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

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Hello again,

My daughter completed an IOP last spring.  I am still concerned she purges but she is very defensive about talking about ED.  What do you think about hiding a microphone in the bathroom to absolutely detect purging?  This would be for the purpose to have an aha moment and force the issue of in patient treatment to save her life in the long run and give her the best chance of a lifetime of recovery.  She has been on a health for college contract for the last six months and has kept her potassium and weight in the normal range, although low.  For example potassium has dipped to 3.5, but mostly has
been 4.0 - 4.6,  and her weight is consistently about 19.3 BMI.  She sees a MD at the college she attends who orders the potassium and is monitoring her in a lose sort of way.  By contract she is supposed to see a therapist and nutritionist twice a month each which has happened but often with some sort of problem with scheduling, cancelling, forgetting etc.  What is your advice out there?  Is it best at this point - 20 and one half - to quit trying to "help" her, pay for college on a strict scholarship idea without being tied to a health contract, etc.  Thanks for your sage advice.
Deb, we lifted the drain cover when toilets were flushed and taps run and saw the full horror gushing down. 100% foolproof unless she bags it up and takes it out or does it away from home- both tactics that our d has used.
Unless she cleans scrupulously there are always tell tale splash marks around the toilet. Always.
Weight is a poor indicator of purging if there is bingeing going on.
You should get weekly bloods done if there is purging to monitor potassium.
NELLY D 20 bulimic since age 12, diagnosed in 2011. 20 months useless CAMHs,7 months great IP, home March 14..... more useless CAMHs.now an adult & no MH services are involved. I reached the end of my tether, tied a knot in it and am hanging on. ED/Bulimia treatmentis in the dark ages in West Sussex.
Seconding Nelly's advice. Also, a spot check on potassium can only tell you if things are right at that moment dangerously off the rails.

Also, in our experience, purging can become absolutely silent and instantaneous. I once observed D (who didn't realize I'd entered the room) turn her head and purge into her napkin, RIGHT IN THE MIDDLE OF A TABLE FULL OF PEOPLE, none of whom caught that she wasn't just politely wiping her face. Not a sound, and the whole thing was less than a second, I swear.

Another thought - can you schedule her for a dentist appt? They can often tell if purging is ongoing as well, through symptoms like enamel wear, swelling of salivary glands, esophageal irritation & so forth.

As for what is best to do - well, I think before going the route of cutting anything off, in your shoes, I'd try to see what I could do to create a tighter support system with more help for her. The work on young adults is revealing that getting a strong band of allies to help your D navigate pushing back against her ED urges and managing her stressors in a healthy fashion, can be a successful approach.

I would also offer a reframe - the goal of boundary setting is not to change HER behavior - although that IS what you ultimately want! - it's to be open, and as a family to understand how you, her parents, intend to use your resources to support her health. So it's not so much "Go to the doctor or the money stops!" it's "We cannot in good conscience support your being away from home unless we know it is safe to do so. When you adhere to our agreement, we feel better about trusting that you are safe." As a young adult, there isn't an easy mechanism to get others to understand that her *capacity* for true autonomy is compromised in some proportion to how severe her ED behaviors are. So we have to settle for next best - build our case, be open about what kinds of step we see as being healthful and that we will support, keep working to get as many of our children's network - friends / family / peers / bosses /teachers - to ally with D's health rather than her ED. It's a slow process. And unfortunately, there is the possibility that you can find yourself terminating financial or other kinds of support - but that doesn't mean you have to stop advocating for your child's health and well-being!

I say this having tried various unsuccessful strategies to get our YA into a treatment program she can comply with, that actually works. It's really tough stuff, and there is no guarantee you'll get what you want. But I find that what I CAN do, is A) be the boss of my own underpants and B) be relentless in communicating my love and support for whatever steps D takes that are towards an eventual, if not yet realized recovery. (And C pray that ED doesn't get to her first. But there you are. I've tried many strategies, and the only universal is that none of them have been painless. I hate ED.)

The thing about leverage is that eventually it backfires.working with your d as a team is a better approach.re finding evidence of purging-I find a quick swish of the toilet brush under the rim of toilet finds stuff that looks like gross confetti-that's your evidence.you won't ever hear it once they learn silent purging.
We just had a life threatening event with d as her potassium was 2.2. In practical terms this means she was in danger of a heart attack.she has weekly blood tests and a nurse checks her obs every week.these are the things I would be focusing your attention on for now.you could say that you are worried,that you will make the appointments,tell her about the reason and go from there.our hardline was that our d had to agree to weekly obs at the doctors.thats it.taking away the things that make her life worth living is a no go for us.
We do ask that she rests as much as possible.we worked on a timetable that accomodated for her tiredness.
Not sure this is what you wanted to hear but hope it is helpful,
"The thing about leverage is that eventually it backfires.working with your d as a team is a better approach"

Sotired, these are important issues, and I just want to expand a little bit, and offer another couple of reframes.

