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

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My daughter attended Rogers this summer and did really well there.  However in September (when she turned 12) she started middle school.  We've had a few struggles getting weight on and she has a 504 in place.  She hasn't gained much but she has started to go through puberty and grew an inch since the summer.  However, in the last two months her personality has changed 100%.  Examples:

1.  She used to love being home (and wouldn't leave my side most of the time) - she now only wants to be at friends houses (new friends from middle school) or in her room with the door shut.
2.  She used to be sweet and kind (even in the worst of the feeding).  Now she goes out of her way to say hurtful things to me and her twin brother.
3.  She used to be compliant about taking her medicine (Prozac 20mg).  I found out recently she was pretending to take them, then spitting them out and hiding them under the bed.
4.  She's very into the 'androgyny aesthetic' and seems to be questioning/unsure of her sexual orientation.
5.  I recently discovered (Saturday) that she has been cutting.

I know she needs to be putting more weight on but we seem to be at an impasse at 82.6.  It's so frustrating and I really don't know what to do.  Truly I don't.  I promised her a dog if she kept with the program and I know she really really wants one - but it doesn't seem to be making a difference.  She's definitely eating what's in front of her.  Her only real resistance is to the Boost plus but she won't drink a shake I make either.  She's supposed to have 2-3 Boosts a day.  I'm lucky to get one. 

Her new friends seem to be much like her - Androgyny, anxiety, one with disordered eating.

Hi Playbal,

It can be hard to tease apart what is ED and what is teen angst, but you know in your heart that ED is around. You know it because you identified it:

" She hasn't gained much but she has started to go through puberty and grew an inch since the summer. However, in the last two months her personality has changed 100%."

I'm not suggesting that there's NOT a component of this that is teen angst, but there's really no point in parsing it out when she's also ED. Deal with the ED first, get her weight up and keep her moving forward in growth. Dealing with ED is one thing you CAN do.

You say she's compliant with eating - hallelujah for that! That makes it easy to bump up her calories until you see a good rate of gain - 1-2 lbs/week.

Most kids gain about 25 lbs just before they start their pubertal growth spurt. And then they eat like crazy through their teens. Linear growth seems to take too much energy for a body to fuel it directly through food - they need a ton of food PLUS that pre-pubertal chub reserves to keep up. When ED hits so young, these kids are already behind because they've missed out on that pre-growth weight gain. Many times our health professionals are complicit in keeping them from gaining appropriately - they may be overly concerned about childhood obesity or healthy eating or they may buy into the sufferer's fears of gaining "too much" and so only recommend a minimum target weight - which may keep the kid sick longer than necessary and at this age, may stunt her growth.

If I were you, I'd be pushing the weight gain, keeping her safe from self harm, putting normal parental boundaries around her and see what happens.

(((((Hugs))))) Teens are hard enough!
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
Hi Playball,

I am in a very similar situation with my 17 yo D. She has been in recovery for two and a half years, weight restored for almost that whole time with mini relapses here and there that we have caught. But definite struggle with depression and anxiety the whole time. She stopped taking her Zoloft secretly, too, and that sent her down a dark spiral. Over the past 6 months she has changed friends, experimented with substances, stole, started cutting, etc. Lots of negative coping mechanisms. So, not exactly the same as your D, but same trajectory.

So, to answer your question from what I'm seeing here, some of it is probably normal teen angst. Even well adjusted happy kids fight depression and stress. She may have a desire to be with other kids who are struggling like she is, hence the androgenous different group. I think they do not feel as bad about themselves when they hang out with other kids who have their own issues. They feel they can be themselves and more authentic and honest about their struggles than with other kids who appear to have it all together. However, other kids with struggles have their own coping mechanisms that your D may have picked up.  Our T said cutting can almost become contagious among a group. And it's addictive, which I don't get, but see in my own D. 

We are looking into mood disorder treatment right now and particularly a DBT program that addresses cutting, suicide and depression with evidence based skills training. I would talk with your doctor about that maybe for your D. They have skills groups that are outpatient. I believe they are a lot of work for the patient, but seems to be very effective in giving them skills. 

It's tough parenting a teen but especially one with an ED and other issues. It's never easy to separate the behaviors into normal and ED. I'll post an update on what we end up doing - we have a short time until she's an adult and wants to go to college, so we have to act sooner than later.

