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

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So our child has been weight restored for 9 months. However. The fbt agreed recently to increase weight by 2 kg as we were seeing a lot of behaviors. However after that, we still see food hiding, purging, and restriction behaviors when we are not with her. D complies for us, just not others. We changed therapists and are trying a new medicine to reduce anxiety. We did notice a few weeks ago, that as we increased the target, some of the constant leg shaking has reduced. However, after break, she started to lose weight again. She has insisted that she manage this herself and we agreed that if she fell below target, she would not be allowed to do outside activities. If after a week, there is no improvement, we would go back to stage 1 supervision, and so forth. Mind you, she is young, but has been weight restored for 9 months. She says she knows what to do, but doesn't want to do it. She went below range and has missed some activities she wanted to do. The attitude is quite rough because of missing those activities and blames me for her issues. She also suffers from emotional anorexia and poor body image issues still. She is in her growth range. While I know we are still early, the one meal we are asking her to do is lunch at school. I don't feel that at this point, it is too much. In addition, with the attitude of she wants to do what she wants but doesn't want to do what she needs to do, we feel that instead of sitting with her at lunch, she needs to see the consequences of her behavior in a different way as we supervised every meal for the first 10 months and have been fighting stage 2 progress for 4 months. I am not sure that she should be allowed to go and do and us fight her every day the school calls to say she didn't eat and her lie to us about eating. While we want her to be busy and active, she has to learn that that means she needs to eat every meal. I think we are really tired of the did she or didn't she eat arguments and want to put this in her corner. The fact that she says she doesn't want to give it up and can't accept how severely sick she can become has made us think that she needs to see a new approach to what happens when she doesn't eat. Is this wrong for someone who is not an adult? Has anyone had good success with this approach?
I don't feel that at this point, it is too much.

But it is too much especially since she wasn't weight restored for that full time and may not be again.  She is showing you in every single way possible that ED is still strong and she needs more help and support around each and every meal.  To be honest, I wouldn't even ask her if she ate because you are asking to be lied to.  That is where she is at right now and as much as you may wish she were farther ahead, she's not.

It's tiring I know and I'm all for having some consequences to not eating like losing the ability to go out and do things.  The problem is she needs to be at a good weight for a long time before you can really start moving out of plating and supervising meals.  My daughter never has admitted how sick she was and she may never admit it.  I can't tell you the number of times I felt betrayed by my daughter because of the things she would promise and then not do all around eating. My only remedy was to stop beating my head against the wall and take a step back.

As hard as it may be to stomach, it sounds like you need to be in control of food again and if you don't see it eaten, it wasn't eaten.  Go forward on that assumption and don't ask about whether she ate something.  It really helps the did she eat or didn't she question.  You may need to go back to supervising her at lunch or having someone at the school sit with her to make sure everything is eaten.  Maybe when she is at a good weight you give her one day a week lunch at school and see what happens.  If her weight goes down, cut back on her activities and go back to full supervision.

I know this isn't what you want to hear but inability to see how sick one is plays a key role in anorexia.  I know she has been in a lot of treatment in the last year and a half.  Maybe you focus solely on food and weight at this point until you get that good and go forward from there.

Hi sunny6,
That she has been WR for 9months is great!

You write that she is still hiding food and purging when she is not with you. I think this makes me think she is not ready to take any responsibility for her food at this time.  I have seen here, too many times to count, that control seems to be handed back too early resulting in relapses. I wonder if that is the case for your child. My D has been WR and growing well now at 14 months past the first WR and we had to get to 6-7 kg more to see brain healing which was 4 months after the first WR and she is now 8months after that. Her brain is so much better after the first 4 months of the first WR and even better now. I still do all meals for her, but she does eat well at school She is a "social" eater. 

I know lunch at school does not seem much for you, but if she cannot do it,it is too much for her. The Ed world does not make any logical sense! 
So you say that you are giving her consequences for missing her lunch?  How about saying that when she eats she will go do what she wants?  Do you think you need to take her out of school to ensure she is eating? Will she eat with friends at school? I know it is hard and ED really turns our worlds upside down.

When you mention that she doesn't want to give it up, I presume you mean ED? If so she still needs time and maybe even more weight than the extra 2 kg? 

I am not sure if you have seen posted on ATDT anosognosia about how they are so ill they cannot see how sick they are? 
I really feel you are still very, very early in this. It takes a lot of time for the brain to heal and I really feel she needs more weight. I don't think there is harm in that and maybe a lot of good. 

