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

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cjac16
Really do not know what to do any more.  My d was diagnosed with AN five years ago.  Over that time we have had successful WR but the AN mutated into Bulimia.  She is now of normal weight but the Bulimia has such a hold.  She was put on sertraline about eight months ago which seemed to make some difference initially but for a limited period.  Her dose was increased and appeared to make zero difference.  I would give her her medication each morning and witness her putting the tablet in her mouth and swallowing.  Unbeknown to me she never actually swallowed them and saved them up taking 35 on the eve of my father's funeral.  After two hours and realising that they had not worked she came to us.  Fortunately the does was not enough to kill her but make her very sick.  She was kept in hospital overnight and is now being seen by her ED consultant once a fortnight and has the NHS crisis team visiting every day.  She just wants everything to end and I feel absolutely helpless.  She has now been prescribed escitalopram which I now make sure I see on her tongue and once swallowed she has to open her mouth and wiggle her tongue so that I can see the tablet is not hiding.  She has been on this for two weeks so no effects yet as takes 4-6 weeks.  Has anybody else been in this situation and if so what did you do that helped.  The main problem with the crisis team and the consultant to some point is that my d will just tell them what she thinks they want to hear so we are getting nowhere.
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ValentinaGermania
"The main problem with the crisis team and the consultant to some point is that my d will just tell them what she thinks they want to hear so we are getting nowhere."
That is what most of them do and ED is really good in tricking people out. Do not blame yourself for not realising that she did not take the pills, that could have happened everywhere here.
My ideas: how old is she? Is she living in your household? What did you already do to help her stop purging? Does she have any bathroom privacy? Do you supervise her already 24/7? Do you serve regular meals and snacks to avoid binging?
Keep feeding. There is light at the end of the tunnel.
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Foodsupport_AUS
It is so disheartening when things seem to drag on and on. We were still in a pretty bad place also five years into D's illness. 

It is interesting that they have been using sertraline and escitalopram for her bulimia when the drug that has the most evidence is fluoxetine - is there are reason that is not being tried? https://www.mayoclinic.org/diseases-conditions/bulimia/diagnosis-treatment/drc-20353621
One good thing about fluoxetine is it comes in a soluble tablet form, even better for compliance. 

As for treatment what is actually happening at the moment? What sort of treatment is her ED consultant offering? Unfortunately some services treat bulimia less seriously than AN and have a tendency to just watch? As Tina has mentioned what can we do to help  you help her?
D diagnosed restrictive AN June 2010 age 13. Mostly recovered 10 years later.  Treatment: multiple hospitalisations and individual and family therapy.
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mrh74
We are in a similar position in that my daughter appeared to have recovered from anorexia and was weight restored 8 months ago.  She is due to be discharged from the CAMHS ED team in May but she has developed severe anxiety and depression and tried to strangle herself ten days ago.  She is in the process of being transferred to the general CAMHS team and was admitted to the local adolescent pyschiatric unit on Thursday due to concerns that she wouldn't be safe over the long weekend.  She is due to be discharged today and I am very concerned that she will say whatever is necessary to get out then we will be back to monitoring her 24/7 which is exhausting and terrifying.  Are you having to monitor your daughter constantly?  I'm sorry that I don't have any good suggestions or tips but  wanted you to know that you're not alone, even if our daughters' situations are a bit different.  My daughter is on fluoxetine and quetiapine but no effects yet, other than the quetiapine does help her to sleep.  Thinking of you x
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cjac16
Daughter is 19 and living at home.  Now in third year of Lower Sixth at college as missed so much time.  I have to shop daily for food so that the cupboards are empty in the kitchen which is not great.  D will binge on absolutely anything in the dead of night and then purge as she gets huge comfort from this.  At the moment I am sleeping in with her to prevent any suicide attempts.  Bathroom doors have had no locks for years.  She eats perfectly normally with meals and has been wr for years.  To be honest, the crisis team are pretty useless.  They now ring on a daily basis and my d just doesn't answer the phone.  The don't seem to follow up the unanswered call in any way.  As for her consultant, as she is over 18, I am not allowed to be present at the meetings.  Last time, however, he did call me in to let me know the d had told him one particular method she was thinking of to follow through with suicide so that I was aware.  We have all knives, razors, medication, scissors, toilet cleaner/bleach locked in the boot of my car which is not really practical for family life but has to be done.  The medication is to bring the depression and anxiety under control but as yet has done nothing.  I will ask why they have not thought of fluoxetine on Monday at next appointment.  It is literally like living on a knife edge.  On top of that I am having to go down to my mother's which is 1.5hours away to deal with winding down my father's estate and helping her come to terms with things.  Then I have my 14 year old who is struggling with secondary trauma disorder brought on by all the chaos we have been through with my d who is a school refuser as a result.  All getting a bit much.
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ValentinaGermania
Hi cjac16,

