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

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Dear members,
thanks to all who helped me one year ago. The situation is very bad now and I am really exhausted.
My daughter is now 26 years old, anorexia began at the age of 16. She was in several clinics, but
she always relapsed after a short time. One year ago, she is 1,70m tall and her weight was only 34 kg, 
her doctor applied for a "Vormundschaft" (may be it is called "guardianship" in English), but it was rejected.
I always try to help her, but now I don't know what to do. We have been making eating plans for a year 
and now her weight ist 37-38 kg. She lives 130 km away from me and studied medicine, so she knows
about the consequences of anorexia. Now she finished and will start to work as a doctor in a clinic. But
work in german clinics is hard, sometimes she will have to work 48 hours straight. So it is very important
that she increases. 
The problem is, getting a weight over 40 kg seems to be too difficult. She also started to do a lot of sports 
again. She currently has a 2300 calories daily diet. In the evening she tells me if she followed the plan.
Once a week there is a weight control at her doctor. This seems to be a problem. If she sees that her
weight increased, she reduces the food or does more sports. I don't know how I can help her further.
10 years anorexia made me ill, too, I'm suffering from depression and there is no chance to get an
appointment with a psychologist here in Germany. Perhaps there are people who had the same problems
with her adult child and can tell me how they helped her (or him)? That would be great. 
I am sorry to hear that you daughter is still struggling so much. It sounds as though she has managed to gain a small amount of weight but is still very unwell. 
Is there any requirement in Germany for notification about medical registration when someone is incapacitated? It would strike me that your daughter is physically too unwell to be working in any capacity as a doctor, her judgement is likely to be inappropriate, and she may be a risk to patients and herself. 
Here there is a compulsory requirement for treating doctors to notify of incapacity? Ironically this sort of notification may help drive your daughter to be able to care better for herself. 

Her awareness of the medical risks of eating disorders is likely to be poor unless she specifically studied this herself. Eating disorders are poorly taught in medical schools world wide. That being said sadly for most with eating disorders even when aware of the risks to their health this is not enough to help someone recover. To some degree it is very like smokers, who hear of all sorts of consequences from smoking but despite this still continue to smoke. On the other hand, being at risk of losing something she wants to do, such as working as a doctor, may help her to make steps forward. 
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.

Dear Gisa60,

What a difficult situation. 
What kind of medical oversight does your daughter have? At the weight she is at currently, she would need to have frequent appointments and have her heart and electrolytes carefully monitored on a regular basis.

It does sound as though she might really benefit from taking some time off and focusing on her health, both for her safety and the safety of her patients before she starts working at a clinic.
Being a dr. is grueling and if she is not at an adequate weight her decision making process might be impacted.
Perhaps wanting to be a competent medical professional could help motivate her to try and restore more weight and care for herself.

Is there any way she can come home and eat with the family for awhile or is there someone in the family who can go up and stay where she is and help her as a meal support? Does she currently live with others or by herself? Typically it is difficult for people with anorexia to feed themselves enough, as evidenced by her low weight, and it can be helpful to have support people to help with meals on a daily basis.

Sending warm thoughts your way,


Dear Foodsupport_AUS,
thank you for your answer. In Germany there is no requirement for notification about medical registration when someone is
incapacitated. Our clinics have problems to get doctors because they don't earn much money but have to work 50 hours and
more a week. So there prpportion of foreign doctors is very high. The students who finished university have to work at the
clinics for 5-6 years for a specialist training, in Germany they are called "Assistenzärzte". The clinics need them otherwise they
would collapse. Everyone who starts to work there needs a health certificate, but it my daughter got this without any problems.
She knows that the education at the clinic will be hard, but she thinks that she will manage it. 
I hope that your daughter is fine and that she won't get a relapse.
Dear Kali,
thank you for your help. Unfortunately my daugher only goes to the doctors for weighing every 2 weeks. There are no frequent appointments. She hardly accepts help. I talked to her about help at her home, because I could do that, but she refused.  She thinks that she can help herself better. I don't know what happens if I force her, maybe she will refuse to eat. She knows that it will be hard to work as a doctor but it doesn't seem that she can change something. The anorexia is too powerful. It seems she cannot struggle agianst it. 
With kind regards
Dear Gisa60 I can see why this feels too hard for you. 
It surprises me that your daughter got a health certificate, it would either seem that they don't actually a care if your daughter is a risk to others, nor do they care about your daughter's health. Is there a way that such a certificate could be challenged? 

Realistically you cannot force your D to do anything. She is an adult, and is not living with you, and will be supporting herself. The way I see it your best way forward is to make a situation for her that helps push her towards more intensive treatment. 
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.
Dear Gisa60,

I am really sorry about what you are going through with your d.  I was trying to work out what I would do in your circumstances because this is a societal failure in that structures which are supposed to be there to keep everyone safe have failed to protect her. 

