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

Welcome to F.E.A.S.T's Around The Dinner Table forum. This is a free service provided for parents of those suffering from eating disorders. It is moderated by kind, experienced, parent caregivers trained to guide you in how to use the forum and how to find resources to help you support your family member. This forum is for parents of patients with all eating disorder diagnoses, all ages, around the world.

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AuthenticJ
First timer here. 21 yr old daughter who started with anorexia Sept 2018 and became bulimic a few months later. She came home from University early 2 weeks ago, her choice, restrict/binge/purge cycle was overwhelming her. Agreed to give me control of meals for 3 weeks, 1650 - 1700 calories/day. Worked well for 12 days then last 2 days not eating everything prepared and binge/purge at night. I'm keeping rational, calm, trying to act like a nurse would, and mentioned I may not be able to continue with our agreement if she can't hold up her end. Angry and sarcastic at last contact (she's still in bed). Have had excellent therapy for last 14 months and good progress. I know she can do it and often she does too. Do I hold fast on cancelling our agreement if she can't do her part?? 
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MKR
Hi @AuthenticJ,

Welcome to the forum, sorry that things have taken this downturn after you have been doing so well!

First of all, I would draw on the most successful parts of your therapy so far. You would have gleaned some good tips. Seems like one of those was having a contract in place.

I wouldn't cancel the agreement, but I would re-negotiate it. The goals are reducing binge-purge events and gaining weight. You might want to modify those, like no night binges etc. 

I would also revisit the Rewards and the Consequences. Like, a reward if she can make it through the next day, next two days without binging etc. I assume you have locked up all the usual binge favourites and serve her variety meals that cover all food groups. 

A more drastic measure would be to sleep near her room or even on her room floor to prevent these night time excursions. You can state this as a Consequence.

In our contract Consequences were more supervision and Rewards were more independence, both introduced/ removed by small increments.

It sounds like your daughter is motivated and does well but then gets overwhelmed. Is she having trouble sleeping? Would a massage or a weighted blanket help? I am hoping that the slowed down environment at home will do her good.

At the same time, try to put some structure into her days to give her a sense of achievement and lessen any anxiety. She must be keen to complete her coursework.

These are just some ideas, until you hear more from the forum.
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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Foodsupport_AUS
Welcome to the forum. 

It is positive that your D has chosen to come home for more support and is willing to have that support. At the same time it is not at all surprising that she has wavered in that resolve, it is very much the nature of the disease. 

A few thoughts - 1700 calories per day is very low. For an average 21 year old this would be a weight loss diet. You don't mention your D's physical state, but is she near or at her highest weight ever, or is she well below this? There is evidence that binge/purging behaviours tend to be exacerbated with weight suppression - that is being below their previous highest weight. If this is the case, then weight gain is essential and intake would need to be increased considerably. 

I agree with MKR about renegotiating what is doing. It is better if you can help her heal in place rather than her deciding to leave. That being said the way to her healing is going to be eating those regular meals, and avoiding that restrict binge purge cycle. Perhaps start with asking her why she thinks things have changed. Encouraging her to conclude herself that she needs to follow the plan if she is going to get better. 
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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AuthenticJ
Thank you MKR and Foodsupport_AUS, 

My daughter is at a safe weight and has been for several months. Of course it fluctuates and she still has body dysmorphia, but there is no danger. 

I agree that renegotiating the agreement is the right thing to do. We need to have a discussion about what was working, what changed, how things can be rearranged to make it better. She is a smart, confident young woman and love and connection have been at the core of her (our) recovery journey. Recently we have used DLG (Discover, Learn and Grow) with LCJ (Love, Connection and Joy) as a focal point. I need to keep remembering that and incorporate it in this bump in the road. (I did try to discuss what an appropriate calorie level would be for her, and will try again through renegotiation). 

This is the first time I have reached out to other parents/caregivers going though this, and it is uplifting to have a sounding board, again, thank you so much. 
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MKR
AuthenticJ wrote:
She is a smart, confident young woman and love and connection have been at the core of her (our) recovery journey. Recently we have used DLG (Discover, Learn and Grow) with LCJ (Love, Connection and Joy) as a focal point. I need to keep remembering that and incorporate it in this bump in the road.


