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

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admum
Hi. Our D 15 was DX recently as having Ednos under ICD 10. I accept that she has an eating disorder but increasingly think she has a comorbid BDD. She is getting therapy for her ED. This is focusing mainly at present on stoping her purging and maintaining her weight. She gas a mix of AN and purging. She doesn't binge. We attend part of the sessions Her weight is within the normal range although she has lost weight. We caught it quite early and started monitoring and feeding her immediately even before dx.
The team have said that she will receive treatment for body image issues at a later date. I believe this is a group intervention.
I have looked at the criteria for BDD. I think she fits this. This week she was unable to go to school one morning and came home early another day as she was so emotional. She gets ready for school. Will spend ages changing outfits but in her mind make her look fat. She checks herself in mirrors constantly. Talks about wanting surgery for her bum, breasts reduced, fat removed, nose shape changed.....often she feels unable to go out as she feels so bad about how she looks that she thinks people are laughing at her. I have to drive her most days as she cant face the walk due to these feelings. Sometimes she tries but starts crying. She has lots of lovely clothes but tries them on cries and cant wear them. She has a safe pair of skinny black jeans. Uniform has been a nightmare. I have bought so many skirts trousers etc but she just doesn't feel comfortable in them. She also has ASD. Its not a sensory issue. She cant cope with her feelings about her body.
I feel that this is severely affecting her life. She obsesses about her body. She used to be on lots of sports teams. Now she runs at night when No one can see her.
I asked about SSRI for BDD. The team say no. We treat ED first. May not be BDD. Does anyone else have comorbid BDD. Can you recommend good books? I have just ordered broken mirror.
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OneToughMomma
My heartfelt sympathy to you and d.  It must be so difficult for you both.

My d is recovered and says that as she gained weight she felt slimmer.  In other words, weight was a cure for her body dysmorphic symptoms.  I don't think we are the only family here at ATDT with similar experiences.

Your d may require treatment for BDD, but in my experience, her team is right that the symptoms might abate as the ED behaviours are stopped.

Of course it is up to you as her mum to decide if you want to push for treatment for BDD now.

Wishing you all the best,

OTM
D in and out of EDNOS since age 8. dx RAN 2013. WR Aug '14. Graduated FBT June 2015 at 18 yrs old. [thumb]
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Torie
I agree with OTM. This vile illness makes them feel fat fat fat when they are underweight - and it's just plain weird how they feel less fat once they are back to a proper weight. Of course, wr is no guarantee that this feeling will melt away, but for many it does. Good luck and please keep us posted. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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admum
Thanks both. The issue is that she is a normal weight. She looks thinner than she did. Her body shape has changed. She has a Bmi around 22. Although when she has been weighed she has had comments along the lines. Oh that's more than expected. She isn't packing pockets etc. Paed said at review. Weight is fine can go down and still be healthy but obviously not a good idea given AN symptoms. Thats a specialist paed at a leading hospital. I said well if its state not weight I dont understand. She isn't supposed to gain weight. Just maintain. Her MH is v poor i didn't get an answer. Now in her mind she can continue to lose weight because paed says ok. Its heartbreaking seeing her cry and not want to be seen outside. I cant see how this cycle will be broken without intervention now. If she was underweight it would make sense. Sorry I just feel so frustrated
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Torie
If you're sure this is a healthy weight FOR HER and if she's been at this weight for a while, it's probably time to try to find someone who can help with this. But just as a few people are naturally thinner than most, a few are also heavier so you can't go by BMI alone on that. 

I have to admit I envy those whose Ed-kids "just" need wr to restore mental health. For many (mine included), the anorexia seems to be part of a bigger picture. Ugh. As if AN weren't enough. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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admum
Thanks Toothfairy.purging is still happening. I agree its exhausting trying to stop. My d has done a lot of damage to her teeth in a short space of time and even that hasn't stopped her. That's why they are working on that now. I suppose I have to be patient. I'm just worried as she is starting to miss so much school and has exams soon. School have Sai will try and support by letting me pick up work for her. Given that they hadnt noted anything on her file. after letter from hospital I have doubts.
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Sotired
With your d having asd as well as an,that will make everything harder for neurotypical psychologists to understand.does your d see therapists who have experience treating asd as well as an?with the more rigid thinking patterns that happen it might be worth looking into your d seeing an asd therapist .my asd boy has seen an asd therapist to help cope with his sisters ed and the setup is quite different for them.anyway that's just a thought.even high functioning aspies need some help understanding that the world isn't laughing at them,that people aren't being mean when they think they are but might just be gently teasing.i don't know what interventions you tried pre ed for your d but it may be worth revisiting some of them.what were her coping mechanisms pre ed?how did she calm herself?all asd people need something else on top of what neurotypical people experience.my s requires gentle pressure to help him re ground himself when upset. I understand that an feels like quite enough but her symptoms may ease a little if you look into some asd treatment.
Sotired42
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admum
Yes Toothfairy perfectionism seems to part of characters many have. It makes school so hard for them. Icd10 is the international classification of diseases. In UK they use rather than DSM.

