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

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My daughter is over a year weight restored and has maintained the same weight (with a 5 lbs. range). Periods returned and have been regular for 14 months The last 8 months have been completely fine (same as pre-ed) in terms of eating, mood, social life and personality. I've gone from thinking about her ED 100% of the time, to 10% of the time. She's been discharge, "graduated" from her outpatient ED Clinic. All has been well. She eats whatever we give her, chooses many of her own snacks and meals. She will easily choose peanut butter chocolate ice cream cake for a snack. No fear foods. In the last week, breakfast has become a challenge. She felt nauseous while eating a few times last week. On Saturday, before a stressful day ahead, she had a hard time eating breakfast. My husband and I were quite terse with her during breakfast. She got very upset and ultimately vomitted her breakfast. (She never ever vomitted while ill, exercise was her purge.) We (she) replaced the calories. She continued her day. Every day at breakfast is challenging since then. Anxiety is huge. The time it takes to eat is triple what it would normally take. Yesterday took over an hour so we made her stay home to remind her and any and all remnants of ED that LSUYE. She eats (and we witness) alll other meals and snacks consumed with ease. Her comorbid is anxiety. I feel she has it in her head that breakfast is gonna make her have anxiety and make her feel sick. She's terrified as well about what is happening. She says she has no ED voice and she doesn't know what this is about. She is clear that food is non-negotiable and she simply has to eat it. What's going on? 
Food is medicine... one mouthful at a time.

Hey EDhater
I'm sorry your daughter is going through this - especially after being WR and seemingly getting back into life. And, of course, that you're having to go through this, too. I get the worry and frustration.

My guess from what you've said is it is anxiety related. It is a guess and others may have opinions but 1 year after IP and W/R, ahead of a stressful time, my d can still get nauseous. Sometimes she says: I don't feel anxious but she realises she can get the anxious feelings withough having anxious thoughts necessarily. I think she is more anxious when she feels nauseous because a) she doesn't want to be sick b) is concerned that we will think it may be an excuse or an ED thing so how it is perceived by you may also be a concern. So, then it becomes a bit of a cycle - geting nervous because of feeling nauseous and then feeling more anxious etc.

As long as she replaces the calories, you are covering your bases on the ED front is my feeling. And you have shown her this is not negotiable. I think you're doing great here.

My suggestion (and others may have theirs) is to fake confidence, reassure and keep calm, like it's no big deal.

This could be by saying something like:I guess this is worrying for you but I've read about it/asked an expert/Dr/dietician and it's really common - even when better if we feel a bit anxious for any reason. The advice is to get breakfast eaten with quickly and get on with the day. It will pass. Here, have a shake....

Maybe use distraction again - could you watch something together, talk about future holidays or something during breakfast

Are there 'easier' things to eat to make breakfast calorific but quicker? A smoothie or something? I know we don't want to get into negotiations about food too much but away from breakfast, what about suggesting: just for now while nausea is an issue, would you prefer this or this first thing?

My guess is she is as scared as you are, if not more so and so it could be that you could help contain this anxiety and keep it in perspective for her while setting parameters

Actually, just today I sent my d off with a packed lunch for college. She has the first of an important exam after lunch and so I told her: It's common to feel anxious before an exam and not feel very hungry but you realise you need to eat everything regardless, right? (Just heading this off at the pass......)

Well done on getting your d to this point. Hopefully this new breakfast thing is just an odd blip that can be overcome with calmness, consistency and a bit of time. Wishing you all the best. I'm sure others will be along with some ideas soon, too.xx

Hi edhater,
sorry to hear that she is struggling a bit at the moment but good to hear that she is in such a good state regarding the rest of the issues.
I am also quite sure it is a spiral of anxiety that makes breakfast hard at the moment. You might need to just get through it but maybe you can help her with some ideas worth a try:
- what about distraction? TV at breakfast table?
- what about a totally different breakfast in another room or with different food she would normally not eat for breakfast (for example a high caloric drink instead of something to eat)?
- what about waking her up with a shake in the hand, drink that and then have some relaxing time with yoga or something like that before the rest goes in?
- what about changing the routine: if she normally eats first and then get dressed can you change that? If eating is the last point on morning list can you ask her to get up a bit earlier and eat first?
She might be anxious about the vomitting too. You said she was nauseous a few times so maybe she is anxious that this will happen again. Is it possible that she ate too fast? Do you have any idea why she felt sick during breakfast?
Keep feeding. There is light at the end of the tunnel.

