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

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HI - I started this in another thread.  Thanks for the coaching from Tina72 to open a new thread.
I am in Ontario in Canada.  My D is over 18, living at home, and making a difficult transition from competitive athlete to starting university next month.  We do not have a diagnosis as she won't admit to having an ED.   I have more than once found evidence of the disorder, and have been careful to broach the topic with - I found x, this makes me concerned because y, and I want to help.   She gets angry, denys it, walks away or makes threats of leaving, etc.  She no longer goes to family events, or if she does she will arrive late to avoid food.  She won't go out with people for meals, just coffee.   She prepares her own breakfast which is just oatmeal, eats salad for lunch and dinner.  She drinks diet pop - we have never had pop in the house and she buys it herself because I won't.   The disorder is the eating of cookies, granola bars, sweet chewy foods but she doesn't swallow it - I find it chewed up and spat out in bags.   I don't know how much she has lost but she has gone from a very healthy, strong muscled athlete to a very thin angry, isolated person who still looks good but even a size 2 is baggy.  I am guessing 20-25lb in 8 months.  I know food is the cure, but how do I get her to eat differently?  How can I get her to recognize the issue and get help?
Dora45 wrote:
I know food is the cure, but how do I get her to eat differently?  How can I get her to recognize the issue and get help?

Hi Dora, and welcome.  If you are paying for her education, phone, computer, transportation, etc. you have leverage you can use to require her to eat normal meals.  ("Normal" is a great word to uses with AN sufferers as their brains often twist "healthy" to mean "fat" or perhaps "low calorie," depending on the context.)  My d is 19, and she knows for sure that eating like a normal person and maintaining her weight is necessary in order for the money to keep flowing in her direction.  

It will very likely be difficult or impossible for her to recognize the issue, as AN is a biologically-based brain disorder, and one of the symptoms is an inability to see that there is a problem.

Please feel free to ask all the questions you like.  We're glad you found us.  xx

"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
HI Torie, I worry that if I pull her freedom, phone, car, ability to get to her job and school that it will all backfire on me.   She has always been of a personality that responded better to a carrot than a stick so has anyone had success with providing a positive vs negative motivation?  
Dora, it is always scary to take an effective stand against ED.  I would urge you to consider the possibility, nevertheless.  You likely have a good bit of parental authority at the moment, but that is eroding with each passing year / month.  

If you want to consider positive rewards, please consider something very short-term.  "When you have eaten this meal I prepared, I will give you $___ toward a new computer (gas/car/whatever). " type of thing.  Longer term rewards (gaining x pounds; eating >1 meal, etc.) seem to be much less effective than eat-this-one-meal = get-this-reward.

If your d has AN, you will find that it is an extremely difficult illness to beat.  You will likely need to muster every resource at your disposal, which very likely will include doing things that are very difficult and painful like requiring full nutrition in order to enjoy the financial benefits you provide.

Our "adult" children often try to have it both ways: They want our financial support the same as when they were minor children, but with all the freedom of adults.  It is fair and reasonable to point out that they are not yet ready for the financial responsibility of adulthood and therefore they have to live with the rules of the household. 

It is no fun for anyone to be in this situation.  xx

"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
Hi Dora45,
first thing I would say it that all sounds very alarming and you will need to take your d to her GP to get blood, heart and bones checked and to get a diagnosis. It all sounds like she is having RAN but she will not admit to have an ED because it is part of the illness that she does not see that. And it is not necessary that she admits to have an ED to be diagnosed and it is not necessary to get help.
See the GP before an appointment without your d and tell him what is going around. I hope some nice people from your region will join in soon and give you some advice where to go. She might have already severe heart problems and it needs to be ruled out that there is an emergency case. You need to know if she is safe for refeeding at home or wether she needs to go IP.

To say it very direct, I think it is no good idea to allow your d to start University in the next time at that state, even if she will still live at home. You cannot know what she will eat there and normally food that you have not seen being eaten is NOT eaten. She will lose more weight because she will not have enough intake for all this walking around and studying. Normally patients should be at least 6-12 months without any symptoms to be allowed to go to University. So you might need to think of her having a gap year to get into good recovery and start University later. Same for the job. I do not think she has enough power to do that.

Then you need to learn a lot about how to refeed her and how to treat a ED patient because parenting an ED child is very different from normal parenting. She needs very strict boundaries and rules to be able to fight against ED and it is important for her recovery that she can blame someone else for food intake to be able to eat again. So she will not eat because she decides to or she wants to but only because you require it from her. That will work. And yes, that will backfire to you and you will have a very hard relationship for some time before it gets better but that is necessary. Food is her medicine and food has no go in no matter what hell or high water comes (thats what lovely Torie always says here). See it like chemotherapy. If she had cancer, you would do everything that is needed to get that chemo into her even when she does not want it.

I would read Eva Musbys great book first: Anorexia and Other Eating Disorders: How to Help Your Child Eat Well and Be Well
She has some great informations and helpsheets how to get started on her website: https://anorexiafamily.com/
Treatment of AN is the same at age 11 and age 18: Food. Regular normal high fat food. The brain needs a lot of fat for recovery. All fear food needs to be worked on. She needs to regain the lost weight asap.

Torie gave you some ideas how to do that with an adult patient. You do not need to see it as punishment. It depends on how you say it. I never said to my d "I will take your cellphone if you do not eat xy". I always said "you can get your cellphone back after lunch", "you can take the car key to drive to your friend after you finished dinner".
We do not have much leverage at that age. We need to take everything that means more to them then AN. You pay for university, car, cellphone I suppose. So you set the rules. She is probably not able to drive safely at that state, they can faint from one minute to the other. So please think about that, too.

I know it sounds hard and strict at that beginning. I thought I cannot do that with my 17 year old d last year when I first read about. But guess what, I was so desperately lost that I tried and it worked. I told her that life stops until she has eaten and that I am serious with it and after some first fights about it she was able to eat again. And with every kg she gained this thin and lonesome and sad girl moved out and my real d came back. Step by step. Months after months. It is a long journey and recovery is not fast but it is possible. The proof is walking around in my house and is laughing and singing and even cuddling me again.
At first she hated me for what I did to her. She could not see that I only did it to AN. Now she says that I saved her life. We have a really good relationship again.

So you need to decide wether you will support your d or AN. If you pay for everything and watch her ruining her life with ED, there is something wrong.

"She drinks diet pop - we have never had pop in the house and she buys it herself because I won't."
That is great that you do that and that is what you need to do with all other food. No diet food or low fat yoghurt and milk in the house. You cannot avoid that she will buy some but you can require her to drink something else for meals at your table.

You need a plan to get started. Read and learn and get a plan. 3 meals and 2-3 snacks are needed. Most patients need at least 3000-4000 calories a day to gain about 500-1000 g a week. That is the target. The sooner her brain is fully nurished and the weight is back the better the outcame.
Ask, ask, ask. And come here to vent if needed. It is a f---- damn illness. It sucks. It is the hardest thing we ever did to help our d to recover from that. But it is the most worth fight I ever fought in my life.
This forum was a lifesaver for us. These parents here know what you are talking about. We are open 24/7 and you need no appointment [wink]


