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

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sophiesmum
Hi everyone,

My girl (15) has suffered from anorexia for months, she weighed 38 kilos a few weeks ago, and has now started gaining weight. Things are not getting any easier in the house though. ;((( I've read a parents guidebook and I'm seeing a psychologist, but a lot of questions remain unanswered. I'm here looking for some practical tips. Hope you can help.

1. Sophie binges every now and again, and I'm worried about her eating too much at a time provided she usually has very little. Can this be bad for her stomach?
2. She always feels guilty after a binge and blames me for buying the food. I never know what to say.
3. Sophie worries a lot about calories. What can I do to lower her anxiety?
4. My girl insists on choosing the food and cooking /supervising me in the kitchen, and that we both eat the same. The guidebook says I should be firm not to let this happen, but it's been a while already since things are this way. Should I change our routine? I really hate this low-fat foods, maybe I should have meals alone at a different time?
There are just the two of us most of the time, so it doesn't affect anyone else other than me.
5 Sophie resists seeing a therapist and doesn't seem to have a contact with her psychiatrist either. She believes they are "making every effort to make her fat." Should I convince her of the contrary? Maybe I shouldn't force her to see them?
6. How can I convince Sophie that foods like butter, sugar and flour are not "dirty"?

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mjkz
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1. Sophie binges every now and again, and I'm worried about her eating too much at a time provided she usually has very little. Can this be bad for her stomach?


I'm not sure what you mean by a binge.  She eats more than usual?  My daughter would "binge" but usually that meant she ate more a food than she wanted to and was upset.  I don't think when on a weight gain plan it makes any sense to try to stop her from eating.  She will have periods where she can't eat enough so I wouldn't worry right now about binging.  I would be on the lookout for ways she might be trying to get rid of calories like purging, overexercising, laxatives, hiding food, etc.

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2. She always feels guilty after a binge and blames me for buying the food. I never know what to say.


Food is your medicine.  There are no bad foods.  Keep buying that food.

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3. Sophie worries a lot about calories. What can I do to lower her anxiety?


Not a thing sadly.  It is all part of the illness.  All you can do is keep feeding her and when she gets worried, say something like I'm sorry this is so hard.  Keep eating.

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4. My girl insists on choosing the food and cooking /supervising me in the kitchen, and that we both eat the same. The guidebook says I should be firm not to let this happen, but it's been a while already since things are this way. Should I change our routine? I really hate this low-fat foods, maybe I should have meals alone at a different time?


She shouldn't be in the kitchen cooking at all.  You should be doing the meals and nothing should be low-fat.  It makes no sense to feed someone who has to gain weight low fat anything.  You should absolutely change this routine.  My daughter did the same and it was not productive.  I never did eat the same as my daughter because one of the things I said to her was that everybody is different and has different needs.  If it helps her to eat with you, then by all means eat with her but you don't have to eat the same thing.  Some parents here have done that to keep their kids eating but run into problems with their kids wanting everyone to eat exactly what they are eating.  It is entirely your choice which way you choose to do that.  I also added extras to my daughter's food so adding oil, butter, etc. really helped increase the calories without increasing the amount of food.  You may need to do both.

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5 Sophie resists seeing a therapist and doesn't seem to have a contact with her psychiatrist either. She believes they are "making every effort to make her fat." Should I convince her of the contrary? Maybe I shouldn't force her to see them?


You will never convince her of the contrary so I wouldn't even try.  It is entirely up to you whether you want her to see a therapist and psychiatrist.  My daughter did because she was on meds and  had comorbids prior to anorexia arriving on the scene.  Some parents here never have their kids seen by a therapist or psychiatrist. I would insist that she see her physician regularly (no choice in that) and play it by ear.  If you see an issue that she needs help with, then take her to the therapist or psychiatrist.  It is also worth keeping in mind that a lot of therapist and psychiatrists don't really know or don't support things like adding extras to foods to promote weight gain, etc.  I would explain to the therapist and psychiatrist the approach you are taking and the fact that you need them to support you doing all the cooking and Sophie only having to eat.  If they can't support that, I'd not go back.

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6. How can I convince Sophie that foods like butter, sugar and flour are not "dirty"?


Here again, you can't at this stage.  You require her to eat and you serve all meals.  If she has trouble, say something like food is your medicine right now and I'm giving you what you need.  Then strive for distraction.  You will see Sophie struggle a lot and it will be extremely painful for both of you but in the case of eating disorder, soothing that distress actually adds fuel to the fire.  Say something neutral and then move along to something else.  If she persists, then say something like I'm not going to negotiate with your eating disorder.  Distraction is your best bet. Also short term rewards like planning something she wants to do after a meal or snack.  After you finish your snack, we can go to the mall or whatever.  After you finish lunch, your friend can come over and visit.  If she doesn't finish, then you don't do the reward of course but very short term things like that can really help them finish meals and snacks.  Cut out all exercise too and do use things like walks or runs, exercise in any form as a reward.

