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HateEDwithApassion
Hi,
We have switched from our ED T to a DBT T a few weeks back. We were not making progress and my D is in a DBT skills group and it just seemed to make sense to be more solution, behavior-oriented in the weekly therapy. I like the therapist. He is a guy. He's direct. He doesn't take my D's attitude or crap apparently - she told me that. I like this guy! ha

Anyway, in the first meeting, my D answered yes to 7 of 9 questions for borderline personality disorder. As I read about it, I do feel it's accurate. She's had relational issues long before ED, pulling away abruptly from friends and having very black and white thinking about whether they were nice or not. There was no in between. She also has said on numerous occasions during conflict that "everyone leaves." My H and I were baffled by what that meant, and she could or never would explain it. We are married and happy, had no family deaths, no pet loss. We couldn't figure out what the heck she was referring to. (Fear of abandonment is a key part of it, whether true or imagined.) 

So, I see a lot of her personality described in the BPD. Wondering if anyone else has had a child diagnosed with this and if you could share your experience? I have searched the board for this topic, and it sounds as if others have received that diagnosis, but symptoms relieved after WR and stable for a long time. I'm not seeing any stabilization of some of those behaviors and they were around first. I know they tend to not diagnose this until older, but I've also read that does teens a disservice since we diagnose other things much earlier. Why wait if we can help them now, is what some say. It's not a highly medicated thing - but mainly DBT skills training anyway, so seems no harm. Would anyone share their experience? Just wondering. I'm kind of relieved since it explains a lot, but it's also a hard diagnosis for my D to accept. I hate the name of it!

Thanks for sharing your experiences. 


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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Torie
HateEDwithApassion wrote:
So, I see a lot of her personality described in the BPD. 


I don't know much about BPD, but it seems that active ED symptoms are the same as many of the BPD "qualifiers." So I think it makes sense to have her doing DBT but declining to add other diagnoses to the list.

Please do keep us posted on how the therapy is working out. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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deenl
Hi HateEDwithapassion,

Just a thought while I was reading the last paragraph - If nothing is going to change esp. the treatment is accepting the 'label' really necessary? Your d is who she is and is receiving the best treatment for the more difficult aspects of her life and ain't that all that matters? Just my perspective, I am not in your/her shoes so ignore if not helpful.

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

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • 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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hopefulmama
HateEDwithapassion - 

My d was diagnosed with the same by a psychiatrist while she was still in the throes of anorexia. I later learned that it is not usually considered responsible to make such a diagnosis when an ED is still present as there is so much cross over with the symptoms.

However, about a year after my d was properly WR, we still saw several relationship issues as you mentioned.  Our very wise family t said she thought it was valid to consider that BPD might be a diagnosis for my d.  She justified this thought on the relationship patterns that we had observed post ED that had repeated themselves many time. However, she advised going through the formal diagnosis process or even mentioning the diagnosis to my d.  We were already 3 years into ED (although in recovery) and she believed the LAST thing my d needed was another diagnosis.

Rather, she suggested that we examine the symptoms and figure out how to help my d work against her natural tendencies. This was great advice.  Like you, I did read up a lot on BPD.  It helped me understand the natural inclinations my d was experiencing.  I admit to feeling overwhelmed at first. In time though, our wise family t's advice paid dividends.  With more DBT and encouragement to work against type in relationships, my d was able to move away from those natural tendencies and has been able to develop meaningful and satisfying relationships and sustain them (the sustaining had often been the issue in the past.)  The tendencies are still there, but her ability to recognize them helps.  She also knows that her first response is always going to be to cut and run and she works to do the opposite. 

Maybe it helps your d to know that with BPD as with all mental illnesses, there is a wide range and spectrum of conditions. Maybe just recognizing the tendencies will help her as it did my d.  I would also say that you still have to kill the ED first.  I wouldn't think you would see big changes in the BPD until the ED is behind you.  To the degree that the DBT helps the ED and the BPD, all the better. It also takes a lot of time. Finally, Marsha Linehan, the founder of DBT, was a severe BPD case.  It helped me when our family t pointed this out to me and helped me to see that even in this extreme situation, she was still able to build a fulfilling life worth living. 
Enjoying my 23 year-old daughter's achievement of active recovery that was made possible by the resources and education I found on this forum.

