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

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pettelly
My 14 yo daughter became anorexic just over a year ago. Pretty severe behaviour but luckily caught quite quickly. We were happy with the treatment but, IMO, target weight was too low and she's been hovering around 50 kg. Target was 51 and just been put up to 52(she's 164 cm and always been on 50th percentile BMI before anorexia) but I think should have been at least 52 and now should be 53 or 54. I know small differences but I think that 1 or 2 kg does make a difference to her. But it's really hard when she sticks to the lower target that the clinic gave her, she just won't accept my target.

Over the summer we had a small relapse, went down to 49, now - very slowly- back up to 49.5. But been stuck there for a couple of months. Not losing, not gaining. Eating but very very controlled (seemingly) and I think her calories needs are high. 

After noticing snacks disappearing and that she had food in her room, she opened up and said she's been hoarding in her room, bingeing and then vomiting. She's only done this a few times. She's so tearful, contrite and ashamed which is so different to her anorexic behaviours which are combative and aggressive. 

This isn't a whole new ED, right? I feel inside like it's a continuation of the anorexia even though the behaviours are so different. That she's been treading water and eating enough to keep a lid on things but it hasn't gone away, that the bingeing is a symptom of that. We're not back in the absolute darkest days but we're not out of the woods either.

Added on top that she's struggling at school. Her old friends ditched her with the anorexia. She made a new best friend last year after she came back to school but the friend's just moved away and, while she has some friends, she's feeling a bit lonely. She says the bingeing and purging make her feel less empty [frown] 

Our psychologist at the ED clinic is on holiday this week so really at a loss what do do. 

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Foodsupport_AUS
 Sorry to hear that your D has now started purging. From what you have said it sounds as though your D has developed binge purge anorexia, this is unfortunately not uncommon.       You are absolutely right that it is likely to be more of the anorexia.   The commonest cause of bingeing is restriction. 

I think you are right that the target weight was too low, and unfortunately it is time to dig in again. 
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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Kali
Dear Pettelly,

I'm sorry to hear that the binging and purging has come into the process but congrats on at least getting her weight up to the point it is now.

I think you are right about her weight needing to go higher, in the 53-54 kilo range. Since she is 14 she will need to be gaining every year.

My daughter also had b/p anorexia and the way it was handled was that she was not allowed to go to the bathroom after eating for many months and was under strict supervision. When I finally allowed her to go the bathroom freely, I checked the bathroom carefully and followed her to the bathroom if we ate in a restaurant. Have her go to the bathroom before she eats. Also if she is eating regular meals during the day you can time them out so that she is relatively full during the day. Don't allow her to bring food into her room and don't let her stay in her room with the door shut. Purging is something which requires close supervision in order to interrupt. According to my daughter, food can stay in your stomach up to 2 hours after eating. Stay with her after meals as much as possible for those two hours, play a game, watch tv, etc. I also deliberately frightened my daughter by telling her that her teeth could be ruined and about some of the other side effects from continued purging.

Feeding 3 meals and 2-3 snacks so that your daughter doesn't get hungry enough to binge has also been helpful for some families. Supervision is key here.

Also is she is having trouble socially, are there some activities you can encourage her to get involved with (aside from sports) which she might like and where she might meet others with similar interests? Art, music, social justice, volunteering for a cause she believes in, etc?

Some families have found that having and caring for a pet is very helpful in recovery.

Hope things improve. 

warmly,

Kali
Food=Love
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pettelly
So i've raised this with the clinic. But they redo the calculations and say 'well, the lower band of  50th percentile is 52kg'. But that's NOT what I get from all the online calculators. They're the professionals and they've been so good and on the ball with it - it's just this target weight issue which is bothering me. And it makes it so hard with my daughter who, of course, is going to run with the lower number (and see it's as the absolute maximum and is doing her best to hover just below it, not the minimum weight that she needs to reach). This of course means that one bout of sickness and she's back into anorexia as she has no reserves. 


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pettelly

She knows the dangers and she's really scared.

It's different to the anorexia in that she is totally on board with wanting to stop and worried that the urge is too strong. She never spoke like this with this insight when we were deep in anorexia. She *says* she doesn't want to lose weight. 

We are very strict on 3 meals and 3 snacks which she religiously sticks too (normally) but the meals are not big enough. She's not purging after regular meals but she has been hoarding food in her room and then going on a binge and then purging I think it's because she has been so controlled with the food and not quite eating enough that this urge comes upon her but i'm not sure about the causality for the depressive feelings. 

