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

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Alwaysthere
Hi All,

Can someone shed some light on this issue for me... I see many people talking about incentives to get their child or sibling to continue eating, some examples I've seen are parents threatening to withhold money, cars, other items, etc. Does/can this actually work? I'm wondering because it doesn't seem like taking away privileges would actually get to the root of the issue- why they are restricting, for example, so I'm just curious if this is a good method? My situation is a little different because my sibling is in her 30's, so we can't exactly withhold many things from her since she no longer lives with us, but maybe there would be something we could offer/take away that would make a difference to her?

Thoughts?

Thank you!
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Enn
I think the ‘trick’ to incentives is finding your loved ones’s currency. So when the kids were young, their currency were their toys. So in order to get that toy, they had to make their beds. It is essentially a reward system and it is not punishment. I work at my job for money, I don’t work, no money. Of course with an adult in her 30’s maybe showing her why a great life she could have without ED on her head maybe an incentive. Does she have a passion that can be fostered? Does she wish to have children or travel? One needs to be healthy for those things. 

I know what I wrote is very simplistic but the concept is better illustrated that way, and makes sense to me. Others may have different analogies to explain that.
My d wanted a new phone for her birthday when she was diagnosed one month in, so she ate to ‘earn’ that phone . To not eat had consequences that were real to HER., but maybe not important to someone else. 
You are trying to find the right hook to get the fish to bite and eat and get better. Ultimately I cannot see that getting them to eat any way you can by withholding something could be considered punishment. There is no harm that comes to them if they don’t have their phone or the car or money. We are taking care of them and getting them to eat is the best gift we give them. The reward of good health is the long term goal not the short term pain of not having the phone etc. 

I do not wish to sound at all glib and you ask a very serious question. This is such a serious illness we do anything we can to get the treatment (food) in any way we can.
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)
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Enn
Ps the root is the issues is that it is a biological illness. They did not make a choice nor was it something in their childhoods for most. Of course there are exceptions, I am sure.
the first treatment is to get them medically stable by food then the other issues like depression etc can be sorted out.
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)
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Foodsupport_AUS
No it doesn't always work, it needs to be fine-tuned and individualised. Many people do however have a "currency" that will encourage certain behaviours.  As scaredmom has mentioned eating disorders are biologically based illnesses, and there are therefore biologically based behavioural associations with this. Much research has shown a decreased sensitivity to rewards and a heightened sensitivity to punishment in those with anorexia. Using this can therefore help shape behaviours. My own D has very, very low reward sensitivity (ie. does not respond well to positive reinforcement) and very high punishment sensitivity (ie. tries hard to avoid negative reinforcement). She always has. So negative reinforcements for her always made much greater changes in behaviour, however if too strong she could just shut down altogether. She would not work hard for a reward because it meant little to her, but she would work hard to avoid something she saw as negative. Those with bulimia/ binge eating on the other hand are said to have heightened reward sensitivity, though some studies suggest this is related to food more than monetary rewards. 
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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Enn
I really like this explanation Foodsupport_AUS. 
It is so interesting that even feeling so hungry they don’t eat. They have noted that even pleasurable acts like sex they don’t enjoy. 
Very complicated indeed.
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)
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Torie

Alwaysthere wrote:
I see many people talking about incentives to get their child or sibling to continue eating, some examples I've seen are parents threatening to withhold money, cars, other items, etc. Does/can this actually work? I'm wondering because it doesn't seem like taking away privileges would actually get to the root of the issue- why they are restricting, for example, so I'm just curious if this is a good method?


This illness is so freaking weird.  I don't think there IS any root of the issue in most cases. Someone's kid made a great video a few years back ... in it, she said something like:  "Sally and Suzie and Sarah started dieting together.  After a few weeks, Sally and Suzie couldn't keep dieting any longer.  Sarah didn't have that "problem"; in fact, she couldn't stop dieting."  Often, it is as simple as that.  Then when you get the weight back on - and keep it on - their brain heals and they are (pretty much) their old selves again. 