It is worth getting her weight recovered as fast as possible. That really is the only way to shorten her distress.  You will start to see a change in her thinking about six months after hitting true weight restoration which is usually at or higher than preED weight.  Kids with anorexia need a higher level of calories for up to six months after hitting true weight restoration.   As you read here, you will find that some of our kids required 3000-6000 calories a day for long periods of time to gain weight and then maintain it.  My daughter needed 4000-6000 to gain and then around 3500-4000 to maintain.  It sounds like an obscene amount of calories but you do what needs to be done.  I have found that smoothies are my best friend.  You can easily get 1000 or 1200 calories in a smoothie.  There are recipes here on the forum for high calorie meals.  I started feeding my daughter muffins that packed 1000-1200 calories per muffin as an easy way to get a lot of calories with a smaller amount of food.

You will have to work on increasing your ability to see Sophie distressed because it is doing to happen a lot and the hardest part about refeeding (besides all the cooking and shopping) is seeing your dear daughter in so much emotion and physical pain (refeeding is physically difficult too) and knowing you have to keep pushing her.  You can't make it better.  You just have to get through it.  Hope this helps.
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EC_Mom
MJKZ has given you great advice, I second all of it. Unfortunately you are unlikely to see any improvement in her self-perception and her ability to eat for quite a while, and weight gain is what AN patients fear the most, so this is all very stressful for her. Nonetheless it will pay off over time, truly.

Please know that for most of us here it has been crucial to separate the illness from the child. This is not her choice nor her fault, even though it feels like she is the one doing these challenging behaviors. AN in effect takes over their brain; some of us have described it as akin to demonic possession (The Exorcist) and others as a hostage situation (inner voice holding a gun to their head to not let them eat). You need to assert your authority and take all the burden off her with regard to choosing and eating, because the AN is punishing her for all of it. 

It is important to ignore all the vicious ED blabber, not give in to any of it, and yet remain kind, calm and consistent as you require her to eat. She makes no choices about what to eat, and does not cook with you. You, meanwhile, put into the food as many calories as you can. 

If it makes it easier to eat when you eat with her, you do that (but you can have different portions and even different stuff--"Different people have different nutritional needs" is the mantra).  Basically ANYTHING you can do to both require her to eat and yet reduce her anxiety is fine. TV, games, funny cat videos, anything that keeps her eating. No use trying to persuade her of what you are doing. You are in charge. ED can blame you if it wants.

Also, there is anxiety before and during eating, and guilt thereafter. All normal and awful. Your job is just to support and distract. Figure out good very-short-term leverage for eating ("As soon as you're done we can go visit the neighbor's new puppy!").
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sophiesmum
Dear MJKZ,
Dear EC_Mom
Dear toothfairy,

Thank you all sooooooooooooooooooooooooo much for your support. It's comforting to read your comments.

MJKZ, what I mean by a binge is Sophie occasionally eating all she can find. For example, if she takes a piece of cheese out of the fridge, she may not stop until she finishes it. Yes, I am on the lookout for all excessive exercise etc you are describing. Thank you again very much for the phrase you are suggesting "Sorry this is so hard. Keep eating." 

EC_Mom thank you so much for the mantra. A good mantra is never too much... I'll think what kind of distraction can work for us.

toothfairy, thank you for the link. Yes, it is indeed very important to find the right professional team, yet there is little publicity for ED in our country. It was really hard for me to find adequate help and next to impossible to find out how good they really are. I do hope they have the right qualifications and experience, but we'll never really find out before it works. 
Yes, Sophie has had a full medical evaluation, and what I found out was devastating. She is visibly better now, her weight is 50 kg, height 175 cm. 
She is shocked by her weight of course, and is determined to lose a few kilos. 
She is taking medications and sees a therapist once every two weeks.


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Foodsupport_AUS
Welcome to the forum. Sorry that you have had to find your way here. You have had some good advice so far. 

You don't mention where you are. Sometimes we can put you in touch with other resources. A great job on getting 12kg gain so far. It is hard work. Her feelings and expressions at present are entirely predictable. The best we can do is validate her distress but it is also important not to get into the endless loops of discussion that ED produces, that in fact increases her anxiety even though we think when we are offering reasons we are reducing it. That one took me a long time to learn. 

I think it is important to know that medication has no proven effectiveness in those with anorexia but is often used to treat comorbid conditions.

