you told me some time ago, I have been forced to have plan B, C, D, etc.  I've contacted several places and most have 4-5 month wait just to be assessed.  A couple of the places won't take us in because we are not in the catchment area.  I am waiting to hear from a couple of more places and we just found out that my husband's work has a in-house doctor that can refer us to someone, so we are hoping to go through him versus my own doctor who told me to just wait for the hospital when I asked her to see if she can refer us to other facilities. 

Today, I separated the girls for dinner--THANK YOU ALL FOR YOUR ENCOURAGEMENT!--one at the dining table and the other in the livingroom.  It was chaotic as I ran back and forth for soup bowls, chopsticks, etc......but we did it, and T1 was anxious the entire time, saying that she knows I gave her more.  She was very anxious after so I suggested that we go out and get a cake to celebrate and we did!  ha ha

I do agree with Aussie that BMI isn't the best indicator, at least for someone like her who seem to suffer from OCD related issues.  I know she has a long way to go for her brains' healing. She did say that she heard the voice even before ED, so I wonder if she needs a different kind of therapy than FBT.  I just know that they are going in the right direction as far as weight gain is concerned.  But a little help from the hospital would have been so nice along the way.  Thank God you guys were always brainstorming for us and encouraging us.  Please share more thoughts and ideas if you think they would help reduce comparing for my T1.  Thank you!!!!
sandytoes

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Reply with quote  #10 
Quote:
Originally Posted by annabanana


Today, I separated the girls for dinner--THANK YOU ALL FOR YOUR ENCOURAGEMENT!--one at the dining table and the other in the livingroom.  It was chaotic as I ran back and forth for soup bowls, chopsticks, etc......but we did it, and T1 was anxious the entire time, saying that she knows I gave her more.  She was very anxious after so I suggested that we go out and get a cake to celebrate and we did!  ha ha

Please share more thoughts and ideas if you think they would help reduce comparing for my T1.  Thank you!!!!


Dear annabanana,

If your daughter can eat a cake if her sister does, it seems to me that the issue is more the comparison anxiety than food anxiety? I would absolutely try anti-anxiety medication. I was one of those parents who was completely against it, and in hindsight, I should have agreed far sooner.

Sending you much strength.
mjkz

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Reply with quote  #11 
Quote:
Today, I separated the girls for dinner--THANK YOU ALL FOR YOUR ENCOURAGEMENT!--one at the dining table and the other in the livingroom.  It was chaotic as I ran back and forth for soup bowls, chopsticks, etc......but we did it, and T1 was anxious the entire time, saying that she knows I gave her more.  She was very anxious after so I suggested that we go out and get a cake to celebrate and we did!  ha ha


Go AB!!!!  I would just keep doing the same thing.  She might not have fear foods but more of a fear of having more food.  Just keep the comparisons at a minimum and maybe down the road you might put them back together and deliberately give T1 more food just to challenge that fear.  My daughter always wanted me to eat the same thing she did and I deliberately didn't because of her fear of having more food.  I kept telling her that different people have different needs and I don't need the same amount of food that she does.  It really helped the comparing thing a lot to see me doing something different than what she did.  Other people on here eat what their loved one eats and if that works for you, great.  I wanted my daughter to see right from Day 1 that different people have different needs to be healthy.
Torie

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Reply with quote  #12 
Quote:
Originally Posted by annabanana
Today, I separated the girls for dinner--THANK YOU ALL FOR YOUR ENCOURAGEMENT!--one at the dining table and the other in the livingroom.  It was chaotic as I ran back and forth for soup bowls, chopsticks, etc......but we did it, and T1 was anxious the entire time, saying that she knows I gave her more.  She was very anxious after so I suggested that we go out and get a cake to celebrate and we did!  ha ha


Woohoo!!! Way to go!!!

Team AnnaBanana: 1
ED: 0

I wanted to try to help brainstorm ideas to help with the separation - I wonder if T2 could eat with a friend or relative from time to time.  

Have you developed a mantra to use when T1 tries to engage you in conversation about what T2 is eating?  Maybe something like, "It isn't normal to compare your meal with someone else's like that."  Or,  "Please stop fretting about T2's plate or I will have to give you an extra pea."  In any case, I always found it helpful when I could pre-plan my response so I didn't have to create one on the spot.

Keep up the good work!  xx

-Torie

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