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

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Red
An I'll-do-my-best-to-keep-it-brief summary of where we're at right now:

D has been (definitely) w/r for over 18months.  She eats 3m/3s, often unsupervised although can not be relied upon to eat properly when at a sleepover or out with friends and the situation doesn't present itself. Attitude around food is gradually relaxing, although the Christmas chocolate will just sit untouched in her room and there is always resistance toward ice-cream. As with most teenagers, I guess, I try to convince her that fruit/veg and protein are valid food groups, perhaps more valid than Pringles, ketchup, Diet Pepsi & chocolate!

Self-harm has lessened to every couple of months & she is beginning to recognise PMT for what it is.  School, while still stressfull, is becoming somewhat easier and most weeks see full attendance. There is extreme reluctance to study/do homework which I believe is partly can't be bothered and partly fear of failure.

Contact with friends is very very limited, in large part because of somewhat too insular relationship with boyfriend but also because she selected many of her 'group' when still quite ill and was drawn to people with emotional issues/cutting etc & now they drive her mad.

She wears the exact same hairstyle every day.  The same outfit every day (not the same clothes, but the same shorts,tights, hoody/baggy jumper combo). She insists that jeans don't suit her, all her friends dress like this etc etc.  While Magic Wardrobe helped us to make some decent progress, we had to back off somewhat for several reasons, primarily a need to work on other things and to stop the almost psychotic beliefs/behaviour we were seeing.  We knew that another abuse allegation was on the cards.

She desperately wants to be 'normal' and 'not have to think about something she used to have'.

In return for not insisting she attend after-school science revision, d has agreed to participate in a 'ladder' (thanks Amoma!) to normalise attitude to appearance.  As a start, she has worn jeans daily for a week and now has to wear them at least alternate days (although I know there'll be lots of resistance/negotiation around this bit).

I have made some notes prior to presenting the poor girl with the 'ladder' for clothing. Have I missed any steps?  Are my descriptions of normal 16-year old behaviour about right? D is my oldest. For those who don't know, we have no support, it's just us. 

If you've made it this far, thank you! My notes follow in the box below...
The future is not set; there is no fate but that which we make for ourselves.

"Not my daughter, you bitch." Mrs. Weasley
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Red
What does normal look like?

*Dressing differently according to the weather, activity, occasion, fashion, the effect you want to have on others, what your friends are wearing and - to a lesser extent - mood.

*Comfortably wearing a wide range of styles, clothes & outfits that are different nearly every day - not just different clothes, but types of clothes.  Rotating the outfits in your wardrobe & introducing new items.

*Going to the shops and having fun selecting & trying on clothes, without being upset or anxious about what you see in the mirror.

*Having a few favourite items that change over time that might be worn a little more frequently, although not too much more.

*Wearing clothes that show off your figure, or cling to stomach/show your arms/boobs/bum without anxiety.  Often even with joy, mostly without noticing.

*Selecting clothes because you honestly like them, not because they cover part of your body that you worry about.

*Sometimes wearing your hair up, sometimes down, depending on the weather, activity, how you feel, what your friends are doing etc.

*Accepting compliments about your outfit/hair or an item of clothing, not rejecting them (i.e. say 'Thank you' or say where you got it from/why you like it).

{I also have a shorter list of 'what is not normal' but am not sure about its inclusion, because it basically describes her behaviour so could be seen as picking on her/getting at her}.

LADDER


Jeans daily for a week, then at least alternate days.

On a non-jeans day, not always shorts & tights - skirts & trousers as well.

1) 1.shorts; 2.skirts; 3.trousers; 4.jeans worn with a vest/T-shirt and jumper.

2) 1.shorts; 2.skirts; 3.trousers; 4.jeans worn with a vest/T-shirt and shirt.

3) 1.shorts; 2.skirts; 3.trousers; 4.jeans worn with a vest/T-shirt and open cardigan.

4) 1.shorts; 2.skirts; 3.trousers; 4.jeans worn with a fitted or close-fitting T-shirt and open cardigan.

