I am sorry to hear of your daughter’s experience. Each young person, families, circumstances are different. The illness is very different each time. What follows is the result of my observations and research in relation to my child being in the grip of AN. I am no clinician, just the parent of a super-resistor living in Melbourne, Australia. I don’t pretend being right, experienced, non-biased or have the magic bullet. Maybe you will find in my words some useful elements that work for you.
Some young persons develop an ED on its own, some have a pre-existing mental health related terrain.
They lose the ability to feed themselves, sometimes consciously (desire of control), sometimes not (lack of awareness that they are ill). In any cases ED has its own agenda and is highly addictive as starvation prevents insight (Regions of the brain affected) and creates a state of happiness as a side effect (Designed so the starving person would be more alert to find food?).
The young persons are left unable to eat and comprehend the criticality of their situation. They feel that they need to defend themselves against all the people around them who want to force food on them.
The typical treatment for AN is indeed food: Replenishing their body and with restoring the brain functions the insight will increase (despite the addiction to starving or the food phobia).
The cost for the family may be very high depending on the level of resistance the young person will show.
For some families, taking control of the food and sitting at the dinner table for hours has worked. Maybe because the parental authority was accepted enough by the young person to be able to replace the lack of insight and fight back the desire for control AN kids often display.
With older children, and adults I suppose, this approach may backfire (leading to a super-resistor patient?) or just be inefficient. The young person may “start to recover” and/or may relapse.
My experience is that nothing can replace treatment compliance by the young person. And for this, they don’t necessarily need to be aware of their illness (of course it helps if they are! But typically, a starved brain loses very quickly whatever is left of self awareness). So the key question is, how do you get an ill person to comply to their treatment, even if they have no awareness of being ill, have a great fear of the treatment or reject your authority?
It helped me to first change the way I looked at my child:
Let go of everything your dear child has achieved in school or in society in general. They may be so successful that their achievements define them, in the eyes of others, their parents, even maybe in their own eyes. This is not who they are inside, it’s just their outer self. Their academic performances, their great personality may come back with time, or not. Who cares, the challenge is about surviving the illness and living a good life, whatever it may look like for them. If they truly “recover” along the way, which is definitely possible, that will be the gift of a lifetime.
Put yourself in their shoes: Speak with them to understand how they experience their reality. Do not judge or offer your opinion. Genuinely gain their trust and keep it (Be a real, unconditional friend and support). The illness is not about you. You do not collude with the illness by listening to them, it doesn't mean you agree. Make sure your child knows that what they say is respected (You don’t have to agree with someone to respect their point of view). Your opinion will play a role later, to guide them, but is counter-productive until you have their trust.
Do not let the illness provoke you into reacting to the deeply disturbing thoughts your child may become able to express (something amounting to: “I will starve myself and you are going to watch and let me do my thing”). Some parents believe that caring for a child with AN is the worst thing they ever went through in their life. You mention in your post that you have experienced the worst trauma and I’m deeply sorry for you and your family. For the regular lot of ED parents, I think it helps to consider that our suffering in the face of AN is nothing compared to our child’s suffering.
Make them feel accepted as they are, love them with warts and all (Stop telling them they are ill, don’t tell them they are not, it’s just irrelevant). Maybe your child will separate the illness from themselves, maybe not. If yes, then blame the suffering they experience on the dark side and work with their “healthy self”. If not, do not talk with them when the AN is controlling them (you will see it in their eyes, face or language), delay the interaction even if you’re desperate, angry or want to be right. The idea is to foster compliance, cooperation, instead of relying on coercion & confrontation to break though the illness.
Give them other things to think about. Food thoughts and sitting at the dinner table has overtaken their life (and a great chunk of yours. Don’t assume they sleep better at night than you do).
It is not collusion to give your child a non-AN space. Give them normality in between yours and their efforts. Laugh, play, clean the bathroom, watch movies, study, talk about American politics, take care of the pets, etc. This too is “the treatment”
Don’t expect them to let go of their view of their situation or to be thankful. Like any human being, they don’t want to be wrong, to lose face, be humiliated or their ideas ridiculed. Again, they don’t need to think you are right to comply with treatment. You are right and it does not matter. They will respect your position only if you have listened to them, demonstrated your understanding of their point of view, showed respect for them as person. It is enough if they find reasons to comply, which may be completely different than the obvious one (=survive).
Do not be afraid to change your ways. Listening and admitting you were wrong in acting one way or another is not a sign of weakness but demonstrates a sense of responsibility and strength. Apologise to your child if you lose it or had the wrong approach, everybody makes mistakes and may hurt someone without wanting it. Apologising is simply recognising the suffering you may have caused or increased. It’s accepting responsibility, not necessarily guilt (and even if it was, who cares!).
Concentrate your efforts on getting them to comply with the treatment (Great life, good food to fuel it):
This is the most important part once you have their trust (or are no longer threatening them). What is it your child wants apart from starving?
Do they like to have a great relationship with you, who care, understand and respect them, who don’t dismiss them as ill and who don’t tell them to just eat that sandwich, who don’t guilt-trip them.
Do they want to be treated as a normal person? Live a normal life, stay out of the hospital? Can you respectfully agree to disagree regarding the criticality of their health declining? Can they accept that you can’t let them starve because it will lead to the destruction of their inner self (Soul? Personality?) that you cherish above everything? Focus on the common ground, it will grow with time (and food).
Move away from coercion, cooperate:
It’s ok if they are just doing it for you: Not because you are suffering or telling them to eat the whole plate or you will make their life harder. But because they care for the relationship they have with you, they care about the life that you’re helping them have. They will only become compliant with the treatment if they find the overall solution you offer better than the addiction of starvation & control. In other words, even if your child may think that everyone is wrong about AN, they can choose to cooperate. Your job is to make it their decision.
It seems that coercion (parental authority, force feeding etc) may work for some kids. If it doesn’t work or carries an unbearable cost (psychological trauma of the young person or the family), changing gear and approach seems right.
I believe that no matter what path you choose, the one described above is helpful and may even be used alongside a regular AN treatment (take control of food intake etc). Trust and respect, sounds simple, right? I know AN targets exactly that. I think there is a case for going back to basics and fight back your rightful despair (anger, frustration, sadness, mourning their former self) because it will take the better of you. Personally, I moved from saying to my child “AN is not your fault, but it’s your responsibility to recover from it” (I know, that’s not great…) to totally accept her symptoms (anorexia, lack of awareness) and solely concentrate on how I can help her comply with the treatment. I believe it is possible and essential to build a great relationship with your beloved child despite the horrible grip of AN, and no matter how it will mistreat them and you. I want to believe that this solid and loving relationship may along the way create better prospects of recovery.