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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Hi, My 15 year old son is anorexic and currently going through re-feeding. He is putting on weight really well. However, he is also transgender (assigned female at birth) and as a result is finding the weight gain extremely distressing , not just because of his anorexia, but because it is sending his gender dysphoria skyrocketing. Each week he gets weighed and puts on weight (and subsequently curves), and each week he feels more and more distressed. 3 nights ago he took an overdose. Thankfully he is fine, but wishes he were dead and doesn't know how much longer he can cope. 
I know that he needs to put on weight and even overshoot so that he can fully recover from his anorexia, but I honestly think that his gender dysphoria is impacting to such a degree that I don't know if this truly is the right path.
Does anyone else out there have a child who is going through / has gone through a similar situation?  I would really really appreciate hearing from anyone who can give me some advice around how to manage these 2 things together, and anything that they have found that has helped.
Welcome to the forum, sorry that you have had to find your way here. 
There have been a few parents on here whose children have either been transgender, or gender questioning. My understanding is that eating disorders are markedly increased in the transgender community. I can't at all speak to dealing with this with my own child, however I can speak to dealing with this in a child who just wanted to die and had a number of suicide attempts. 
I think there is a place for potentially going more slowly when there is such extreme anxiety that it is life threatening. We certainly had to go softly with my D. At the same time there can be no brain recovery with ongoing malnutrition so food has to continue and consistently. For my D yoyo-ing weight was much worse for her mental health than steady and consistent gain. Given the severity of reactions to some kids with any weight gain, it must be hard to know how much to assign to gender dysphoria and how much to the eating disorder itself. 

You may like to do a search of the forum for Transgender - use the magnifying glass icon - and find other parents who have been dealing with this. 
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.
Eds' are super hard to deal with. I am glad he is putting on weight and the anxiety may get better over time.  The weight gain and changes in the body habitus of course can affect their state. Is there support for the gender dysphoria in terms of the ED and anxiety? Is he on hormones as part of transition?  Surgery yet? 
I am sorry abut the overdose- and so glad he is OK. 
Is there a therapist involved that you and he trust to help? 
I will try to find some information for you as I have not the same issues you are dealing with. 
Please ask all the questions you have. We all do wish to help!
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
Tabitha Farrar (eating disorder recovery coach, blogger, vlogger, podcast host, etc.) recently had a podcast with Dr. Gaudiani (MD specializing in eating disorders) entitled Considering trans and non-binary individuals in eating disorder treatment. Dr. Gaudiani's book Sick Enough: A guide to the medical complications of eating disorders also has a chapter on gender and sexual minorities. 
Thanks mommiful, scaredmom and Foodsupport_AUS for all your helpful comments and advice. I found the Tabitha Farrar info useful and have ordered her book from the library. I have gone back to the ED team we are under and have now set up some sessions for my son to discuss the gender dysphoria, as honestly it's become clear to me that we can't just work on the anorexia and expect it to follow the usual recovery path. Right now, the biggest risk to his life is his gender dysphoria - not the anorexia. It's really difficult as there just is no real research or pathway on how to manage a teen who has both anorexia and gender dysphoria. Instead of gradually improving as his weight improved, his level of anxiety has skyrocketed. It's hard, but I am figuring it out bit by bit.
Sending warm support to you.  You are right that your journey will require tackling both gender dysphoria and AN together, and there is no roadmap going forward.  Anything you learn or are able to pass on to others in a similar situation will be so welcomed and useful.
Taking the best care of yourself should also be a top priority so that you can be in the best physical & mental shape possible to help your son.  Sending hugs.
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
RachaelMc wrote:
Instead of gradually improving as his weight improved, his level of anxiety has skyrocketed. It's hard, but I am figuring it out bit by bit.

My d's anxiety also increased as the weight went up, got really bad at the extinction burst stage and only started to improve at WR. For the most time during refeeding, a misplaced word or even glance could set her off. 
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
Hi RachaelMc.

I am so sorry for what you are going through.  As Foodsupport above says, there seems to be a significant cohort of ed patients who are also affected by the transgender issue and it is something which ed clinicians the world over are going to have to start addressing.

I see that you are in New Zealand.  I really don't know what your facilities are over there - but if you can find a gender clinic I would try and get an appointment asap so that specialists in the issues of gender can have an input and assess exactly what is going on.

The issue of transgender is serious in that, gender clinics may use hormone treatment to delay adolescence so that any surgery required later down the road is less severe, - but at the same time weight gain is required in terms of fighting the eating disorder to bring about recovery - which totally flies in the face of what may be required in terms of gender issues being addressed.

It is a highly complex situation - and I simply cannot imagine what it must be like having a child in this situation.  But I think the two issues of weight gain and the delay of puberty simply have to be considered as part of the whole picture if your child is going to be treated successfully, fairly, and with compassion in terms of what is needed in terms of his future,

At the moment I would try and ensure that he knows that you love him, want the best for him and need to do what is necessary to get him the care he needs in order for him to move into the next phase of his life.  But I do think that some input from a specialist gender clinic for adolescents needs to be your next port of call.
Believe you can and you're halfway there.
Theodore Roosevelt.
A recent podcast episode on the Full Bloom show was very helpful to me in understanding some of the issues around this, and mentions some experts on this intersection between transgender and eating disorders: https://podcasts.apple.com/us/podcast/20-what-about-ze-how-does-body-positivity-work-for/id1451972744?i=1000440198859

I do want to say, after many years of watching families support people with EDs, that anxiety/ED are looking for ANY way to escape recovery and escape successful intervention. Often, those "reasons" are completely understandable and true to the person, but they STILL can't be allowed to be in control. There is no recovery without regaining and maintaining normal metabolism and body composition -- the brain can't recover and development can't come back on line. Even if the "reasons" are understandable and meaningful the greater threat to that person's life and future is the continued maintenance of the ED. EDs hijack normal concerns, and cause the person to use ANY exit, and that exit is usually the parents' understandable compassion and caring. Parents want to comfort and listen and lessen suffering. But then we are also going to be what ED uses to stay in control. Weight restoration isn't just a treatment goal, it's the only path to brain recovery and delay lessens the chance of recovery. Being distressed with weight gain is expected and normal and PART of the process, regardless of whether it is welcome and even if it strikes at the heart of the person's difficulties and identity. Letting our loved ones feel distress, and being there for them during that, and keeping the recovery process going in the right direction, is our unique challenge as caregivers. Every family does it uniquely, but there isn't a door number two that I know of.
Laura (Collins) Lyster-Mensh
F.E.A.S.T. Executive Director