It took me a long time to understand that.  I wondered what I had done, what had happened to her, what was so terribly amiss in her life.  Of course there may be traumas to attend to, whether or not ED puts in an appearance.  But for many, there just aren't.

In any case, the first step is to get the weight on.  When my d was cutting, talking suicide, and losing weight by the day, the good folks here taught me that I HAD to find a way to get the weight back on.  I learned that she could not get well without that.  End of. Most everything else (depression, anxiety, etc.) takes a backseat to AN and weight restoration.  (Suicidality does trump ED as a treatment priority.)  Then when they are weight restored, we can address whatever issues remain.

As you know, it is ridiculously hard to get that weight back on.  And so we pull out all the stops, play all the cards in our meager-seeming hands, do whatever we can (bribery, threats, etc.) to require them to eat.  When not eating has become the path of least resistance, it is a real trick to turn the tables so that eating becomes the path of least resistance.

We can't force them to eat, but we can require them to eat (especially if they are young), and we can incentivize eating.  Of course, there is no magic bullet that works for everyone, but "threatening to withhold money, cars, etc." can and does work for many.  It is also a powerful counter-force for young adults in fragile recovery who head away to college with the siren song of ED whispering in their minds. 

Great question - thanks for asking. xx

-Torie

 





"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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Mamaroo
Alwaysthere wrote:

My situation is a little different because my sibling is in her 30's, so we can't exactly withhold many things from her since she no longer lives with us, but maybe there would be something we could offer/take away that would make a difference to her?

Your situation is different than having a child living at home. For some children a combination of carrot and stick works well, in my d's case, when she was so ill, I only gave carrots. I think it could be the same for your sister. Maybe sit with her one day and make a list of short term goals, which is not weight orientated, but things she could do when she is healthy again. Going travelling, learning a new skill, spending more time with family, etc. Whatever your sister wants her life to look like in the future. If she could see past her illness to the things she wants in life, then it could motivate her to go through treatment (which is not pleasant) to reach those goals. I would not concentrate too much on the past. I heard a good analogy recently. It is like driving a car, looking towards the future is looking though the front windscreen. The mirror lets you look backwards like looking into the past. You can't drive the car by looking in the mirror the whole time, that it way the mirror is so much smaller than the windscreen. Same with life, you need to look forward much more than looking back, otherwise you will never get yo your destination.

D became obsessed with exercise at age 9 and 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. View my recipes on my YouTube channel: https://www.youtube.com/channel/UCKLW6A6sDO3ZDq8npNm8_ww
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ValentinaGermania
Here incentives worked very well and much better than taking privileges away. My d was 17 when we started refeeding and is now nearly 20 and still incentives keep her going and maintaining her good state. Think about what your sister would like to have or to do. We got my d with driving lessons and a car because she was keen on having that freedom when she cannot have freedom with eating. In most cases there is something they are interested in. Think about what she loved to do before her life was focused on ED.
Keep feeding. There is light at the end of the tunnel.
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Alwaysthere
scaredmom wrote:
I think the ‘trick’ to incentives is finding your loved ones’s currency. So when the kids were young, their currency were their toys. So in order to get that toy, they had to make their beds. It is essentially a reward system and it is not punishment. I work at my job for money, I don’t work, no money. Of course with an adult in her 30’s maybe showing her why a great life she could have without ED on her head maybe an incentive. Does she have a passion that can be fostered? Does she wish to have children or travel? One needs to be healthy for those things. 

I know what I wrote is very simplistic but the concept is better illustrated that way, and makes sense to me. Others may have different analogies to explain that.
My d wanted a new phone for her birthday when she was diagnosed one month in, so she ate to ‘earn’ that phone . To not eat had consequences that were real to HER., but maybe not important to someone else. 
You are trying to find the right hook to get the fish to bite and eat and get better. Ultimately I cannot see that getting them to eat any way you can by withholding something could be considered punishment. There is no harm that comes to them if they don’t have their phone or the car or money. We are taking care of them and getting them to eat is the best gift we give them. The reward of good health is the long term goal not the short term pain of not having the phone etc. 

