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

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Ian_C
Hi everyone, I'm a newbie! I have only just discovered this wonderful forum, I don't know how it managed to escape me for so long!
My d was diagnosed with AN just over a year ago. She had gone to live away at University and returned home after the first term with a lot of weight loss. She had had a very stressful time there living with other students very unsuited to her, getting little sleep and living in very untidy conditions. Looking back, she had actually started to lose a bit of weight before going to Uni - she is type 1 diabetic and had moved on to strict carb counting at diabetic clinic's suggestion, and was already into healthier eating, and diabetic clinic had started to note a weight loss but had said no more than it was something to monitor.
Upon AN diagnosis, weight was so low that we were recommended for my d to be immediately admitted to a specialist ED inpatient ward, she was resistant but we just about persuaded her to go in. A few days after admission, she was placed under section because she was not eating enough and also she was at this point forced into NV tube feeding.
About 6 months later d had reached what is normally the start point for a proper treatment plan, after gaining enough weight to be physically safer, but insisted throughout that she could not go further than this point and could do it all better at home. The section was removed just before the 6 month time limit. D started coming home for extended leave and it all happened very quickly, half a week then a full week, and was losing weight during this home leave. I felt we were very much being rushed into having her home 24/7 and didn't feel well prepared at all. She was also doing a lot of physical exercise at home, which she had also been doing secretly in the ward more and more (I did tell the ward this but they didn't do anything about it), and although the ward had suggested a provisional discharge date in August, they wanted her to carry on with home leave but not actually discharge yet due to the weight loss, but d discharged herself against medical advice and came home.
The next seven weeks were a living nightmare for d, myself and my wife. Every day revolved around her exercise in her bedroom, prepare for meal, eat meal, exercise in her bedroom again etc. D would eat meals ok but the portion sizes were slipping. Weight loss was fast and the community nurses were tracking this weekly but were unable to be any further help. D tried to give false weight readings (putting coins in pockets) and said she couldn't cope with being re-admitted but eventually was so low in weight and physically struggling that she was admitted again to the same ED ward under section.
These last 5 months have seen a much better attitude from my d, she didn't want NV tube feeding again so has eaten all meals put in front of her (struggled a lot of course). No exercise routine at all although keeping standing and not sitting is a constant issue. D has felt the ward have pushed things along too fast at times and had refused an additional snack recently, but agreed to put that back in a couple of weeks ago or they would not have allowed home leave.
Currently home leave is running at 2 nights a week, in fact 3 nights last week due to attending a family funeral. Home leave is going pretty well, although it's tiring. There is much planning going into shopping lists and meal plans. Eating meals with us is ok. She doesn't leave anything. I suspect portioning is teetering on the brink of reducing slightly but otherwise ok.
D has just hit the target weight that was set this time (higher than last time) and whilst the ward would like her to carry on with further weight restoration and a more comprehensive treatment plan, d is adamant she can't do that and wants to come home to maintain at this weight. She can't see any further weight increase in the foreseeable future but accepts she can't lose weight at home. Ward are suggesting a 4 to 8 weeks maintenance period first, which will be a combination of in ward and at home but no doubt the proportion of days at home will increase. There will be some community support upon discharge. Although I don't see that achieving much if I'm honest. D always says that talking doesn't achieve anything. Section is due to run out in three weeks and ward have said they haven't made a decision yet on its renewal, keeping their options open. D doesn't think they would succeed with a renewal although d failed with a Managers Hearing appeal a few weeks back.
We are very pleased with the physical progress and recovery but mentally our d is shattered and is really struggling with weight gain already made. There hasn't been the hoped-for lightbulb moment. She already thinks she has been pushed too far.
I'm off work with stress at the moment (partly because I also lost my Mum last month) and am worried how things are going to go!
D is very convincing that she wants to work with us at home and things are definitely a lot different to last time. On the other hand, the thought of discharge and d no longer being pushed along by the firm hand of her 'enemy', the ward, is a scary one indeed.
I'm sure many of you will identify with the fact I have always felt stuck in the middle. I could always see that what the ward do is needed but then I am on the end of the mental torture this causes my d and I have to somehow try to motivate and encourage her to accept what is being done.
She is at a very low ebb today because ward have refused, for at least another week, to remove an extra snack that was recently put in - d thinks it should come out because she has gone slightly above the lower end of her target range. Also they granted her 2 nights home leave for this weekend instead of the requested 3 because they want her to attend a café group on Friday. D is telling me she is a burden and doesn't want to cause all these problems for us anymore and that she is 'done'. She has spoken like this before when things have gone against her, but it's still tough for me to hear.
I am also torn between wanting her home for good 24/7 (after all, she is a lot of what I live for), but worrying if the three of us can cope at home together yet (or ever), considering what a disaster it was last time she discharged herself. I remember how mentally tough and how tiring it was in those 7 weeks before, with so little chance to recuperate or take a breather.
Would love to hear from some of you!
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Torie
Hello, and welcome.  I am glad your d seems to be getting the help she needs at the moment.  From what you have said, I think I would fight to keep her under their care until the transition home is further along.  Most here find that whatever works inpatient needs to be continued on at home, which is a Herculean challenge as the center has a whole staff of trained people with various shifts through the day and night, while our homes are staffed by one or two parents only.  It is very difficult and taxing.