Don't give up hope!
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HateEDwithApassion
Thank you all. Just to clarify, it's not me that's applying or accepting the label. It's my D because she's been made aware of it now. Her T told her she is BPD and told her it was okay for her to go to a specific website he gave her to learn more, but not to trust much else about it on the internet. Of course, like I would, too, she has been reading everything, no matter how old or where it's sourced. Exactly what he told her not to do. But human nature.

In my mind, I would be relieved to know that many of my feelings and relationship issues that I can't explain (she has never been able to say why she feels empty or why she feels people all leave, or why someone is either a friend or abruptly dismissed from her life, etc.) can be explained and effectively addressed so she doesn't have to be controlled by them. That's at least how I see it as her mom. I feel like it's a relief to understand this more, and quite frankly, it explains why she moves from ED to other coping mechanisms. I am truly starting to think the BPD was here first, and the ED was the first way she learned to cope. Now that ED is more controlled, she immediately went looking for another mechanism, like SH. And pot. Then when those are shut down, she goes back to ED behaviors. It's like, what's the underlying thing that's driving toward the need to have coping mechanisms though?

I'm not sure it has turned out to be a good thing that T told her this - but he's a straight shooter, and I do like that. This is his expertise. He is definitely going to hold her accountable to work in therapy, which I also like. And to be honest, I'm kind of tired of questioning everything in therapy because I honestly realize that I don't know what's the best or the worst thing to do anymore. I don't know - I'm not really upset with this diagnosis. I feel like it finally made so many things outside of the ED make sense to me.
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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HateEDwithApassion
Hopeful mama,

I really appreciate your reply since you share a similar situation to ours. I'm so glad to hear your D is doing well!! Seeing your child who has struggled in relationships do well must be amazing!  Gosh - I hope to one day come back here and write that, too!

Sustaining relationships is definitely my D's problem too. She only lets people come so far. Then when she gets a whiff of disappointment or they don't seem as devoted to her, she literally walks away from them. Doesn't look back. She left her main friend group this fall by simply switching lunch tables without saying a word to any of them. Her closest friend at school had no idea what was going on and was so sad that my D simply started ignoring her. That is not normal. That is beyond ED. And it's the kind of things we would sit with our mouths open wondering why and how she could be so cold to others.

It's sad. And she's never been able to explain it to her ED T. They would go around and around. Her ED T was so insistent that my D must know why she felt this way, but my D would insist she didn't. No headway was ever made. Then my D decided she couldn't trust her ED T anymore (And she did do a few questionable things) and since progress was stalled anyway, we decided to move on. 



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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Aussie
Hi HateEd,
My d is 17 and has been unofficially diagnosed with BPD. Her psych won't officially diagnose her until she is 18. My D's ED was the first sign that something wasn't right. Once we got the ED under control my d still had severe depression, emotional dysregulation, etc. It is very common for those with BPD to have an ED. My d has known about her diagnosis since she was 15. It helped her to understand some of her behaviour and thinking. When I first was told about BPD I did a lot of reading so did my d. It takes a while to get your head around it. If I can help you in anyway just ask. X
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IrishUp
We also had a BPD diagnosis given by one team, which another team later refuted, and a third refrained from formal diagnosis until other comorbidities could respond to treatment. There is probably more that I have forgotten, and IDK whether it remains in her chart.

To my mind, the important part about ANY diagnosis is "How does this affect treatment decisions? How does this change the approach we/the team should take?" Whether or not our D's emotional dysregulation, self-harm and other symptoms were due to BPD or ED or alien satellites, the facts on the ground were those symptoms needed intervention, and the best EBM for behavioral symptoms includes cognitive behavioral therapies, so we pressed hard for those. DBT was a long haul, but we saw improvement and continue to see the positive effects from it.

