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

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I'd like to get some feedback about when a person with an anorexia brain becomes able to access and be helped by therapeutic intervention.
My daughter is 14 years old and is currently at an inpatient unit in the CAMHS in the UK.
I understand that a persons brain that is malnourished is not able to operate efficiently in regards to processing thoughts that drive behaviours associated with anorexia.
I was wondering what criteria clinicians use to determine the appropriate time when people with anorexia can re-engage with positive therapies. I have been told one such measure is the 'height to weight percentage value'. I guess any such criteria has a degree of subjectivity when individuals are taken into account and assessed, but are there any other measures that are used to establish the time to engage with therapy? When can someone be rational enough to be able to want to and actively change their anorexic thoughts? Even though she can distinguish anorexic thought from her own and always has been able to.
It seems my daughter is caught in a place of being too undernourished to engage with therapy, but unable to control the thoughts which therapy would help to alleviate.
Any thoughts would be appreciated and gratefully received.
Hi, welcome to the forum.
I have seen reference from a US doctor of wfh needing to be about 85% for young person to be able to engage. My D did start therapy before that but I wasn’t sure it was that effective before then and nutrition was her main need and getting used to eating 3 meals and 3 snacks daily. Certainly lots of anorexic thoughts and behaviours disappeared with weight gain. 
When the time comes that she is rational enough to participate in therapy, you may find that therapy is not needed.  My advice is to focus on getting the weight on and only after that consider what additional work is needed. xx

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

Torie wrote:
When the time comes that she is rational enough to participate in therapy, you may find that therapy is not needed.  My advice is to focus on getting the weight on and only after that consider what additional work is needed. xx


that is  what we found as well. My d did need support for some anxiety after WR, for about a year or so. Now doing very well still anxious about school etc, but I think that is more normal. Did need some meds though for two years. 

I remember asking the forum members a similar question when we started. I wanted d to engage and see the light and error of her ways to make my job easier. It did not happen with therapy. It took food and a lot of time and then even more time and food. The brain has to heal and also catch up what it lost and the mature further. Once the weight is up you will see changes and can gauge what other therapies are required . 

sending my best.🌿

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)
Hi Craig19,

Welcome and I hope you will find support here.
In our case, therapy seemed more beneficial when weight started going on.
Our d. had therapy the entire time she was ill, even when underweight.
But it really was the normalization of eating and weight gain that helped her.

She did have therapy called "REACH" therapy which was very helpful while she was undergoing refeeding, which focused on the behavioral aspects of the ED. For example how to offramp and change the behaviors which had become habitual and supported the eating disorder. An example I can give was cutting food up into tiny pieces, which is common among people with EDs. The therapists had her eat with her other hand because she could not then cut the food up so small and had less control. It also addressed other aspects of the illness and behavior but that is the simplest example I can give. She later said that was the most helpful therapy she received. The idea was that when a person who was ill launched into an eating disorder behavior, they discussed the options to change the behavior and then had to put those new options into practice under supervision. The idea is that the brain rewires itself and as you practice the new behavior and do it over and over again it becomes the new habit. 

We started FBT at 70% Wfh. Waste of time for us then and therapy is still a waste of time, now 95% wfh. I guess some kids weight  restore and manage their lives going forward with no therapy and others will require therapy and or meds to manage their lives. I believe weight restoration is key before you can determine what, if anything is still required.

Hope it all works out for you.
@Kali that’s really interesting re REACH therapy. I had not heard of it before, although I am aware of concept of needing to rewire brain. I just did a quick google about it’s use in addressing habits of anorexia. And also came the notion of food restriction becoming a habit rather than being to achieve an outcome. This makes a lot of sense to me with respect to my own daughter. It makes sense but I have not seen it described so explicitly before. I will need to read up. X
We tried EMDR approx 18 months after WR and felt that this was the right time to try a therapy as she had built up some resilience to deal with distress. It was successful but tough at the beginning as it addresses the scary thoughts that seemed to cause the most distress at the beginning of her illness. 
Thank you all for your comments. Love and light to one and all. xxx
Hi @Craig19,

I also think REACH therapy sounds interesting, because it is practical, hands on.

Our family therapist did not want our d to participate until she was judged "ready". So the sessions proceeded parents-only.  Occasionally (1x in 2 months) our d would be requested to join, however if she went into her ED tirade or became tearful, she was dismissed as not ready.

I guess it's a bit of state, not weight - as they say.
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
REACH therapy sounds excellent. I have never heard of it before but appears to tackle the behaviours rather than the thoughts 
In my view any therapy which looks at the psychology alone and the 'why' the patient became anorexic is a waste of time anyway and there is still a lot of this around.
My own d while IP had a therapist who placed the anorexia at a point on a scale or ladder and explained the need to my d for the illness to move down the scale or ladder until it disappeared. They discussed her progress during the nine months she was IP. I think they also discussed the advantages and disadvantages of not letting go of the illness. My d was about half way along when she was discharged. Nowhere near recovered but she said she liked this therapist's approach and said it made sense to her. I have never heard anyone else doing anything similar.
Believe you can and you're halfway there.
Theodore Roosevelt.