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

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EmC


My daughter, aged 20, three years in just wrote a brilliant piece in her blog.  i have copied and pasted a small bit that resonates with me.  I am the person looking on... we have done it in the family environment having had a nightmare time 'in the system', don't get me started!  We have come so far in the last year, but we seem to have reached that transition period and just can not move on...  The contemplation stage.

Does anyone know what I mean?  Did you go through this and do you have any thoughts/tips to move along quickly!  She is currently studying which has been amazing, she is what i would call a functioning anorexic.  Just need to get the weight on!


(Below is what she wrote)

Probably anorexia’s most frustrating feature for the person looking on, willing the sufferer to get better and not understanding why he or she doesn’t, is the baffling chasm between insight and action. Anorexia is perhaps unusual amongst mental illnesses in that the coexistence of a profound understanding of the ways in which the disorder is negatively affecting one’s life and health with a complete inability to act on that understanding by embarking on recovery isn’t just an anomalous feature of the illness in a minority of sufferers some of the time, but seems to be one of its core traits.

 

There’s usually an earlier phase of illness in which the sufferer denies that anything is wrong, but once denial comes to an end and is replaced by acceptance of the fact of being ill, there is all too often a striking failure to then make the next transition: to eating more and starting to get better.

 

 


The defining characteristic of the ‘contemplation’ phase, in which the problem is acknowledged and change is contemplated but not yet committed to, is ambivalence. In this stage, which can last a long time, very small things can make a difference, can shift the delicate balance slightly away from the status quo. In the evolution of any successful recovery process, many forces act in many different directions, and the difference between failure and success may be only a minute imbalance in favour of either stasis or change.

 

As difficult as it can be to accept, relapse is actually a natural aspect of recovery.  Relapse, which is defined as returning to a level of disordered eating after a period of full or partial remission from these behaviours, commonly occurs in about 35-60% of individuals recovering from Anorexia.

 

Many thanks for your time and welcome your response.

Emma


 

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Torie
Hi EmC, I'm sorry, I can't remember if your d is living with you at the moment.  Can you please update us on the current living situation?  Thanks. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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ValentinaGermania
I think I know what you mean. You come to a point in recovery where you start to think "80% recovery can be enough. She is eating and she does not die any more and I am content with that". But that is dangerous.
With ED it is important to fight that b*st*rd totally out of your house. Every single ED behaviour you accept as "o.k." is a door opener in a month, a year, or any other time for ED to come back.
I personally think it is very important to aim for 100% recovery. NO ED behaviour left. NO fear food left. That has the best outcome (that is scientific prooved).

How can we help you to reach that?
Keep feeding. There is light at the end of the tunnel.
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Torie
"Probably anorexia’s most frustrating feature for the person looking on, willing the sufferer to get better and not understanding why he or she doesn’t, is the baffling chasm between insight and action."
It is interesting that she seems keyed into the question of insight.  I think it's important to know that recovery is possible with or without insight - for example, I never saw any signs of insight in my d until well past wr. xx

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

As difficult as it can be to accept, relapse is actually a natural aspect of recovery. 



I know that this has been told to many patients here but I do not believe that.
It sounds like a relapse is "expected" or even "needed" to recover.
I saw a lot of kids/young adults here in the last 3 years that did recover without any relapse. We have a relapse prevention contract and a safety net and my d did not relapse up to now (year 4 in recovery now). It is possible to avoid relapses and to aim for 100 % recovery and patients should be told that so they can start to believe in their recovery.

Keep feeding. There is light at the end of the tunnel.
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Foodsupport_AUS


I know that this has been told to many patients here but I do not believe that.
It sounds like a relapse is "expected" or even "needed" to recover.
I saw a lot of kids/young adults here in the last 3 years that did recover without any relapse. We have a relapse prevention contract and a safety net and my d did not relapse up to now (year 4 in recovery now). It is possible to avoid relapses and to aim for 100 % recovery and patients should be told that so they can start to believe in their recovery.

 



The presence of a relapse prevention contract is actually a recognition that relapse is incredibly common. The goal is to catch things before they become too serious and to nudge people back towards where they need to be. If you don't have to enact any of those clauses, there never was going to be a relapse. If you do then may be there was. There have been many who really had to bring things back up back in full treatment mode. That is relapse. 
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.
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Foodsupport_AUS
EmC wrote:


My daughter, aged 20, three years in just wrote a brilliant piece in her blog.  i have copied and pasted a small bit that resonates with me.  I am the person looking on... we have done it in the family environment having had a nightmare time 'in the system', don't get me started!  We have come so far in the last year, but we seem to have reached that transition period and just can not move on...  The contemplation stage.

Does anyone know what I mean?  Did you go through this and do you have any thoughts/tips to move along quickly!  She is currently studying which has been amazing, she is what i would call a functioning anorexic.  Just need to get the weight on!


(Below is what she wrote)

Probably anorexia’s most frustrating feature for the person looking on, willing the sufferer to get better and not understanding why he or she doesn’t, is the baffling chasm between insight and action. Anorexia is perhaps unusual amongst mental illnesses in that the coexistence of a profound understanding of the ways in which the disorder is negatively affecting one’s life and health with a complete inability to act on that understanding by embarking on recovery isn’t just an anomalous feature of the illness in a minority of sufferers some of the time, but seems to be one of its core traits.

 

There’s usually an earlier phase of illness in which the sufferer denies that anything is wrong, but once denial comes to an end and is replaced by acceptance of the fact of being ill, there is all too often a striking failure to then make the next transition: to eating more and starting to get better.

 

 


The defining characteristic of the ‘contemplation’ phase, in which the problem is acknowledged and change is contemplated but not yet committed to, is ambivalence. In this stage, which can last a long time, very small things can make a difference, can shift the delicate balance slightly away from the status quo. In the evolution of any successful recovery process, many forces act in many different directions, and the difference between failure and success may be only a minute imbalance in favour of either stasis or change.

 

As difficult as it can be to accept, relapse is actually a natural aspect of recovery.  Relapse, which is defined as returning to a level of disordered eating after a period of full or partial remission from these behaviours, commonly occurs in about 35-60% of individuals recovering from Anorexia.

 

Many thanks for your time and welcome your response.

Emma


 



Your daughter's piece does show a significant understanding of the illness. She is right that wanting to get better is not enough to help someone undertake the behaviours that are required to lead to full recovery. Very commonly in adults, and adult treatment settings (I see you are in the UK) they are expected to do all the work themselves. As Torie has mentioned FBT does not require any motivation to get better on the part of the person, and sometimes full nourishment can lead to a change in thinking and allow them to move on without ever really needing to think about why they weren't eating enough in the first place. 

Are you in the position to support her in eating and meals better? Is she living at home? Is she financially independent? What tools can you use to help her move forward? 
Potential options - move to a full on FBT mode for young adults - difficult if you are not on hand and may not be appropriate 3 years in
Learn motivational interviewing as per "the new maudsley method" to help you move her forward from contemplation to action. 
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.
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Torie
EmC wrote:
Just need to get the weight on! 

So true!  And so weirdly, perversely difficult to achieve.  Please let us know how we can help. xx

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

Time and again I come to this forum and find exactly the issue I am grappling with.

My d is younger but we are in the same transitional phase which feels like the rock is about to get pushed up over the peak of the mountain, only to have it slip down again. Is it me? Am I not doing enough? Like ValentinaGermania I too wonder if 80% is good enough. I caught myself staring at a mum and daughter in the grocery store yesterday. The d was maybe 15 and she just looked AN. But there they were smiling and doing their shopping like nothing was wrong. Why can't I just accept where things are and let her coast in a safe but not recovered state?

My gut is telling me that the answer to moving through the transition is to be the rock. To not waiver, to not ignore, to not give in. Given that, it is far easier to say than it is to do.

D fell down the rabbit hole of AN at age 11 after difficulty swallowing followed by rapid weight loss. Progressing well through recovery, but still climbing our way out of the hole.
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ValentinaGermania
Barberton wrote:

Time and again I come to this forum and find exactly the issue I am grappling with.

My d is younger but we are in the same transitional phase which feels like the rock is about to get pushed up over the peak of the mountain, only to have it slip down again. Is it me? Am I not doing enough? Like ValentinaGermania I too wonder if 80% is good enough. I caught myself staring at a mum and daughter in the grocery store yesterday. The d was maybe 15 and she just looked AN. But there they were smiling and doing their shopping like nothing was wrong. Why can't I just accept where things are and let her coast in a safe but not recovered state?

My gut is telling me that the answer to moving through the transition is to be the rock. To not waiver, to not ignore, to not give in. Given that, it is far easier to say than it is to do.



I never regretted the decision to go on and to be the rock and not to give in at 80% in the last 3 years. You would not stop treatment if your oncologist would tell you that the cancer is beaten down 80%. You would aim for 100% recovery in that case.
Looking back I can say that we saw big progress and development here with these last 20%. She is now without any symptoms. That is what recovery should look like in my opinion.
Keep feeding. There is light at the end of the tunnel.
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EmC
THANK YOU SO MUCH FOR ALL  YOUR REPLIES.  My daughter is currently studying in Oxford which has been a god-send, not THE Oxford but doing a course for a year.  Living in digs with four other girls, living life like a student, except for the going out and getting wasted!  i have something to be thankful for!  It has been the best clinic ever.  With her own peers, and having to sit and learn is very difficult but it has given me time off, as the last two years I have been her full time career.  i am lucky she comes home Monday, Tuesday, stays WED and Thursday then back for the weekend.  She is still massively under weight.  She is a functioning anorexic!  I want like we all do my daughter back 100%  so as your replies say i am not going to stay at the bottom of the summit we are going to get to the top of Everest!  nothing less. Not going to give in at 80% going for 100%!  Just don't know how to do it...  We have followed the Maudsley approach the whole way, after being so let down by the clinics over here.  CBT did not work, in fact made it worse, when our daughter was told not to eat over her meal plan incase she became a binge eater!! I ask you, some of these therapists need to get a grip!
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ValentinaGermania
EmC wrote:
I want like we all do my daughter back 100%  so as your replies say i am not going to stay at the bottom of the summit we are going to get to the top of Everest!  nothing less. Not going to give in at 80% going for 100%!  Just don't know how to do it... 


That is the right attitude! You rock!
We can help you brainstorming ideas how to get more weight on and how to get her into the boat if you want that. Please share all your questions and worries.
Keep feeding. There is light at the end of the tunnel.
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Torie
EmC wrote:
i am lucky she comes home Monday, Tuesday, stays WED and Thursday then back for the weekend.  She is still massively under weight. 

I wonder if it is possible for her to stay home Wed and Thursday as well, given that she has so much weight to gain.  I realize this is difficult when she is 20, but i will not get simpler at 21 or 30.  If you are paying for her phone or housing or whatever, this does give you important leverage.

Keep swimming. xx

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

It is great that your d has the insight - even if at present she simply cannot fight the illness.  20 is still very young in terms of brain and body maturity, but as she moves into her twenties, develops her personality and strengths and becomes less concerned about the desire for thinness (a hugely desirable quality at this age and stage among young people), when she sees how it is limiting her capacity for life and enjoyment, she will be able to let it go.  My own d finally shook off the illness in her mid twenties when she got tired of eating being so controlled and joyless and was constantly seeing her friends relaxed and enjoying food.  And her illness was preventing her from doing her job properly and she was actually putting patient lives at risk because her thinking was so impaired.
Just keep encouraging her, telling her that one day she will be able to put it behind her and start enjoying food and place less emphasis on her weight.  That this will come with maturity.  Keep telling her that you believe in her, that she simply must not give her whole life to this illness, and that you will not stop fighting for her recovery and that you will not settle for anything less than full recovery.  
She needs to know that you have confidence in her being able to do that - and ask how you can support her any further, and also, what does she herself think would help?
Hugs.  You are doing great - and yes, in spite of useless clinical input.
Believe you can and you're halfway there.
Theodore Roosevelt.
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EmC
Have any of you come up with a contract between yourself and your child to reach goals.

if so can you share them with me?  Can you think of any good ones....?


my first one  is 

You will not stop at anything less than 100% recovery.  I made the commitment to her that I will also not stop at anything less.  I will not stop until we are there.  
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ValentinaGermania
We had a contract. Written down but we did not aks her to sign it so she could not refuse that.
We wrote down what we do for her:
Pay for living, insurances, car, phone, pocket money, university, everything needed.
Goals were driving licence (we payed every day eaten without complain with one driving lesson), then a car (maintaining 6 months weight) and university (maintaining 12 months).
She has to:
eat 3 meals 2 snacks, at least one warm meal every day, maintain weight, see the GP regularly for all tests, share results with us etc.
No moving out for the next 2 years. She had to chose a university she can reach by public transport. At least 3 days all meals eaten at home every week.

I hope I did not forget something important. Others will be around with their contract ideas soon. You can also use the search button above to search for posts about "contract".
Keep feeding. There is light at the end of the tunnel.
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