One thing to note about personality disorders is the fact that when intervened on early, they are amenable to change over time.

Quote:
Although personality traits are largely consistent across time, they also remain dynamic throughout life; individuals with personality disorder tend to change more over time than those without it, typically, but notalways, in the direction of improvement."

Howes et al. Lancet 2015

The above is true in the absence of treatment. The terrific thing about behavioral therapies & early intervention, is that because of neuroplasticity - the facility our brains have to bio-chemically and physically change based on learning and experience - there is *terrific* potential to change the course of how maladaptive personality traits develop as our children mature. We can strengthen our children's natural strengths, and teach compensatory skills where we cannot ameliorate deficits. So even if you don't always see results in the short term, CBT, DBT, ACT and the rest of it have long-reaching, positive effects.

HateED, I think your story illustrates the limitations of insight-oriented therapy (also, maybe you can send ED T the definitions of anosognosia and alexithymia? Because this business of insisting your patient knows something they don't is, um, off, and that T sounds like they might need a refresher course on common cognitive-psychological symptoms). The ability to have insight is itself a result of higher-order cognitive functions, which can suffer impairments for many reasons. The inability to distinguish CAN'T from WON'T is defo a problem for a therapist!


IrishUp
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HateEDwithApassion
Hi
Thanks, Aussie for sharing. I will definitely reach out to you on this journey. I feel relieved to understand what we are dealing with and in my heart of hearts, I feel it's the right DX. 
IrishUp, I think you really have summarized the issue - does the diagnosis make any difference though if the treatment still matches the behaviors she's doing regardless? I think the answer is no in our case.

D is doing DBT skills group and finally just started with an individual DBT T - however, last night she told me the coping skills are bullshit and don't work. Ha - well, I suppose if she would actually try them, we would know for sure.  I have to realize that DBT is not magic or fast, and that she is only now starting with individual therapy that's DBT focused. But I admit I'm frustrated that she doesn't seem very engaged in the DBT work. That was why her ED T, when I asked about DBT, said she didn't know if my D was well enough to do it. Well, she wasn't well enough to do all of that insightful talking either! That was getting us nowhere.

ED was new to us, like it is to all of us, and I trusted this doctor who is certified specialist in it. Why she never volunteered DBT or even CBT when she saw the behaviors is just so surprising. I feel the mental health people I've talked with literally don't know much about anyt about other therapies outside their office. That was a big surprise to me, and made me realize we have to be our kids advocates, and can't take the word of the professionals as 100% correct every time.

 So, can't look back, but going forward is sure slow, scary work, too. Thanks all. I am so grateful for your replies and only hope I can be helpful to all of you sometime soon.
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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HateEDwithApassion
Aussie,

Can I ask you - how did your D feel about the DX? My D told me the other night that she was reading about it and felt hopeless because so much online says your relationships are all difficult, etc. I told her that is without treatment - that treatment is very effective. That much of what is online is no longer true. But she has seemed to grasp onto this as being a lifetime thing even though the new T said it is not something she will have her whole life - that with work in therapy, she will recover. He was very clear about this, but that black and white thinking, you know! BPD is his specialty, and he founded and ran a DBT skills group in our area with another T who is certified Linehan therapist, so I feel he is more than capable of dealing with these things, and also being aware they are going on in her head. But wondering your experience.

Also, did your D do DBT or CBT or another therapy, and was she very engaged or went through the motions? That's a question for anyone reading this, too. I believe these type of therapies are the  only path to help her, but I also know she has to be somewhat motivated to do them, right? Thanks again!
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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lorpat
I did not get a formal dx of bpd for my daughter, but I think she has the tendencies.  She is almost 17 and wr, but still having loads of issues and in her history, I thought she just had bad luck with friends - but now, I see it as a relational issue.  Anyway, I found this "family guidelines for bpd" to be REALLY helpful to me:
http://www.borderlinepersonalitydisorder.com/family-connections/family-guidelines/
One day at a time...

daughter diagnosed 8/15 when she was 16,
wr through maudesly method 1/16,
currently in potential first relapse
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IrishUp
" ... , last night she told me the coping skills are bullshit and don't work."