5) 1.shorts; 2.skirts; 3.trousers; 4.jeans worn with a fitted or close-fitting T-shirt.

6) 1.shorts; 2.skirts; 3.trousers; 4.jeans worn with a range of tops/blouses.

7) Keep working on 'normal'.

OK - be gentle!
The future is not set; there is no fate but that which we make for ourselves.

"Not my daughter, you bitch." Mrs. Weasley
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mec
Sounds great Red. Don't have any advice but definitively want to borrow the ladder concept to get my Asp. son to get more variety of foods.
21 year old daughter who was DX with RAN at 9 years old. The work of recovery is ongoing. 
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Amoma
Yeah you Red for doing this on your own for your girl.
Part of instituting  EXRP for us was having consequences/rewards. It provided extrinsic motivation throught the structure.
Also key is a safety plan,. I had to learn that. Even just looking at a feared item can cause intense anxiety and you must have a plan. And a plan B. And it can take you by surprise.
We didn't do explanations of what is "normal" and expect insight.
I hope others who have done EXRP will chime in as well. You are a hero for your girl.
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Red
Amoma, thanks to you for the concept. A jeans day today, which appears to be getting easier although had to insist that baggy jumper came off (I said because it smelled!). We are ready for the anxiety, although with a 16 year old & no support, our only real plan B, C etc can be removing electrics & not being allowed to see boyfriend, both of which are way too punitive. We are not looking forward to it, but it must be done; she gets stuck so easily! Main reward will be money (something we already do for 'Challenges') as we already use a later curfew as incentive to get through the school day.

The 'What is normal' bit is because she is so desperate to be normal right now and we really do need her to be a little bit on board in order to avoid her just refusing/leaving/hurting herself & claiming I did it.
The future is not set; there is no fate but that which we make for ourselves.

"Not my daughter, you bitch." Mrs. Weasley
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Amoma
For those who don't know here is what EXRP is

Exposure and response prevention (ERP) is a treatment method available from behavioral psychologists and cognitive-behavioral therapists for a variety of anxiety disorders, especially obsessive–compulsive disorder and phobias. It is an example of an exposure therapy.

The method is predicated on the idea that a therapeutic effect is achieved as subjects confront their fears and discontinue their escape response.[1] The behavioral process is called Pavlovian extinction or respondent extinction.[2] An example of how this process works: Imagine a person who repeatedly checks light switches to ensure they're in the off position, even when entering a clearly unlit room. The person would be exposed to their feared stimulus (leaving lights switched on), and would refuse to respond with any safety behaviors. It differs from exposure therapy for phobia in that the resolution to refrain from the escape response is to be maintained at all times and not just during specific practice sessions. Thus, not only does the subject experience habituation to the feared stimulus, they also practice a fear-incompatible behavioral response to the stimulus. While this type of therapy typically causes some short-term anxiety, this facilitates long-term reduction in obsessive and compulsive symptoms.[3]

Recent results indicate that ERP can be carried out effectively with minimal face-to-face contact between the therapist and the subject.[4]

 

 

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Amoma

Body dysmorphic disorder: a preliminary evaluation of treatment and maintenance using exposure with response prevention.

Source

Department of Psychology, Fordham University, New York, NY 10023, USA.

Abstract

In recent investigations, body dysmorphic disorder (BDD) has been shown to share common etiological and symptom presentation to obsessive-compulsive disorder (OCD). When treating BDD, there have been some investigations suggesting that exposure with response prevention is effective in alleviating symptoms. Ten patients diagnosed with BDD participated in a study examining the effects of treatment and maintenance using exposure with response prevention. They received a standard behavior therapy protocol which consisted of exposure in vivo and in imagery, with response prevention. Symptom severity, depression, anxiety, and avoidance were assessed weekly during treatment. Following treatment, a 6-month maintenance program was instituted for five patients, with the other five serving as controls. Patients in the maintenance program were assessed bi-weekly with all measures and a 6-month follow-up was conducted. Patients improved for measures of avoidance, BDD symptoms, depression and anxiety when using exposure with response prevention. Although all patients remained symptom free at follow-up, those in the maintenance program continued to improve. Based on these results, BDD appears to be amenable to exposure with response prevention treatment. Additional treatment gains can be obtained when structured maintenance programs are implemented.