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admum
Torie do you mind me asking if the other MH issues / comorbids only dx once ED under control? I can see the sense in the mindset Drs have of treat the ED first but just feel frustrated.

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admum
Hi sotired. Psychologist is supposed to have worked with asd before. Pre Ed she used sport to help anxiety. Now her BDD symptoms stops this. I also use pressure. Wrapping her in duvet etc. The laughing at her thoughts I think are from the "monster bdd/Ed" rather than an Asd misinterpretation. She has started cycling which can help. She has always needed a lot of sensory input and so loved speed. She used to skate to school but again her BDD thoughts stop this. She feels more exposed on skates than a bike I suppose. Even cycling is sometimes not possible.


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Torie
admum wrote:
Torie do you mind me asking if the other MH issues / comorbids only dx once ED under control? I can see the sense in the mindset Drs have of treat the ED first but just feel frustrated.


I don't mind at all, but not sure how helpful my experience will be. Just before Christmas 2014, I found out my d was cutting, fasting, and thinking suicide. I took her to a t who claims to practice DBT as fast as I could - she sent her to psychiatrist who diagnosed depression and prescribed Prozac. I started making her eat more right away, but had no idea we were dealing with Ed. (Total shock as no known relatives have suffered from ED as far as we know.)  I can't remember how I figured out AN was part of the package - t didn't diagnose her with AN or anything else, and wasn't much help. Or perhaps she was - no way to figure out what was making things better/worse in the initial whirlwind. D was getting more suicidal though, so psych said she should stop the Prozac, which my d very much opposed in the first place. Eventually, her ped caused a big problem by telling d she could lose weight (?!?) so I had to take my d to the beloved Dr. Peebles at CHOP, who diagnosed AN and told my d to eat what I told her to.

That's pretty much the extent of the professional help (and hindrance)  we had, as we were doing fine with re-feeding until moron ped created the need for a TRUE Ed expert to validate what DH and I were doing at home.

Here's the thing, diagnoses aside: My d was suicidal and cutting BEFORE she started restricting. It all happened so fast - mid-summer she was fine, then boom massive self-loathing, suicidal ideation and cutting, then bang realized she felt better when not eating and kerpowie started fasting as a way of alleviating the terrible dark depression and ... hello Ed. She didn't tiptoe into AN as so many do - she would fast for one day, then eat for a day or two, then fast for two days, until she had lost 20 pounds in less than a month. I had NO IDEA how bad it was until non-Ed sibs happened upon her journal and called me in a panic. Timeline: Late summer self-loathing, depression. Fall: Cutting and darker depression. Started fasting late Nov. Family realized crisis situation late Dec. 

First on the scene were D's friends. Oh thank heavens for them. They told their moms who clued me in that d was fasting and that they were worried about her just a few weeks in so I was able to apply pressure to eat more very early. (But I had no idea D would lie and scheme about it.) My level of  concern was no match for the severity of the situation, but at least we drastically slowed the plummeting of weight. I have always felt that if even another week had passed (or maybe even just another week), she would have ended up IP. And oh thank heavens for ATDT, too. Such a lifeline.

Re-feeding was relatively easy (surely no walk in the park, but no plate throwing etc.), but she  has been well and truly wr almost 2 years and only slowly - oh so s-l-o-w-l-y - is the depression easing. 

