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

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salmy
Hi, all,
D (almost 17) is fully WR + 10% and has been so for the past 2 months. We are fully into Phase 2, which is truly a different kind of challenge then refeeding was. Each week D takes over more responsibility for her food. We are about 2 months into refeeding. We have had a few setbacks where we had to take back over whatever had been put on the table for the week. Phase 2 is hard, I feel scared all the time. I am afraid that if we don't do this perfectly that we will be living like this for the rest of our lives. We are running into the personality issue, where D does not want to be told what to do. She has always, always, always been this way. Our FBT therapist is urging us to move her forward in taking responsibility as we struggle against her immaturity as well. She is doing things like not following the plating rules  - plate fully before you eat, make needed adjustments and serve your whole snack and make needed adjustments before eating. She argues and questions us when we say that she needs more. She thinks I am angry at her and make her take more than she needs. She thinks I am a control freak for pushing her to do this right and well. Then, she rebels against me, gets angry, shuts down, makes a mess (on purpose). Today, I was finally truly fed up and told her straight up that she is getting in the way of her own recovery by refusing to just follow the directions and do this right. I do really think it's her personality and not ED that is in the way here. She needs some agency in her recovery so that she is not fighting me but is instead digging in against ED.  I wish she would read Neural Rewiring for ED Recovery by Tabitha Ferrar. She makes a great case in this book for being intentional and purposeful, every time. I'm going to talk to H about requiring her to read it.
D16 diagnosed AN October 2019 -25% of body weight, but still "healthy weight" per Dr.
Started FBT Dec 2019
July 2020 Fully WR + 10%
2 Months in to Phase 2
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Scaredmom2019
We are October 2019 RAN Diagnosis as well. D is 17. We have slowly moved in and out of phase 2 and back to.phase 1. To be honest,  I personally cannot take all the monitoring as it has caused my own mental health to struggle. I also really want to do this "right". I'm obsessed with it probably.
I've started seeing my own therapist who has a lots of experience in ED to.help ME traverse this awful path. It has helped quite a bit to get the reassurances and support when I'm doubting. 

We also have not followed the FBT perfectly. Sadly, I have found that I'm more and more "ok"  with managing this awful illness versus curing it. 
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Enn

These are my thoughts: 
it takes time and I mean about 6 months to see brain healing starting after WR.
to give them any autonomy even at 17 when just WR is too early. Just my opinion. They need time for brain healing first I think and then teaching them the routine you have set up and repetition over many months before we give them control. ED is not that far in the rear view mirror. Things are closer than they seem- truly! 

once they learn the routines and have a few meals and snacks to pick, then some choice can be given very very slowly. I know we want this over yesterday. I know we want them to ‘get it’ and choose recovery. But to do it so soon reminds me that just because the body is healthier it does not equate with cognitive healing.And even then after a good WR it takes years for the bones and height and body to get where it needs to be. So to expect the brain to come back so quickly I feel is dangerous and sets one up for the back and forth and increase risk of relapse/weight loss and ED not totally being vanquished.
I would urge everyone to read the ‘stage and timelines and how they set us up to fail thread’ - it is the truth.

my d is only 15 and was dx at age 12 and even though doing very well it was only since Covid as she is home alone that she takes care of breakfast and lunch and one snack on her own per day. I would be very methodical and very very slow about how you go about this stage. There are no stages that kids are supposed to get to at a certain time. They each have their own rhythm and journey.

There is no perfect way. That does not exist. As long as your child is gaining or maintaining and behaviours are settling, those are the goals. Not a timeline. I know it is frustrating and it may seem that others’ kids are doing this all in a year or so, that is not reality it take years and there may be a lot of back and forth and challenges along the way and taking back control and giving a bit etc . 

Be patient and  look at how far you have come. That is not an easy feat. Pat yourself on the back you do deserve it. Get a plan in place and take small steps forward. You will get there. 

 

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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PurpleRain
What Enn said,.m D  is 14, dx at 13, she has been WR + for a year. She started having semi supervised (by this I mean, supervised by school staff that would not insist she eats, only report to me) mid morning snacks when she was 4 months WR +. We stayed there for a looong time. Only now, 1 year after being WR she has midmorning and afternoon snack by herself (and not really, we are all home because of lockdown,.but not in the same room). She can choose and prepare snacks, sometimes choose breakfast (sometimes I decide what's for breakfast for everyone because is just easier). In my opinion (based on what I have read here and observations of my D)sloowly does it. I don't think about phases anymore, I think about moving forward, whatever long it takes. She is doing great, she asked for seconds yesterday!!! Yey! She has accepted seconds before but never asked. My D has also ALWAYS been independent and stubborn, but I find the longer she has been WR the less she argues about food. 
13 yo d started to eat "healthy" September 2018, she had a growth spurt a bit later, followed by tummy bug. She started restricting breakfast and school lunch in January 2019 (that we know). We succesfully refed at home.
I have found inner strenght, patience and compassion that I did not know I had.
Never retreat, never surrender
keep feeding
 