"A few days after admission, she was placed under section because she was not eating enough and also she was at this point forced into NV tube feeding."

Good first steps, it seems.

"About 6 months later d had reached what is normally the start point for a proper treatment plan, after gaining enough weight to be physically safer, but insisted throughout that she could not go further than this point and could do it all better at home."

This is a good example of how distorted AN thinking is and how unable a brain is to make decisions about food, portions, etc. while under the influence of ED.

"I felt we were very much being rushed into having her home 24/7 and didn't feel well prepared at all."

Clearly your instincts were spot on about that.

"... d discharged herself against medical advice and came home.
The next seven weeks were a living nightmare for d, myself and my wife. Every day revolved around her exercise in her bedroom, prepare for meal, eat meal, exercise in her bedroom again etc. D would eat meals ok but the portion sizes were slipping."

In general, we have to carry on at home pretty much exactly the same as was done in the treatment center.  Did they allow your d to portion her own meals?  It is a difficult and tricky transition to learn to plate a proper amount, and most here find we need to go really, really slowly on that.  I plated my d's food for what seemed like ages after she was weight-restored because the AN brain is not able to be rational about that.

"D ... said she couldn't cope with being re-admitted but eventually was so low in weight and physically struggling that she was admitted again to the same ED ward under section."

Another example where you were wise to listen to your instincts instead of what your d's AN brain was saying.

"... she didn't want NV tube feeding again so has eaten all meals put in front of her (struggled a lot of course)."

That is another good example of what works: Knowing that the nutrition is going in no matter what.  Having no option NOT to accept the nutrition.

"D has felt the ward have pushed things along too fast at times and had refused an additional snack recently"

A nice example of the AN brain at work.

"... but agreed to put that back in a couple of weeks ago or they would not have allowed home leave."

And an example of something that has worked to get the nutrition in.

"Home leave is going pretty well, although it's tiring. There is much planning going into shopping lists and meal plans."

AN pretty much takes over your whole life, doesn't it.  I remember that fog of plan meal, prepare meal, feed meal, lather rinse repeat as though your life has nothing else.

"Eating meals with us is ok. She doesn't leave anything. I suspect portioning is teetering on the brink of reducing slightly but otherwise ok."

Do you think the center would be on board with telling your d that YOU will be responsible for portioning?  I really think it is asking for trouble to let an AN brain have any say in that.

"D has just hit the target weight that was set this time (higher than last time) and whilst the ward would like her to carry on with further weight restoration and a more comprehensive treatment plan, d is adamant she can't do that and wants to come home to maintain at this weight."

That is not rational; her brain is still under the influence of ED.  If at all possible, all decisions about weight, portions, calories, etc. need to be made by someone rational i.e., you, your wife, or the center.  The person who is least able to make these decisions is your d.

"She can't see any further weight increase in the foreseeable future but accepts she can't lose weight at home."

She needs someone to overrule this irrational position.   Her brain can heal, but only after she has gained the weight she needs - all of it - and kept it on for a while.  If she is permitted to maintain her current weight, she will remain trapped in the he1l of ED.

"Section is due to run out in three weeks and ward have said they haven't made a decision yet on its renewal, keeping their options open."

From what you have said, I'm pretty sure I would fight to keep her under their care until you and your wife are confident in your ability to keep the ship on course.

"We are very pleased with the physical progress and recovery but mentally our d is shattered and is really struggling with weight gain already made."

Another example of your rational minds juxtaposed with an irrational AN brain.

"There hasn't been the hoped-for lightbulb moment. She already thinks she has been pushed too far."

And another.

"I'm off work with stress at the moment (partly because I also lost my Mum last month) and am worried how things are going to go!"