I was thinking that I would contact the director of the clinic where your d is going to be working and raise the matter with him or her. 
However, FoodSupport has clarified my thinking and I would not hesitate to contact the body which issued the certificate and make a formal complaint. It does not matter that there is a shortage of doctors. Those doctors who are signed off should be well enough to do the job. Whoever signed the certificate, whether it was the GP or another person, must be held accountable. At least this is a step you can take to get your d the attention that her health requires. 

Believe you can and you're halfway there.
Theodore Roosevelt.
Dear malstevUK,
thanks a lot for your help. Yes, I already talked to a director when she worked in a hospital during her studies. He 
promised to speak with my daughter but nothing happened. Only one doctor, who used to suffer from anorexia,
offered help. Everyone else looked away. When she starts to work in August I will contact the director of the clinic.
But I'm thinking about moving to her against her will. She is asking for help but she only tolerates help that she 
determines herself. I think she's afraid of losing control und anorexia doesn't allow that.
Dear foodsupport_AUS,
my daughter told me that she was'nt examined by the doctor. She (or he) only checked
the vaccination card. All she had to do was show an adequate vaccination protection. 
My daughter is very ambitious and achieved the medical degree with top marks. She 
passed the state exams with a weight of 31 kg (1,70m tall)! So I could imagine that she
is able to work in a clinic for a while, but at some point she will collapse. And she will 
continue to ruin her health. I'm very afraid that she will die.
Hi again Gisa60,

Very disappointing that the director of the clinic did nothing and never spoke to your d. 
Does your d know that you were in touch with the director? I imagine she would have been angry if she had known. 
I am wondering if telling her that you will be in touch (again) if she does not get her weight up by a couple of kilos will push her to make some changes. Probably not but it is worth a try. 
What is she doing in the meantime? Is she working? Would she come home for a few weeks to get her meal plan back up. 
I would not hesitate to express your concerns that she may well collapse once she starts these very long days and insist on her getting more support. Can she put herself under specialist ed services again, rather than just her GP? 
I would certainly be 'chipping away' and trying to make her see the seriousness of the situation in the meantime. Does she have any close friends who would be willing to support her in getting her weight up. 
How did she manage to go from 32 kilos to 40? Was she hospitalised? She has made a comeback from this extremely dangerous weight so something at that point worked. What do you think it was? 
Believe you can and you're halfway there.
Theodore Roosevelt.
Dear melstevUK,
My daughter doesn't know that I got in touch with the director. I think so that she would have been very angry.
She visits me from time to time. Then we discuss the eating plan. In the evening she writes to me if she has eaten everything, at the moment it is 2300 kcal. Unfortunately, she does more and more sports so that she does not gain weight. I've already spoken to her about the problem, but she's not being honest. She also knows that it is difficult or even impossible for her to work as a doctor.She is also aware of this. But she says she doesn't know how to get rid of anorexia. It is completely dominated by it. Nor does she know why she needs this addiction. She was in an eating disorders clinic in 2018. At that time she weighed 31 kg. After three months, she released herself. Then she weighed 42 kg. After that, she immediately reduced her weight. Since then she has weighed between 36 and 38 kg.
She has a couple of friends who no longer live near her. A doctor she knows from the clinic was also anorexic. She gave her a few tips. 
I am considering whether I can help her on the FTB principle. I have a motor home and could drive away with her for a long time. Then she would be more relaxed and maybe eating would be easier. But I don't know if she'll go along with me. She doesn't want to go to a clinic either. Thats the biggest problem, she is afraid of change something.
Hi again Gisa60,

Going away with your d sounds a great idea to me. Does she have any commitments at the moment or is she free to be with you? 
Your d has been underweight for so very long so it is probably terrifying to put on weight. 
It concerns me that there seems to be so little medical supervision at present. It seems incredible that she can still exercise. What a cruel and horrible illness this is. 
Perhaps you can 'sell' the idea as having a break  and breathing space before her clinical placement starts. And hopefully you can make some progress together. 
You can also discuss the idea that you will feel obliged to take some kind of measures to protect her if she cannot get her weight up. She won't like that of course. 
But you could also discuss what supports you could put in place other than just seeing the GP. 
Believe you can and you're halfway there.
Theodore Roosevelt.
Hi Gisa60, I would wish somebody here has send you to me as all here know that I know the german laws and rules here. And I can help you to find a therapist that supports FBT and with ideas to help you daughter as mine is 20 and an adult to. Good that a friend of mine that reads here now and then asked me to log in today! Please contact me PN by clicking on my name. Then you can send me an email.
The battle might be lost but not the war. Try to not give up on her.
Keep feeding. There is light at the end of the tunnel.