That sounds beautiful! 

You are right, this is just a bump on your road to recovery. Perhaps even an adjustment to living in a confined space for now.

Keep going,
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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Foodsupport_AUS
AuthenticJ wrote:
Thank you MKR and Foodsupport_AUS, 

My daughter is at a safe weight and has been for several months. Of course it fluctuates and she still has body dysmorphia, but there is no danger. 

I agree that renegotiating the agreement is the right thing to do. We need to have a discussion about what was working, what changed, how things can be rearranged to make it better. She is a smart, confident young woman and love and connection have been at the core of her (our) recovery journey. Recently we have used DLG (Discover, Learn and Grow) with LCJ (Love, Connection and Joy) as a focal point. I need to keep remembering that and incorporate it in this bump in the road. (I did try to discuss what an appropriate calorie level would be for her, and will try again through renegotiation). 

This is the first time I have reached out to other parents/caregivers going though this, and it is uplifting to have a sounding board, again, thank you so much. 


It is great that your daughter's weight is within a healthy or safe range. The relationship between her previous weight and now is important. If she is below her  previous weight it is likely her body is physically trying to increase her weight and mentally she may be suffering as she is trying to suppress this weight. It is one reason why full recovery is hard to achieve if they don't regain all the weight they have lost. It is also possible to be very physically unwell and be at a normal weight or even overweight. 
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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Kali

Hi AuthenticJ,

Welcome to this club that no one wants to join. I hope you will find support and some ideas here to be able to help your daughter.

As the others have said, I wonder whether 1700 calories is enough to fuel a young adult. It was recommended for my d, who is 5'3" and small boned, that she eat diet of 2700 calories daily to maintain her weight, after weight restoration. What is your daughters height and current weight? Who wanted the contract to have 1700 calories a day? Was that at her request? 

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Worked well for 12 days then last 2 days not eating everything prepared and binge/purge at night.


This may show that when she suppresses her appetite, the binges happen due to hunger and the purges happen afterwards because she didn't want to eat. 

I would not cancel the contract however I would double down and make sure that she is eating three good meals and having some snacks in between. Every day is a new opportunity to do better and clearly she would like help since she came home. Recovery is not a straight line and there will be steps forward and backward. Has limiting bathroom visits after eating been part of your contract? In our case, my d. spent 3 months in the hospital and was not allowed to use a bathroom at all after eating for that whole time and it seemed to break the cycle. Also if you can, sit with her after eating and talk or watch tv or take a walk with the dog or whatever else you might think of, so that she can be distracted from thoughts of purging after eating. I would also increase the calories but from my lived experience, I don't think that discussing calories with someone who has an eating disorder is productive and you are likely to meet with resistance. For your daughter, eventually getting to a place where she not counting calories is an important step forward to normalizing her eating and something to work toward. 

warmly

Kali

Food=Love
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AuthenticJ
Unfortunately she decided to take back control of her eating. With an adult child (mine anyway), taking any kind of control like dictating calories, making her eat, stopping her from going to the bathroom etc. is out of the question. Every time it's been attempted or even suggested all love and connection is lost, and I know you may think I should be stronger and take the hit, but it is diabolically opposed to the therapy model we have been working with - which is she must own her recovery and we provide empathy, love and support. 

I don't know if we're making little, good or excellent progress. Maybe someone could let me know based on:  Sept 2018 boyfriend breakup triggered severe AN while at university (a 5 hour plane ride from home). December 2018 she came home. Intensive therapy (not in an institution). Weight gain and basic physical health OK and bulimia began. Went 3 weeks binge/purge free over summer 2019 and went back to university (we were reluctant but were somewhat convinced it would be better for her there because she felt she would surrounded by friends and she felt extremely isolated at home). Did fairly well first term (got through all her courses) but she said she needed to come home part way into second term because the restrict/binge/purge cycle was several times a day, using laxatives, and she wasn't getting out of bed) and she is here now. She gave me control of meals for 14 days and in the last 2 days she started to not eat everything provided, and binged/purged one time at night on Wednesday and Thursday. And now we are here. She is close to her pre-AN weight, however she was a varsity field hockey player so not as fit. She is very communicative and desperately wants to be better. 