19 yo D. AN - since about 15 years old. WR quickly - but the last four years have been tough. Since Sept. 2017, two residential stays, now in IOP, fighting a relapse. ED is hanging on, mental state not great, can't get her to remain at a weight long enough or high enough to see mental healing. She's on a gap year that will likely now turn into two.
Oh dang, Playball, so much of that is familiar. There really seems to be no way to know how much is Ed and how much is regular teen garbage until you clear away the ED and see what's left. I think it was HEwaP who said cutting is almost contagious - we did see that effect. All the tips we got (ice cube, red line, rubber band to snap) didn't help. Taking away the sharps wasn't perfect, but helped some. In the end, she just stopped doing it.

I think they tend to pick healthier friends as they themselves get healthier. But in the meantime, yikes.

My d never had a boyfriend pre-Ed, but she had crushes. Just as Ed came on the scene, she got in a relationship with a girl. And then a different girl. Now that she is doing much better healthwise, she is again interested in a boy. I don't know what to make of that - coincidence? Yet another example of Ed adjusting her brain wiring? Dunno. I hasten to say that there are some real advantages of having your d in a relationship with another girl (as opposed to with a boy), and truly, whatever makes her happy, but I do wonder what to make of that interlude. Or maybe she'll decide she does just like girls? Whatever. Curious.

The main thing, I think, is to keep feeding. Take it one day at a time - so many things get easier and better when the weight has been on for a while - no way to know what that place will look like (i.e., what issues remain to be addressed) until you get there.

Feed on ....


"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
"I know she needs to be putting more weight on but we seem to be at an impasse at 82.6.  It's so frustrating and I really don't know what to do.  Truly I don't."

OK, well. Let's see. Tell me if I've got this straight:

Your d needs to gain weight.
Your d is eating what you put in front of her.
She's not gaining.

Does it seem reasonable to you that you need to require her to eat more, and to look for and close any loopholes?

For the first, here's some things to check for (you may be doing some or all of these, it's just maybe a useful list of suggestions):

3 meals 3 snacks
lots of dietary fats--hwc in her milk, butter in the rice, etc.

instead of Boost, make your own smoothie. A fruit/yoghurt smoothie can definitely be packed with upwards of 1000 cals. My d also hated Boost. After the first month or two, she not only didn't like the taste but associated the drink with being sick. Also, my smoothies have 3x the cals!

All meals and all snacks must be finished before anything else happens. Ie--all breakfast must be eaten before going to school, all snack must be eaten before going to a friends house. 

For the second (closing loopholes):

it sounds like at this point you need to SEE her eat everything she needs to eat, otherwise it probably isn't getting eaten. In other words, if she wants to go to a friend's house after school, she'll need to come home first to have a snack, and then go. etc. (IF she only wants to be at a friend's house, one reason for that is that she won't have to eat there.)

If she's doing a lot of activity or a sport, that might need to be stopped at least until she gains what she needs to.

If she has ever purged, or even if not, you might need to check that that is not happening.

Also, you'll need to watch her swallow that med and check her mouth afterwards. She won't like that, but too dang bad. Tell her you know she doens't like to be monitored, and you don't want to do it, but that unfortunately her illness is at the moment making it necessary. You could emphasize to her that when she is better and capable of taking care of herself, it won't be necessary for you to monitor her so closely.

As for whether this is ed or teenager stuff, the only way to find out is to get her weight to a good point and keep it there, and see if symptoms abate. My d was 15 when she went through refeeding, and yeah, it was often super hard to tell what the heck was going on. Don't let it stop you from doing what needs doing.

Also, from my limited knowledge and observation, androgenous fashion has as a main component extreme thinness. I'd therefore suspect that your d's interest has more to do with ed than with sexual orientation, at this point. 

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.
Thanks for the responses.  PsychoMom - She is on 3 meals/3 snacks/2-3 Boost+ a day.  Very little weight gain (certainly not keeping up with height imo).  We are going to discuss doing our own smoothies tonight in lieu of Boosts to see if that works (I'm sure she also associates them with being sick).  She's not doing any sports anymore (in fact she recently threw away all her old soccer jersies and trophies.  She doesn't seem the least bit interested in going back to soccer anymore.  She doesn't take PE in school either (or dance) as this is an Arts School.  The cutting and attitude is new - since she started middle school.  We are also doing the 'mouth check' now for her medicine.  She 'may' be doing some lunch ditching as the nurse she eats with doesn't seem to make her finish - she just watches her eat.  It's frustrating.  Neither my husband or I work close enough to 'supervise' her lunch nor can we afford to quit/take LOA from our jobs - so we try to calorie up at breakfast and dinner for sure. 