All the best,

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)
Thank you for the input. At this time, I cannot physically be present for each meal and snack. I have asked family to supervise and that is when we find the food hiding. She was determined this summer to get better and was making great progress; however, the pressures of school, whether social or performance, have set her back and she is refusing help from me and we can't even practice the skills she learned. We could see it slipping even though we were able to keep the weight within the original range fbt set through the fall. At school, there are people who know about edo's supervising and there is absolute defiance. Sitting there the entire time and refusing to take a bite. I will then try to serve the meal after school and it hits the fan with the stories and refusals. There are no good IOPs in the area, and honestly we can't afford it again nor can any of physically get her there. We talked UCSD, but feel that all we will leave with is a contract like what we had out of IOP that we recently went back and updated. I got tired of the fighting over what happens when I am not the one serving the food and watching and needed a new way to address it. I have had a year off with her and can't take anymore time off (even lunch hours at times). While family wants to help, she is back to the old magic tricks that dad and I learned a long time ago to look for when new people eat with her. We have changed up snack so that it is not something that she can eat with her hands and I send a reminder every day on how much to eat and to do whatever in the bathroom before they sit with her for snack. For now, that seems to have helped some. I know it takes time for others to understand what supervision looks like. I have talked to both our fbt and another therapist who is more traditional in their approach and both agree that we need to talk less about the eating and explain when she falls under the range, we will support her to get back which means a different meal plan and no activities without supervision and enforce the IOP contract. When we think of the extinction burst and weight range, that was 7 kg ago. Her bmi is above the range experts believe is needed for recovery. She hasn't grown for the last year and a half and never lost her periods through all of this, so I am really struggling to believe we need to go higher. We feel that the behaviors are serving her somehow to manage whatever she can't talk about and she needs to go back to where she was this summer in using her other skills. If encouraging and supporting her aren't getting her to engage, what do you do?
Honestly I don't know what to tell you because it really sounds like she can't do what you are asking of her.  You said that she is losing weight and that if she doesn't restore the weight you go back to Stage I with full supervision and you plating food but then you say you can't do that.  I do get how frustrating it is.  I had to do for over two years starting at age 21!!

I do think she is still pretty young and needs more help.  IOP or inpatient probably isn't appropriate where she is anyway but somehow you need to figure out a way to stop talking about food and just keep feeding her.  If she refuses to eat at school, then feed her the meal after school if you can't go into the school to sit with her.  My daughter went everywhere with me sitting in waiting rooms at appointments, etc.  I didn't give her a choice because I knew if I left her home alone she would be binging and purging.  I don't know what your work situation is but maybe she needs to come and sit someplace while you're at work so you can feed her the meals after school and then she can study quietly after.
sunny6 wrote:
We have changed up snack so that it is not something that she can eat with her hands and I send a reminder every day on how much to eat and to do whatever in the bathroom before they sit with her for snack. For now, that seems to have helped some. I know it takes time for others to understand what supervision looks like.

That is a good idea. You can add liquid supplements (ensures, sustagen, up and go etc) to that list as it is not so easy to hide it.

My d is 18+ months after WR and if I don't remind her about her supper (snack after dinner) she would not take it. My d doesn't need supervising at school, luckily, but for the 3 snacks I have to choose and supervise them otherwise she would just forget, as she doesn't have normal hunger cues yet. 
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
It sounds like you have some really difficult decisions to make.  It must be thoroughly exhausting to have gone through so much, so long, and I can understand that you need to be back at work.  And yet, it also seems that your d still needs a high level of supervision.

On Oct 26, you said: "We had her 3 kgs over where the therapists recommended earlier in the year. During an IOP stay, her weight reduced slightly but stabilized and so she has been hanging around there. However, based on behaviors and thoughts, her fbt wants her back up to the earlier weight. The last week, we have seen weight gain, but not yet where she needs to be. " [emphasis added]

So I gather that if she is well and truly weight restored, that is new, in which case, she will need a high level of supervision for quite some time still.

My guess is that she is not now and never has been well and truly weight restored.  You probably know that is the commonest mistake clinicians make, and a super unfortunate error at that.

I expect that reasoning with her will not work well as it sounds like ED is still really strong.  Reasoning with ED is almost never fruitful.  One way or other, the loopholes will need to be closed, and proper weight restoration (without purging) will need to continue for quite some time in order to break ED's back.  To be blunt, the choices seem to be:

a. Find a way to continue full supervision by you and/or your h;
b. Find someone you can hire who is able to provide proper supervision;  or
c. Continue to live with ED.

I'm so sorry, but I don't see any other options.  I don't think there is any type of therapy or medication that will bring your d back.  The only way out is full nutrition, proper weight restoration and eliminating purging.  And then continuous enforcement for a l-o-o-o-o-n-g time.

Sucks so much, I know.  So very unfair.  I wish I had a magic wand to send your way. xx

"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
"At school, there are people who know about edo's supervising and there is absolute defiance. Sitting there the entire time and refusing to take a bite. I will then try to serve the meal after school and it hits the fan with the stories and refusals."

If she refuses to eat lunch at school, she cannot go to school. We took our d home for lunch for the last year.

You need to keep the supervising level high for a very long time.

"we supervised every meal for the first 10 months and have been fighting stage 2 progress for 4 months"

If she is still having ED behaviour and you still need to supervise meals it is way too early to start stage 2. Go back to stage one until you see really big change in mood and behaviour and then start very slowly with stage 2. Many of us did that too early (my hands up, too). We are 22 months after diagnose now and still in stage 2.
Keep feeding. There is light at the end of the tunnel.