Bingeing can occur at times and it is common for someone who is bingeing to feel guilty. It is also common for them to consider purging either by exercise, vomiting or laxatives.  The number one trigger for binging is restriction of intake so if she is bingeing she is likely to need more high fat, high protein foods to help to curb this. 
D diagnosed restrictive AN June 2010 age 13. Mostly recovered 10 years later.  Treatment: multiple hospitalisations and individual and family therapy.
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mjkz
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She is shocked by her weight of course, and is determined to lose a few kilos.


I forgot to say and the above statement lends even more weight (pun intended) to the fact that you might need to do blind weigh-ins so Sophie doesn't know her weight.  My daughter didn't really start getting better until we stopped letting her know her weight.  She would get weighed once a week at the doctor's office and they would not let her see her weight.  My daughter is 170 cm and would not break into triple digits in pounds for a very long time.  She kept her weight really low no matter what we did so once we started not letting her know her weight, she actually did much better.  She threw some mega meltdows at first about not knowing her weight but not having a number let her know obsess about it.
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Yes, Sophie has had a full medical evaluation


She needs regular medical evaluations all through refeeding.  It is encouraging that her weight is going up but she still needs regular appointments. Normal labs does not mean healthy (contrary to my daughter's opinion).  My daughter had heart problems that didn't really show up until she was almost weight recovered.  My daughter went weekly for a very long time and then once weight restored went to twice weekly and now monthly. She sees her psychiatrist monthly and her therapist twice weekly.  My daughter has a history of trauma too as well as comorbids so that has led to her being in therapy so often.

We are actually considering cutting down to once weekly and then twice weekly on an every other week basis.  She had no choice in whether or not to attend. It was a requirement to keep her healthy and so she goes.
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HateEDwithApassion
Hi,

I think the advice you received above is excellent, and I agree with every word. One other thing I wanted to add... even as her weight improves and she visibly looks more healthy, the disordered thinking and the ED voice may be louder than ever in her head. She may not want to upset you, so she may pretend she's doing great and feeling great and you might think - whew... the ED is in the rearview mirror.

Please don't let how she looks on the outside lull you into thinking the ED is quiet on the inside. Particularly as she's gaining weight, that voice is yelling at her and creating even more anxiety as she sees her body changing. Yes, her brain will be getting healthier, but being WR doesn't necessarily silence that monster inside. That can take a while. 

My family didn't realize the conflict within because my D was WR really quickly, but I don't know that she was ever at a high enough weight to shut him up.  She's still been tormented the whole time.  I wish I had known the severity of it, so I wanted to share that insight with you as you create a calm, compassionate environment around meals and home for your D.

Great work getting weight on her. Keep going.
19 yo D. AN - since about 15 years old. WR quickly - but the last four years have been tough. Since Sept. 2017, two residential stays, now in IOP, fighting a relapse. ED is hanging on, mental state not great, can't get her to remain at a weight long enough or high enough to see mental healing. She's on a gap year that will likely now turn into two.
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sophiesmum
HateEDwithApassion, thank you very much for your support. Yes, what you are saying is very true. I have learned from the guidebook there is a very emotional stage two, Sophie seems to be getting into it.

Foodsupport_AUS wrote:
Welcome to the forum. Sorry that you have had to find your way here. You have had some good advice so far. 

You don't mention where you are. Sometimes we can put you in touch with other resources.. 


Dear Foodsupport_AUS, thank you for your support. We are in Saint Petersburg, Russia. There is very little professional help here available for ED patients. If you are aware of any professionals who can be trusted, please let me know. 

mjkz wrote:


I forgot to say and the above statement lends even more weight (pun intended) to the fact that you might need to do blind weigh-ins so Sophie doesn't know her weight.  .



Sadly, blind weighs-in are not available. The best I could do is no weigh-ins at all for a while, which helped until she found scales elsewhere and did it herself.
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mjkz
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Sadly, blind weighs-in are not available. The best I could do is no weigh-ins at all for a while, which helped until she found scales elsewhere and did it herself.


Blind weigh-ins are always available.  I had a team that thought my daughter needed to know her weight in order to take away any meaning the number might have.  That might hold true for some but not my daughter.  What I did was purchase a set of scales that I weighed her on once a week and let her team know she was not be weighed by anyone but me.  There are scales you can get with a hand held readout that the person on the scales can't see. 

I also told my daughter not to weigh herself because different scales can give different results and the one we were using would be consistent.  Now I'm not stupid enough to think she absolutely never weighed herself elsewhere but she also didn't want to have to deal with many different numbers so if she weighed herself elsewhere she never complained to me about it.
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deenl
Hi Sophiesmum and welcome.

It is really common for family life to become more emotional and fraught during treatment for anorexia. This is a necessary phase on the road to recovery and generally passes in time.

As I understand it, your daughter has been suffering from anorexia for a number of months, refeeding commenced a few weeks ago (what form did this take?) and she has gained 12 kilos. She is still showing restrictive eating behaviours by obsessing about calories, eating low fat, cooking for herself or supervising in the kitchen while you prepare the meal. But she is also binging at times. Have I understood the situation correctly?