I'm not so worried about the androgyny/orientation thing right now (or ever really).  It does seem to be a 'thing' at her rather eclectic school (so many tortured artists there).  I'm more concerned as to whether it is just causing her additional anxiety.  I hadn't however, considered, the 'thinness" associated with it and perhaps I should.  Mostly right now it's keeping her hair short (partially shaved), wanting a septum piercing, wanting to dye her hair pink, dressing in black (it's sort of a combo androgyny/emo).  The cutting thing scares me though.

No purging that I can see.
Hi again,

OK, some people have posted on here a typical day of what they would feed their child, and the responses can give ideas of how to up it. Please feel free to do that. 

Also, for a time my d could not would not eat a snack at school (she managed lunch OK except at the very beginning) so we facetimed for snack. You could do this in the nurse's office, with or without the nurse present. IF ed's really trying to be sneaky, this won't work, (she can still drop pieces of food or hide them in her hand, etc) but it would be a higher level of supervision than you've got now, without you having to take very much time off work. (You'd  just have to facetime her from work.) Of course, if you then see her not eating everything, you'd have to have a next step. The next step could be that you feed your d more at home that day, or, better, you drop everyting and drive to her school and take her out of school and feed her lunch. The idea being, that she gets the message and only does that once or twice, and then you just keep monitoring.

Or, you could try and educate the nurse and to do a better job helping you. Or, you could hire someone to supervise your d's lunch. Possibly a TA or a part time teacher or a coach? Would need to be someone who could grasp the concept of meal support, tho. 

Sigh. I don't know about you, but my d has breakfast at 6:00 am and gets home at 4 pm. That was just simply way too long for her to go on inadequate nutrition, for her to get well. It was a huge pain, but I know I was super lucky that I didn't work regular hours and could go have lunch with her and facetime her for snacks. And more than that, probably more than anything, she KNEW that if she didn't eat and I found out I would be at her school in 20 minutes with a bag of food and I would take her out of school until she ate it. It would have been so much harder if I'd had a job I couldn't leave. 

Re: all the new things she's learning at middle school: oh, dear. Have you checked her phone/devices for what sites she's visiting? Keeping her away from pro ana sites would be worth the conflict that monitoring her phone would probably cause. Or you do it surreptitiously. I managed to check my d's phone and computer when she was ill, without her knowing.

As for the school itself, have you talked with the head of school? About your d's health and what the school could do to best support it, and about the concerns you have about the school culture? A good Head of School should always be open to communication with parents. This is a main advantage of private school. They want you to be happy and they often have more of the resources to make that happen!! You don't have to wait until you're sure there's some problem, you can just make an appointment and say, we're new here, this is what I'm observing and what concerns me and what I think my d needs (you can bring up the nurse who needs to be better educated in eds, maybe). 

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.
I ditto everything psychomom says. Any behavior change with our d and I know to get her a few more calories. She was 12 when she was diagnosed and had stopped growing. Once we started refeeding, she started growing and hasn't stopped. Yay! She's grown at least 7 1/2" in 2 years. Of course every time we check in with dr we have to go up a few more pounds. It's a never ending process that won't quit until she's through puberty. In total, she's gained 67 lbs. in 2 years too, just to give you an idea of how you have to constantly play catch up. 

Also, my d stopped her period for 2 cycles just recently. The dr had us add a few more lbs and 2 lbs later, she started her period. That's how sensitive their bodies are to just a few pounds, imagine how their brains are.

Even with these mood changes, it doesn't mean you have to allow bad behavior. Regardless if it's Ed or adolescents, if our d's not speaking kindly or acting decent, she doesn't get to have fun/have her phone/etc. Those are the rules we had to start enforcing once we got through the major refeeding stuff. 
Daughter diagnosed with anorexia at 12 in 2013 without having any image issues/concerns about calories or exercise. Hospitalized - 3 days. FBT at home along with outpatient therapy - 16 weeks. Recovered/weight restored - 4 years. Still gaining and growing but has no hunger signs yet.