So sorry about losing your Mum.  How sad and terrible to be faced with that on top of ED.

"D is very convincing that she wants to work with us at home and things are definitely a lot different to last time."

She probably really believes that.  And I have no doubt that she is very convincing.  But she will not recover until she regains ALL the weight she needs.  And even though she may think she will work with you once she is at home, if I were a betting person, I would not bet on that actually happening.

"On the other hand, the thought of discharge and d no longer being pushed along by the firm hand of her 'enemy', the ward, is a scary one indeed."

Trust that thought.  Your instincts are right.

"I'm sure many of you will identify with the fact I have always felt stuck in the middle. I could always see that what the ward do is needed but then I am on the end of the mental torture this causes my d and I have to somehow try to motivate and encourage her to accept what is being done."

I think there are some similarities to having a child in need of cancer treatment.  It is truly terrible to have to require treatment that causes them such trauma and duress.

"She is at a very low ebb today because ward have refused, for at least another week, to remove an extra snack that was recently put in - d thinks it should come out because she has gone slightly above the lower end of her target range."

Another example of how incapable she is of making this type of decision just now.

"D is telling me she is a burden and doesn't want to cause all these problems for us anymore and that she is 'done'. She has spoken like this before when things have gone against her, but it's still tough for me to hear."

It is so hard to watch them suffer.  Terrible.

"I am also torn between wanting her home for good 24/7 (after all, she is a lot of what I live for), but worrying if the three of us can cope at home together yet (or ever), considering what a disaster it was last time she discharged herself."

Of course you want her home with you.  It is obvious that you and your wife are loving parents, and I'm sure you miss her dearly.  But really, the center needs to work with you to make sure you are set up for success during the transition home.  They need to help you create the same framework at home that is working there so that there is no option other than full nutrition.  Your d cannot make rational decisions right now, and it must be established that all decisions will be made by you.  If she comes home expecting to make decisions about portioning, number of snacks, etc. well, I think we can guess how that will end up.  The center needs to make clear to your d that she needs to eat whatever you require, and they need to work with you to develop Plans A B and C for the inevitable times she says she won't or can't eat that.  

"I remember how mentally tough and how tiring it was in those 7 weeks before, with so little chance to recuperate or take a breather.
Would love to hear from some of you!"

I remember how difficult those days are, but surely not nearly as well as you do!  I am glad you have joined us (although so sorry you had the need) and I hope I have not overwhelmed you or been too blunt.  Please feel free to ask all the questions you like. xx

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

Hello and welcome from the north of England. 

My thoughts for what they are worth.....she has come very far and to trip at the last hurdle would be demoralising for you and her. Of course you want her home...you love her. I would say if you are able throw all your resources at her however you are also important here. I feel that sometimes it’s like we need permission to put ourselves first. In your case I say absolutely do this. You’ve lost your mum and your D has a serious illness...
The professionals appear to have been doing a good job here. AN wants to come home desperately and deep down you know that she is not ready yet if she is arguing with them over snacks etc. 

I used to say to my D that if love could cure her she would have been well 2 years ago. I wish it were that simple but the truth is it does take 24/7 solid graft. We need to be in the right place mentally and physically to provide that support. 

You will choose the right path and whatever you do do not judge yourself harshly. Be kind to yourself. 

virtual hugs. 

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Ian_C
Thank you for your replies which are very helpful.
Regarding portioning. We had a 15 minute session with a nurse in the ward just before the last discharge in their kitchen showing us what a portion should look like on a plate eg protein, carbs, veg.
We have told them we need more help on this again.
When D has been home on leave or when she discharged herself before, she has initiated her portioning with me stood next to her, which I then say if I agree with or not. That does have the disadvantage that if I say she needs more then D thinks I am just saying it to get her to eat more whatever. If I say it's right then she sometimes thinks it must already be too much!
I do my best but I don't really have a clear idea of what is right.
Also D initiates the picking of the meals for the plan for when she is home on leave and then checks what we think of it....and I haven't really got anything to go on other than to say it looks alright to me. Because her trend has been to gain weight until now, including on home leave, this hasn't concerned me. But I am more worried about this if she transitions home as this wont be just 48 hours or so at home but will be for every meal every day and we can't afford for things to slip.
I have felt that when I get a lot of hearing my D's view on things she talks me round to seeing things her way, sort of 'against' the ward, but when we meet the ward or D's consultant (once or twice a month in a formal session) then I realise that what they are doing is spot on and needs to continue. Sometimes I have been primed by D to say supportive comments for her but then when I haven't because I have realised that the ward is right, D gets upset and I'm torn between feeling I have let her down and knowing I have done the right thing.
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Torie
There are a lot of positives here - the biggest of which of course is the weight gain.  Kudos for that!