One last question (Sorry!!) - which maybe I should start a different post about. How do I deal with a husband who doesn't "get it"? He loves his daughter and wants to help but I feel he treats her like she's a healthy person. "It's so wasteful" "Just stop doing it" "She did is for 12 days, she knows how".  She feels full judgement by him, and Earl (we call her ED Earl because of the Dixie Chicks song "Goodbye Earl") takes over and she spirals. And of course, I'm smack dab in the middle and get everyone's wrath. Which I have decided to get out of btw, and today have told hubby he needs to talk to his daughter about it - I can't be middle man anymore. Any other ideas??

So grateful for your time and your thoughts. xo
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Kali

Hi AuthenticJ,

My d. is also a young adult and I did not let her take control of her food when we were helping her recover.
Basically I served 3 meals a day. When the meal was ready I called everyone down to eat and very simply her job was to eat. I didn't discuss calories. We did discuss some of her favorite things to eat and I did try to serve them as long as they had enough calories and nutrition. I did take some of her wishes into consideration as long as they were not eating disorder inspired wishes. (lo fat milk..drinking only water with meals, etc, were nixed by me) But if she had a preference between two meals that both had enough calories and nutrients, I did give her the one she preferred.

There were snacks that she was encouraged to take on her own.
We encouraged her to plate her own food with adequate portions.

One of the things we found helpful was her desire to go to college. We were able to help her motivate herself by working towards that as a goal. Are there some things your daughter would like to do when she is well enough and would it be possible to help motivate her to stick to a recovery path like that?

Even though your daughter is 21, she is still your child. As far as food goes, having some boundaries can be helpful for her recovery. Her eating disorder may not like the boundaries but they are meant to support her recovery so that she will be safe and eventually be able to have the life she deserves free from the eating disorder. What is DLG and LCJ? I haven't heard of that as an eating disorder treatment and would love to know more about it. 

The way I saw it, even though she was an adult, the part of her brain which had to do with food was not working properly and she was not able to change that by herself. She needed a lot of help and support in order to do so.

warmly,

Kali

Food=Love
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teecee

Hello from the north of England. I can hear there are lots of positives and those are important to focus on. We had blips (our D is 18) but rather than for example stopping paying for the phone we would give her a short time scale to turn things around which fortunately she always did. We are now in a position that when she has blips she approaches us to tell us for support. That’s the most valuable thing we’ve got at the moment as it keeps it all out in the open rather than things becoming secretive again to avoid punishment. We told her that we would have no problem in enforcing restrictions if we felt there was a safeguarding/life threatening risk. She agrees and for our part we continue to encourage and support. 

She has been receiving EMDR therapy and I have to say that from a family point of view it’s been life changing for all of us but not least my lovely D. I’m so happy for her. 

Keep supporting and loving her. You’re a great parent...the fact that she came home to you for help says that. Xx

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MKR
teecee wrote:
... rather than for example stopping paying for the phone we would give her a short time scale to turn things around which fortunately she always did.


Excellent idea, @teecee! I forgot about this method, we use it to keep her hoarding (and discarding food) under control. Every now and then, I say yo my d I give her xy minutes to bring out all the hidden stuff, no questions asked. Of course, if she didn't there would be a consequence (eg. me going into her room) but we didn't need to. I also saw relief on her face that action was taken.
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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mommiful
AuthenticJ wrote:
She is very communicative and desperately wants to be better. 


This is a great strength that will help your daughter in her recovery. Desperately wanting to get better doesn't mean it's easy to do or that she can do it on her own, without any help, but she will figure out how to do it, and you will together figure out how you can help her. 

I can see how your taking control may not work so well in this situation. That's what we found with my daughter. She needs all the strength of her resolve to get better, and feeling like someone else is driving the process can undermine that resolve.  