PMID:
9009045
[PubMed - indexed for MEDLINE]
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Red
Thanks Amoma. How I wish we had quality support...
The future is not set; there is no fate but that which we make for ourselves.

"Not my daughter, you bitch." Mrs. Weasley
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Amoma
Well I won't lie even with quality support the lion's share (so make that 95%) was done by me....

They helped me see long range. They supported me when I couldnt see how it was possible
How it would help and actually make things better.
They kept me on task.

Use the folks here for support and structure.  There are many on here who are in the same boat their child wearing the same pants every day or their child eating the same safe food ever day. So what you are doing is significant and instructive. Maybe other on here will jump in and say
Okay today is the day to challenge the no changing pants behavior. Today is the day to challenge eating mini muffiins and nothing else.
Today is the day to challenge my chlld only eating food I prepare, not being able to eat at a restaurant or eat with others.
Today is the day to challenge the always taking two stairs at a time, or not scooting back and sitting in the chair properly.
You develop a plan, and you bounce support off each other. So invitation extended!!!!

It is not easy but it can work really really well....
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Red
So far, the jeans thing is being accepted. Haven't presented formal 'plan' yet (mainly because h broke the printer !) but we're on our way. Did you set out any specific timescales?
The future is not set; there is no fate but that which we make for ourselves.

"Not my daughter, you bitch." Mrs. Weasley
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Amoma
We did one challenge per week. On the weekend so the anxiety push wouldn't screw up work/school and we could all be there for her. I had to learn that the hard way. The first challenge on the lowest rung I didn't stay close enough to keep her safe and she scratched her legs to bits. Lesson learned. Second challenge was met with bear hug, and distress management with me at the foot of the bed, or seated outside her door. We used different techniques to manage distress. Ice cube stroked on the arm can distract the brain. Think of techniques like these.

She really did not like discussing the challenges too much ahead of time. Nor did she like the idea she might have to give something up in the moment. We decided not to tell her in advance what that would be because she spent so much energy on arguing with us over that. We decide what it is in the moment. Was how we approached it. She herself got to pick out the rewards...

In the end the most feared thing was a non event.....it was given and done and was met with "so what" non anxiety......
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gobsmacked_US
Sounds good, Red. Interesting how I'd focused on all the good things you'd said about your daughter eating and made an assumption she was better in this way too. So sorry you've continued to go through this.

I can't help you on the EXRP much. I just want to say that my daughter, after a brief period while refeeding of dying her hair different colors and wearing a variety of clothes started doing what your daughter is doing now. She was never at the extreme of refusing to change clothes or refusing to wear jeans, and her clothes were always clean, but she had just a few pieces of clothing she was comfortable with, they were all on the loose side, they were all dark, and while she'd say she wanted more clothes, almost every shopping trip would end up in tears, not because "I'm so fat," but because it was all just so overwhelming and she didn't like anything and nothing fit... She stopped wearing all the fun and special clothes we'd bought for her, too. She clearly didn't want to attract any attention. She also stopped wearing dangly earrings (one of the joys of her life, previously) and other jewelry. She was never a big makeup person, but she completely stopped that. When she'd be in a school performance where she was asked to wear clothes -- black bottom and white top -- she'd wear black jeans with an old gray sweater over them (she couldn't even do the white) and worn-out chucks and looked very under-dressed for the occasions. I'm not a formal person at all and even I was embarrassed.

At one point I said something, and she was hurt, because she saw her plain and simple way of dressing has her "style," and her father and therapist thought we were picking the wrong battle, so I let it go. It really rubbed me the wrong way, but I kept my mouth zipped.

This past summer (one and a half years post w/r, and over a year after she'd started dressing very plainly) she started experimenting with clothes and hair a bit more and has kept going. She's back into vintage clothes, she's dressing up for performances, she's wearing colors, she's wearing jewelry and occasionally makeup, she's putting her hair up, she's taking risks.

Something changed for her, on her own. I don't know how it happened. In our case I am glad I stopped pushing her, because she came to it on her own.

Just a different perspective.

Coming back to edit: I don't want this to sound like I think you shouldn't do exrp for this. Just that we had some similar things going on and that they did resolve themselves. We did use ladders to deal with the fear foods, and I am glad we did, and I would do it again. You obviously know your daughter best and know what she needs.
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Red
This is what I was hoping for GS, but it is plain that, in this respect, she just isn't able to move on. Yesterday, she wore shorts, tights and hoody in 4degree weather but 'wasn't cold'; she wore exactly the same clothes in the summer at 24degrees but 'wasn't hot'. Hmm. Pre-ed, she liked fitted tops, had a couple of pairs of favourite jeans etc.
The future is not set; there is no fate but that which we make for ourselves.

"Not my daughter, you bitch." Mrs. Weasley
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Amoma
Colleen had some great thoughts on this subject on another thread. So I took the liberty of copying her here:
______________________________________________________________________________________
I often say here that 'whatever ED drags in has to be dragged back out.'  I don't say that flippantly.

I believe that EDs are biological brain disorders. I believe that there is something physiologically different about the brains of people who have EDs and that it gets expressed during malnutrition. Their brains change. I don't know exactly WHAT is going on or WHERE in the brain it is happening; I don't know the extent of the change or damage that has been done; and I have no way of knowing how things are improving in the brain. We don't have a scan that shows us before and after pictures; we can't measure it like a tumor or a temperature.  I can't measure the amount of healing that has happened in her brain. All I can do is observe behavior. If she's still exhibiting behaviors that arose during or as a result of ED, then there's a part of her brain that hasn't healed.  We have to address ALL the behaviors that ED changed.

We don't have a way to change the brain from within, like medication or radiation.  Traditional talk therapy tries to change the mind in order to change the behavior.  We know that doesn't work very well for EDs.  We know that it DOES work if you turn it around:  change the behavior and the brain will follow.

Interrupting the behaviors around food intake is obvious.  But I extend this to ALL behaviors that arose during ED, even those that don't have anything to do with food--relationship issues, rigidity around clothes, exercise, impulse control, hygiene, etc.  We see so many commonalities in our kids on these non-food issues that it strikes me that they are symptoms, not real life issues.  And all we can do is go after symptoms.  It's MY opinion that we need to reverse as many symptoms as we see.  I suspect that there is even more brain damage that we can't see or observe, so we have to address everything that we DO see to give our kids the best chance at full recovery.  To do less would be like leaving a bit of tumor behind.

My d was eating and maintaining her weight for a year without help, so her food issues were resolved.  It didn't mean she was healthy yet.  She was still symptomatic IMO--she was incredibly hostile to me, and that was a behavior that ED dragged in.  We worked to change it on our own--we were in therapeutic no-man's land on this one.  She had only just 'recovered' from that symptom three weeks before leaving for college.

So here's what I see with hindsight: that if we had allowed our d to go away with the hostility behaviors still flaming, I think she would have relapsed harder and more quickly. I don't think three weeks of behaving normally was long enough to really 'set' her recovery. However we had a tight safety net in place. And when it wasn't tight enough, we tightened it some more.

Here's something to think about:  my d didn't appear crazy to anyone outside the family.  She was rational, reasonably happy, ate well, was social.  The hostility was dismissed by professionals or written off as 'typical teen behavior'.  Her personal therapist told me, "You can't expect her to be the same person she was before."   Another therapist told me, "This might not be the relationship you'd like with your d, but it's the one you have.  You need to accept it."  *We* were the ones who saw the behavior as abnormal and continued to try to change it on our own.

Because it was such a destructive AN behavior, we were motivated to change it.  However, I hear ED hiding in other situations here ATDT--and being accepted for any number of reasons:
1. because it's hard to challenge ED behaviors and parents may already be exhausted
2. because there may not be professional support to challenge them--they may be seen as 'within the range of normal' even if they are not normal for this child
3. because the behaviors are not life-threatening (no one has died from hating their mother)
4. because the behaviors seem trivial (why fight over clothing?)
5. because the behaviors seem beneficial (doesn't exercise reduce anxiety and depression?)
6. because the behaviors seem like an extension of the kid ('she lives for soccer')
7. and because sometimes our kids present very reasonable rationales for their behavior ('she really does have ethical issues around eating meat')--and we like our kids to be reasonable and independent.

