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

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sunny6
We are 2 years in and although weight restored according to multiple people, our child continues to be out of control with behaviors particularly for the last 3 months.  We met with a new FBT therapist to try to see what else we can try at home before moving into higher level of care.  This individual claims to have studied with Lock and Grange.  However, they made the statement that you don't have to be back on your historical curve to stop the behaviors.  Has anyone heard this?  

We are really tired and not only are we dealing with constant eating disorder behaviors, we are now seeing a strong push for control and flat out defiance not just around food, amounts, and eating, but also other household rules.  We really are at a loss and this person suggested immediate inpatient.  However, weight fluctuates just at the lower end of the curve that we were given by our last FBT and no one will take our child even with behaviors occurring every few days because they are right around target.

They suggested a contract for our child.  Our DBT therapist sees now that one serious issue has been handled that they need to address these newer issues.  

Should we just give it time?  Why would this person who claims to be a FBT therapist and who has the historical growth data suggest that weight below targets doesn't matter?
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sk8r31
Not sure where you are located, but would the 5 Day Multi-Family program at either UCSD or UCSF be a possibility for your family?  I think you would gain a tremendous number of skills and tools to help with behaviors, including creating a suitable contract specifically for your family.  It may be worthwhile to contact the program & speak with an intake specialist or therapist to see if it's a viable option.

Our 'team' suggested a residential treatment program for our then-17-year-old, and told us that 'FBT would not work for your family'.  We headed off to the UCSD program 2 weeks later, and never looked back...
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
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sunny6
We have considered ththe UCSD program.  However, it is believed that since we know how to weight restore and identify behaviors and put stops in place, that one week wouldn't be beneficial.  We would need to do a more intensive program there, which is a possibility.  I have been working on trying some virtual therapy through some of the individuals there as well.

Thanks
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Foodsupport_AUS
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We are 2 years in and although weight restored according to multiple people, our child continues to be out of control with behaviors particularly for the last 3 months.  We met with a new FBT therapist to try to see what else we can try at home before moving into higher level of care.  This individual claims to have studied with Lock and Grange.  However, they made the statement that you don't have to be back on your historical curve to stop the behaviors.  Has anyone heard this?

The conventional wisdom on the forum is that kids need to be back on their curve. There will be many parents who will also say that their child needed to be well above their curve. Unfortunately there is actually little data about this, and all of the Lock and LeGrange studies actually used only 90 to 95% of expected body weight as a marker of weight restoration which for most of us we would say is not fully weight restored. 

I guess the question I would ask is, rather than send her inpatient will they support you in gaining another 5-10lb? If not why not? If you could get weight on in the past is it worth pushing for more. 

My own daughter has largely recovered at a weight below her previous growth curve, so more weight is definitely not the only way. For her what made all the difference was consistency and variety. 
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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tina72
 I have seen and known a lot of ED kids in the last 3 years and I do not know ONE that recovered and was NOT on his/her historical weight chart or above. Please question that and ask them WHY they do not want to support you with that.
Keep feeding. There is light at the end of the tunnel.
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sunny6
Thank you.  I was a bit surprised by it.  They tried to tell us to use some measurement of a base weight at 5 feet and then so many pounds for each inch above that.  I reminded them that it was for kids that are in fact average for the growth curve.  I had just never been around a therapist who practices FBT say anything but return them to historical curves.  I think they will support us, but it was clear they were perplexed as to why we wanted our child to be on their historical curve.
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tina72
So it seems possible that they do not have much experience with ED there...
ED recovery is not a number. Forget all numbers and target weights with a growing child. Feed her/him as long as you see a change in state, not only in weight. All this behaviour you describe is still ED. In some cases a few pounds or kilos make a big difference. Here it was only 2 kg more than the professionals thought she must weight to see a slow but steady progress in her state.
Keep feeding. There is light at the end of the tunnel.
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mnmomUSA
The "contract" issue caught my eye.  UCSD one week family intensive is PERFECT for that.  We went when we were 2+ years into the battle with DD "weight restored" for some time before we went.  We needed help figuring out how to get ALL the ED behaviors extinguished.  We left there with a contract in hand, which DD helped negotiate (it is very collaboratively done), which meant she bought into the terms, which is essential.  Something "imposed" on them is not likely to be as successful. With that contract, standards were clearly spelled out, with both reward and logical consequences built in.   She knew.  We knew.  And, it was easy to get on with it without fighting, negotiating, etc....all things the ED otherwise loved to do.  It worked for us.  And, was well worth the investment we made in both money and time.  

To answer the other question, I've never personally heard of anyone being successful who wasn't back to their historical growth curve. Locke and LaGrange suggest 95% IBW number, but there's a lot in there that I think represents some mythical ideal, as opposed to ACTUAL experience.  I'm just saying that in ACTUAL experience they need to get back to their growth curve, and STAY there (which means for any adolescent or teenager that they continue to gain weight until their early twenties).
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!
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