Are you familiar with the work of Tabitha Farrar? She has some great short videos on her YouTube channel, and her book Rehabilitate, Rewire, Recover!: Anorexia recovery for the determined adult walks individuals with eating disorders through the process of figuring out what kind of support they might benefit from and getting support while being in charge of their own recovery. Reading this really helped me in working to support my daughter and not get in her way.

 

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AuthenticJ
Hello everyone again. I became quiet for a while because I started to feel we were doing this wrong. However, we had a 3 hour family session with our amazing therapist and I feel back on track. I have come to understand there are many possible methods and strategies to recover from and ED and of course, each journey is unique. Our journey sounds similar to yours, mommiful. The control has to be with my daughter or it will not work. She can ask for what support she needs and it will be given without judgement. On that note, she has asked me to prepare meals again under a different scenario, it's not ideal (4 meals, 1400 calories) but at this stage in our journey she is not at any serious health risk and she is trying this as a strategy to stop the binge/purge cycle. 4 days in and so far she has fought it off, and been primarily stable or happy mood wise. #1 for us is to make sure she does not feel guilt, shame, worthless, or a burden to us (her primary addiction emotions that the ED latches on to). 

I will look into Tabitha Farrar - thank you mommiful. A terrific book I found that parallels our journey is "Life Without Ed" by Jenni Schaefer. It's an easy read (with humour) and good ideas written from her perspective and parts from her therapist. 

And Kali - you asked what DLG with LCJ meant - it is just something we came up with for our journey and it stands for Discover, Learn and Grow with Love, Connection and Joy, which works for when things are going well, and when they feel like they aren't. 
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Foodsupport_AUS
I understand truly why you have gone down this path. At the same time I am not clear if you have mentioned to your D and her therapist your concerns with this new plan. I note the new plan is for an even more restrictive caloric intake than previously. It is likely that this may actually exacerbate your D's thoughts and behaviours as well as leading to weight loss. That does not mean this can not be an interim step but I am hoping your D is clear this is not the way to recover.
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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Seashell
I have a similar situation to yours although the huge difference is my daughter doesn't want to get better. I'm inspired by your story. Thanks for sharing.
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Torie
This is such a terrible illness.  There really is no "good" option for tackling it.  One of the problems is that what seems best in the short term (allowing the sufferer / eating disorder to have control) can result in additional weight loss, making the eventual slog up that much more difficult.

You are the one there on the ground, and I don't presume to know what is best for your family.  For other readers, though, I would like to say that normally the number one priority is to get the weight back on asap.  Yes, this wreaks havoc on all involved and all family relationships,  but it has the best chance for full recovery.

I wish you and your d all the best. xx

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

HI Authenticj,

How are things going? 

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However, we had a 3 hour family session with our amazing therapist and I feel back on track.

I'm curious, what did the family therapist suggest as far as eating? I would hope that she/he would be strongly encouraging a higher daily intake than 1400 calories. It does help when the professional team is strongly on board with refeeding and full nourishment. 

warmly,

Kali

Food=Love
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AuthenticJ
Hi Kali, the therapist has stressed significantly that "it is not about the food!". It is about not triggering my D's 4 source addiction emotions (guilt, shame, worthlessness and being a burden). If we can avoid/eliminate these emotions the food aspect (the addiction - which could have been alcohol, drugs, sex etc) will take care of itself. With a healthy mind there is no room for addictive behaviour. J (my D) is at a healthy weight - it will fluctuate for sure with some restriction and binging but we are not concerned - so we can focus entirely on her mental health progress. 

She has taken over her eating again - she posted to our therapy group (our family and the therapist) that "Because it's not about food, I would like to have control of my food again. I am not a victim of Earl. I feel by being scared of food and calories and not having control I'm giving control to Earl. It's not about the food, it's about my four core emotions. I'm not scared of Earl. And I never will be again."  Earl is our name for the ED. I'm cautious that Earl will rear up again and we will be ready with love, non-judgement and prepared to do what we can to help her not feel the 4 core emotions. So far so good....
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Foodsupport_AUS
I am very concerned that the therapist does not understand the biology of eating disorders. Addictive behaviours can be an issue, however without nutrition all of those thoughts and emotions can go out of control.They are likely to get worse.  You cannot separate the food from the illness. It is important. As her weight loss increases you are likely to see a worsening of her thoughts and behaviours. 
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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Kali
Hi Authenticj,

