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

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Hi -

I'm new to this and this post will likely look like my mind right now. A bunch of "stuff" that's being thrown around. I just feel like there's so much on top of the ED to deal with and I'm so concerned I'm over- or under-doing whatever it is I'm supposed to be doing to help my D. So here goes - apologies for the length!

I've noticed that my 14 year old D (weight restored since July) has highest levels of anxiety and body issues in the morning, right after waking up. She cries, says she feels so fat and is so unhappy with how her legs look. She also tries to hide her breasts - albeit, that's likely what many teenagers do when they first get them. I've also noticed that when she gets anxious about her body, she starts getting pale in her face and hands become cold. She follows this with comments like: "I'm not worth anything," and "Therapy is not helping at all. It doesn't make a difference." She now wants to shave her legs every other day - because it makes her feel better. Really? Or is that OCD? I'm letting it go - maybe I need to give her space to be her?

She did a session when in hospital to see if she had body dysmorphia. They said she did not - to which she commented: "See, I told you I see myself exactly the way I am - FAT and ugly!"

I often sit with her for a while when she's down like that - we do the breathing box exercise, sing or whistle, listen to music, read...anything to calm her down and get her mind off things. Lots of validation although sometimes I get the dang words wrong and it has the opposite effect - good thing is she lets me know right away how bad I messed up. For about 2 months now, every day she tells me she has a "bad body image." We tossed old clothes, bought new clothes (many times) and every other week, those clothes are either too tight, too short or too "something." I spoke to the therapist about it a few times and she says we just need to hang in there and it takes time - a year or more, for her to be in a better mindset of accepting and appreciating her body.
Is anyone else experiencing higher levels of anxiety and body image issues in the morning as well? Any suggestions? Is there really nothing we can do about body image right now?

Lately, she's also having a harder time falling asleep. She says she "has soooo much energy" in her body. We started calming oil and short, slow walk in evening. But she's still saying she has all these thoughts and I've noticed it's her worrying about the next day and other things (because she'll call out from her room saying she forgot to do this or that, could someone remind her tomorrow). She didn't have this before ED. She would hit the pillow and be asleep right away. Therapist says this is another area that will get better over time. I need to let go.

One other question I have is around executive functioning. At early age, my D was diagnosed with executive functioning issues.  I met with another therapist the other day who was working with kids that have a lot of anxiety and she said many had exec functioning issues or ADHD - at least the ones she was working with. She said that learning to be more independent, learning to have a voice and organization and study skills help kids with anxiety. While my daughter is a very good student, it takes her many, many hours of work to get done what others might get done in 30 minutes. So I asked the therapist if I should also do work on studying/organization to reduce school stress she was feeling. The therapist said that until my daughter was in a better spot, I should not consider working on any of those as the ED needed to be the primary focus right now and any additional therapy could actually be even more stressful for my D. I wonder though: Is there any correlation between executive functioning and ED?

Thank you!

D started "healthy / organic foods" eating after Christmas 2018. Became more selective Jan/Feb and in March started restricting quickly including water. Took to ER because she looked and felt weak - her heart beat was down to 31 bpm, her blood pressure was very low. We stayed in hospital for 2 weeks until heart was a bit more stable. Then to ED hospital end of April - July; she didn't eat for 2 months and was fed with IV food and hydrated. Transitioned to Partial Inpatient (all day hospital, home at night) in July, then to Intensive Outpatient ~2 weeks in August and home since. Weight restored in July - has maintained weight since. Still seeing Ed behaviors like "accidentally" dropping food on floor or off of plate, leaving 1 spoon of whatever on a plate for meals, etc. We are working through those behaviors one day at a time and I've put a behavior plan in place for home to keep the behaviors out. 

Welcome to the forum, sorry to have to find your way here. A few thoughts, with such recent weight restoration it is possible her brain has just not healed yet from all the restriction and starvation. It is also possible that although on paper she appears weight restored she is not - anxiety and distress tends to peak at around 90% of weight restoration. 

I know how hard it is to deal with our children's anxiety and distress. It is common for them to say that nothing is helping and nothing will ever get better. It is worth when she is getting distressed about her body and her appearance to let her know that you can see she is distressed but then to try and move her on to other thoughts and other activities? An anxious mind just goes over and over the same territory. There is no reasoning her out of this, you can let her know that her body is capable of doing all sorts of things, and fat is an opinion not a fact. I wonder if rather than doing calming activities when distressed you looked at doing some more physical activity - a demonstration of the strength and wonder of her body rather than trying to do the more mindfulness type exercises. My D found these too hard to do at this time, as soon as she stopped she would switch back to her body related thoughts - whereas physical distractions seemed to last longer. 
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.

Welcome! You have come so far! Getting to WR is such a feat! Well done!

I do hope you find the support you need. 

I do have a few thoughts:

  • She was just diagnosed since April and on WR since July. At 14 there really is no WR she will need to continue to gain over time into her 20's.
  • Being WR only since July is such a short time. It takes about 6 months WR (proper WR) to start seeing the brain changes. 
  • Many professionals estimate the WR target a bit too low. We had to get to 6-7 kg more than the first WR to start seeing her brain improve. That was 3 months after the first WR target and 9 months into the diagnosis (she was 11. 9 yo and now she is 14.5).
  • Having issues with body dysmorphia may take more time and weight (ie "weight and wait"). And you may not be able to appease her right now. It may not be the right time. Try to be patient. A lot of this can get better over time. And if she still has these ED issues, more weight will not hurt. 
  • Is her difficulty related to underlying anxiety.  My d started having issues with not being able to sleep and anxious about the next day, but those were her first symptoms prior to the diagnosis of ED now that I look back on it. She is now on meds and has been for 2.5 yrs and doing well. Does your d have co-morbid anxieties that may  need meds?The therapy may not work for awhile (ie ? needing more weight). Sometimes their anxieties get worse prior to getting better and sometimes it has nothing to do with ED. 
  • Regarding her school work. We had a lot of procrastination 1.5 years in ( last year this time actually). My d wanted all her work to be perfect and struggled to get it in on time. If she felt her work was not 100% she could not hand it in. I started telling her that part of being a good student was knowing when to hand things in and if she got a "C" that it was more important to hand it in on time and it was not about the mark, as that was real life. I tried to shift her thinking a bit that being responsible was a skill to learn as well.  That worked for my d, but time also helped her I think. She also started some CRT (cognitive remediation therapy: games actually that helped her rigid thinking). The rigid thinking and perfectionism can be traits seen with ED. 
  • You mention that she still has ED behaviours ie leaving food and dropping it. That is for sure ED and you will need to tackle those issues. And again more weight may help..
I think you have a good therapist when you say this:"The therapist said that until my daughter was in a better spot, I should not consider working on any of those as the ED needed to be the primary focus right now and any additional therapy could actually be even more stressful for my D."
I agree with that. The other things will come. I know it is so hard after all you have already been through. But it takes a long time. Years not months. 
Please ask all the questions you have. 
I am glad you found the forum. It was my lifeline. It was so good to know that I was not alone. 
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)
Hello and welcome.

You have gotten good advice from FoodSupport and Erin.  I agree that it is possible she is not fully weight restored, despite what the professionals might say.  Failure to set target weight high enough is the commonest mistake by clinicians, and something we experienced.

I never did learn how to respond to the anxiety.  About the most progress I made was figuring out that my instincts were exactly backwards, and when I tried to reassure her, that probably just reinforced her idea that there was something to be anxious about.  Oh, and I did get better at distracting her by changing the subject.

A number of people here recommend _Freeing Your Child from Anxiety_ by Tamar Chansky.  Worth a read, I think.

Please feel free to ask all the questions you like.  We're glad you found us.  xx

"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
Thank you, FoodSupport, Erin and Torie! This is wonderful advice and it means so much to have this community of support.

My head gets it: she's not weight restored which is why she's still dealing with the flashes of ED behaviors and anxiety about her body / looks. My heart is torn: she's not thin, bigger than all her friends and yet she needs to gain more. My heart feels it will just crush her albeit I know in my head it's what is needed.

I will talk to our nutritionist and therapist about increasing intake. As far as the crumbs on the floor and hiding food - I took those more as her calling out for me to help. I say that because she hid food in plain sight under a cabinet but so far in the front that it was the first thing you see - it was once and after we discussed it, she hasn't done it again. The crumbs she continued - I contacted the therapist and nutritionist for them to also talk to her about those and that those are ED behaviors. I also put the behavior plan in place and that has now stopped. The thing we're now working is her leaving a spoon of this or that on the plate. I again pulled in our nutritionist and therapist and asked them both to also speak to her about it and that's the behavior plan we're working right now. They did tell me that they interpreted her behavior as wanting to rebel against me because I was "in control" and making her do 100% of all meals. They said it is alright to let go a little. Today, she asked if she could make up the food she left - she didn't finish her tomato soup (5 spoons full)...but she was OK with having 15 chocolate almonds instead so that it wouldn't count as her restricting. I'm surprised she'd eat more calories in choc almonds but not a few spoons of tomato soup - more signs her brain is not there yet and more weight is needed.

@Foodsupport_AUS: Yes! You are so right! More physical activity would be better. I just had the image of when she goes to soccer. She never wants to go (although she asked to be signed up for soccer "because it's her favorite thing to do" - it's a casual, non-competitive and more of a social team). But, at the end of soccer practice and games, she is in a much better spirit and happy. She's not an over-exerciser so that's no worry. I appreciate the suggestion. Thank you for that - it's all so clear now.

@Enn: I did not realize it takes at least 6 months after WR for the brain to change. It puts things into perspective for sure. No morbid anxiety, no cutting, no vomiting - my D was diagnosed with AN and we have not seen any of those actions from her. The doctors at the clinic and outside do not think she needs to be on any meds. Other than daily vitamins, I have her on nothing as far as meds. I love the way you shared with your D about school work and how turning things in and being responsible was such an important lesson and maturity.

@Torie: Thanks for calling out "when I tried to reassure her, that probably just reinforced her idea...be anxious about." I totally do that - and wonder why she's not calming down when I'm using logic and facts. I'm just making her more anxious. I've ordered the Anxiety book!

I'm going to also speak to our therapist about cognitive remedial therapy. My D was having problems reading at one point - and one of the exercises we did was Lumosity. I don't understand CRT well enough yet but it looks a little similar to what we did when we used Lumosity. I could see her very much enjoying this type of therapy as a physical way to work her brain function. Thanks!
A couple more thoughts:

1. So very sad to say I'm not sure I know any women who love their bodies.  Toxic society for that.  Not sure if there is a way to use that angle to help your d or not.

2. AN is in the anxiety family.  Many sufferers have other anxiety issues before and/or after ED.  The fact that your d is most vocal about her dismay in the morning is interesting because ED usually gets "louder" as the day progresses, which makes me suspect that piece is a separate issue from AN.  In my experience, anxiety is a tough nut.  (Two of my d's have been diagnosed with anxiety disorders.)  OTOH, I would pick anxiety over AN in a heartbeat.

Keep swimming. xx

"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
Oh and P.S. you probably already know this, but when they regain the weight, it tends to go first to the face and belly.  After a while it redistributes.
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP