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

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hopeful_mum
My d said yesterday that she doesn't want to have anorexia but she doesn't want to put on weight. Is that progress?? She has been WR for nearly a year now. Haven't had any real problems over food since last Sept. We control and supervise all food. She eats around 2500 every day n she would have a massive meltdown if we tried increasing on that. Hwr body dysmorphia is alot better. She seens ok with her current weight.

I always thought if we didn't control her food she just wouldn't eat. But after her comment yesterday I'm thinking that maybe she would eat but I do think she would have the tendency to take smaller portions than we give. But seeing as she made this comment do you think it might be the time to try her with intuitive eating? How do we transition to that? Gradually, meal by meal or could we just give her a few days where she is in charge of her food intake n see how she does?? Advice on this stage would be great. Thanks
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deenl
Hi hopeful mum,

It's nice to feel there is progress being made. We are nowhere near the stage you are at but a few thoughts flitted across my mind.

  1.  She will ALWAYS have the genes and predisposition for restricting. I would begin with some conversations about the reality of her illness and some relapse prevention education. I guess if you search here you will find lots of information
  2. Begin small. Offer maybe two choices of snack and see what she chooses. Does she sometimes choose seconds if she is still hungry? In fact, thinking about it I would begin bringing lots of variety into her current diet. 2300 cals one day, 2500 another, 2700 another. After all, that's how most people eat, flexibly and without fear.
  3. For me, intuitive eating is not the holy grail. Since we have ED in the house, I notice more how we all eat. We are split down the middle, me and one son eat intuitively but my h and other son do not have such strong cues from their bodies. The eat mostly out of habit and occasionally eat more of something extra nice and/or pleasurable or comforting. But the important thing is that they eat what their bodies need for health and happiness.
  4. Have very clear expectations and share them with her. Have a really good safety net. Don't leave things to chance and trust your instincts if you think things are not going well.
I have to say, just from your description, that I think your d needs more information and more planning before she is ready to eat instinctively.

Wishing you the best of luck,
D



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.
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Torie
Hi HM - Sounds like you've done a great job so far. Glad to hear how far you and your d have come.

I learned from the wise folks who came before me that this is best done very s-l-o-w-l-y. I'm not sure if you d is serving herself or if you still serve her, but that's a good place to start, and with you there. Can she select a meal for herself when you eat out?

Also, does she understand that she needs to continue to gain a little each year through the teen and young adult years? That's what normal maturation looks like and is oh do important for our Ed-kids.

Keep up the good work! xx

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

Yeah, I've heard similar from my d. For a long time she wanted to weigh exactly the minimum required, because she didn't want to get sick again, but she also didn't want to weigh even one more pound than she had to. Sigh. What this means is that yes, for a long time she'd eat less than she needed, because she was trying to hit that exact minimum amount (and kept erring on the side of under, not over it.) 

Imagine trying to gauge each meal so that at the end of the week the scale would say 140, not 141 or 140.4. SO STUPID. So infuriatingly irrational!!! But still, a great improvement from wanting the number to go down every week.

Keep repeating to your d that it's normal for weight to fluctuate within a range, tell her her range, and yes, remind her that women keep gaining well into their 20's. I also had a number of conversations with d about how weight gain of between 5-10 pounds is invisible--people's weight changes by up to 5 pounds from morning to evening, and they don't look any different, do they? Women's weights vary by up to 5 pounds monthly, and they don't look different, do they? MY d gained 26 pounds in three months, and no even noticed THAT. Now, talking about weight is dangerous and can be triggering, so don't do it if it seems to cause more harm than good. 

As for return to independent eating: we did this slowly, step by step. When she could do one small thing on her own, we'd progress to the next. Her first step was pouring her own milk. This was hard; she'd pour less than a full glass. I'd correct, she'd fuss. AFter a while I told her that she'd get two chances to get it right, and if she whined, argued, complained, negotiated or otherwise bugged me we'd go back ot me pouring it myself. The trick is to keep FULL nutrition while you're transitioning her to independence. That's why supervision and assistance is important, as opposed to just letting her try it herself (because it's highly likely that she won't get enough.) 

For us, it was a long journey, and it's not over. MY d still eats sliiiiiiiiightly less than she needs. Maybe 97%. But she's very active and independent and has a great life, and I'm hoping we'll get there.

best wishes,



D diagnosed with EDNOS May 2013 at age 15, refed at home Aug 2013, since then symptoms gradually lessened and we retaught her how to feed and care for herself, including individual therapy, family skills DBT class, SSRI medication and relapse-prevention strategies. Anxiety was pre-existing and I believe she was sporadically restricting since about age 9. She now eats and behaves like any normal older teen, and is enjoying school, friends, sports, music and thinking about the future.
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hopeful_mum
Thanks all. Well I take from your advice that I need to go s-l-o-w-l-y. Ok that's fine. I can do that.

I do have conversations with d about the need for her body weight to continue to increase as she gets older. She still does not accept that. In the very same conversation that she said she didn't want to be anorexic she also said she wanted to stay the weight she is now 53.3kg for the rest of her life. (She is 160cm height and just turned 15). So still more work needed there. She has maintained this current weight for months now and it is a good weight for her now but might not always be the case.

Yes I still serve her. I think the idea to introduce her pouring milk or serving her own dinner sound like good starting points. I definitely like the idea of '2 prompts n you're out' method. These sort of tactics have been invaluable in this journey. Set boundaries n stick to them.

Hubby is away for few weeks so will start after easter. Will report back at some point.

Thanks all as always your advice is priceless. X
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hopeful_mum
Oh and another point I don't like to own up to is that she doesn't eat lunch. We are doing so well but I'm afraid lunch is our achilles heel. She has a large breakfast, goes to school and then doesn't eat (only has water at scchool) until she comes home at 4pm. Not ideal I know. She did express desire to start doing her lunches again. But before she would just chuck them away which is why we have this arrangement now. Maybe now she is in a better place she may be able to cope with lunch??
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OneToughMomma
Dear Hopeful,

I'm sorry to say that she doesn't sound ready to me.  You say,
  • she would have a massive meltdown if you tried to feed her more than normal
  • she is not able to eat lunch at school
  • she says she doesn't want to put on weight
  • she does not accept that she should gain as she matures.

Please don't get me wrong-- you are doing a great job and she is able to talk to you. That's amazing. The stage where she is now is completely normal--I remember it well.  I just don't think she is ready for intuitive eating if she is not hungry at school.

It seems to me that rather than give her independence with her meals at home, maybe try getting her to eat at school.

Are you sure she is WR? If she has maintained a certain weight for a year, then she has lost, relatively speaking.  She should gain every year to stay healthy.

You're doing great, just keep going!

xoOTM
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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Colleen
This comment?  The one about not wanting to have anorexia anymore?  That is a good sign.  It means there is some level of understanding that AN is standing in the way of her life.  But it doesn't mean that she is able to ACT, no matter how fervently she says it.

My d has said many times, "I never want to go back there."  She has said it warmly and genuinely when she is healthy. She has said it right in the middle of a relapse because she can't recognize a relapse.  When I pointed out that she was losing weight at the rate of 2 lbs/week, she looked right at me and said, "That doesn't mean anything.  I'm not going back there."

So what I'm trying to say is that it is encouraging to hear this from our kids.  And we really WANT to believe it.  And we WANT to treat them like sentient beings capable of meaning what they say and acting on it.  But recovering from ED isn't about motivation.  It's about behavior.  If she can say that AND serve herself a good snack, or pour enough milk in a glass, or finish a meal without prompting, or eat off The Plan, then YAYAYAYAYAY!!!  And if not, smile when she says that, encourage that kind of thinking, remind her of all the good things life offers outside of ED, and keep supervising, keep requiring, keep a tight lid on ED.   Eventually what she says and what she DOES will start to line up.

I feel like my d, at 24, is finally able to start putting "I don't want to go back there" with "Therefore, I must keep my weight up and eat regularly" together...and acts on it.  I don't know if it's brain healing, brain development or the experience of several relapses.  But we are getting there!  "There" being a cautiously safe place in solid recovery.

You are so wise to take it slowly!
Colleen in the great Pacific Northwest, USA

"What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease."
Alexander Pope, 1688-1744
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Psycho_Mom
Hi,
Oh, I didn't realize about lunch. Gosh, see if you can get lunch happening before anything else. Even if you think you're compensating caolrie-wise, going that long without food is reenforcing being used to the feeling of hunger, reenforcing ed and ed behavior.

People have supported school lunch in many different ways. I just went to school, picked d up and drove around until she ate the lunch I'd brought. She hated it and I said the other options are having lunch with a teacher, coming home for lunch, or dropping out of school. Any of which I was prepared to do, because ed made me so mad.

Ask if you need advice on how to make lunch work,

best wishes,
D diagnosed with EDNOS May 2013 at age 15, refed at home Aug 2013, since then symptoms gradually lessened and we retaught her how to feed and care for herself, including individual therapy, family skills DBT class, SSRI medication and relapse-prevention strategies. Anxiety was pre-existing and I believe she was sporadically restricting since about age 9. She now eats and behaves like any normal older teen, and is enjoying school, friends, sports, music and thinking about the future.
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melstevUK
hopeful.

Haven't been on for a while.  Just want to say;


"My d said yesterday that she doesn't want to have anorexia but she doesn't want to put on weight. " - That's par for the course and indicates still full-blown anorexia nervosa.  Don't try to give any independence away around eating.  Tell d you will supervise and monitor until as such time as she leaves home.  Stay cool around the idea that this is the norm and around that this is what needs to happen.  If you hand over any independence, it will be hard to get back.  Stay chilled, say she is developing and growing and that she has an illness which will always make her calculate incorrectly about what her needs are.  Don't fight, just tell her you will be in charge for as long as it takes. 


"She eats around 2500 every day n she would have a massive meltdown if we tried increasing on that."  There will be an increase needed at some stage.  Better to stay in charge for the next few years and allow independence to develop and take place with friends around the structure of eating and meals.  This will be much easier in the long run.  Don't wish for independence too early, or give it away too early.  Stay focused for the long term.  It will be easy to play it this way in the long run.

This is an illness which just can't be hurried.  If you get away with starting treatment when BMI is around 16, then you may manage a quick turn around.  If your child falls any lower than that - the reality is that you will need a good few years to move things forward.



Believe you can and you're halfway there.
Theodore Roosevelt.
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hopeful_mum
Hmmm thanks for the reality check. I think the longer we go along this journey we get tricked that something is normal when it isn't normal. Because we are so far away from the dark days this current situation becomes normalised and tricks us into thinking we're nearer the end than we really are. Humph [frown]

But glad for the reality check. I do really need to sort out the lunch issue 1st. We allowed her to supervise lunch straight for discharge from IP coz she was going into a new school n didn't want anyone realising she was ill. She did manage to eat unsupervised at lunch for about 8 months. But when we started increasing her intake when we realised she wasn't actually WR she started dumping lunch.

I was so determined to spend this academic year supervising every lunchtime but she just totally balked. Said she didn't care if we took her mobile or if we didn't allow her to go to school she flat refused to meet me. (I was offering to drive to bottom of my road where school is so she could jump in car, eat n get back into school as quickly as possible). I had been worn down by a summer of nothing but supervising meals that I'm afraid I didn't have the strength to fight it. We gave her lunches for couple of months but once we realised it was all getting dumped we just refused to give her food at lunch n compensated calorie wise at breakfast and snack. I know it's not ideal but I was hoping we could still obtain recovery with our unique arrangement. So maybe this should be my first hurdle.

It's definitely true that once you give up control of something it's so difficult to get back. We never should have allowed her control of lunch. But she had hated her old school so much which is major trigger for her illness. We so wanted to give her a fresh start n didn't want supervised lunches to get in the way of forming friendships.

Oh my this illness is complicated!!!

But supervise til she leaves home MelstevUK? Is that really the best idea. Isn't it best to get her to reestablish feeding herself before she leaves home. Weve always said to her that if she wants to study away at uni then she will have had to have been feeding herself for at least a year before we will allow it. We have 3 and half years before that time but I know how quickly time flies and before we know it we will be facing this dilemma.
Thanks again for all your help.
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OneToughMomma
I think you are right, Hopeful Mum, she needs to learn to feed herself before she can leave home. And it might take longer than 3.5 years. I know our d needed an 'extra' year before she could leave. I think the most important thing is doing what is right for our kids when it is right for our kids, and not worrying about an expected time line.

So maybe now you can start taking baby steps towards the goal of having her eat independently.

xoOTM
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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Psycho_Mom
Hi,

Yes, of course. She'll need to show she can feed herself adequately, consistently and independently before she goes to uni. And getting there will likely be a slow process of gradually handing back control while still supervising to make sure she stays well.
It's possible my d is one of the slower ones (and I don't think it has much to do with her lowest BMI) but she's been well wr for 2 1/2 years, can aaaaallllllloooooost feed herself enough, and we're planning on college in the fall, with a contract and monitoring.

