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

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sahmmy
Those of you who have had FBT support,
1. At what point did you start the hand-off? Is 93% WR a sufficient point to allow 17, almost 18 year-old to eat lunch unsupervised at school?
2. How long do you try it, and what criteria would you use to determine if she is successful or not? How much time would you allow?
My d's weight is sideways for 5 weeks of trial. I'm wondering if this is not a good plan.
d=18, R-AN, Generalized Anxiety Disorder. Refed at home with information gathered from this forum and lots of books. Relapsed. Refed. Relapsed. Refed. 17 sessions with an excellent individual therapist. 19 sessions with unhelpful dietician. 3 sessions of DBT (didn't like it). Psychiatrist available if needed. Prozac - fail. Lexapro - fail. 5HTP - fail. Clorazepam/Klonopin = major improvement, only used when necessary. Genomind SLC6A4 short/short - not able to process SSRI's.
d=15, lost 14 lbs in 8 months, Ped [nono]diagnosed as a crystal on a hair in the ear canal
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OneToughMomma
Dear sahmmy,

Our FBT made those decisions, and I'm assuming you don't have an expert you can trust to help you?

So here's my opinion based on my experience to help you make your plan. Remember I'm no expert.

Your d isn't WR yet. If it were me I would not change a thing until I were 100% sure her weight was where it needed to be. I would want her to be higher than she ever had been. But most importantly, I would expect to see signs of brain healing before handing over any control.

So, is she eating when she doesn't 'have to'? Does she seem to enjoy food? Or does she complain about eating or try to negotiate less? I would ignore what she says and look at what she does. I would not change a thing until I saw my d totally comfortable with the current situation.

I see from your bio that you have done this before, and if I were you I would be very careful. At her age you might not get another chance.

I would go slowly and have very tight parameters, aiming to avoid the mistakes from your past. We say here that phase 2 is a dance, back and forth. This is not cutting them loose to sink or swim for a few months. So, maybe keep everything exactly the same but let her eat lunch unsupervised once or twice a week. Tell her that any loss means stepping back to more supervision. Do that for a while--a month?-- and then add something else if she succeeds. If she loses any weight, then you take a step back to supervised lunches and try again later.

It's a long haul, I know. We, like you, got our d to WR a couple of times before having an FBT who could help her gain a healthy independence. Note that it was a year after WR before she graduated FBT. And even then she had a wobble after a few months. Take it slow, sahmmy, so that these efforts aren't wasted.

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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Boysmum
I honestly don't think 93% is enough. We were at 110% in June and he wasn't ready. We are 5kg up from that now at the end of August and I am considering trialling eating with friends at lunchtime after being back at school a month, so at the start of October.
Food hiding has gone, he has eaten lunch out with friends this summer and we have planned what he would have and then he has self reported back to me (I always used to call and get a friend he was with on the phone to double check but have been able to stop this most of the time. Still do it at random times though) and he has maintained/put on weight so I know he's been telling the truth.

I think they have to be even a little bit over 100% for at least a few months for their brains to heal completely.
13 yr old son diagnosed April 2015 with Anorexia.
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sahmmy
Well, we went in to this team requesting FBT, but it has turned into Individual Therapy.
And no, I don't trust the dietician who is friends with the therapist, and the therapist is supporting the dietician's decision.

She sometimes eats if not required/supervised. She'll plate enough, but only eats about 50%.
She gets angry if I say anything like "you need to finish that."
She asks things like "Is it 'fix-it-yourself' night?" (for dinner), meaning no family meal. We haven't had 'fix-it-yourself' night in maybe a year or so.
She asked to go out to dinner with boyfriend after school one night this week, and could she be home 4 1/2 hours later, out of the house for a total of 14 hours that day? (no supervised eating all day) Answer = No.
She was dishonest about whether she ate her evening snack about a week ago.

So, behaviours in a good place? I'd say not, but the dietician doesn't want my input. Dietician and therapist threatened that she might leave as soon as she turns 18 if I don't comply with not supervising her lunches.
d=18, R-AN, Generalized Anxiety Disorder. Refed at home with information gathered from this forum and lots of books. Relapsed. Refed. Relapsed. Refed. 17 sessions with an excellent individual therapist. 19 sessions with unhelpful dietician. 3 sessions of DBT (didn't like it). Psychiatrist available if needed. Prozac - fail. Lexapro - fail. 5HTP - fail. Clorazepam/Klonopin = major improvement, only used when necessary. Genomind SLC6A4 short/short - not able to process SSRI's.
d=15, lost 14 lbs in 8 months, Ped [nono]diagnosed as a crystal on a hair in the ear canal
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Torie
I wouldn't recommend this for younger teens, but I wonder if your d has friends who could verify her eating? That's what we did for at least a year. We would agree on a trustworthy friend, and D would ask said friend to text me what D ate. At first, I got reports like, "D ate chicken, corn, salad, and cake," leaving me to wonder  about the amounts. Sometimes I would then ask, "Did she eat at least as much as you did?" and other times I would just pack the meal and the friend would verify that she ate the entire meal or specify which items D didn't finish. (Note: Her therapist said NOT to do this. I know some forum members agree with the t, but it worked for us.)

I don't know what it means to be 93% weight restored. For many here (raises hand), that last 5 pounds/few kilograms was really hard. Have you considered an arrangement along the lines of: If you gain at least a pound this week, next week you can eat __ meals with a friend?

The main thing, of course, is to get to 100% wr asap. How much weight does she still need to gain?