OMG, YES! does THAT sound super familiar. I mean, both our kids have been through fairly intensive behavioral interventions (non-ED S for PTSD and anxiety) and it's like there is some kind of script hidden in the waiting room for the kids to find!

I think that was the song D sung easily for the first 3 months or more (and she was in an intensive residential program). Her team let us know that this is actually pretty typical, esp. since people who generally need DBT or CBT have issues with expecting instant change and distress tolerance. 

As for going through the motions, we were coached by both kids' teams to leave the "winning hearts and minds" stuff off, and just work on coaching, providing support structure, and expecting skills-using behaviors. I was particularly dubious about s, because he spent the first like 6 or 9 months of CBT slinking reluctantly into the T's office with that "no bones" walk only a 7 or 8yo can manage, flopping onto the couch, then hanging upside down off the couch while heaving the most aggrieved sighs ever heaved for the next 45min! He would literally OOZE himself onto the floor when asked to participate in whatever activity was scheduled for that appt, and stay there until it was time to go. [BT with younger children is doing role playing or therapeutic activities in session, but mostly providing the parents with specific exercises and suggestions for home. It's the repetition at home that does the majority of the work.]

Anyway, despite every intention of both kids, and with a substantial amount of gritted teeth, determination (and medicinal libations applied as needed) on the parents' side, there was noticeable improvement after 3 months for D, and we stopped hearing about the "skills don't work" stuff within a couple of months after that. S was younger, and in a less-intensive age/stage appropriate program, so it was a longer trajectory for him, but the changes came just the same.

I'm here to fire up the virtual margaritas if you need them!
IrishUp
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Psycho_Mom
"BT with younger children is doing role playing or therapeutic activities in session, but mostly providing the parents with specific exercises and suggestions for home. It's the repetition at home that does the majority of the work."

It IS? That is EXACTLY what I would have wanted for d. And she was 15-16.  Role playing, activities (as opposed to a lot of blathery talk) and exercises and suggestions to do at home, where and when challenging things actually occur.

I kept ASKING t for things like this. And she said blah blah adolescent blah blah self sufficient blah blah. So, I should have been taking d to a BT for younger children?

Please tell me more about this or direct me to good info?

Thanks!

D diagnosed with EDNOS May 2013 at age 15, refed at home Aug 2013, since then symptoms gradually lessened and we retaught her how to feed and care for herself, including individual therapy, family skills DBT class, SSRI medication and relapse-prevention strategies. Anxiety was pre-existing and I believe she was sporadically restricting since about age 9. She now eats and behaves like any normal older teen, and is enjoying school, friends, sports, music and thinking about the future.
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isoharmony
Personality disorder had been thrown into the mix at some point with my daughter, but with an ASD diagnosis since she was little, we were aware of the social deficits and social anxiety. The BT you're talking about with younger kids reminds me of Carol Gray's Social Stories. The definitely need to role play and prepare for certain social situations before they are in them. My d would still benefit from this at 14. Not to mention the social situations get more convoluted with teenagers!
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isoharmony
Another "curriculum" for social skills....Social Thinking by Michelle Garcia Winner.
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PuddleduckNZ
So tough to know which is what with mental illness and especially where ED is concerned.

I don't have experience with this but do know oppositional defiant disorder was bandied around with my Son, and a bunch of other stuff.

Now he is in recovery from his ED he is pretty much normal, whatever that is. Even his anxiety is very minimal now and he is nearly off meds for that.

This is not helpful really, just adding that I know how frustrating it is to have to extrapolate what the real problems are with mental illness.