I think sometimes we can be convinced that the behaviors are NOT ED-related, only to find out otherwise when they are interrupted and the beast is poked.  Then we are surprised by the reaction to a fairly innocuous event.  To me that says that ED is still there and has not been fully eradicated.  And if it were me, I'd be on that symptom like white on rice.

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gobsmacked_US
Interesting. My husband is reading Carrie's book (I haven't read it yet) and he jut read something about how people with anorexia often aren't able to map their bodies so well (I'm probably murdering her book -- sorry Carrie), and that turned into a discussion on how our daughters regulate heat. My AN daughter isn't so great about dressing for the weather, but she looks relatively normal next to my younger daughter (who has Asperger's). The only way she manages is because we have a thermometer that has a girl on it who is appropriately dressed each day for whatever the temperature is outside. She picked out that thermometer herself, because it bothers her so much to be told what to do -- she may have challenges, but she's smart. Despite that, today was 1f (-17c) when we woke up, before the wind chill, and it never warmed up that much, and we still had a huge fight about her wearing gloves and a hat this morning. I finally gave up and drove them to school so I wouldn't have to worry about her standing outside waiting for the bus.

Sorry for the interruption -- back to EXRP.
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anotherbite_CAN
Red, my friend....you rock. Sucks...all this work but you and Mr. Red are my heroes.

I think it is an amazing thing that she "wants" normal. That is something pretty big. We know they can get better without wanting it but....wanting something a bit more normal (even if they can't get there on their own) must help in some way. If only if it makes the discussion of the "plan" easier.
I still have to remind to add variety (Jeans and leggings ok but still no dresses in the mix). I do prompt still ie "where jeans tomorrow as you have worn sweats for 2 days"...she complies.

I think your normal list is fantastic. I think it is tangible and right on. The one thing I would say from our experience is even when rewards or incentives don't work keep laddering up. Rewards didn't always work. We had a conversation about the clothes stuff a few days ago ad she said "nothing makes it easier...you just have to make me wear stuff I don't want to". We are doing well with clothes mostly (enough variety and normalcy at the moment). Like I said, we haven't pushed dressed but have expectations re: jeans/leggings/ shorts, clingy, loose, etc.

Funny...hair is a thing at the moment. She is embarrassed by her curly hair and straightens it every school day. I have let it go for the time being because ed did not drag this one in....she hated her curly hair (and celery) before ed. It is veering on becoming a problem though. The interesting thing is that it's more a co-morbid problem (anxiety related....she doesn't want to stand out with her crazy mixed girl curly hair) than a straight up ed thing. I find for us laddering works for the co-morbids but flooding works for the ed symptoms.

I will be thinking of you guys and cheering you on.
xx

P.S. I was just thinking of you as I picked the girl up 20 min ago from a friends.....she had breakfast then spent day with her friend and did not eat lunch because they didnt and she was too embarrassed to ask. She asked if she could have a banana as they were on a bowl on table but she "felt bad" asking for anything else. The minute we got outside she said "mum, I'm so hungry can we eat as soon as we get home". I though of your girl not eating if out with friends and they did not eat.

I honestly think that also is more of an anxiety thing (too embarrassed to "stand out") than an ed thing. Not a good thing either way but one is a little easier to manage.
D dx at 10 years old in June 2011. She is now 16 and happy and healthy.  We were IP for 8 weeks and then refed at home for what felt like forever.  We chased vertical growth for years...as is typical for the age.
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Red
It is an embarrassment thing, I'm sure. But one day she has to be able to surmount it. She certainly does want to be normal but of course swears that however she is behaving is normal and however we're behaving isn't!! The jeans thing hasn't been going too badly, I knw the fitted tops will be v tough. Every time I try to buy something for her, she 'doesn't like it' & if she chooses something, it's always baggy, so I refuse to buy it. Nonetheless, we're going to have to go and purchase some tops, as hers are all ruined from being stretched & pulled out of shape last year. Amoma, Colleen is my hero, I love her!
The future is not set; there is no fate but that which we make for ourselves.