It is up to you how you want to handle the portioning and the menu.  For me, it was simplest and safest that D had no say in that - in your household you may decide to allow input.  I would just advise to "start as you mean to continue" because it is very difficult to wrest back control once you have relinquished it.

ED can argue like a lawyer!  It is nearly impossible to win an argument with ED so my solution was to decline to engage in those discussions.

"I have felt that when I get a lot of hearing my D's view on things she talks me round to seeing things her way, sort of 'against' the ward, but when we meet the ward or D's consultant (once or twice a month in a formal session) then I realise that what they are doing is spot on and needs to continue. Sometimes I have been primed by D to say supportive comments for her but then when I haven't because I have realised that the ward is right, D gets upset and I'm torn between feeling I have let her down and knowing I have done the right thing."

You haven't let your d down.  Just the opposite.  You have done the hard work of being a loving parent and following the difficult path that takes her toward health.  Your real d may see that; one day she may even thank you for it.   It is a badge of honor to be hated by ED.

Keep swimming. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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Ian_C
Thank you Torie.
Regarding portioning, the ward have allowed d to start some portioning a while back and also some self catering there but they are always overseeing it Indeed, a lot of the complaining from d to me is about the ward telling her to put more spread on, more peanut butter etc! So, although when I think about it, it seems a bit ironic that the ED is doing its own portioning, I take your point we need to start how we need to go on, so we will need to decide, with a steer from the ward, the best way to do this so that portions don’t start ok but then start shrinking.
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MKR
Hello from another parent whose child wishes to be in charge of the kitchen 😀.

Portioning and plating of meals: youy daughter needs to trust and eat what she's been served. It's a hard long road to get there and I wish you all lots of strength!

The less your daughter is involved with buying/ planning/ preparing/ serving food, the faster she will recover.  Because at the moment food must be on her mind 24/7.  I used to get 10 text messages a day ALL food-related, like What's for dinner?, Do you know capsicums are on special?, Can I replace rice with veg? and so on.  Instead of the more normal Have you seen my math notebook?.

The ED gets the grip on the child and we need to rescue them from the clutches.

So... in short, you parents need to take charge of the Kitchen and Dining Table. And snacks to be had between meals. This is done by nudging, encouraging and some tough love: We are not stopping until you have eaten this. LSUYE = life stops until you eat. 

Nudging,  encouraging but NOT persuading or reasoning because ED can debate with you forever. It was so hard not to get caught up in an endless discussion in our house.

You may have to use your financial power over your daughter, like discontinue paying for thing until compliance. Not blackmailing but agreeing in advance on consequences, in a form of a contract. Include rewards in  that contract, so there is a taste what lies ahead when ED is beaten.

I hope this is not overwhelming.  Stay strong!

All the best, 
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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ValentinaGermania
Ian_C wrote:
Thank you Torie.
Regarding portioning, the ward have allowed d to start some portioning a while back and also some self catering there but they are always overseeing it Indeed, a lot of the complaining from d to me is about the ward telling her to put more spread on, more peanut butter etc! So, although when I think about it, it seems a bit ironic that the ED is doing its own portioning, I take your point we need to start how we need to go on, so we will need to decide, with a steer from the ward, the best way to do this so that portions don’t start ok but then start shrinking.


Here portioning under observation was just too much stress at the start after IP and we plated all in the kitchen and presented it like in a restaurant for all at the table and that was less stress. To get her out of the kitchen also made it possible to up the calories on a small portion so less stress for her stomach.
Keep feeding. There is light at the end of the tunnel.
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Ian_C
D is 19 by the way.
When I typed that I didn't really know what a correct portion was, I realised this is a priority for sorting out with the ward, and to discuss whether they agree with d even doing the portioning herself under supervision.
D's target range is 17-17.5 bmi at which point it would be reviewed. She hit 17 on Monday but today has dropped back slightly below (Lost 0.2 kg). She has told me that when she is discharged she wants to work at staying above 16.5....not 17 as she thinks that is too high.
We have a CPA monthly meeting next Wednesday where I presume we will hear the ward's latest thoughts on where we go from here.
I have rung the ward today to ask for a catch up over the phone before then. Prior to this admission, the ward manager and consultant met us without d present and talked us through everything and the idea at the time was that we would keep a communication channel open between us and the ward, separate from d, (so long as d had agreed ward talking to us, which she always has) which sounded great but it hasn't really happened. Also, we have not had anyone asking us after each home leave how it was for us, so if anyone is telling them how its going then it can only be our d. I think its long overdue I have a chat with them about how leave is going - including how we do portioning and that d still finds it very hard to sit, so we never sit and watch telly together and we always need to be 'doing' something which doesn't involve sitting.
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Enn

A BMI of less than 20 really does seem low. There was a parental survey done and what they found was that parents felts that their child recovery was noted at a BMI of about 22.

