F.E.A.S.T's Around The Dinner Table forum

Welcome to F.E.A.S.T's Around The Dinner Table forum. This is a free service provided for parents of those suffering from eating disorders. It is moderated by kind, experienced, parent caregivers trained to guide you in how to use the forum and how to find resources to help you support your family member. This forum is for parents of patients with all eating disorder diagnoses, all ages, around the world.

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lluka
Hello and thankyou for this lifeline. 
My 19 yr old D has AN and is just into stage 2 of FBT. This program has worked incredibly well for us so far. Im just getting increasingly frustrated at her really bad attitude regarding me and my effort to help her. When i bring up the topic of her ED, she calls me a control freak and says theres nothing wrong with her (all she wants to do is go out partying, which, just recently, ive said yes to once a week). I actually second guess myself constantly. She is becoming increasingly defiant and disrespectful, and shows absolute contempt for our FBT counsellor. She puts in zero effort at his sessions and refuses to answer his questions. I am worried she will not progress if she doesnt accept her illness and make an effort. She is compliant with all food, she just has a really bad attitude and constantly tells me shes an adult and can do whatever she wants.  Any ideas on how to get her to snap
out of it, or is this just part of the ED? TIA
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melstevUK
lluka,

There are others who will be along soon with their ideas - my views might not coincide with those of the majority.

The AN is definitely linked in to this in that more freedom will give your d the possibility of not eating.
Is her weight still going up?  

Personally, in your position I would bother less about the defiance with me in the home apart from saying it is unacceptable and focus more on the attitude towards the FBT counsellor.  I would argue that it is absolutely unacceptable to show contempt for anyone and tell her that it needs to stop.  No matter that she is an adult - all people deserve to be treated with respect.  And I would say that there is no partying at all unless that attitude changes at the next appointment.  

I would also say that, even if she has other friends who party more often, she gets to party once a week maximum.  

Some rebellion is to be expected in the teenage years and having an ed in the mix makes the whole notion of discipline more challenging.  I have always taken the line of imposing my values rather than rules, and picked my battles accordingly.  From little my own d was never allowed to make a scene in public but I allowed some cheek in the house - there were only the two of us and she had to show her anger somewhere.  Your d is rebelling, and the an is colluding as it will be trying to strike back.

When your d says there is nothing wrong with her - I would point out that she has an illness with the highest mortality rate out of any psychiatric illness, and that it is more dangerous than the others because the sufferers don't realise how ill they are.  And that treatment has to continue and that she needs to be compliant around eating and weight gain.  Only when these conditions are adhered to will you consider all the adult choices around freedom.  At present she is still living at home.  Tell her that if she does not work with you, she may well be an adult in age but she will never be able to live independently without fighting her way out of this illness.  And tell her that she is lucky because you understand the illness whereas lots of people don't.  

If you can get her to take heed without exploding, try giving her a hug at the end and tell her that you know that this is horrendously difficult for her but there is not other way forward than to continue with her treatment and with eating and weight gain.  
Hugs - this is such a tough journey.
Believe you can and you're halfway there.
Theodore Roosevelt.
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sandie
Great that D is compliant with all food and that program has been working well for you. I agree with Melstev about making sure food intake/ weight gain is continuing with increased activity/ partying. My D is not at the partying stage yet but I can imagine the potential pitfalls for ED treatment of late nights/ inadequate sleep/ sleeping late next day/ hangovers.
Just to share, my 15 year old ED D is highly defiant and disrespectful. Probably more accurate to say has bouts of high irritability/ low mood/ agitation which she expresses through anger and poor behaviour. I think it is likely a mix of personality, teenage rebellion, brain irritability due to ED and low mood/ depression. We noted some improvement with recently started ssri. It is exceedingly difficult to discipline. She is always asking for different things- clothes/ beauty treatments and I am starting to try to link this with improved behaviour. Eg if you stop slamming doors this week, you can have x. This is not my usual parenting approach and i can't report on whether successful yet! I think the main thing is to feedback in some way when behaviour is unacceptable. I am also trying to choose battles to focus on most important.
My D reacts very poorly if I mention ED. She cannot cope wth the notion and it does not seem to help her move on if I mention ED. I know others have said it can take a long time to gain insight. For us, 9 months in, the priority is to keep feeding/trying to address increased energy needs with increased activity and trying to increase variety.
D was unable to engage with therapist till restored to about 85% wfh which i understand is typical. Maybe worth having private chat with the therapist about your worries. Xxx
Courage is not the absence of despair; it is rather the capacity to move ahead in spite of despair
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Foodsupport_AUS
It is great that she is compliant with food but sorry that you are having to deal with so much other stuff at present.  FBT of course was traditionally aimed at younger adolescents but has been used up to mid 20's  sometimes called FBT-TAY. The concept of older teens and young adults is that they should naturally have more independence and those boundaries need to be respected, at the same time they are not as independent as they may like to think. Commonly they are financially dependent, housing dependent and often still dependent for social guidance too. I agree with Melstev that insisting on some basics like courtesy to others is essential. As she moves into stage 2 so long as she is eating you are half way there. I am sure some of the attitude is to help her feel she is not dependent. Most teens of course think they don't need parents at all. 
Is there any psychoeducation being covered? Things like how regular meals and sleep hygiene is important for mental health. 
This is a tough time. 
D diagnosed restrictive AN June 2010 age 13. Initially weight restored 2012. Relapse and continuously edging towards recovery. Treatment: multiple hospitalisations and individual and family therapy.
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Mamaroo
I know of carers here who told their d that it's an eating disorder, not a rudeness disorder. You are within your right to tell her that such behaviour is not acceptable anymore and you can motivate her by making going out conditional on good behaviour at home. My d was also very rude during refeeding, but I got more strict after WR. I applied the same rule to our non ED d, who also went through a rudeness phase.
D became obsessed with exercise at age 9 and started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. View my recipes on my YouTube channel: https://www.youtube.com/channel/UCKLW6A6sDO3ZDq8npNm8_ww
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ValentinaGermania
Hi from a mom of an also 19 year old (but in year 3 of recovery now).

From all that you write I have some alarm bells ringing that maybe stage 2 is too early. Who told you to start that?
It does not worry me that she does not engage with the FBT therapist (mine did not too), but she should normally be not agressive to yu any more and have more insight that she is sick and needs help in that state.

We are in year 3 now and started phase 2 about a year after WR. Was your d WR and in a good mood and state when you started it? Had you worked all fear food down before?
Keep feeding. There is light at the end of the tunnel.
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lluka
Thankyou to all so far for your advice. To answer a few of your questions....she has no more fear foods; our FBT councellor moved her to phase 2 because she reached the minimum goal weight. If she goes out on a saturday night, i make it imperative that she is home by 9am for breakfast, and that she will be eating to her normal meal plan for the rest of the day (even if she is hungover). I think she is sick of all the rules and regulations...but...SO AM I!!!! I have two younger kids who have less rules! I think i just got too hopeful, because she was doing well. I forgot about the rollercoaster bit. 
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ValentinaGermania
So maybe that was a bit too early moving to phase 2 with only minimum goal weight...a common mistake of professionals here.
We have a contract with our d. If yours is still living with you and financially dependent from you you should use that as leverage/threaten.
We have a contract that says what we do for our d (pay for living, insurances, car, phone, University etc) and what she needs to do for that (go to GP regularly, have blood tested, regular weighings, maintain her weight, eat 3 meals 2 snacks each day, keep us informed and talk to us etc). She knows that when she skips meals she loses the car key (and she LOVES her car) and that she must stay at home for a gap semester if she loses more than 2 kg and cannot catch that up within 2-3 weeks.
Worse a try to think about something like that? Many parents of adult "kids" here have a contract...
Keep feeding. There is light at the end of the tunnel.
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Ridgehen24
This is very helpful to read. As my 19 year old D was diagnosed 6 months ago while away at college. Fortunately she checked her self into IOP treatment for several months although not near home. It has been so challenging to be 3,000 miles away and know how serious an ED and have my D unwilling to communicate with us regularly.  Even more so because of medical privacy laws.

The concept of contracts is very helpful since she is dependent on us financially for many things but throughly believes she is a full fledged adult. Good news she is WR but still trying to figure out how to live in the college environment. Her reward for recovery is being able to go back to college. 
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ValentinaGermania
They all think they are adult and can do what they want the moment they turn 18...and some times later some of them realise that it is not that great to be responsible for everything and that "being adult" also means to be able to care for yourself propperly.

As long as they are financially dependend we should use that as leverage and if needed as threat. In the treches of ED they are often not able to make good health decisions and later when they are 24 and have their own job and money it is way harder to get them back on track or in treatment if needed. We are not helpless at that age, we must just dare to set some rules as long as it is our money that runs their life.

I was glad to have some old rabbits here that told me to put all my power in getting my d WR before she turns 18 and that was really good looking back. Brain recovery started about 2 months before her 18th birthday and she was compliant with food and meal plan and asked for our help then which was great.

Medical privacy laws are there here too but there is also a possibility to have a contract for that, too. I do not know how that is in your country but maybe there is also a possiblity for your d to sign papers so that the doctors can speak to you if needed (in ER/A&E for example).

We have rules for weight, for medical privacy and for a gap year in our contract and that works well up to now (we are in year 3 and she just finished the 2nd semester at University). We also have rules for driving her car (which is still ours on paper). That helps a lot as she loves her car...🙂
Keep feeding. There is light at the end of the tunnel.
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debra18
Ridgehen recovery takes a long time. I don't think she will go to a program for a few months and go back to college recovered.
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ValentinaGermania
I always ask parents with college/university age kids with ED to chose a college/university nearby if any possible and ask them to stay living at home for the first years. We asked our d to have a reduced schedule too and to eat at home at least 3 days a week completely (all meals).
My d is in a pretty good state I think but relapse prevention is needed for a long time. If anything happens that is causing big stress ED is lurking around again within an hour.
Keep feeding. There is light at the end of the tunnel.
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lluka
Thanks for all your responses. It really helps me process everything. 
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