We had the most success with behaviorally focused treatment. When I say behaviorally focused treatment, I mean that normalization of food intake and cessation of behaviors such as purging were treated as the most important things to change and that was fully supported by the professionals who treated my daughter. (Once we found a good team) Behaviors were changed by creating limits for what our d. could and could not do. For example, our d. needed to eat 3 meals a day and 2 snacks. She wasn't able to go to the bathroom after eating in order to stop the purging. She had to eat what was served. And she was not a child, she was a young adult. She was not able to decide to eat 1400 calories or 1800 calories a day even though her eating disorder would have loved that. We emphasized that these things were necessary for her to be able to recover and to keep her safe. And yes she had a ton of therapy but a lot of it was focused on figuring out strategies to off ramp the eating disorder behaviors and to change them, as well as using DBT and CBT to help with that. We also had some therapy as a family, and the therapists were firmly of the opinions that full nutrition needed to be supported and that we needed to all work together as a team to achieve that. Changing habits happens when you do the same thing day in and day out in order to create new pathways in the brain and create new non eating disordered behaviors. 

We did try a more touchy feely therapy focused approach for the first 9 months of her illness and she just got worse and worse. This is not a touchy feely illness. I am (or I used to be)  a touchy feely person but I needed to learn how to be firm as my child was being held hostage by a life threatening illness and I was unwilling to let it ruin her life and rob her of her education and her future.

You may not want to hear this but It sounds to me like Earl is firmly in control here. He has managed to negotiate the calories down from 1800 to 1400. He has managed to assume full control of your daughters eating. He even has a therapist who is of the opinion that this has nothing to do with food and that when some sort of underlying issues are treated then all will fall into place. So now he can take control of food and do what he wants since it isn't about food because the therapist has said that.

In our journey, it was most definitely about food. It was about not wanting to eat enough. It was about eating more then she thought she should be eating because she was hungry after restricting her diet for days, and then throwing up whatever food she finally ate. It was about diminishing variety in the foods eaten. It was about the brain impairment which happened after not eating enough and how that affected her feelings and thoughts. When my daughter was able to normalize her eating we saw enormous improvement. My daughter was discharged from the hospital 4 years ago. She is recovered.

You may not want to hear these things... and I am truly sorry you find yourself in this situation. I am hoping for the best for your beautiful daughter and the life she deserves when she is free of the eating disorder.

warmly,
Kali


Food=Love
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Torie
AuthenticJ wrote:
Hi Kali, the therapist has stressed significantly that "it is not about the food!". It is about not triggering my D's 4 source addiction emotions (guilt, shame, worthlessness and being a burden). If we can avoid/eliminate these emotions the food aspect (the addiction - which could have been alcohol, drugs, sex etc) will take care of itself. 

For my d, the equation was exactly backwards from this.  When she was at a low weight (for HER; she was always at a "healthy weight" according to the charts), she felt a tremendous amount of guilt, shame and worthlessness.  These emotions are classic AN symptoms, and they melted away with enough food + time.

We often say here that food is their medicine.  In that sense, at least, it really is about the food.

My d's therapist had a lot of outdated ideas about AN (similar to "It's not about the food").  We were lucky to be able to take her to a world-class ED treatment center.  THe doctor there called the therapist and directed her to stop talking to d about AN-related topics.  (She still talked with her about school, home, friend issues.) 

This book was a big help to me.  Since regaining all the weight she had lost, my d has been living the life she deserves, happy and healthy at university.  Well, until the university closed due to COVID-19.

Best wishes.

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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Foodsupport_AUS
This blog gives food for thought, posted by someone who recovered after many years of suffering with ED while dealing with the emotional issues. https://www.feast-ed.org/my-past-gave-me-some-gifts/?fbclid=IwAR3UrJX5DIcevKW2CPle6S-oiIRBr8por9s4V6kvZJktf1H_T1epu78Zkt4
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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MKR
Great blog, @Foodsupport_AUS!

Shows what goes on in the sufferer's mind.
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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