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PurpleRain
What Enn said,.m D  is 14, dx at 13, she has been WR + for a year. She started having semi supervised (by this I mean, supervised by school staff that would not insist she eats, only report to me) mid morning snacks when she was 4 months WR +. We stayed there for a looong time. Only now, 1 year after being WR she has midmorning and afternoon snack by herself (and not really, we are all home because of lockdown,.but not in the same room). She can choose and prepare snacks, sometimes choose breakfast (sometimes I decide what's for breakfast for everyone because is just easier). In my opinion (based on what I have read here and observations of my D)sloowly does it. I don't think about phases anymore, I think about moving forward, whatever long it takes. She is doing great, she asked for seconds yesterday!!! Yey! She has accepted seconds before but never asked. My D has also ALWAYS been independent and stubborn, but I find the longer she has been WR the less she argues about food.
13 yo d started to eat "healthy" September 2018, she had a growth spurt a bit later, followed by tummy bug. She started restricting breakfast and school lunch in January 2019 (that we know). We succesfully refed at home.
I have found inner strenght, patience and compassion that I did not know I had.
Never retreat, never surrender
keep feeding
 
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LaraB

@salmy my D has same personality traits but the arguing about food and need for control in my D’s case is part of her eating disorder. And I have been called a control freak countless times. 

I have had much frustration with her psychologist expressing the importance of ensuring her voice was heard and working on her motivation and that led us backwards. 

i just really want to share that I too was worried that “this” ie the arguing about control of food/portion/desperate need to be independent ,was due to her personality for a longtime And that this was acting as a barrier to her recovery. It has helped me a lot to view this need for control/arguing as part of her eating disorder and indeed with food and time, this behaviour has disappeared. 

 

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Foodsupport_AUS
Sorry to hear that things continue to be a struggle, but at the same time I would say this is very much expected at this time. Although some can do FBT in less than 12 months, there are many, many, many parents who find that this time frame is far too short. Even those parents whose children seem to have recovered quickly often see problems for three years or more. Her push back sounds normal, and also sounds like ED. My own daughter has spent most of her illness insisting that she do it herself. Sometimes though she found  it was easier for her to just be fed, rather than trying to battle those thoughts all the time. 

I would argue that most people don't like being told what to do. Teenagers particularly don't like being told what to do, or what is good for them. The trick is to try to get her to do things herself as needed appropriate for her age. When it comes to getting her own snack, perhaps being more specific about what constitutes a snack so there is less need to get her to add more?  How is she going with eating unsupervised, and prompting herself that it is time for her snack?
D diagnosed restrictive AN June 2010 age 13. Initially weight restored 2012. Relapse and continuously edging towards recovery. Treatment: multiple hospitalisations and individual and family therapy.
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MKR
Hi Salmy,

With time you may find your child relieved that you take care of meals. This will probably be in proportion with those food thoughts easing off. 

How about your calmly state the "In my house, I serve the food". No need to explain. Just move on to a different topic.

We, too had epic dramas around the WR time. So much so that I'd thought there had been a weight loss, but most probably a tiny growth spurt.

Keep feeding so her body can have a buffer and you won't be stuck in this phase.
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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salmy
 When it comes to getting her own snack, perhaps being more specific about what constitutes a snack so there is less need to get her to add more?  How is she going with eating unsupervised, and prompting herself that it is time for her snack?


When serving herself, she will often serve a little less than what I would serve her and then argues with me when I ask her plate just a bit more "Mom, it's fine, you're such a control freak, you are trying to overfeed me, I'm not even hungry!" 
As for eating unsupervised, she eats her afternoon snack without us watching her, though we are still checking to make sure everything that has been served has also been eaten, and I'm trying not to watch her like a hawk like in the early days because that was causing more trouble. She very seldom prompts herself for snack. We do not often hear "I am hungry". Maybe once or twice she has said she was hungry when it wasn't time for snack or a meal and then really did not want to eat at this hunger signal because it wasn't "time" and fought having something when her body said it needed nourishment.

MKR wrote:
Hi Salmy,

With time you may find your child relieved that you take care of meals.

