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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Hi everyone, I was referred to this website to try and see if there was a way I can help my sister in law.  She is in her 30s now but living at home and being cared for entirely by my in laws.  She has had an eating disorder since her teenage days (anorexia at first but now it has morphed into an over-exercising disorder).  She was recently hospitalized from malnutrition and her organs had begun to shut down.  She was in the hospital for a few weeks in critical care and then on regular ward and now she is fully discharged and back home however she has reverted back to old habits--eating only salad and shakeology and then running, doing exercise videos like insanity and p90x, etc all day long. 

My family and I are at a loss as to what to do to help her.  She is technically an adult and doesn't think she needs help most days so if she's not willing to seek help, what can we do??

Looking for any advice or things that may be similar between my case and yours and some strategies her family and I can try to help her situation....we don't want to lose her!
Hi there and welcome.
I won't try to offer advice, as I too have my L plates on, just didn't want to read and run.  There are some great people on this forum, and I'm sure you'll get some helpful advice from them.
This is a very good site/place to be.
D, b.2002, diagnosed with depression, anxiety and EDNOS Spring/Summer 2016.
Some restricting, some vomiting, some self-harm for good measure.
FBT, CBT, now on 3rd type of anti-d's.
D is "cured" of the ED but still on low dose of anti-d's. Will I ever be cured?

Hmmm.  Are her parents on board with getting her help?  If so, I might suggest looking into a family intensive week (where the sufferer and family support people attend an intensive one week program to help getting everyone on board and moving in the same direction).  There is one at UCSD (UC San Diego) for adult patients, as well as one at the Center for Balanced Living in Columbus Ohio (https://centerforbalancedliving.squarespace.com/new-fed-description) that at least one person here has found very helpful....maybe more.  Look for posts by ninhursag...her (adult) partner and she attended, and (I believe) found it very beneficial.

Here's an article about it you might find useful.  If I was a support person for an adult, this would definitely be high on my list to check out!  http://www.theatlantic.com/health/archive/2016/03/treating-anorexia-in-adults/475845/?utm_source=SFFB

My D (who was then 15) and my family did the program at UCSD for teens, and found it enormously empowering.  Well worth the investment.
D, age 18, first diagnosed March 20, 2013, RAN, at age 13 Hospitalized 3 weeks for medical stability. FBT at home since.  UCSD Multi-family Intensive June 2015. We've arrived on the other side.  :-)  D at college and doing great!

Below is a link to an article Carrie Arnold wrote earlier this year about the week long program at the Center for Balanced Living referred to by mnmomUSA.  It describes the old and current thinking about treating EDs and specifically the new program at CBL for loved ones and their supports.  

You are a great sister-in-law to get involved.  Big cyber-hug for you!!

DD diagnosed with anorexia at 14; FBT at home with the help of psychologist and medical dr; 3+ years later and doing well (knock on wood)
Hi, my daughter who is now 34 has struggled for years, in and out of RTCs and various talking therapy.  None has worked for long. She too was a chronic overexerciser, running miles on no food for days. Since her last inpatient (collapsed in late June), we have taken control of her food. She had to leave her job, we moved her across country, and since she has no income, we made a deal: live in our house, eat what we make, we'll find a team, and you have a chance at recovery. We are doing a modified FBT, but basically she eats what we give her, no options. She sees a dietician (not all that helpful), the nurse practitioner for weight and labs, and an ED therapist twice a week. She has a psychiatrist to manage her meds. So far, she is weight restored, though still probably will gain a few more and it needs to redistribute. She cannot work, yet. Just got clearance to drive. The EDPS forum has made this possible for us, as well as reading Carrie Arnold's book, Eva Musby's books and videos, but mainly the support from EDPS. Food is first. Nothing in therapy has really helped her without enough food, certainly not in the long run. Her brain has just seemed to click back on, her sense of humor is back, though she still struggles some. She has comorbids of depression and PTSD. Living at home as an adult has been fine so far. We both work, so Tuesday and Thursday she has to manage lunch and snack on her own.  She was not cognitively capable of making the right choices around food so we took the choice away, for now. This helps with the guilt and shame (ED can blame us). If there is ANY way someone can take over while she gets her weight up and her brain healed, it would be a good solution. Good for you for caring. [smile]
One more thing to add: they can't see how sick they are. They are incapable of it. If there is ANY leverage the family can use, then they should use it. We've heard various stuff about "autonomy." She won't have any autonomy is she doesn't live. That's what we finally had to decide. Small price to pay for all of us while she has a shot at real recovery. We totally support autonomy when she is ready for it.
Good luck.
Hey, so one of the things that it unfortunately seems to take with adults to break through the ED fog is for the physical damage to snowball. But one they are semi functional somehow it's all no big deal again and they are fine. It can help to hammer home what happened before- the physical and psychological collapses.

Ask if that's what she wants from her life? Living on her parents' couch careening from disaster to disaster? Can she imagine a better life? Can she learn that 'control' of food is stealing her control of every other aspect of her life? She might say she's too old, it's too late and there's no point. That is very much eating disorder talk

For reference- my wife first went into treatment at 27, was weight restored by 30 from a starting BMI of about 13. For the last six years since, she has been mostly weight stable, but lots of other ED behavior, unstable nutrition, purging, suicidal despair and a lot of anger that gaining the weight wasn't making her feel better as she was promised it would. RTCs and treatment centers could help her gain weight, but never controlled the other behaviors effectively. Once I became involved in the process I found that there was a lot of talk about her owning her recovery and that if she did not want to eat no one could force her and we just had to let her. I was told trying to insist on food was controlling, was making her illness about my needs and was causing the constant relapses.

She loved loved loved hearing that AND at the same time my rejection of that was also a huge driving force to her finally being able to trust that I had her back, was not going to just let her spiral down. Really her eating disorder loved hearing that. She actually began to trust the process. I say began because there is still so much push back. The habits of restricting and purging are so instinctive and wired in that they feel healthy and natural. It is a huge huge leap of faith to believe they are anything else. Despite logic, rationality and the real physical damage done. Like this is the hardest most frustrating, angering part for a support person. But it's what it is.

We did a very helpful stint at the Center for balanced living in Ohio for their week long intensive program. I would absolutely recommend it for getting everyone working together and building the necessary trust. However the support person needs to understand that this is just the beginning and you need to build on it. But yeah there is hope, there is effective treatment and if you find it and stick with it you can get better.