The fact you’re d wishes to stay ‘above’ 16.5 is all ED. I am sorry. 19 is just an age, and maturity in our kids lags a few years from their chronological age. 


Keeping her at a low weight may not at all help her to recover. Also recovery should also mean she does not care about her weight and food.

Having proper discussions with your team about who does what and when prior to discharge will be useful. You need to have plans that are very detailed so that there are no slip backs. 

 

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)
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teecee
We don’t focus on numbers but certainly didn’t see real progress until 22-24 BMI ....
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ValentinaGermania
Ian_C wrote:
D is 19 by the way.
When I typed that I didn't really know what a correct portion was, I realised this is a priority for sorting out with the ward, and to discuss whether they agree with d even doing the portioning herself under supervision.
D's target range is 17-17.5 bmi at which point it would be reviewed. She hit 17 on Monday but today has dropped back slightly below (Lost 0.2 kg). She has told me that when she is discharged she wants to work at staying above 16.5....not 17 as she thinks that is too high.


At 19 you can work very good with a contract and incentives for motivation. Such as driving her own car, going to college/university or having a nice job.

At that age a good portion is at least what you and hubby eat. Here more hubbys portion size.🙂

A rage below BMI 20 is a good start for a relapse. That is definitivly too low. Most patients recover at a BMI around 21-24.
It shows very well how deep your d is still in her ED thoughts when she says 17 is too high.
Keep feeding. There is light at the end of the tunnel.
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Torie
I wonder how they came up with a target range of 17 - 17.5.   I agree that is far too low for most.  I wonder if anyone here has had success at such a low BMI; surely not the Torie family.

It is like walking up a hill of sand.  Gravity keeps pulling at you so that you go up two steps and slip back one.  When you get to the top of the hill, you are no longer being pulled back down like that, but if you try to stop a step or two from the top, it is just too much work to try to stay there.  The sand will shift under your feet, and you will always be fighting that.

You may wish to plot her historic growth on mygrowthchart.com (or is it mygrowthcharts.com) if you have historic figures.  Many find that their kid started slipping off their natural curve a few years before anyone had an idea there was a problem, so it is often necessary to look at her curve before that time (going back two + years before you had an idea there was a problem).  

She needs to return her historic place on the curve, no matter how she feels about BMI 16, 17 or 18.  What she thinks is unlikely to have any good relationship with where her weight needs to be.  xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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Enn
How is she doing with her diabetes? Is she on a pump or subcut injections? Also those with type 1 dm can have diabulimia, where they stop their insulin acutely and lose a lot of weight quite rapidly. You mentioned she does not have bulimia, but this is different. This is the intentional omission of insulin for the sole purpose of weight loss. 
Just wish to make sure, and I am sure, that you have a good handle on that part as well. 
https://www.nationaleatingdisorders.org/diabulimia-5
https://www.webmd.com/diabetes/what-is-diabulimia
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)
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Enn
As I think about it, what are her blood sugars at? High sugars lead to a catabolic state in the body. The body urinates the sugars out (ie calories--> wt loss) and then the patient goes into starvation mode and burns fat which then add up in the blood as acid (ketones) and the patient may experience DKA (diabetic ketoacidosis). Again I am sure you know that. The point I am trying to make is that if her sugars are high, it will be hard for her to gain appropriately.
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)
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Ian_C
I believe the wards usual minimum is 18 although that’s not their preference. But set d’s at 17-17.5 because of her intransigence on the matter. I’m not sure yet if they are then accepting her only maintaining at this weight or whether they will try for any further. The consultant said at last cpa that they would “review” at that point but d is 100% set that it’s maintaining only now. I rang the ward today to ask for a meeting with ward manager and consultant without d present to discuss some of this - they said they would provided I raised this in next weeks cpa meeting and d must know about it. That doesn’t make it easy but I think it has to be done.
D is nearly six foot so would tend to weigh more and I think media publicity that obesity leads to diabetes could have led to some of this as it used to upset her (it’s often not specified it’s TYPE TWO not type one for which this is the case).
Blood sugar control was historically very good. Has generally run higher blood sugars in ward than at home and when hasn’t gained target weight d has sometimes expressed concern it might be due to high levels affecting absorption of food. D does not have a pump and does her own insulin calculations (will ask me to agree them with her at home). Before first admission her background/24 hour insulin dose was down to 1 unit...,,I can remember in the “good old days” it being 27 units! I think it’s at 6 now.
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Ian_C
I must admit I’m feeling a bit sick at the prospect of trying to push d that she must go further but I totally get the analogy about the sand and that standing still on the climb leads to slipping back.
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teecee
I absolutely understand that sick feeling. The hardest thing for me was enduring her distress. Remember you are doing life saving work for your daughter. Be easy on yourself first and foremost. 
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Foodsupport_AUS
Welcome to the forum. There is no doubt that our children with ED can be very convincing and coherent when defending their eating disorder, the need to not gain weight etc. Personally if she still only BMI of 17 I would be working very hard on trying to require further ongoing gain. It is clear from your posts that your D is still very mentally unwell with her AN and in reality is being ruled by her ED and not by any drive to try to be healthy or to recover from her AN. Her distorted thinking that all will be fine if she is just allowed to lose a little weight is further evidence of this. 