I wouldn't worry about college right now, actually (ha! not worry?!) Just worry about lunch. I see your reasoning for how you're doing lunches, and it's true that every family needs to figure out what works best, and that friends and social stuff is important and motivating. For our d, it was also really helpful (in addition to having a downside) that none of her friends knew she was ill--appearing "normal" was a huge motivator for her. All her friends ate lunch, therefore d was able to go back to eating school lunch fairly early (we were lucky tho that she got ill in May, and by the time summer vacation was over she was wr, so we only had a few months of supervised school lunches.) She could eat school lunch because she wanted to appear "normal". And yes, in the months that I met her for lunch, all her friends kept asking where she was, and she'd say she had a health appointment, and they thought that was weird, and she hated it.....

But you know, that was also motivating for her. She hated me taking her out of school for lunch, and knowing that I would do it again in a minute if she lost weight or I got wind that she was ditching it, motivated her to keep the privilege once she got it back.

And yes, totally balking sounds scary. Let me point out that she didn't totally balk, she threatened to totally balk. You don't know what will actually happen when you call her bluff. Plan it out, and have Plan A, Plan B, Plan C and be prepared to do them in the highly unlikely event you'll need to. Let her know that the current system isn't working (avoid blame, or blame the illness, not her) and she needs to eat lunch and she needs help to do it. (If she's now eating extra big breakfasts don't cut down on them tho, just add lunch!!) So you're going to begin meeting her for lunch, temporarily, until she shows she can do it on her own. What will you do if you go to school the first day to meet her and she refuses to come to the car? (I'd recommend go in to the school and tell them you're there to pick up your d for a health appointment--best communicate with the school in advance.) What will you do if she then refuses to go back to school? (Drive her back and park right in front and say, get out! And if that doens't work, possibly say fine, keep her home, keep feeding her, pick up her homework, take her back to school the next day, do hte same thing again the next day. Again, this is bluff-calling. You can call someone's bluff if you have a backup plan you are prepared to do.) If she won't go to school, then she's home getting fed and gaining weight, which is OK, right? and if she's not eating what you give her then what happens? She gets Ensure? and if she won't have that then do you have a Plan C (visit to hospital.)

Or of course, there are other options if the school can help. Lunch with a teacher? Meet your d at school in the counselor's office? Facetime with d for lunch in the counselor's office? (I did this for snack with d, but if your d is highly resistant or prone to hiding/ditching it probably wouldn't work.)

You could discuss it with d. Make it clear that going without lunch is not an option, but work out with her what her most preferred option would be. That way she'll feel respected and also start to get the idea that you and she are working TOGETHER so that she can get well but still have a life. She'll also know what the other options are, and what will happen if her preferred option doesn't work out.

best wishes,

D diagnosed with EDNOS May 2013 at age 15, refed at home Aug 2013, since then symptoms gradually lessened and we retaught her how to feed and care for herself, including individual therapy, family skills DBT class, SSRI medication and relapse-prevention strategies. Anxiety was pre-existing and I believe she was sporadically restricting since about age 9. She now eats and behaves like any normal older teen, and is enjoying school, friends, sports, music and thinking about the future.
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melstevUK
"But supervise til she leaves home MelstevUK? Is that really the best idea"

If you still have three and a half years to go then I would say yes.  If you expect the worst, anything less is a bonus.  Once you allow the control - monitoring/checking in/encouraging weight gain - whatever you want to call it  - to be handed over to your d before she is ready, I can state quite openly and flatly that you will regret it. 

Tell your d openly that she has an illness that takes a long time to get over and you are going to ensure full recovery.

The fact that your d wants to be normal is indeed a huge motivator - but what is normal about not eating lunch?  Did your d eat lunch before she was ill or was it the norm to skip it?

"I had been worn down by a summer of nothing but supervising meals that I'm afraid I didn't have the strength to fight it" We each and every one of us understand that.  Sometimes we have to cut ourselves some slack and there is nothing wrong with that.  We all want out children weight restored and recovered and we really hope (and probably expect) that once they are weight restored they are recovered.  But experience on ATDT shows that - especially during the teenage years - the anorexic symptoms reappear when there is a growth spurt and more food is needed.  And if you don't have structures/consequences in place to deal with this - the illness will take a hold again.

I don't want to sound like the voice of doom - there is so much that is positive that is going on with your d and you need to keep a hold of that.  But you will be better placed if you keep a long term view of what you need to do and remain vigilant and able to step in and up when required with extra nutrition.  So maybe leave the doors open and d's mind open to the fact that this will need to happen along the way. 

It's a hellish journey but you are doing well.  Stay positive and encouraged - and wanting a normal life is one of the best motivators on the recovery path.  Maybe you can persuade d to have lunch with friends so that she does, indeed, appear 'normal'.
Believe you can and you're halfway there.
Theodore Roosevelt.
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