We had already been through a time when more responsibility was given and she fell apart and even said that she wasn't ready for that responsibility. So, we took it back and then tried again a bit later. This all gets so complicated because we are being told that all of her behaviors at this point are not ED connected and that it is time to move her toward maturing and taking responsibility for many things in her life.
D16 diagnosed AN October 2019 -25% of body weight, but still "healthy weight" per Dr.
Started FBT Dec 2019
July 2020 Fully WR + 10%
2 Months in to Phase 2
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Foodsupport_AUS
It doesn't sound like she is really ready for the independence yet. Her response sounds typical for ED. 
Outside of meals could you have that conversation? It is normal for her to not necessarily feel hunger at this point. She requires large amounts of food because of her hypermetabolism and it may well be that she does not have any drive to eat the amount that she needs. Perhaps having a talk about why she may not feel hungry but still need to eat a certain amount? 
One of the things that is often talked about in ED treatment is the tendency for weight loss when discharged from higher levels of care. For many years patients have been blamed for this, but research is showing now that this is a part of their inbuilt make up - so even if they are really motivated to work hard, to keep on eating, to not go back to treatment they really struggle to eat the amounts needed. 
D diagnosed restrictive AN June 2010 age 13. Initially weight restored 2012. Relapse and continuously edging towards recovery. Treatment: multiple hospitalisations and individual and family therapy.
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salmy
 It is normal for her to not necessarily feel hunger at this point. She requires large amounts of food because of her hypermetabolism and it may well be that she does not have any drive to eat the amount that she needs. Perhaps having a talk about why she may not feel hungry but still need to eat a certain amount?  

I am not expecting her to recognize her hunger cues yet I get really excited when she says she is hungry, lol. We have noticed she is more aware of her hunger when she has been really active. We went backpacking in the ADK a few weeks ago and she was hungry often and ate so well. A few weeks ago (after the backpacking trip) at her first weight check since COVID with her nutritionist we decided it was a good time to bring her calories down some from 4000 to 3600. It seemed like her metabolism had caught up and her nutrition needs had changed. We have slowly made this change, and are looking for an uptick in ED behavior... which I guess we have seen because it has gotten really complicated since then. I think what is confusing here is trying to hear and honor my actual D and to separate that from the beast, ED.

@Enn, I'm not sure where your post went so I have copied it from my email.... 
I am sensing and maybe wrong here, but you are being pulled in different directions. You know that something is not quite right and that d cannot manage any autonomy AND at the same time the team is pushing you to allow her that autonomy. When you have given some independence it back fires? Please correct me if I have this all wrong.


Do you feel a certain way about what is happening? How would you feel taking more control for longer? I know it is so hard. 

Yes, we are getting mixed messages.... I actually think we have a better chance of D maturing and recovering fully if she is working on either one or the other for a loooooong time. We can't be fighting for maturity and eating at the same time because then we are in conflict all.the.time. Yes, with some independence she demands MORE independence and choice. This is where it gets chaotic and I get confused....is this D or ED? I have felt really nervous as I let go of some of the control, my anxiety is off the charts right now. This makes the whole situation tense. I would prefer to hang on to the food responsibilities except for things like choosing her drink and pouring it, snack choices and plating. Those things are easier to get her to flex when we needs to add more or make a different choice. 
D16 diagnosed AN October 2019 -25% of body weight, but still "healthy weight" per Dr.
Started FBT Dec 2019
July 2020 Fully WR + 10%
2 Months in to Phase 2
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Enn
Hi there 
you wrote this: I would prefer to hang on to the food responsibilities except for things like choosing her drink and pouring it, snack choices and plating. Those things are easier to get her to flex when we needs to add more or make a different choice. 

This is what you should do then! Hold on to what you feel you need to do. Of course if you are pulled in different directions you may question your feelings. I think you should hold on more, what is the rush? Really what will you lose if you go slowly and take a methodical and detail oriented pace? To let go too soon I just feel is too much for your d.


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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PleaseEAT
Just wanted to add IMO Hold on to any “control” for as long as you can (if I could turn back time I would have)
Talking from experience, once control is given to them it’s VERY hard to take back as you probably know and It only gets harder the older they get 
All the best 
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PurpleRain
my D (14) has been back to her growth curve + for a year (yey!). The only control she has back is deciding between options and sometimes choosing herself her mid morning and evening snack. She can prepare it herself (not often) and eat it semi supervised (I'm around all the time because of lockdown). Before lockdown she was able to eat it supervised at school. I plan to keep it that way for a looong time (she has eaten with friends, with my parents, and a very few times on her own at home, snacks only). She would be starting high school in a new school (some friends would be there). We would try snacks unsupervised, and see what happens. By then she would be 15 months back on her curve. For us, sloooowly does it.
13 yo d started to eat "healthy" September 2018, she had a growth spurt a bit later, followed by tummy bug. She started restricting breakfast and school lunch in January 2019 (that we know). We succesfully refed at home.
I have found inner strenght, patience and compassion that I did not know I had.
Never retreat, never surrender
keep feeding
 
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salmy
Yep, I think we need to continue with hanging on to most of the food responsibilities. She is working hard on maturing some right now - has hung out with a friend 3 times this past week, and she is doing some normal teenager things as a result like eating candy, and actually sat on the couch to watch a movie...  I'd say she is still making progress but that we need to disconnect food responsibility from the push for maturing as well. Thank you for helping me remember to just take it slow. There is no reason to race to her having full responsibility in this moment. â¤
D16 diagnosed AN October 2019 -25% of body weight, but still "healthy weight" per Dr.
Started FBT Dec 2019
July 2020 Fully WR + 10%
2 Months in to Phase 2
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