I think it may be time to start to work on changing tack when supporting her. For her long term health she needs to be at a significantly higher weight. I am guessing she still doesn't have periods yet, which of course apart from affecting her fertility puts her at high risk of osteoporosis. Her poor diabetic control puts her at high risk as of other conditions as well. There is a difference between supporting and loving her but not supporting ED. Letting her know that you will no longer support any of those behaviours which will interfere with recovery is a start. This includes things like no longer supporting her line of "she has been pushed too far" in weight gain. She hasn't, she is frightened, but she really does need that much higher BMI to at or above of where she has been in the past. I suspect this was not 17.5. Leaving her there is a recipe for her to just bounce back again, more sectioning, more inpatient stays and to potentially not ever recover. 
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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Ian_C
Thank you for your replies. They help to crystallise my thoughts.
D comes home tonight for two nights home leave. I’ll try to be strong when conversation inevitably turns to the kind of things we have discussed and try to make that shift in the way I support her recovery.
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ValentinaGermania
These last kg feel like impossible but they are really important, as much as working down the fear food list. She will stay chronical ill if she does not get to a healthy weight.
We always told our d that we will support all normal and healthy life but we will not support ED.
If she starts a conversation about BMI try to stop it and just say "we will see that when you are recovered" and change the subject. No not engage in that ED talk, any number that you will give her she will use against you. 🙂 Postpone any discussion and try to cook very heavy stuff when she is at home 😁...
Keep feeding. There is light at the end of the tunnel.
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Ian_C
Thank you Valentina. I know what you say is right. I’ll keep this in mind this weekend.
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Torie
Ian_C wrote:
D is nearly six foot so would tend to weigh more

I'm not sure if this is what you are referring to, but one of the flaws of normal BMI calculations is that they underestimate how much weight is needed for tall people.  It's just how the math works out with this (flawed) formula.  A medium height person at a medium BMI will have a medium build.  A tall person at that same BMI will be considerably leaner.  (And a short person at that BMI will be stouter.)  

Good luck this weekend. xx

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

Hello IanC,

Welcome to ATDT. You have already gotten very good advice here but just thought I would chime in with a couple of things.

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I must admit I’m feeling a bit sick at the prospect of trying to push d that she must go further but I totally get the analogy about the sand and that standing still on the climb leads to slipping back. 


Try to separate yourself from your daughter's distress at weight gain by remembering that the big picture requires you to be strong and insistent that she be fully nourished in order for her to be able to eventually thrive and live the healthy life she so deserves. This will involve taking her weight higher. If you feel worried about being able to do that at home, perhaps the unit will keep her until her weight goes higher?

The fact that she is so adamant about remaining at the low weight is ED driven. We found at home that if we tried to engage our d. in discussions about why she needed to weigh enough and talked about gaining weight, it didn't help. What did help was just making sure day in and day out when she came home from treatment, that she had consistent full nutrition. I also refused to take her home from residential until she had achieved a bmi of 20.5, maintained that for 6 weeks while gradually having more freedom, and then agreed to a menu that she would eat at home, and stepping down and being under the care of an outpatient treatment team. 

warmly,

Kali







Food=Love
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