My thoughts would be, 
1: is this just a blip and may just resolve on its own?

2: Does she need more support for anxiety as a comorbid?

3: How did she do the rest of the day

4: are there other stressful things going on right now?

5: Is it the ED dance that we need to be watchful for all the time? You did replace all the food lost and she is eating well. Is there a growth spurt?
I know that you only have a few posts up and cannot recall your d's age.

Hard to know really what is going on and maybe time will either work it out or will bring to light the issues that need to be addressed. 
Sorry no advice, just thoughts on how I am thinking about 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)
Thank you all so much for your responses. My D began restricting in April , 2017. We realized we had a problem in October 2017. We took her to our GP immediately and he referred us to ED Clinic outpatient. She was diagnosed with R AN. In the 2.5 months, it took to get an appointment at the Clinic, we began refeeding at home. She was weight restored in April 2018, at 65% of her weight percentile. She spent most of her life at around 50%. We considered her weight restored when her state changed consistently, I'd say 90% back to normal. At that time, based on the same caloric intake, she stopped gaining weight and just maintained. In June of 2018, we slowly began to give her more independence around choosing meals and snacks and we slowly took away supervision. Her weight and state have not changed since that time. 

Yesertday when we kept her home, she had some anxiety during lunch with her Dad, but completed it in reasonable time. Snacks and dinner for the rest of the day were completely normal. Today, breakfast took an hour and she was full of anxiety and upset. At approximately 45 minutes into breakfast, I told her that she had 15 minutes to finish it or she would stay home from school. She finished it in 15 minutes, very stressed. I then said I'd be picking her up for lunch (I've never done that before, even during refeeding.). She agreed and I did. I told her that if she could not eat it in the hour, I would be keeping her at home for the afternoon. She finished it with me and I took her back to school. Missing school is an enormous stress for her, but she knows we won't bend if we decide on a boundary. She did have some anxiety at lunch, but ate it in 30 minutes. She even chose pasta over her regular packed lunch because she'd be at home so I could prepare it. The pasta option was definitley higher in calories. She does prefer pasta.

My husband and I spoke this morning and agreed that our anxiety and stress while she's having difficulty eating is not helpful. So we agreed to do everything we can to stay calm during the eating. My gut screams that this is anxiety and not ED, however we obviously cannot allow any meals or snacks missed which could encourage ED. She knows this. She said, and I think I believe her, that she's not thinking about her body and knows she can't not eat. She's terrified about what is suddenly happening. She said "is eating going to be hard for me again forever?"

I told her that tomorrow she must eat her breakfast in 45 minutes or she won't go to school. She's nervous about that deadline, but I said that every day there has been slight improvement and that tomorrow should go well (Of course I can't eat and feel like vomiting at the very thought of breakfast tomorrow.). I called her ED Therapist from the Clinic we were discharged from, this morning, and explained what was happening and she said that my husband and I are usually correct in our responses and to stay the planned course. I asked T to talk to D's Psychiatrist (D had a team: SW, Psychiatrist and Nurse Practitioner) and ask for a referral for someone regarding the anxiety. D's T is also going to talk to the Psychiatrist about a possible increase in her med dosage. She has been on Prozac, 20 mg, for the past year. My daughter is confident that her anxiety has been less since she went to Prozac, than it was pre-ED.

Her T asked if she has any increased stress recently. This is possible, but it's definitely not crazy stress. Prom is next week and the boy she likes did ask someone else to go, which upset her. School is the usual anxiety which is significant, but not off the charts. There were some problems with a non-close friend over the weekend, but that has since dissipated and her close friends did support her positively throughout the situation.

My gut says this a blip and we'll (she'll) resolve it, but felt the need to reach out for advice/input.
Food is medicine... one mouthful at a time.
Keep us posted. Hope things turn around soon.
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)
edhater wrote:
Her weight and state have not changed since that time. 

Hi edhater,

Did you mean that her weight has not changed or that her percentile has not changed? If the former, it might be contributing to the anxiety. Teens and young adults should be gaining weigh consistently until the mid twenties.

Just a thought.

Warm wishes,

2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, stable but no progress. Medical hosp to kick start recovery Feb 2016. Slowly and cautiously gaining weight at home and seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • Swedish proverb: Love me when I least deserve it because that's when I need it most.
  • We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.
  • If the plan doesn't work, change the plan but never the goal.
  • We cannot control the wind but we can direct the sail.
Hi edhater,

"On Saturday, before a stressful day ahead, she had a hard time eating breakfast. My husband and I were quite terse with her during breakfast. She got very upset and ultimately vomitted her breakfast."

To me, all the anxiety around breakfast now seems to relate to this episode.  I have a phobia of vomiting and if I had been sick like that I would be terrified that it would happen again, however much I knew I needed to eat to stay well.  And while your responses seem normal in terms of managing the ed - I don't think they are practical in helping her get over this episode.  I wonder if giving her some choice about what she has for breakfast, putting less time pressure on until she gets her confidence back up that she can eat again at this time of day will help.  It might work better temporarily, if you pack a lot of calories into breakfast, to try and put more in at other points in the day.
Also, it seems that anxiety is triggering a response of feeling sick - which is not at all uncommon in people who don't have an ed.  It is just more difficult to manage in a patient with an ed because eating needs to go ahead in spite of that.  
My instinct would be to cut her some slack for a few days around breakfast, reassure her that she is going to be fine and just because she was sick on one occasion does not mean that it will become routine.
I also wonder if it would be useful to find some ways of helping her manage the anxiety, e.g. taking deep breaths and then slowing breathing right down, maybe doing some visualisation exercises, or something like this.  
Alternatively, is there a short course of anti-anxiety medication she could take just for a few days to see if that would help?
Believe you can and you're halfway there.
Theodore Roosevelt.
I agree with the others that this looks like anxiety more than ED.  I myself suffer from anxiety, and I know that when anyone in my family gets sick with a stomach virus, I can keep myself up all night with nausea.  I have often made myself sick thinking that I would get sick. My anxiety was always the worst at night because my kids would wake at 3 am and start puking their brains out!!  As my kids have gotten older, and the occasion for stomach bug has lessened my anxiety has in turn lessened, so if anyone has stomach bug, I am on high alert, but will not make myself sick.  I think that it's very possible that your D has created an anxiety around breakfast, and the fact that there is still much need for her to eat and eat well (not skip ANY meals) this simply adds to the anxiety she has created.  Is it possible that on that first day, she was not feeling well?  That after she vomited she worried about the fact that she would now have to make up for the lost calories and that created anxiety?  Now there is a time limit and a possible repercussion, creating more anxiety.  She may be anxious about this happening every day that she eats breakfast, BUT if she continues to eat breakfast everyday and not vomit, the anxiety will lessen, until it isn't even a thought any more.  So I think that the consistency is good, anything you can do to distract is great, maybe TV or music, chat with her and create a calm atmosphere.  Keep doing what you are doing to keep the calories where they were and ED cannot sneak back in.

Best of luck and keep us posted!
Thank you all so much for your replies. We've had an eventful couple of days and I'm feeling bad, but hopeful, for my incredible kid. Yesterday morning, breakfast was a disaster. Full on panic. It took her over an hour to complete her breakfast, but she got it in. I kept her home from school. I called her therapist from our recently "graduated from" ED clinic and left another message that was clear, concise, and yet clearly crisis ridden. To my absolute shock, 2 hours later, we got a call from the hospital (ED Clinic) and asked if we could come and see her psychiatrist within the hour. That appt. helped so much. Her Psychiatrist talked to D alone first, then called me in. The Psychiatrist assured me (and D) that she feels certain that his is anxiety and not ED, however possibly anxiety "about ED" as well as so many other things. She said D had got herself in a funk about not being able to eat. (During one breakfast D even said, "is this how ED comes back? Instead of making me not want to eat because I'll bet huge and because it means I'm a failure, maybe it's not a voice now --- just nausea and I'm being tricked by ED to not be able to eat....") I think it's possible that she was more scared that ED was sneaking in than we were... Psychiatrist said we need to manage this anxiety and that while she understood my concern that it could be ED, we need to try and let that go for the moment. She increased her dosage of Prozac from 20 mg to 30 mg. She also diagnosed Clonazepan (extremely low dose) for if and when D wakes and feels certain she will not be able to eat. She gave me a list of therapists, specializing in anxiety to pursue (I have booked an appointment for D in June and they will call if there's a cancellation and we can get in sooner. Finally, she talked about how to manage these anxiety ridden meals: "calmness, kindness, encouragement, distract, distract, distract". She spoke to us both directly and said that she sees relapse every single day and that this "blip" is not what relapse looks like or sounds like. I told Psychiatrist that I was concerned about giving shakes, etc. For breakfast because we had got ourselves to the point in recovery that she could eat anything with no stress. I explained that I was worried that she'd become dependent on shakes for breakfast and that that was not realistic, i.e., in real life you can't only have one thing that you are able to eat at certain times. She said she understood my concern, but said that it is true that to keep ED at bay, it is critical we get the nutrients and appropriate amount of intake in each day, but that I could loosen the reins a bit for the moment and just make sure it gets in in a way that she can handle until she can stop this cycle of anxiety about eating She gave me the analogy that when someone has the flu, they may only be able to stomach something like dry toast and ginger ale. She said, "so consider this bout of anxiety like it is the flu and she can only stomach shakes for breakfast until she feels better. " She said she'd like to see us again (despite the file being closed-I'm so grateful) in 4 weeks to see where we are with the Prozac and anxiety, etc. D and I drove home feeling like we had a plan to begin to understand, minimize, and manage her comorbid of anxiety, while of course always being congnizant of ED and always remembering that food is our medicine and will always be. I feel bad for D that we got into this blip, but once again I'm so proud of her strength. Today, she went to school after a shake that went down with anxiety, but went down nonetheless. We are back to one meal at a time... but this time to deal with anxiety not ED. I feel more confident in her recovery than ever after watching her navigate this last week. She really is my hero.
Food is medicine... one mouthful at a time.
Amazing edhater!  Your daughter is so aware of her disease and wants to fight it!  Of course you should feel so proud.  Keep up the great work and please keep us posted.  I am sure that this will pass and you all will be stronger for it.
Sounds like you have a good plan and I’m sure it’s just a “blip”
my d suffers from anxiety and had a similar anxiety episode, not vomiting but very anxious (except it was in the evenings after dinner) and has anti anxiety meds before breakfast, lunch and dinner  and although we are not “tablet” takers,  if it’s what she needs to keep her eating and well, its what she needs to do
possibly she can come  off them in the future but the physciatrist is in charge of that
(thank god for them) cost a fortune but worth every cent!
im not sure on your d age but also remember they grow into their 20’s so maybe she could be having a growth spurt too?
You are doing an amazing job edhater! It’s so scarey when you think ED is coming back  isn’t it!
good job on getting it sorted
one foot infront of the other 
you and your d are hero’s and very brave!!
Well done on following through with your instincts and contacting the ED clinic.  Also fantastic that they responded so quickly and were able to support both your d and you.  Hopefully, the med change will help with increased anxiety.  It certainly sounds like a 'blip' and not a relapse to me.
We had 'blips' in our journey too, where increased anxiety occasionally meant a change in meds, and ultimately that proved helpful and allowed our d to relax a bit more and enjoy her life more fully.  This usually happened around transition times...when she was going off to university was one time I recall where d needed a 'tune-up', with more support short-term.
Hoping that your d's anxiety resolves soon, and that life becomes a little smoother for you all in the near future.
Sending warm support,
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou