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

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Hi all. Not posted in a while, mainly because things have been going rather well. D, aged 15 (RAN) is pretty much weight restored and we are transitioning into phase two. She still has many AN thoughts, but we can also see some progress too.
She was initially terrified of making choices, but I promised I would be her safety net, and she is adamant she does not want to go back to how ill she was during the summer. She has confronted a lot of her fear foods, and now eats pizza and chips once a week! 
The problem we are experiencing now (and have been since all this begun, but I feel it is now really holding her back) is how long it takes her to eat. Dinner is 2 hours, lunch, breakfast and snacks an hour. It takes her 20 mins to eat a biscuit/cookie. Add into this the fact that she spends about 20 minutes preparing to eat - getting comfortable, etc. She is finding it so frustrating. I had hoped she would get faster naturally as she healed, and maybe she still will (some of her obsessive behaviours are improving, such as her quest for total cleanliness - she has cut her number of showers in half), but I don't want this to hold her back. Does anyone have experience of helping speed up eating?
We had this problem, and it is what we went to UCSD to try to solve.  We developed a "contract" which required D to finish meals in 30 minutes, snacks in 15.  Each meal/snack where she met this requirement, she received a "point."  Because we do 5 meals/snacks per day, she could earn a maximum of 35 points in a  week.  At 30 points per week, she accumulated rewards.  After one week, small reward (being able to hang out with a friend, for example), one month, intermediate reward (shopping trip to her favorite mall), two months "big reward" (tickets to a touring Broadway show).  Two months was all we needed to extinguish the behavior.  She proposed the rewards, and with some negotiation, we agreed on those in our contract.

If she did not meet the time requirements, the meal was removed, and she was required to do a boost (we used a protein bar....others would choose something different).  One boost for 25% or less left, two for less than 75% left, 3 if it was a complete failure (the idea being to replace the amount left with AT LEAST the same calorie equivalent).  In the time we did this, she failed a handful of times, particularly at the beginning when it was clear the system was being tested by the ED.  In the first case, she literally had two bites left and we boosted.  I KNEW what was happening.  If I had let her get away with taking two minutes more, the next day it would have been 4, then 10, then right back to where we started (similar to the times we mentioned).

Also, failure to meet her weekly goals, had short term consequences (negative) that she helped decide (take away allowance, lose electronics, etc).  Failure to meet weekly goals for multiple weeks meant moving to higher level care.

Note that we NEVER failed to make weekly goals.  The beauty of this contract was that it did not require perfection (e.g., she got rewards for substantial compliance), although in the short term, the calories were always made up.

I'd be happy to answer any questions if this isn't clear.

The behavior of taking too long or leaving little bits are now both gone.  She eats like a normal person now, and cleans her plate pretty darn well.  I catch her, often, looking at her plate and then making it even a little cleaner.  She knows what she is supposed to do.  :-)
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!
Our daughter was much younger when we were refeeding so this may not be effective for you. However, in the spirit of sharing our experiences perhaps it might help. We went to a Center that specialized in FBT and this was the direction they gave to us. In the beginning, we taught her how to "match bites" of those around her. She was supposed to watch what we were eating and try to not only take the same amount, but to pace herself based on the rest of the family.

Of course, it took us awhile to get to this point but once we knew our d was capable of eating in a timely fashion we had to enforce it.

She was given 45 minutes to eat a meal and 25 for a snack. We would set a timer so that she could watch and be the judge. It didn't help me any to nag her through the last 10 minutes trying to get her to finish (as I found out the hard way). By having a timer in front of her, it allowed her to learn how to pace the meal on her own. If she didn't finish, we had to over correct and give her more food. We would add something different like a small handful of nuts or a cookie and reset the timer for 5 minutes. If she didn't finish the meal then, we would add a little more food to the pile of over correction.

After the second time of over correcting, we stopped adding the extra food but only told her we would be adding it at the end. It was too overwhelming for her to see a huge pile at that point. We ALWAYS would add something more when she finally finished. Just the act of seeing us follow through was enough to eventually get her to learn how to pace herself and finish in a timely fashion. 

I know it seems so counter productive to add more food to someone who is already struggling, but for some reason, that was enough of a consequence for her to want to get it over with. Honestly, it took about a week of this before she finally got the message and learned to speed it up. ED pushes hard if we let him.

Let's face it, we weren't asking her to really enjoy it, right? I'll cross my fingers for that day.... 

Hope this helps. Stay strong and persevere!
Daughter diagnosed with anorexia at 12 in 2013 without having any image issues/concerns about calories or exercise. Hospitalized - 3 days. FBT at home along with outpatient therapy - 16 weeks. Recovered/weight restored - 4 years. Still gaining and growing but has no hunger signs yet.  
This was a huge problem for us, it is still one remaining thing we have to work on.

We tried so many things, incentives/removal of privileges worked moderately, but only once he was close to moving into a place of recovery.

Replacements worked some of the time, other times we ended up with a 2hr meal and 30 min supplement however.

It was not until we had a back up plan with hospital that we were more successful with him complying and speeding up meals.

We aimed for 1hr and 30min snacks initially and in time have been able to shut it down to half that.

It has been hard, the slowness is very difficult when one meal runs into another for months on end. ((hugs))

Son 9yrs when he became unwell 2013, ED slide from April 2014, dx at 10yrs July 2014, 2 hospitalisations - dx so many times Behavioural Anorexia, EDNOS, ARFID. FBT from August 2014. Anxiety, Emetophobia. 13.5yrs old now! In recovery, gets better every day with constant vigilance, life returns.
Length of time at the table was an issue for us too with our s. At worst all meals took 1.5 hours!We applied exposure therapy with the reward being something our dear s dearly wanted...In his case it was being able to attend a mini tennis tournament. Within a week it was done & he got used to the pattern of 30 min dinners and 20 min snacks. I'm not saying it will work for everyone, but with counselling & serious consequences we got him through that hurdle. We are now working on making everything 20 min. Still a way to go...