Sorry this is so haphazard - I'm typing at top speed because I have to get off the computer 10 minutes ago. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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admum
Thanks Torie. Have tried to reply so many times but phone is playing up. Will keep this short. Unfortunately I think my D does have other comorbids. She is ASD and so anxiety is a given. After long talks I think BDD pre existed ED. Maybe chicken and egg. Apparently 25% have Ed and BDD.
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admum
Its hard to work out chronology. I know purging started sept/oct last year. Restricting ie throwing away breakfast and lunch as not always eaten together probably ar least a year before that. BDD feelings poss date back to start of
Secondary school with some symptoms back to primary. I hadn't realised how
Long ago she stopped after school sport. Definitely chicken and egg.
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admum
Have started to read one of leading books on BDD the broken mirror by K Phillips. So enlightening. My D fits BDD. It has helped me understand her turmoil. I used to get so annoyed with her constant mirror checking and changing clothes. She cant help it. Its all consuming. Her talk of cosmetic surgery for at least last 2 years. She admitted to SH once prior to purging. I worry that as we control purging the SH might start. Both appear to he an anxiety reliever.
Both H and I feel BDD needs help. Need to discuss with psychologist at next appointment. If anyone can recommend books or studies to read please let me know. Easter was followed by some restricting as guilt over eating while we were away for Easter and the chocolate egg she had.
Main treatment for BDD is SSRI and CBT. My D stayed with aunt for a night and in middle of night texted me to say so fed up with how she feels. Wants to like herself and feel good about herself. Hates how these feelings restrict her life and control . Wants T to deal with this now not later. She wants to get better. Doesn't accept its BDD or ED. But does acknowledge symptoms. I know I'm lucky. My D is not seriously ill. But it does seriously affect her life. She isn't an average 15 year old. Her ASD does make life more complicated. I have taught both my children that different is cool. But it doesn't take away all that added stress that living with an ASD brings. The statistics of Eds BDd and suicide are so frightening.
Had my moan/scream in the dark. Off to look at the sea. To calm my nerves. My darkest fears. Get some perspective. .
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Torie
Admum - I think you know this, but if she isn't at good weight FOR HER, she will exhibit BDD symptoms. If she maintains good weight (for her) long enough, might lessen, might not. I see I accidentally typed "DBT" when I meant to type "CBT" - DBT seems to help lots of kids with issues like your d and mine.

Please keep us posted as your technology permits. Keep swimming. xx

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


I don't mind at all, but not sure how helpful my experience will be. Just before Christmas 2014, I found out my d was cutting, fasting, and thinking suicide. I took her to a t who claims to practice DBT as fast as I could - she sent her to psychiatrist who diagnosed depression and prescribed Prozac. I started making her eat more right away, but had no idea we were dealing with Ed. (Total shock as no known relatives have suffered from ED as far as we know.)  I can't remember how I figured out AN was part of the package - t didn't diagnose her with AN or anything else, and wasn't much help. Or perhaps she was - no way to figure out what was making things better/worse in the initial whirlwind. D was getting more suicidal though, so psych said she should stop the Prozac, which my d very much opposed in the first place. Eventually, her ped caused a big problem by telling d she could lose weight (?!?) so I had to take my d to the beloved Dr. Peebles at CHOP, who diagnosed AN and told my d to eat what I told her to.

That's pretty much the extent of the professional help (and hindrance)  we had, as we were doing fine with re-feeding until moron ped created the need for a TRUE Ed expert to validate what DH and I were doing at home.

Here's the thing, diagnoses aside: My d was suicidal and cutting BEFORE she started restricting. It all happened so fast - mid-summer she was fine, then boom massive self-loathing, suicidal ideation and cutting, then bang realized she felt better when not eating and kerpowie started fasting as a way of alleviating the terrible dark depression and ... hello Ed. She didn't tiptoe into AN as so many do - she would fast for one day, then eat for a day or two, then fast for two days, until she had lost 20 pounds in less than a month. I had NO IDEA how bad it was until non-Ed sibs happened upon her journal and called me in a panic. Timeline: Late summer self-loathing, depression. Fall: Cutting and darker depression. Started fasting late Nov. Family realized crisis situation late Dec. 

First on the scene were D's friends. Oh thank heavens for them. They told their moms who clued me in that d was fasting and that they were worried about her just a few weeks in so I was able to apply pressure to eat more very early. (But I had no idea D would lie and scheme about it.) My level of  concern was no match for the severity of the situation, but at least we drastically slowed the plummeting of weight. I have always felt that if even another week had passed (or maybe even just another week), she would have ended up IP. And oh thank heavens for ATDT, too. Such a lifeline.