I am sure you are speaking from your own experience and didn't mean to imply any universals. Within my own experience, leverage HAS been used successfully and there have been PLENTY of times that attempts to "work with the team" have been utterly unsuccessful. Everybody's experience on the ground is different, and indeed, within the same family over time, a strategy that has been useful in one situation turns out to be ill-advised in the next. We are all flying by the seat of our pants here, and the One Right Path is impossible to know in advance, even if such a thing actually exists. So lest anyone feel that their own choices are being criticized, I just wanted to insert the usual caveats that posting members are speaking from their experiences peer-to-peer, but only each of us has expertise on our own situations!

A lot of times it comes up with YAs that we hesitate to take a particular action, for fear of "making" a situation worse or "driving" our child to [some unwanted action, like running away]. And here are the reframes I find valuable:

1. I try to keep front and center that just as I did not CAUSE ED, if my kid is making ED choices, that is due to the DISEASE, not due to me. I am not in any way failing or worse A Failure(TM) because I did not magically know what would and would not be successful in combating a disease that has taken up residence in my kid's brain.
2. I hesitate to use the word "backfire' or other stuff that implies failure. FEEDBACK NOT FAILURE is really important, and it's not just words. It's making sure I don't beat myself up with inhuman expectations and pick up baggage full of blame and other isht, that isn't mine.

When D was approaching 18, I advocated for some hard line boundaries. What happened was D wound up going on a very bad spiral after that. But here is the thing, my INTENT was not make or force D into $_Wanted Behavior. I wanted some things for D very very VERY much that didn't happen. Some of which still have not happened. But I was and am aware, and I have written many many times, that one cannot MAKE or FORCE another person to do anything, reliably, without risking doing more harm than good. I saw the writing of the wall on where D's likely trajectory was, and I DID NOT want to fund that trip. Nor did I want to put the rest of the family at risk, and give it a home in my home. I did NOT want to be *forced* into using my resources to make ED stronger. I was, otoh, perfectly willing to move mountains for any number of healthier options.

The fact that D had a huge setback after my stated boundaries is not, to me, evidence that anything backfired. D's state at the time was such that it would have taken a hell of a lot more that what I had on the table, to compel her into different choices, because of factors utterly out of my control. Nor do I blame D's team, who swayed the other parents to different courses of action. They too, were all choosing as they thought best! My heart was wrung with what she went through and things that happened, and my regret for that period of time will never go away. At the same time I do not for one second regret my choices to limit the impending harm, and keep it from affecting our family any worse than it did.

So THIS is what I mean when I discuss boundary setting, sometimes called "tough love" (a term I don't really like). When such unfortunate junctures come up, as they will for parents of YAs who are still struggling with active ED, we parents really DO need to acknowledge that we have very little legal power, and our influence can often be side-stepped.

What CAN'T be removed, is the fact that we ARE the parents, and are more invested in our children's health, than any other person they will meet, with the possible exceptions bffs and partners.

And our own autonomy and rights can't be removed either. We have the right to use our resources as we deem best, and to be as bothery as we can about advocating for our kids' health and well-being. For a parent who holds financial or other kinds of interests, those are resources they have the right to delineate the terms of use. But whatever actions we take, if a goal is articulated as being aimed at someone's behavior other than our own, we ARE likely to be entering a situation at risk of failing that outcome. In such instances, I think the healthier approach - certainly the one I've had more success with over the years - is focusing on making boundaries around my own resources, and articulating my love and desire for health & happiness for my kids, and willingness to support THOSE goals.

So to bring this back to Deb's situation, and indeed for the many other parents of YAs, YES, healthy collaboration and team-building are optimal. And may I also suggest that there are techniques that can be helpful, generally called Motivational Interviewing, in getting our reticent YAs to move in directions that are away from active ED and towards recovery.


Prof. Janet Treasure has outlined some more ED specific MI techniques as well

She does note a HUGE caveat - that MI is not appropriate in emergency situations. It's an approach that needs calm time and space to utilize.

ETA: This recent article by Carrie Arnold is also relevant to the discussion here. I found it interested, and will be looking to see if I can "poach" anything useful for our current situation.