P.S. Sorry for the long post. I tend to give too much information with one post, but I want to tell you soooooo much...
Keep feeding. There is light at the end of the tunnel.
I am so sorry you find yourself here. I am an Ontarian too. Canadian mental health association services in ontario are widely distributed and you may be able to self refer. I have sent people in my city to them via self referral. Some may have a nurse practitioner who is well versed in ED and can do the physical exam and blood. They seem better than the family doctor. They are specialized in ED. So please look it up and or call your local hospital and you can ask your family doctor if they are comfortable with eating disorders...
I wish you all the best. Keep asking questions we are here to help.
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
Well my new friends - I have to hope we come back from this.   She does not recognize that she has a problem.   I told her why I think she does and that I want to get help.   She looked at me and told me I was insane, insulting, and horrible.   To her she has no problem, she can choose to change anytime she wants.   At least in doing this she acknowledged what she had been doing, but to suggest it is an illness and that she might need help was offensive.   She will not go to a doctor and I can not force her to.   The financial balance means nothing to her.  She says she will move out as soon as she can and that she won't take anything from me until then.   Layer on the threats that our relationship is now damaged forever, etc.   I get that it is ED talking but how do I move from this space into something more positive?  Thank you for the links and encouragement.   This is horrible.   
Welcome and warm wishes.
Parenting an ED child requires all normal parenting rules to go out if the window unfortunately as they cannot respond as they do not recognise how seriously unwell they are.
I agree with advice so far.
Maybe you can insist on GP check up (bloods and bp both sitting and standing) before she can return to driving due to your concerns. She could be a danger to self and other toad users so you can explain this is your major concern. If you insist this could be motivation for her to ‘prove you wrong’. Just a thought.
Hopefully she is not financially independent from you so you have real leverage. I told my D there was no way she could go to university if I felt she was still suffering. My Ds motivation was not having independence. We all have motivation it’s just finding what your Ds is.
Best wishes. Xx
teecee, thank you for the message. I am feeling quite overwhelmed right now with fear for my D and with her anger/hate coming at me.   I like the idea about her giving me 'proof' in a Dr assessment.   I have lots of reading from the links you have all sent.  Thank you.   
"She will not go to a doctor and I can not force her to."
RAN is a life threatening disease.
Compared to a heart attack or cancer I think you would be able to get her to see a doctor. You would not discuss that.
Get an appointment and get some male help for that day and get her into the car. No other way. Some here needed police or ambulance to get the kids see a doctor but it is necessary. You do not know how bad she already is. They can look o.k. the one day and be in ER the next.

"She says she will move out as soon as she can and that she won't take anything from me until then."
How can she afford that? Is she financially independent at that age?

To say it very clear and open, if you watch her going on with that your relationship will be damaged forever because that disease is life threatening and she can die.
ED will damage your relationship forever, not you helping her out of it.

It does not lead to anything to discuss that with her. She will never see that she is sick. An alcoholic is the the last person that sees he has a problem. That is a mental health disease and you cannot talk logical with her. That is wasted time.
Do not watch her ruining her life because you are afraid what can happen. The things that will happen if you do nothing are worse.
It is horrible. But is does not need to stay horrible. There is a way out.

Keep feeding. There is light at the end of the tunnel.

Hello and welcome to ATDT...you have already been given great advice but I thought I'd throw my two cents in here also.

I'm the parent of a daughter who became very ill with AN b/p subtype with suicidality and self harm at age 17-18, started college and then we brought her home and she was in very intensive treatment for the year she was home, and is now at age 20 back at university and doing much better than previously. 

The first step you can try would be to make sure you have organized mealtimes in your house, and that you serve a wide variety of foods and that they have a good fat/protein nutritional content. Stop letting her take salad for dinner, and if she has oatmeal it can be made with heavy cream, raisins, nuts, brown sugar, etc. Introduce smoothies as part of breakfast. You may see that your daughter will not eat and it will quickly become very very clear to all that there is a problem with food. Try for 3 meals and two-three snacks a day. She will need to regain the weight she has lost. 

You will also need to get her to an md for a checkup and go with her and explain what is going on, and you can do that privately with a phone call before the appointment if you feel that would be better, and preferably a dr. who knows about eating disorders. If she thinks she is going to university, which would be starting in a couple of weeks, usually they require medical clearance/paperwork/up to date vaccinations, right? So doesn't she need to see the dr for that?

Basically, everything you are saying points to an ED. Many of us have also had the honor of being hated by the eating disorder when we step on the tail of the tiger, as they say. It means that you are challenging the disorder. 

I have more than once found evidence of the disorder, and have been careful to broach the topic with - I found x, this makes me concerned because y, and I want to help.   

When you say you have found evidence can I ask what you have found?

Your daughter does not need to understand that she has a problem and she does not need to want to get better in order for you to help her. 

What are the plans for her university study? Will she be living at home while studying? Will she be nearby?

The carrot in our case was that my d. would be able to return to university and that helped to motivate her.



Try to get the GP into your fingers BEFORE the appointment.
Last thing you need right now is a GP who does not know anything about EDs and tells your d everything is fine...
I phoned some up and asked direct questions about EDs. After reading around here you might know more about that than some GPs. Ask about FBT. If they do not know FBT, they normally do not know anything about ED because FBT is the gold standard in ED treatment in 2018.
Keep feeding. There is light at the end of the tunnel.