It would be lovely if you could confirm my understanding so we could help you with more specific ideas.

Warm wishes,

D
2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, no progress. Medical hosp to kick start recovery Feb 2016. Slowly gaining at home, seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. 2018 growing so fast hard to keep pace with weight. 2020 Off to university, healthy and happy.
  • Swedish proverb: Love me when I least deserve it because that's when I need it most.
  • We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.
  • If the plan doesn't work, change the plan but never the goal.
  • We cannot control the wind but we can direct the sail.
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ValentinaGermania
Hi sophiesmum,
as she is only 15 and still growing and 175 cm tall 50 kg is far from WR I think. You will see it in her mood and behaviour when she is really WR. You wil get at a point when you can say: This is my daughter back.
So keep on going. You did a great job getting 12 kg on her. We needed 6 months for 9 kg.

Do you know Eva Musbys book? "Anorexia and other Eating Disorders: how to help your child eat well and be well: Practical solutions, compassionate communication tools and emotional support for parents of children and teenagers" It is great and you will find practical tips for nearly every situation at home there.

To answer your questions shortly:
1. Normally there is no too much, but be careful that she is not purging after that. She is taking cheese out of the fridge and eats it - great! Mine didn´t touch cheese when not urged to.
2. Try not to listen to that, that is ED talk. ED blames her and she wants to give the blame to you. Say something like "I buy what we need to eat to be healthy and I buy what all normal people eat and what I like." Than change the subject.
3. That is only possible by getting her out of the kitchen. Serve ready made plates and put them in front of her at the table. No package, no calorie information. Its hard at the beginning to do that but she will get a great release from that calory counting by that way.
4. No cooking and no kitchen. Sorry but with low fat articles you will not get her where she needs to get. The brain needs a lot of fat to recover. And she wont let you add cream and oil when she sees it. But she needs it like chemotherapy and if she had cancer you wont discuss with her about that. Food is her medicine.
My d found it easier at the beginning that we all ate the same but we did it only very short. She has to learn that different people need different amounts of food. If she wants to go to school mensa or university mensa in future she cannot make everyone eat the same as she wants [wink]
5. Psychologists are not important for all patients. Some need them, some don´t. As it is a metabolic disease therapy is not as important as weight recovery. So if she doesn´t like to go there, I would not force her. But I would force her to gain more weight [wink]
6. You cannot convince her by now because she wont understand it. So you have to hide it in the food because she needs it. We all did that. After WR when her brain is a lot better you can talk about that "healthy food" thing with her. At the moment I would just say: "There is no unhealthy food. It depends only on the amount. Only burgers is as unhealthy as only salad." And than change the subject.
Don´t buy that low fat stuff any more. Try to put yoghurt in a kitchen plastic bowl so there is no information about the content on it any more. Serve this. If she complains only say: "I am your mother. I know what you need. That is just the right amount of yoghurt that you need now." Like a mantra. No discussion about food with ED. That is wasted time.

Go on. You are doing the right thing. You did a great job up to now. It will get better with every kg she gaines. At one point you will see the change. In our case that happend 1kg above the target weight they sat in hospital (which was too low). That 1 kg changed a lot. I didn´t believe that until I saw it.
You will get your nice and lovely daughter back. Just with food. Enough food and calory rich food.
Tina72
Keep feeding. There is light at the end of the tunnel.
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sophiesmum

toothfairy wrote:
Hi there you are doing great, she was at a very dangerous bmi around 12, she is still at a very serious stage at around bmi 16 . Keep going , this is going to take a long time do deal with. Add butter & cream to everything.
Here is a good video.


Hi toothfairy, thank you for the videos, I have watched them. Yes, I'm secretly adding butter to everything.


deenl wrote:
Hi Sophiesmum and welcome.

It is really common for family life to become more emotional and fraught during treatment for anorexia. This is a necessary phase on the road to recovery and generally passes in time.

As I understand it, your daughter has been suffering from anorexia for a number of months, refeeding commenced a few weeks ago (what form did this take?) and she has gained 12 kilos. She is still showing restrictive eating behaviours by obsessing about calories, eating low fat, cooking for herself or supervising in the kitchen while you prepare the meal. But she is also binging at times. Have I understood the situation correctly?

It would be lovely if you could confirm my understanding so we could help you with more specific ideas.

Warm wishes,

D


Hi deenl,

Yes, you have understood the situation absolutely right.
I serve five meals a day on schedule without calorie count. A good point to get started was a trip to Greece where Sophie could only choose dishes from the menu and she didn't know how much butter they contained.

Hi Tina72,

Thank you for your support and advice. I'm already looking for the book you have suggested.
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