"Not my daughter, you bitch." Mrs. Weasley
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IdgieThreadgood7USA
Red, maybe there can be a compromise in clothing exposure. A size or style between baggy hanging off and fitted, maybe My daughters ability to wear challenging clothing seemed closely related to a sustained time period where here body maintained and didn't change. Im am strong supporter of exposure therapy I believe it's most effective. But for some its slow if the distress is high. Now she's a ya and your d might still be growing but those distortions may need to die down some so she can slowly tolerate herself in fitted clothing. Hugs my friend.
"Sometimes you just have to be your own hero"
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evamusby_UK
Red, you're doing a brave and important job, and I love all the responses here.We did a lot of informal EXPR without knowing it, around fear foods, mostly.
We also decided NOT to do it around some habits of an OCD nature, and they went by themselves, with time. Looking back I might have tackled one or two just to give my D more freedom from her internal bully sooner.On the other hand, my D can look back on those as something she achieved totally by herself, and I wonder if that's quite empowering...

For us, it would have been awful to present our D with our plans, our ladder: those notes would be essential but private to us parents. Her anxiety would have been through the roof to think of even the next small step. Looks like kids differ a lot in this respect, so are you sure she'll benefit from being forewarned, and if so, how much of the ladder do you think she can safely see?

Also, we got all our best successes when we stopped using rewards, and we'd never used sanctions anyway. Actually, we mostly backtracked when we used rewards: she undid her gains as soon as she got a chance. Again, kids differ. Reward systems got far too complicated and horrid for us, and I guess for my D there must have been enough stuff going on internally, and in our interaction, to support her through a challenge.
Eva
Eva Musby, mother, author, produces lots of resources for parents at https://anorexiafamily.com and on YouTube https://www.youtube.com/user/EvaMusby/playlists
[comp]
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Amoma
We did not identify ahead of time the entire ladder or what was next on the ladder. It was a methodical step by step weekly supported therapeutic method. It is interesting that the high and truly stratospheric anxiety abated rather quickly. A matter of  three or four weeks.

I was talking with another parent off foum who also did a supported EXRP course after WR with his teenaged daughter and he wrote he was amazed at how quickly it worked.

I try comment on things I have direct experience with, and EXRP is one. But at the risk of being the sole flag waver for a single issue, it is probably best to let others continue to comment. It would be detracting to be over identified with one issue in particular...but for me the results speak for themselves, personally. It worked for us.

But in closing I will pass on that the support came for me mostly.....I am not pushy by nature. I teach yoga and mindfulness compassionate meditation each yoga session. I don't chair the PTO or other large groups. I am not brash or in your face type of personality. I have struggled with my own personal anxiety in the past. I could not appreciate the reasoning behind the clinical methodology or wrap my head around that it would be doable for me, for my anxiety ridden child. I view it now as a clinical treatment methodology that has gained efficacy in all phobia treatment and part of a strategic plan.
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Red
evamusby wrote:
Red, you're doing a brave and important job, and I love all the responses here.We did a lot of informal EXPR without knowing it, around fear foods, mostly.
We also decided NOT to do it around some habits of an OCD nature, and they went by themselves, with time. Looking back I might have tackled one or two just to give my D more freedom from her internal bully sooner.On the other hand, my D can look back on those as something she achieved totally by herself, and I wonder if that's quite empowering...

For us, it would have been awful to present our D with our plans, our ladder: those notes would be essential but private to us parents. Her anxiety would have been through the roof to think of even the next small step. Looks like kids differ a lot in this respect, so are you sure she'll benefit from being forewarned, and if so, how much of the ladder do you think she can safely see?