Its rough.
Son 9yrs when he became unwell 2013, ED slide from April 2014, dx at 10yrs July 2014, 2 hospitalisations - dx so many times Behavioural Anorexia, EDNOS, ARFID. FBT from August 2014. Anxiety, Emetophobia. 13.5yrs old now! In recovery, gets better every day with constant vigilance, life returns.
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Aussie
Hi Hate Ed
Sorry it's taken me a couple of days to reply....Internet problems . When BPD was first mentioned with my d I nodded my head, did a bit of reading and thought yep just another label. She'd had relationship issues with her peers, emotional dysregulation, etc but I put it down to just a teenage thing and at that time we were still dealing with ED. We never really spoke about it. About a yr later after the ed was under control she tried to od and cut herself badly. I realised then that it wasn't just another label. Her psych and psychologist took the time to explain to her the BPD dx. I read everything I could. My d accepts the dx as it helps her to understand her behaviour and way of thinking. She knows that she thinks differently to her peers. Her arms are badly scarred so it's a constant reminder to her that she has a mental illness.
My d has relationship issues too. I have to constantly support her in navigating her way through the issues that arise. My d needs lots of validation and to be honest high maintenance. She still sees the same psych. She has done DBT and uses some of the strategies she has learnt. It's been a roller coaster ride. Every week there is a mini crisis. She can be very emotional. I try to take one day at a time. X
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Torie
HateEDwithApassion wrote:
I am truly starting to think the BPD was here first, and the ED was the first way she learned to cope.


I've long felt that in my d's case, Ed is part of something bigger. I just can't figure out what that "bigger" thing is. Maybe BPD or maybe something similar. 

I was reading around a BPD link someone posted, and saw the claim that BPD often improves during the 40s. Hmmm. Tends to start in adolescence, mostly in females, and resolves (or improves)  when hormones start tapering down. So ... what? I remember someone here (a doctor, I think) suggested activities that increase oxytocin levels so I decided to read about that a bit. Lots of speculation that oxytocin levels correlate (inversely) with so many things we read about here: AN, ASD, anxiety disorders, depression. I'm not expecting a magic bullet, but gosh, it would be nice if the research could move along faster. 

I'm rambling, because that's what my mind does on this topic. I don't know how to help my d. Get her wr - yes, I get that. She is. So now what??? DBT sounds like it helps many in similar circumstances, but I don't have much confidence in the only DBT providers in my area. AND, such a huge time commitment. All well and good except that my d has (non-athletic) extracurriculars that seem very healthy for her - not convinced DBT would provide more value than these activites she'd need to quit in order to do DBT. What to do, what to do.

The idea that diagnosing BPD in teens is verboten strikes me as similar to how they can't diagnose AN until a certain weight loss, etc. Cross the line and - poof - you have AN. Yesterday, no. What other illness is like this?  Where the symptoms eventually are enough to warrant diagnosis, but the day before that, you didn't have the disease? No, you had the disease the day before, just wasn't diagnosed yet. Why don't they say "Maybe you have AN, but too early to diagnose. Start feeding just in case." But n-o-o-o-o, it's "You don't HAVE AN because x,y,z so go home, loony mom, and stop being the food police."

I don't know what it is that continues to torment my d. I have no confidence that I could find any professional who could figure it out. So frustrating. And so I keep reading.

Many thanks to all who have taken the time to share their journeys. With enough pieces of the puzzle out there, maybe some of us can put some of them together. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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Aussie
Just thought I'd add stick with the therapy. My d was in therapy for 3yrs at the moment her psychologist is on maternity leave. I see it as providing another means of support. I also wanted my d to learn and accept that in order for her to get better she needed help. When you google BPD you mainly get the stories of doom and gloom. Your d can get better but it requires a lot of patience, acceptance and understanding. Hang in there.
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HateEDwithApassion
Thanks Aussie and Torie,

I was reading Mec's posting earlier today when she said that at least when we were primarily battling the ED, we could feed our girls, because we knew that healed our kiddos. Now, I feel like I don't know how to "heal" my D, and her pain and torment seem worse than they've ever been. We've got her in two days a week therapy and my poor younger D is forced to work around her surly older sister's doctor schedule, which also stresses me because it isn't fair. 

Gosh - it's so similar with all of our older ED kids - we should really have a hall of fame post that kind of warns parents what the next phase can be and to be on alert.

Torie, you are such a wonderful encouragement and giver of advice - please let us know if there's anything we can do to support you and your D. I read an article about how waiting to diagnose BPD is actually hurting our kids, and that we don't wait to diagnose bipolar or generalized anxiety, so why wait with BPD when the traits are obvious? So true about AN also. Well, she's close but not. Oops, now she is. So incredibly frustrating!
 
As far as DBT, yes - it's time consuming. Yes, it does take away from other activities. Right now, my D isn't too engaged in anything at school, and in fact, begs to come home. So, if your daughter is motivated by being involved at school, maybe you could do a short DBT class over the summer. I know, kind of a pain, but gosh - the skills they teach are incredibly helpful... if they use them. I wish I had moved my D into this sooner even though she's doesn't appear to be buying into them. I have heard that's common, but they still help them. 

Aussie, thank you for sharing your story. We are going to stick with DBT - I feel it's the best hope. What else is there? Such a long, hard road. And we are really just beginning this mental health one. I don't understand why the doom and gloom about BPD. So they feel emotions intensely and act on them. Ok... and it can be relearned with better coping. OK...That sounds very do-able to me. Why the big stigma? It's sad - my D went online and read all of those sad stories, too, so that adds to the hopelessness. Darn internet!

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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Torie
HateEDwithApassion wrote:
 Torie, please let us know if there's anything we can do to support you and your D.
 

Thanks. It really helps to read about the journeys of those who are farther along - I very much appreciate folks who take the time to come back and let us know how things are going.

If I didn't know better, I'd think my d was fine and dandy. (Or, at least as fine and dandy as the next teen.) But the last time I thought that, I was stunned to find out she was actually cutting, fasting, and thinking of suicide. It's the future I worry about - what can I do to lessen the likelihood that everything will unravel (probably at warp speed)? And so I keep reading ...

HateEDwithApassion wrote:
As far as DBT, yes - it's time consuming. Yes, it does take away from other activities. Right now, my D isn't too engaged in anything at school, and in fact, begs to come home. So, if your daughter is motivated by being involved at school, maybe you could do a short DBT class over the summer.
 

Is there such a thing? The only two centers reasonably close to me said it's a 6 mo (or one year?) commitment and they kick you out if you miss two meetings.

Thanks for your kind thoughts. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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HateEDwithApassion
Hi Torie,

That is great that your daughter appears to be doing well. I also know it's scary for you because she may be very good at hiding what's really going on inside her head. My D too. There are times when I've thought it was such a good day and then she'll tell me no or I'll see her arm with fresh cuts. It's maddening, frightening, sad...

As for the skills class, yes, I guess you did hear right when it comes to the group class.  In our case, it's four modules repeated twice for a year-long program. As far as missing two, I believe that's in each module. But I could be wrong about that. We are new to it and haven't missed yet. In the Chicago area, they have an intensive outpatient DBT oriented program that is my next line of defense if we need more help. Three days a week, three hours a day. I have that in my back pocket if needed. I know you are not in that area, but wonder if there might be an intensive outpatient program that's not a skills group, but offers an alternative option? Or even finding an individual therapist over the summer that is DBT trained. 

FYI... I think my daughter likes DBT - even if she's not doing the skills - because it's very practical. She's not being asked why she feels a certain way or to dig into her feelings. She has a very difficult time going there. No, DBT just acknowledges that certain feelings are leading to negative behaviors, and it teaches them to be mindful of those feelings as triggers so they can choose a more healthy behavior in its place. I feel like they are getting an immediate toolbox of ideas on ways to break their cycle vs. rehashing emotions that might or might not have anything to do with what's going on that day. Maybe I'm just more of a practical person so this makes sense to me.


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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