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

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joanne34
Hi, my 13 year old daughter was diagnosed in Nov with AN and eventually was referred to CAMHS(HYMS) in January.   Her weight continued to drop after referral (lowest 41kg) then gradually increased and has now been around 45kg for a while with no sign of increase.   We are trying to address this by upping/enriching food where we can and reining in exercise if it is too much.  Since the referral she has become more and more disengaged with the psychiatrist, which is such a shame as she is lovely and really patient.  She is also being very devious in terms of trying to avoid eating her snacks (e.g. hiding in pockets, sneaking it into the bin half eaten etc) and also trying to do extra exercise by getting up very early for example. 

Currently she checks in with the psychiatrist every two weeks where she is also blind weighed and HR/BP (sitting and standing) are measured.  Heart is fine and she is just below 80% H:W so still very much underweight.   Recently we are also suspicious she may have tried to weight her pockets at the weigh in.   Anyway, all the usual rubbish ED behaviours.   Also we have the teenage angst/attitude to deal with now where today apparently I am not being spoken to.   I'm just ignoring that and chatting away to her as normal.   It does make it difficult trying to remove the 'teenage variable' from the 'ED variable' as they do seem to promote each other!!

Anyway, I jut wondered how common it was for young people to not engage at all with CAMHs and whether they come round or whether you just stopped in the end or made appointments less frequent?

Regarding all the sneaky stuff going on at the moment, it just means we are now being even more vigilant, closing off even more avenues and that will obviously annoy her more so I'm pretty sure I have months ahead of being ignored..........whilst on lockdown.   So glad I can see the ridiculous side of this as pretty sure it could easily tip me over the edge if I didn't!!!  Onwards ad upwards....... 😃

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Enn

At the beginning I used the team for me. We did not have a psychiatrist. We had an FBT therapist who is a social worker. I used the therapist for me, to help my anxieties and she also gave me suggestions  on how to get d to eat or stop violence or how to get her to sit. 

d has really never ‘engaged’. We are at a place now giving more independence on her nutrition and activities and so there are some bumps in the road. I have to learn to give her some autonomy and she is allowed to complain to the therapist how mom is ED obsessed. She really just talks to the the therapist  about how her siblings bug her and how I can’t let go of being super vigilant. She uses that time to also discuss her successes with eating and school and life on a whole. That is all... so far. 

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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LaraB

Hi @joanne34  my understanding is that  individual therapy of little benefit until 85% wfh. If it were me, i would continue to engage with the service. We have continued to go despite ups and downs at times.  My D hated going until at some point, when she was having some social difficulties, something the psychologist said really clicked with her and she felt understood and it was the start of a therapeutic relationship. At times when we have been stuck or going backwards and my D has refused to attend appointments, the psychologist has even done a few home visits. she wanted my D to know that no-one was giving up on her, that we were all going to support her to recovery.  

I think it is important what you said about your D being stuck at a particular weight for a while. Maybe worth arranging to see the psychiatrist by yourself to come up with a plan to make progress as she still should be gaining 1/2 kg per week. We were stuck for a long time at a low weight and a short hospitalisation when things started to slide made a big positive difference. I am not suggesting that your D needs hospitalisation- rather that it would be good to have a joined up plan with service with contingency if progress not being made. Xx

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LaraB
Just wanted to add, now my D sees psychologist for individual therapy and the psychiatrist with me for FBT. We have learnt that it works better for psychiatrist to take a very medical authoritarian approach- ie food is your medicine, you must stick to strict mealtimes etc and the agreement is that D can not negotiate with me or with the psychologist - only the psychiatrist can adjust her food/exercise etc. I separately email the team to tell them what I think needs to happen. This has taken the tension away from my relationship with my D and made it easier for her to comply as the ED was always kicking off against me and now there is “no option”. My job is to just follow the hospital- plan, plan agreed with dr. Just wanted to share in case helpful. 
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Enn
LaraB wrote:
Just wanted to add, now my D sees psychologist for individual therapy and the psychiatrist with me for FBT. We have learnt that it works better for psychiatrist to take a very medical authoritarian approach- ie food is your medicine, you must stick to strict mealtimes etc and the agreement is that D can not negotiate with me or with the psychologist - only the psychiatrist can adjust her food/exercise etc. I separately email the team to tell them what I think needs to happen. This has taken the tension away from my relationship with my D and made it easier for her to comply as the ED was always kicking off against me and now there is “no option”. My job is to just follow the hospital- plan, plan agreed with dr. Just wanted to share in case helpful. 


love that the doctor takes the strong hard line approach! And the best is that you tell the team via emails about the direction they are to take. I did that too and it made the world of difference as the team became the ‘bad guys’ and I just followed what  they ‘said’ to do. That way d could not negotiate with me, if she wanted to fight she knew she had to fight with the team. I was just following doctor’s orders. Well done!! 
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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MKR
LaraB wrote:
... at some point, when she was having some social difficulties, something the psychologist said really clicked with her and she felt understood and it was the start of a therapeutic relationship...
----
she wanted my D to know that no-one was giving up on her, that we were all going to support her to recovery.


The message of "no-one is giving up on her" is sooo important. I love how @LaraB's daughter established a rapport with the psychologist. Sometimes it is just one sentence that hits the spot. It can be hit-and-miss for all of us, but it is worth searching for help out of getting stuck.
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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Foodsupport_AUS
It is really common that some who are ill don't engage with therapists, especially early on. After all a lot of treatment is outside of what the person with ED wants, many don't particularly want to recover. They don't want to talk about their eating. 

Given you don't have a lot of choice in terms of who or where your D is seen, I would be insisting on keeping on going. Your D clearly has a long way to go in treatment, with plenty of weight to gain. She may engage more as she gets closer to weight restoration. 
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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mfab12
My D was 43kg 18 months ago started to attend camhs .. She has never really engaged with them but it was helpful for me to say 'they are telling me this is what you need (eat and move less) and they are the experts so there is no choice' - this was met with a lot of anger but using tips on here (how to get calories in and a strong stance) she regained weight quite quickly (although it was really really challenging) ... She is now 58kg and still not wanting to go to camhs - but reluctantly does. .. She is now older and I've found a good you tuber she will watch her videos and I hope she will actively get involved with someone to help on the future.. Until then keep riding the waves back and forth until the brain catches up.. Good luck... Keep strong..
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BebraveMummy
My D was 11 when became ill, initially tolerated but hated psycologist appointments but after AN diagnosis hated and refused any communication with them. I got the advice/therapy. She continued to have weekly weight check with CAMHS but only ever hello and polite chat (eventually, initially was hard stare). After 12 months, having been wt restored for 9 months and most ED behaviours gone,  got private psycologist involved and very reluctantly D went. Now sees her monthly and and is willing to engage and communicate which may be useful going forward. 
So I think not engaging is really common and not something to be concerned about, keeping door open and letting child know that no one has given up is vital (ED has not won and cant push help away)
Good Luck 
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joanne34
Thanks everyone, it's reassuring to know that this seems to be quite common behaviour.   We are continuing with the fortnightly appointments.   Everything seems a bit relentless at the moment with us having to be hyper-vigilant about everything!!   Her weight has been the same for a few weeks now and we are making changes to promote weight gain so hopefully that will happen.  The thing that keeps me going is knowing we have pushed through the 'completely devastated/highly upset/highly anxious/shutdown' stage.   Now we seem to be at the 'rebellious/high exercise compulsion/trying to ditch bits of food/highly sneaky' stage.   We just need to stay on top of it all and remain as calm as we can.
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