it IS too much. Do you have a possibilty to get out now and then (even just for a 10 minutes walk) to care for yourself a bit? Can you get some help to distract your younger d? It is so hard to live with that situation for all of you.
You say she has been WR for years. Was this target increasing with age? I see it often here that parents think their kids are WR because the team told them a target weight but it is only a very poor target around BMI 18,5 so just not underweight. So please forgive that question if you already answered it but are you sure she is really WR? For example our team thought my d is WR at BMI 18,5 (really!) and it needed only 2 more kg to get her into a much better state and to start brain recovery.
Is there any possibility to change that team? What about contacting Eva Musby for new ideas?
Do you have the possibilty to take her to the US to the very much recommended 5 day intense programs for young adults?
Keep feeding. There is light at the end of the tunnel.
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Foodsupport_AUS
It does sound truly exhausting for you.
Is your D getting active treatment other than the crisis team? Regular medical assessment, using any therapy such as CBT-E which has some good evidence with bulimia?
D diagnosed restrictive AN June 2010 age 13. Mostly recovered 10 years later.  Treatment: multiple hospitalisations and individual and family therapy.
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cjac16
At the moment her consultant seems to be trying to get the depression under control before dealing with ED.  She has an appointment with the consultant and her GP on Monday which she has given me permission to attend so will find out exactly what they plan as we seem to be in limbo as far as I can see.  My oldest son is taking me to Bali on 10th May to recharge and I am leaving my husband in charge.  Although he is on the ball, it does worry me but I need to recharge.  Was meant to be going last month but my father suddenly died so need to recharge and come back ready to tackle things even more now.  D's BMI is around 21 and has been for some time so she really is WR.  Wish we could get to the US but financially and practically just can't do it.  Crisis team are trying to arrange treatment for low self esteem and anxiety.  They are coming round this afternoon so will chase them on that.  Have read that Omega 3 oil and also vitamin have helped with depression for those on antidepressants - has anybody any knowledge regarding this?
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ValentinaGermania
" D's BMI is around 21 and has been for some time so she really is WR. "

If - and that is possible - the depression is a symptom of the ED than focussing on that first means to put the cart before the horse.

" D's BMI is around 21 and has been for some time so she really is WR."

A BMI of 21 alone means nothing. Do you have historical weight growth charts from your d? If she for example has been on BMI 23 or 75 % percentile her whole life before AN moved in she needs to go back to that. We saw a change in mood and behaviour at BMI 21 but that is quite rare, many need to go to 23-24 or even higher. So it might be possible that your d is NOT weight restorated for HER body. Please check that.
Keep feeding. There is light at the end of the tunnel.
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cjac16
Just redone d’s BMI and it is actually 22.5 which is actually slightly above what it has historically been.
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Enn
Hi cjac16,
Can they not consider tackling ED first as that can become life threatening as well as adjust the meds at the same time?
also I am so envious of a trip to Bali! 
I do hope you can let go and really enjoy it!!
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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ValentinaGermania
cjac16 wrote:
Just redone d’s BMI and it is actually 22.5 which is actually slightly above what it has historically been.


If it is only slightly above I would think about giving her a bit more weight so maybe that can change her state and start brain recovery. As said, here only 2 kg made a big difference.
Keep feeding. There is light at the end of the tunnel.
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melstevUK
cjac16,

What an absolutel nightmare.

"At the moment her consultant seems to be trying to get the depression under control before dealing with ED"

Unfortunately I think this is a bit 'old school' because the two will be so intertwined that treating one without focusing on the other will not lead to an improvement in either.   
What does d want to do with her life?  I assume she is trying to get some qualifications at the moment and I would focus on ensuring she stays in college until the end of this academic year so that she achieves what she set out to achieve.
But then I would be asking the consultant if d can have a planned IP placement over the summer months so that she can get intensive support to try and get on top of the b/p symptoms.

It is also worth buying Kathryn Hansen's book 'Brain over Binge' and telling her that you expect her to read it as she will find it helpful. This is one of the better books about the experience of bulimia and helps make sense of how the b/p cycle affect the brain.

I also think you might benefit from taking a slightly tougher line by saying something like 'I know that this is an illness and I know it must be hellish for you.  But I am also not going to stand back and watch you throw your life away to this illness, so you need to start being more proactive and cooperative with all the clinicians and with me in trying to get your recovery back on track.'   Or similar words which you yourself feel comfortable.

Often we have to change our own behaviour, even slightly, and then this may impact in turn on our child.  If she sees everyone around being helpless - especially the clinicians who seem to be pondering on what to do, rather than taking a firm line - the illness just runs rings around everyone.

If you can make the stand that you want to see her in hospital - it doesn't matter that she may refuse, she just needs to see that you are looking for ways and feel strongly enough to make it happen.
When you go away to Bali, tell her to try and make her dad's life as easy as possible by trying to fight the ed voice and start thinking about her future and moving into something better than the way she is living now.

You definitely deserve a break after all that you have been through.  But a big push and focus on d's future also needs to be in the picture so that you can move out of the awfulness of the present.

Hugs.


Believe you can and you're halfway there.
Theodore Roosevelt.
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