Please keep us posted. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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sahmmy
<<How much weight does she still need to gain?
That's the looming question. Initially the dietician agreed that she should be around 120-125 lbs. Over the last month or so, she's acting like I'm number obsessed for accompanying my daughter for lunch at 111 lbs, because I'm shooting for 120 before I even begin to think of letting go. Now the dietician won't say how much she needs to gain, or what she would consider to be weight restored. We agreed to a 2 week trial on the lunches - but did not set out clear goals i.e. If she doesn't gain any, then what?...It's been 5 weeks. She hasn't gained any. I'm waiting for the dietician to give me permission to step back in and help her through lunch. Silly me! for allowing her to have that authority. [frown]

The other stressor is, this dietician is out-of-network, $135/hour, straight out of pocket. Weekly appointments. Ouch.
d=18, R-AN, Generalized Anxiety Disorder. Refed at home with information gathered from this forum and lots of books. Relapsed. Refed. Relapsed. Refed. 17 sessions with an excellent individual therapist. 19 sessions with unhelpful dietician. 3 sessions of DBT (didn't like it). Psychiatrist available if needed. Prozac - fail. Lexapro - fail. 5HTP - fail. Clorazepam/Klonopin = major improvement, only used when necessary. Genomind SLC6A4 short/short - not able to process SSRI's.
d=15, lost 14 lbs in 8 months, Ped [nono]diagnosed as a crystal on a hair in the ear canal
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sahmmy
Thanks for the detailed example. That's what I'm needing to see. Last night for dinner my h told her she needed to eat beans (protein). She refused, said she had eaten fish earlier, that dad needs to stay out of this because there isn't a problem, this is between her and her dietician - they have it all worked out, and we parents don't need to be involved.
Hmmm.
d=18, R-AN, Generalized Anxiety Disorder. Refed at home with information gathered from this forum and lots of books. Relapsed. Refed. Relapsed. Refed. 17 sessions with an excellent individual therapist. 19 sessions with unhelpful dietician. 3 sessions of DBT (didn't like it). Psychiatrist available if needed. Prozac - fail. Lexapro - fail. 5HTP - fail. Clorazepam/Klonopin = major improvement, only used when necessary. Genomind SLC6A4 short/short - not able to process SSRI's.
d=15, lost 14 lbs in 8 months, Ped [nono]diagnosed as a crystal on a hair in the ear canal
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Psycho_Mom
Hi,

Why are you paying someone to undermine your efforts at restoring your d's health? 

I'm sorry, I may not have read correctly, or missed some info in previous posts. But you sound like you and your h know what needs doing: d needs to eat everything you require, needs to gain weight and needs to weigh around 120. Is dietician helping with this endeavor? It sounds like dietician and therapist, too, are making things much more difficult. And threatening you into not feeding your d is not evidence-based treatment, but it is irresponsible and unprofessional, in my opinion.

You don't need permission to feed your d adequately. 

We started the handoff to independent eating when d was well wr and showed by her actions that she was likely to be ready for it. Ie if your d cannot serve herself an adequate meal in your presence, she is highly, highly, highly unlikely to do so when NOT in your presence. 

Therefore too bad for her. No independent eating. She wants independence? Independence is earned.  

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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sahmmy
You guys are so right. It's hard to see the forest when I'm stuck here in the trees. I'm working on h and d to go to UCSD or CBL. H, d and I met with therapist yesterday. He is finally starting to listen to me (maybe?) that we are stuck in ineffective treatment. Some pointed questions at the therapist revealed her thoughts on the process i.e. She decided that FBT would not work because our d was almost 18, so she & dietician decided to do Individual therapy instead, and leave the parents out. She hasn't found the root (psychological) cause yet, but they are still working on uncovering "layers" and making progress, (but can't discuss specifics). My d wants more independence and no parental help. T and d are working on "assertiveness" - (yes, I see, as my d is verbally more resistant to parental eating support - thanks for that!) She couldn't give us a time frame for how long this will take, has no goals or objectives for this process, and in her own words "I live in a gray world..." I share all this, in case someone else who may be stuck in a similar situation can see how ridiculous this is. 

She's a lovely person, and my d likes her, and I do appreciate that d has someone to talk to. But at $140/hour with an hour drive there and an hour drive home in city rush hour traffic...I don't believe that's the best treatment for 17-year-old AN to navigate alone.

I'm way past ready to bail. Working on the h, as we know this requires ALL hands on deck to push through, so I'm waiting for him to get on board so we can drag our d OUT of this!
d=18, R-AN, Generalized Anxiety Disorder. Refed at home with information gathered from this forum and lots of books. Relapsed. Refed. Relapsed. Refed. 17 sessions with an excellent individual therapist. 19 sessions with unhelpful dietician. 3 sessions of DBT (didn't like it). Psychiatrist available if needed. Prozac - fail. Lexapro - fail. 5HTP - fail. Clorazepam/Klonopin = major improvement, only used when necessary. Genomind SLC6A4 short/short - not able to process SSRI's.
d=15, lost 14 lbs in 8 months, Ped [nono]diagnosed as a crystal on a hair in the ear canal
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mamabear
Getting to the root " cause"? That's a bunch of crap.
Your daughter has a brain disease. The medicine is food/fats and a proper solid MAINTAINED weight. Until this happens there can be no " stage 2" . And the stage concept is very very grey. They go in and out and back and forth for a long time. They need support for a long time.
It really is that simple . Of course nothing about this is simple.... But you know what I mean?

I would stop wasting your money. I wasted 2,000 dollars A DAY having my daughter inpatient in a place that didn't know what the hell they were doing. Dietitians scratching their heads at her microscopic gains on 3000 cals.... She needed WAY more. Long story....

You know you need to trust your gut. You know that Ed needs to know who is stronger- YOU ARE!

Be in charge. Go to Califirnia. Reboot and recharge.
Persistent, consistent vigilance!
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