I do not wish to sound at all glib and you ask a very serious question. This is such a serious illness we do anything we can to get the treatment (food) in any way we can.


Thank you! All of that does make sense. I appreciate the help.
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Alwaysthere
Torie wrote:


This illness is so freaking weird.  I don't think there IS any root of the issue in most cases. Someone's kid made a great video a few years back ... in it, she said something like:  "Sally and Suzie and Sarah started dieting together.  After a few weeks, Sally and Suzie couldn't keep dieting any longer.  Sarah didn't have that "problem"; in fact, she couldn't stop dieting."  Often, it is as simple as that.  Then when you get the weight back on - and keep it on - their brain heals and they are (pretty much) their old selves again. 

Thanks so much, Torie!



 





 

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Kali

Hi Alwaysthere,

The sort of incentives we used were more in the category of rewards...the sort of things she could do if she was well, big picture things like traveling or going to college, or having an apartment with friends, or even being able to go away for a weekend to a music festival with friends. The sorts of things one cannot do if one cannot feed themselves properly. For example one very big incentive was when she wanted to go away with her school for 5 weeks to study at a university in another country on an exchange program. (The arrangement was for her to  live with a family who fed her, and eat with them, so not eating on her own while she was there) She really wanted to be able to go. At the same time, we made it clear and she understood that she would not be able to reach these goals if her health, weight and state were not in a place to support those kinds of activities.

Sometimes when meals were tough I would try more immediate incentives: things like "after we eat lunch we/you can _________" (fill in the blanks here...go to the movies, go buy some new supplies for crafts, you can go over and visit your friend, etc. That also worked.

I'm sure there are some hopes and dreams your sister can envision having in her life when she is well which would work as incentives for her to practice better self care and eat when she comes home...why not discuss it with her? It can be as immediate as working towards staying well enough not to have to go back to residential treatment again...or as big picture as staying well enough to someday be able to have a child for example.

As far as withholding driving the car for example, we did at one point have to let her know that she no longer weighed enough to drive the car and that it might be unsafe for her to do so. The dr. had told us/her that. So even being able to drive, after she was weight restored, was a privilege and to be able to stay well enough to drive was an incentive. 

warmly,

Kali


Food=Love
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Barberton
Alwaysthere,

I think I read it somewhere on this forum the concept of 'boundaries' instead of 'incentives' with older loved ones. It's tricky because you don't want to isolate them. Somehow you want to let them know that you believe they can change their behavior (even when they don't) and until they do, you can't support it.

Try reading some books by Russ Harris who's all about ACT (Acceptance Commitment Therapy). It's a good framework for setting goals and helping someone identify what their values are.
D fell down the rabbit hole of AN at age 11 after difficulty swallowing followed by rapid weight loss. Progressing well through recovery, but still climbing our way out of the hole.
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kazi67
Hi Alwaysthere
I’d say having a life worth living or getting back into life is an incentive when they are older 

did your sister have a job before going into treatment?

or even if she has a goal of trying to get a job perhaps part time to start with (that’s what our d does)so she can still also get her self care/rest, appointments and socialising done without becoming overwhelmed 
if she can’t get a job perhaps volunteering or going to an art/craft class or even part time study to get qualified for a job
is there something you could do with her perhaps once a week? 
Or anything you need help with that your sister could do for you?
does your sister have any friends that need a babysitter or housework/chores or even any contacts for job opportunities? 
before my d got her job she did my housework and shopping and I paid her 
now she is considering a course next year and also she wants to volunteer at the children’s hospital 
we found we suggested something then my d needed some time to process and decide what she wanted to do 
Her brain was definately effected and we noticed this as she went from being a very bright bubbly energetic girl who could work 2 jobs, be very responsible and reliable to a girl who couldn’t think straight and she would become very overwhelmed if we put any pressure on her 
it was baby steps and we even didn’t notice the progress until we look back 

first and foremost you sister needs to get her treatment/health, then get to the stage where she starts to think about life after treatment 
she may need to continue appointments to help her stay well 

it might not be the same for you sister I’m just saying our experience and perhaps it may be helpful or not
x
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