Also, we got all our best successes when we stopped using rewards, and we'd never used sanctions anyway. Actually, we mostly backtracked when we used rewards: she undid her gains as soon as she got a chance. Again, kids differ. Reward systems got far too complicated and horrid for us, and I guess for my D there must have been enough stuff going on internally, and in our interaction, to support her through a challenge.
Eva


I think you make some really important points here; I'll do my best to address them:

D has been w/r nearly 2 years. As far as clothing issues go, there appears to be stagnation. If we were less 'on it' , it would be considerably worse. After a couple of years of parent propaganda, she knows that anything she achieves with our support/nudging are things she's achieved, kindly allowing us to be part of her success.

The notes on what is normal are for her, we don't think the entire ladder will be - that'll be to help us stay on track. She may, however, need to know what the 'next step' will be, as she does better when prepared for something in advance. Having said that, when working towards getting her back into a swimming pool back in the summer (with the huge incentive of a weekend break with the bf's family), it helped her immensely to talk through every step we'd take in helping her feel OK with it so I guess it's one more thing we'll play by ear!

I'm not sure how much of our story you know, but d *needed* consequences, couldn't manage without them and certainly needed rewards - that is how she makes it to lessons every day, that is how she stops the urges towards s/h. I think this has a lot to do with her age and stage of recovery. We keep it very simple, but there is an openness that these things are a challenge and we are happy to provide incentives to help. I too am very reluctant to return to LSUY..... actually, very reluctant doesn't come near to covering how I feel about this. I am filled with reluctance and fear at getting d to wear clothes almost any other child her age would wear and it is that, more than anything, that makes me realise how important this is.

Ern, as far as we can tell, d is a lot more relaxed about her body now. She swims in a bikini, is happy to slob around in her shorty pjs, stretches and shows off her tummy without worrying. She hasn't grown in years and hasn't gone up a clothes size, although she is clearly a healthy size and shape. Ever since she was a littlie, she's had a slight tendency to need a 'push' forward and our parental feelings are that this may be one of those things that she's just not able to do by herself. We could be wrong. If you heard her rationales for not wearing a new, trendy jacket ('It doesn't suit this outfit' - no matter what she's wearing) or for not wearing the kind of tops her friends wear, I think you too would feel the chill of ed. in her words.
The future is not set; there is no fate but that which we make for ourselves.

"Not my daughter, you bitch." Mrs. Weasley
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evamusby_UK
Hi Red, it looks like you've planned this as well as is possible, taking into account your knowledge of all the things that help your D, and she's a lucky girl that you're doing this in spite of your own fear. I haven't properly followed your story so far, but I'll be following your successes with clothes and cheering for you.
Eva
Eva Musby, mother, author, produces lots of resources for parents at https://anorexiafamily.com and on YouTube https://www.youtube.com/user/EvaMusby/playlists
[comp]
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SamHeinous
gobsmacked, where did you get that thermometer?  Abby doesn't have TOO many problems with dressing appropriately for weather, but does it sometimes.  Two of our other children on the other hand, could REALLY use something like that to guide themselves.  We're trying to work with them on making informed decisions, on their own.  


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mec
EXRP,

AMoma, please don't keep from commenting on EXRP. You are by no mean a one topic person. We need people who have experience in their areas, to step up and tell us about the stuff. I consider myself somewhat on an expert on SPED, SPED law, Autism and teaching because that is what I have done for the past 20 years. Anytime I see a topic related to these issues I immediately feel free to comment and speak from my unique experience.
21 year old daughter who was DX with RAN at 9 years old. The work of recovery is ongoing. 
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Amoma
Well rather than focusing on me authoring comments, the exciting news is in EXRP is that you don't need an expert to do it. It has a developing evidence base behind its implementation in AN treatment.  As parents on here we demand and our children deserve treatment that is evidenced based....


And here is also some very exciting news on EXRP

Katherine Loeb and Thomas Hildebrandt at Mt. Sinai are doing the FBT-EXRP research right now -- here's a fabulous article about how FBT is exposure and response prevention:

 

Anxiety in anorexia nervosa and its management using family-based treatment

http://www.ncbi.nlm.nih.gov/pubmed/22223393

 

 

 

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