Re-feeding was relatively easy (surely no talk in the park, but no plate throwing etc.), but she  has been well and truly wr almost 2 years and only slowly - oh so s-l-o-w-l-y - is the depression easing. 

Sorry this is so haphazard - I'm typing at top speed because I have to get off the computer 10 minutes ago. xx

-Torie


Gosh Torie, your D sounds so very similar to mine! Even the timing is exactly the same, as I noticed my Ds self harm on 5th December 2014. Again, my D had anxiety, depression, suicidal thoughts prior to ed, but we just didnt know it. My D used starvation to control her anxiety, and of course ED leeched oto that, and the rest, as they say is history. It is only in the past month or so, that my D and I have pieced everything together and things have become clearer - after seeing her current T. I have been told a couple of times that my d is very atypical, and I wouldnt be surprised if she has been misdiagnosed RAN. I think this will be definitely up for discussion further down the line with T.
UK - South East

19 yo D

Dx AN Feb 2015 (Aged 15). Pre-existing low self-esteen and high anxiety. 

2015: 3 x medical hospital admissions. 1 month in IP which she self discharged from [eek].
2016: 3 x hospital admissions. 
2017: CAMHS CBT. WR, dropped out of 2 different colleges and started an apprenticeship.  Started having grand mal seizures and was diagnosed with epilepsy in Nov 2017. Sacked from job because of this.  Tribunal ensued.
2018 - doing a Psychology degree through Open University and working in retail to pay her way in life. Relapses with eating disorder in June 18 and Nov 18 😢. 

On particularly rough days when I am sure I can't possibly endure, I like to remind myself that my track record for getting through bad days so far is 100% and that's pretty good. [Author Unknown]
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Torie
ooKoo wrote:
Gosh Torie, your D sounds so very similar to mine! Even the timing is exactly the same, as I noticed my Ds self harm on 5th December 2014.


Oh dang, I need to stop writing posts when I don't have time to edit them. We're actually a year further in than what I said - my d went down the rabbit hole late in 2013; not 2014 as I mistakenly said. So we're coming up on 2 1/2 years in ... and d is doing so much better now. 

Here's hoping your d will be in a good place, too, with this additional time.

Keep swimming. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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admum
Well a month has passed. School increasingly difficult some days she makes it there for a while. Next week she starts gcses. Anticipate worsening anxiety. Thankfully its only 4 this year so less pressure. This week seeing psych for review and consider anti ds. She has to complete a BDD questionnaire. Frightening what she told me. She hates everything about her body and face. Even her ears her forehead her eyebrows. Her school is all reflective glass and this makes getting around school traumatic. I'm hoping that anti ds will help her.
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Torie
admum wrote:
Her school is all reflective glass and this makes getting around school traumatic.


Oh dang, reflective glass.

I think we're a year ahead of you on this journey, and my d is s-l-o-w-l-y coming to terms with her appearance. I think her therapist once told her to pick one thing to try to accept ... maybe her eyes? I don't know if that's an accepted technique or if it worked or anything, but perhaps worth a try? Eyes and hair can't be "fat" so maybe they are easier to accept?

Ugh. Thinking of you. Please keep us posted. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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admum
Hi thanks Torie . Yes I sort of tried to encourage her to name one this thing she liked. She likes her blue eyes but not their size. She was so convinced her ears were big she measured them they are normal looking ears. proportionate. Apparently when she looks in the mirror what she sees is different. Its not just about fat. Its shape and tbh a very odd perspective. Forehead too wide. Nose wrong shape too big. Eyebrow - just the one is wrong shape. Chin.and on and on. The way she describes features is like she is looking in the mirror at the fairground.
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Torie
One thing I was always tempted to do (but never did) was take photos of all 4 females in the Torie household wearing the same outfit. Cover up the face and ask Ed-D what each photo looks like to her. 

I remember reading a study where they had neurotypical people and (AN? BDD? Can't remember) walk through doorways of graduated sizes. It turns out that we automatically twist sideways when the opening is too narrow to fit through straight on. The sufferers would turn sideways even when going through doorways that were perfectly adequate to pass through without twisting.

I hate this vile illness. And all its relatives. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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admum
Psych dx depression and anxiety. Started anti d. Now waiting for assessment for BDD specialist team. Has definitely got serious body image issues. Anti ds seem to have helped already. Feels a little less anxious. Managed to sit gcse exam today. So proud of her determination today she is reading about BDD
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