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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hannahb
We got the atypical anorexia (bit of bulimia) diagnosis about 6 weeks ago. So am new to this and on steep learning curve. At no point have we judged her or got angry or blamed, and we don't expect an instant cure. We've told her we are totally behind her and are worried and scared, and just have total unconditional love which won't change. Background - hubbie had anorexia as teen due to difficult family divorce but is ok now with food. Family tree on that side in particular has plenty of anxiety/ocd type people. Daughter had to grow up with sibling with extreme needs so life was really tough, even though we did our best to give her security, understanding (I too had grown up with an adopted sibling with extreme needs so know how that feels) unconditional love and all that. In our home we haven't ever done diets or body image crap, and food we hoped was always a low-key thing. I feel like since sibling is now out of the home, it's allowed a kind of post traumatic stress release to snap. Just started FBT have had 3 sessions so far. Purging still going on in secret, I think once a day mainly dinner so not alot of food getting into the system. I have not been purge-policing, but when I smell it (containers in room) I ask gently if she or I can take it and dispose of it. Often she denies there is any, but when she does say yes, I just remove it and flush it down the loo, without any judgement or comment, then just carry on loving her. I haven't had guidance in FBT yet as to if I should handle this differently but I read a thread on here where people have intervened more. Haven't had time to read much on here as only discovered this site today, but HELP - what is the best way to handle this in the early stages? We are still working on getting her to eat meals with us rather than in private. She's preparing her own food still, and I make ours alongside her. I don't want to take away what sense of healthy (?) control or need to have a sense of control that she does have, by taking over the food prep for her food, but at the same time I want to do everything possible to give her the best chance to recover. Sorry for long post.
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mimi321
Hi hannahb and welcome. My D was diagnosed with restrictive anorexia, but did have the urge to purge on two occasions early on, but luckily I was able to stop it. I know that purging can be quite addictive and dangerous, so if it were me, if there is just "some" purging, I would do whatever I could early on to keep it from becoming entrenched. I think this is a good thread with info from mamas with more experience/expertise than me that might help. 

https://www.aroundthedinnertable.org/post/purging—what-do-you-wish-you-had-known-or-done-in-the-beginning-9758969?pid=1306321590

I will also bump up the thread for you.

The following is some info from the very wise and beloved toothfairy, another mama on this forum, that may be what you were looking for. 

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Here is some advice on purging I came across from a leading expert in ED treatment.

1. Often, they simply cannot be left alone, ever. For anything. So – parents need to enlist help from friends/family/church etc to take care of OTHER things in the house – like laundry, food, siblings, pickups/dropoffs, etc, so that parents/caregivers can full-time focus on their child and keeping them safe. Family medical leave, etc, should be used to max. If not possible to leave work, then school or other family members have to substitute as supervisors when necessary. Kids need to be watched in bathroom, in all places of house. To make this workable, parents usually will have kid sit in a common area of home near them as they work and get stuff done. But no bathroom or alone time, ever, until purging wayyyyy better.
2. Parents usually have to employ same maneuvers at night, changing sleeping arrangements in house so that child is not sleeping near a bathroom, and a parent is sleeping near her on an air mattress or other bed, blocking the path from child’s sleeping place to door that could go to bathroom or somewhere else to purge.
3. If child is recently discharged, running/exercise would not be prescribed in any form yet. First form of activity would be school and no others would be added until purging under control and at a goal weight and in school with that going well, first form of activity would be PE or iceskating with friends or bowling or something social and mellow – NOT running.
4. Close followup is needed.
5. If you suspect purging, it likely happened. She/he will need to understand that if you suspect she/he purged, she/he needs to replace the food.
6. Nothing eaten counts unless a designated adult saw it get eaten – so her/him telling you that she ate a banana or anything doesn’t count – it only counts when it is witnessed; otherwise it will just be ‘extra’ and she still has to eat prescribed food in front of you.
7. These behaviors are dangerous and lethal. EVERY effort of you, your team, your extended support system, your school system, should be on containing them and treating them just as swiftly and stringently as you would if he/she was using drugs right in front of you, or running into traffic. She cannot stop on her own, and he/she cannot be reasoned with about them. The containment has to be all around him/her.
8. Online forums often helpful. Go online and speak to people who have been through this.
Promise me you'll always remember: You're braver than you believe, and stronger than you seem, and smarter than you think. - A. A. Milne
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hannahb
Thank you mimi321, so appreciate that. Am desperate to do whatever it takes but want to try and find the best way forwards rather than do something that will add to the problem. Will look at that link now. :-)
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scaredmom
hi hannahb,
I welcome you to the club. 
I do hope you find the support and information you need. This is community of care givers that really care!
So please ask all the questions you have. 
I am sorry your D is ill. 
May I ask a few questions:
1) where are located?
2) How old is your D?
3) What is she eating and is she gaining weight?
4) Many have had to take away any control the child has over food. Food preparation can be very triggering and I know it may not be logical but to take that away from them it is a loving act. She may fight, but when she is so ill about food issues, food is not what she should be doing. That should belong to you the parent who will help her through this. It may be hard but doable. 
As you have written above EDs are biological and I am glad her father is doing well.
ED sare treatable and it is still hard work, so please take time for yourself to do non ED things, something that calms and soothes the soul. 

The list that mimi321 has given you is great. I am sure you will get a lot of information that you can put into action at home. 
Let us know how we can help you. 
Purging has to be curtailed ASAP, from what I have seen on the forum it can be hard to break if it goes on for too long.
Please read around the forum there is so much information and great reading.
I know others will be here soon with their experiences and support.

XXX
Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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hannahb
Thanks Scaredmom. We're in NZ, now in the public health system for this. Apparently there is a local private counsellor who specialises in this too but at the moment we're just doing fbt, hard to know if adding another system alongside would be too many appointments to cope with, or if it would get too confusing having two different professionals going at once.
D is 17. Her weight is stable but bmi for what it's worth is 18, in the 96th percentile for low weight so still in the 'normal' range but for her that is actually what we would consider just outside healthy for her type of body. Ideally if she can put on  4 - 5 kg that would be awesome, however we haven't had a gain yet. She eats fruit, some veg, almond butter, avocados (what a lifesaver an avocado is), rice crackers, dark chocolate. Mainly fruit though. She will now add a scoop of Complan (nutrient powder) to a morning drink which is a big achievement. Otherwise she will only drink water. She will eat a tiny portion of chicken or fish, or mussles, but dinners often don't stay down as best I can tell. Minimal eating during the day, we're trying to work on that. No carbs and pretty much anything outside of that is on the 'unsafe' list for her.
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Mamaroo
Hi Hannahb and welcome from me as well. Don't apologise for the long post, you are welcome to write as much as you need to.

At the moment, there are too many loop holes for her eating disorder. Your goal should be weight gain and no purging and it is going to be hard, very hard, I'm not going to sugar coat this. I had to change the way I parent, before ED our home was a democracy, but then ED arrived and I had to change into a benevolent dictator. Our daughters now have minimal input in what we do or what they eat (even the non ed child) and I would often veto their choices at the restaurant or just order for them ("we are all getting hamburgers today" for example). 

I'm glad you found an FBT therapists and I hope she supports you getting your d to eat what you have prepared (without taking your d's wishes into account). As for the purging, you need to supervise her for about an hour after every meal and no bathroom breaks. When she takes a shower, she should sing or count out loud.  

My d also didn't like to eat with the family, so I supervised her in her room or outside (weather permitting). After several months we got her to eat in the same room with us and eventually at the table with us.  

This illness requires a steep learning curve and if you can only focus on one thing now, I would suggest getting her to stop purging. Supervise, supervise, supervise. 

Sending you lots of hugs 🤗🤗🤗🤗
D became obsessed with exercise at age 9. Started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. She is back to her old happy self and can eat anything put in front of her.
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tina72
"I don't want to take away what sense of healthy (?) control or need to have a sense of control that she does have, by taking over the food prep for her food, but at the same time I want to do everything possible to give her the best chance to recover."

She has no control, AN has the control. So taking over does not take away control from HER, but from AN. That is needed. She has to eat normal food again and you have to work on fear food and you cannot do that as long as she decides what to eat.

You need to try to make purging impossible. So no privacy after meals (at least for 1,5-2 hours). If she purges in her room, no privacy in her room. She can stay with you in the living room after meals. If she purges in the bathroom, no bathroom privacy. Hang the doors out if needed. Sleep with her if needed. If purging is not possible any more, it will stop slowly. The sooner the better. Purging is very hard to get rid of again.
Keep feeding. There is light at the end of the tunnel.
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sk8r31
Welcome to the forum as well, though sorry you have a need to be here.  It is indeed a steep learning curve to get a handle on EDs.  On the FEAST main site, there are lots of resources that you may find useful.  The FEAST Family Guides are a good place to start.  Here is a para on nutrition needed for those suffering from BN:

DO PEOPLE WITH BULIMIA NERVOSA NEED THE
SAME FOOD AS THOSE WITH ANOREXIA NERVOSA?
Nutritional rehabilitation is the first step in recovery from both AN and BN.
This can be achieved by eating a wide range of foods that contain a variety of
fats, carbohydrate, and protein. In terms of the nutritional quality of the food,
there is very little known about what specific nutrients in what amounts are ideal
for re-feeding.
During the first stages of treatment, the calorie requirements are different for
people with AN compared to those with BN. People with AN need to regain
weight as part of their recovery and larger quantities of food are required until a
healthy weight is restored, and usually longer. This is because AN disrupts the
body’s normal metabolic rate for a long period of time – longer than the time it
takes to regain lost weight. Although calcium, vitamin D, and protein are
necessary for regaining bone and muscle mass in people with AN, overall
caloric intake appears to be most important factor for successful re-feeding.
People with BN, however, may not need to increase their calories if they have
not lost weight. Instead, the focus of the nutrition therapy is on spreading the
calories into a normal pattern of meals and snacks to avoid periods of fasting
that may trigger bingeing and purging. Stopping these disordered behaviors is
critical to recovery from bulimia, and people with BN may need to temporarily
avoid foods that “trigger” their binges and purges. For example, if someone
always binges on sweets, then it might be wise to avoid such foods until they are
farther along in their recovery.


Sending warm support to you,
sk8r31
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
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mjkz
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I have not been purge-policing,


You need to be and I can't emphasize that enough.  Purging has been for us the hardest of all things to stop and once it starts, getting it stopped again is twice as hard.  If she is purging after dinner, make sure she isn't alone after dinner and doesn't have the opportunity.  Have her use the bathroom before dinner and then not for hours afterwards.  I made it clear to my daughter that purging was not acceptable in my house so if she was going to purge it had to be somewhere else.  That built in some time between the urge and the actual act and she found out that she could actually sit through an urge without acting on it.  All showers and baths need to be in the morning rather than at night because mine used to purge down the drain.  It's not that you're passing judgment but rather stopping her from destroying her health and her life.  She probably feels pretty powerless to stop it (mine never even saw purging as an issue-she would have happily lived for years purging everything she ate) but the sooner you get it stopped, the better for all involved.
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yellowcaty
Hi hannahb

From a mum of a daughter who purges my advice would be to do everything and I mean everything you can to stop it now. It completely controlled my D life for at least a year (probably much longer in truth) and unfortunately it still does today, although may be not as much. At EDs worse my daughter could purge after everything she ate. She didn’t binge so would vomit even when she was restricting. For months I couldn’t let her out of my sight and even if I did for a minute or two she would find a way to vomit.

She has been in IP for 10 months. For 7 of those she had no bathroom privacy. Two months ago she moved to a new unit and as soon as she got the privacy back there, she began to vomit again. Unfortunately it is her go to when she needs to control her emotions. She now has supervision for two hours after eating and this is helping added to the fact that she does seem more determined to get better.

For us I don’t think we were strong enough at the beginning. We thought we were doing all we could to stop her vomiting, but there were so many loop holes that we missed. At first we were reluctant to go into the bathroom with her and thought standing outside the door would be enough. It wasn’t as she could vomit silently.We thought letting her work in another room with the door open was ok, it wasn’t she would find bottles or bags to vomit in.

I’m not trying to scare you as I think my Ds case was/is quite extreme (but I’m sure not uncommon) but any kind of purging is dangerous and if I had the time back again I would have followed the advice on here word for word.

Keep asking questions and try to stay strong x
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hannahb
Thank you everyone, that's really helpful. And it feels really good to know I can ask questions from people who are ahead of us on this path. With hanky alongside the computer mind you! We supervised last night after dinner so hopefully that's one meal that makes it through the system. I have downloaded the resources from the link above and am working through it as best as my brain and emotional energy can handle, a bit at a time! I am surprised our FBT sessions didn't also give us some recommended resources to read up on, it's been up to me to visit the library and google stuff. As of yet they haven't given us any guidance on dealing with the purging even though I had asked, having read all your input I'm surprised about that too now so I'm going to ask more at the next session. At the sessions we're all being encouraged to try and eat together a few times a week - small steps -  but nothing about taking over preparing her food or supervising. She's been encouraged to try and cut back on the number of purges by them (but at this stage without tools to do that so...). I do think the rate has gone down from when it must have peaked during exams last year but the secrecy is still there and obviously the purging hasn't just stopped because they asked her to try doing it less. She's also being encouraged to try eating a little bit more often, perhaps add a food to the 'safe' list. i've removed the scales from the bathroom. I've asked if they can give her some one-on-one help as well to help with thoughts in her head. That's yet to start but hopefully next session. But anyway, am trying your supervising suggestions, thank you all of you. Oh, a question - for those particularly with an older teen, did any of them find reading a particular book about it helpful? I found a good one in the library about ptsd which is basically strategies and tools that would I think apply to any anxiety type of thought patterns, but she hasn't wanted to go near it yet. Thank you so much again for taking the time to share your knowledge.
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tina72
I am a mom of a 19 year old that was diagnosed at age 17 and I also thought at this time that reading a book about all that would help her but looking back it was no help at all instead of that it triggered her a lot.
She will hopefully not need any strategies and psychological help after getting to a good weight as in most cases all AN thoughts and problems fade with WR + some time x. My d today does not even remember most of the things she said and did in the dark days.
Normal life and distraction is the best cure. And food, food, food.
Anxiety is in most cases part of their genetic character and is through the roof with the malnurished brain but gets better again when brain recovery starts.
Keep feeding. There is light at the end of the tunnel.
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hannahb
Thank you everyone for your support. Tina72 it's good to hear also from someone who's daughter was going through it at the same age. We have just had 4 purge-free days in a row as best as we can tell, with more food going in (not sure if it's enough yet to gain significant weight but still it's good), have been able to up the protein too. The previous week had had less purging and a little bit more food too. We can see a huge difference just in 4 days to how she feels so I really hope we can continue in this direction as much as possible. Her body is adjusting to having the food - we read it is common to then have some bloating and diahorrea (or constipation) during this time and she's now having that happen, but she too has read up on it so said she knows that is probably what is going on. It also probably explains why she was starting to have problems with lactose intolerance late last year when previously she'd always been ok with dairy, I guess her body had stopped making the enzyme to process it. She told me that once her body is healthier it should just make the enzyme properly again and she should be ok with dairy. She's ahead of me on some info. We had a great weekend with heaps of good talking. I know there will surely be ups and downs ahead and that they will be a kick in the guts. But it's nice to see her so much brighter thismorning and to not have the purge smell in the house or outside. I never realised purging didn't smell like vomit. I hope you have all had good weekends too with some special happy time together. Thank you :-)
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scaredmom

hi hannahb,
What a nice post! So glad she is doing better in the last few days. You all need a break and some nice time. 
Take it one day at a time. Recovery is not linear it is a bit jagged with good and bad days, but you are off to a great start and you know, that even when things are not great, they can get better. 
Happy for you!

XXX

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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mimi321
Well done, hannahb, so glad to hear this! You're doing great!💪🏻❤️
Promise me you'll always remember: You're braver than you believe, and stronger than you seem, and smarter than you think. - A. A. Milne
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Iris_US
Purging can take multiple forms, so be on the lookout. If you are staying with her after meals, that’s great! Remember that she may turn to exercise as another way to purge. A third way is through laxatives. Anorexia is a sneaky bugger and you will have to be vigilant to catch whatever form it takes and stop it. My d tried all three ways. If it is allowed to continue recovery is impossible. You need to break the cycle. You can do this!
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Mamaroo
hannahb wrote:
We have just had 4 purge-free days in a row as best as we can tell, with more food going in (not sure if it's enough yet to gain significant weight but still it's good), have been able to up the protein too.


That is great news!!!! I'm doing the happy dance now ðŸ˜
D became obsessed with exercise at age 9. Started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. She is back to her old happy self and can eat anything put in front of her.
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tina72
Great news!
For the intestine system, it is as dead as after antibiotics in many AN patients, so we gave our d some dryed gut bacteria for that (you can buy that over the counter, I have no idea what it is called there) to get the intestine system started again. That was for about 3 weeks and helped a lot.
Keep feeding. There is light at the end of the tunnel.
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SueD
Hi Hannah B I just wanted to say I'm new here also but am in NZ as well.  My daughter is going through PMH. We are into our 9th mth with them.  
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hannahb
Hi SueD, so sorry for not replying. We have been thrown a bombshell over the last few weeks as I have just been diagnosed with breast cancer so are now dealing with that too. Trying to learn about ED as well as BC in unison is a big load. We're continuing with CAHMS (PMH) but I did cancel the psych appt this week as it was more than we could all handle. D is going awesomely well at the moment, she is so motivated to kick the ED and is really trying hard to work with us. I'm so proud of her. Her hands show no irritation for the first time since this whole thing started, she's so much brighter and has gained some weight - hopefully today's weigh-in shows a bit more increase or at the least, no loss. She has fabulous conversations with us that are so open and frank and indepth, that's really precious. But I do worry that my treatment journey is not going to be easy on anyone in the family and I just hope it doesn't make her recovery harder. Right now it seems to be giving her even more motivation to get better, I just hope it can stay that way. So I may not come on here often but thank you for all the support. Much love and encouragement to you all in this horrible stuff.
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scaredmom
Hannahb,
I am glad d is doing so well.
I also wish  to tell you that I hope that all goes well with your cancer treatment. May your journey be as easy as possible.

All the best.
XXX
Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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mimi321
So sorry to hear that about your diagnosis, HannahB! 
Glad to hear your daughter is coming along.
Wishing you and your family strength on both of your journeys to recovery!
Take care. 
Promise me you'll always remember: You're braver than you believe, and stronger than you seem, and smarter than you think. - A. A. Milne
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tina72
hannahb wrote:
Hi SueD, so sorry for not replying. We have been thrown a bombshell over the last few weeks as I have just been diagnosed with breast cancer so are now dealing with that too. Trying to learn about ED as well as BC in unison is a big load. We're continuing with CAHMS (PMH) but I did cancel the psych appt this week as it was more than we could all handle. D is going awesomely well at the moment, she is so motivated to kick the ED and is really trying hard to work with us. I'm so proud of her. Her hands show no irritation for the first time since this whole thing started, she's so much brighter and has gained some weight - hopefully today's weigh-in shows a bit more increase or at the least, no loss. She has fabulous conversations with us that are so open and frank and indepth, that's really precious. But I do worry that my treatment journey is not going to be easy on anyone in the family and I just hope it doesn't make her recovery harder. Right now it seems to be giving her even more motivation to get better, I just hope it can stay that way. So I may not come on here often but thank you for all the support. Much love and encouragement to you all in this horrible stuff.


So sorry to hear that, that is nothing you need to stand in addition! Please get as much help as possible from family, neighbors, friends. Ask for that, in many cases people are pleased to help and just don´t know how.
It is great to hear that your d is making progress, so will you, I really hope you can treat the cancer as good as the ED and be both in good recovery in a couple of months.
Please keep us updated if possible, we are all with you in spirit!
Keep feeding. There is light at the end of the tunnel.
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Foodsupport_AUS
So sorry to hear you news Hannahb. As if things are not stressful enough. Great to hear that D is going well, you have done amazing work with her. 
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
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