We have a dog and a cat who are lovely but she's not really into them to be honest. Well, the cat couldn't care less about us so that's fair enough 😉 


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Mamaroo
Hi, so sorry b&p has reared its ugly head.

I had a quick look at the weight and height curve. For a 14 year old girl with a height of 164cm, she is sitting on the 75% for height. My d is 95% height and 90% weight, so assuming similar ratios, her weight should be just below the 75% curve, which gives us 55kg. I know it is higher than any other estimate, but it might explain her behaviour. Binding after weight loss is very common.

Our treatment team also estimated my d's target weight on the low side, but I reasoned since it was I who was feeding her, I would just keep on adding until she was at proper weight for her.

Can you speak to her Dr without her present and ask that the target weight be increased, or if they disagree, then not to talk about a target weight in front of your d.

Increase the fat content, such as butter and cream to help her feel full and more able to withstand the binging. We lock the pantry, since d's sister tend to binge.

I've attached the chart for you. I hope thing will get better soon.
D became obsessed with exercise at age 9 and started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. View my recipes on my YouTube channel: https://www.youtube.com/channel/UCKLW6A6sDO3ZDq8npNm8_ww
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pettelly
I use the CDC and NHS bmi calculators and get that to be on the 50th percentile for BMI (which is where she always has been since she was little) she needs to be 53.5 kg. 

I don't know why the clinic insist that 52 is OK. I get that it only puts her on the 41st percentile, below her historic growth curve. 
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Torie
I agree with the thought that your d needs to gain x kg to get past this and then she needs to gain an additional couple of kg so that she isn't hovering at the edge of the cliff.  (And then a little more weight each year.) 

I hope you can get the "professionals" on board with that - it is just sickening how many here are undermined by "help" that is worse than no help at all.

I have read that vomiting releases feel-good chemicals (endorphins?) no matter what the cause of vomiting is.  Apparently that's why we immediately feel so much better after we finally vomit during a time of illness.  So it is really important to nip this in the bud.

Finally, vomiting softens the tooth enamel so teeth should not be brushed right after vomiting.  It might help if you point that out to her.  She likely does care about her teeth, but she will also want to brush after vomiting to cover up the smell so that might help a bit.

Best of luck with this. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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Torie
P.S.  I agree with FoodSupport that the commonest cause of purging is restriction.  It will be MUCH easier to nip the purging in the bud if you are able to get her weight up. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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Frazzled
Good advice so far. I agree with Torie about telling her about vomiting ruining her teeth. I also told my D that repeatedly throwing up can cause cancer of the throat. The acid causes the cells to change over time and can lead to Barretts esophagus. 😬
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pettelly
The power of food! We persuaded  D to increase her calorie intake to 2,100 per day and make her meals bigger. This seems to have done the trick. Her urge to binge has decreased and she is much perkier. She's been an absolute delight the past week actually. She even went out and ate pizza with her friend today and then went and bought snacks because she'd forgotten to take her usual ones (she's quite rigid in eating the same meals/snacks so this is a big deal).

I think we need to get it up the calories more, I still feel like we're hovering close to the edge but my husband has been away this week so didn't push her more than 2,100. I need backing to get her out of comfort zone. 

On the advice of the ED clinic, we're moving to a psychologist in the community as well. D hates the clinic with a passion and says that seeing other anorexic kids is triggering and distressing so we've agreed (with the clinic) to see a private psycholgoist outside. Let's see! D insists she likes being a perfectionist, anxiety ridden and rigid 😉 
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ValentinaGermania
Nearly all ED kids are perfectionists, rule bounded, have anxiety and are very rigid. That is part of their genetic character and makes their risk for ED 35% higher than without that (you can read that in "Decoding Anorexia"). So you will not change that character but you can help them to learn to be less perfectionistic, less anxious and to accept changes in life in a better way.

Great that you stopped the binging with more food. And don´t you think eating out pizza and buying snacks herself is worth a gold star moment? That is really great!
Keep feeding. There is light at the end of the tunnel.
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Francie
Hi Petelly, I'm happy for you that you're able to control the b/p cycle with more calories. Anything it takes to stop that awful cycle! We were not lucky enough to stop it early and while our d has reduced her b/p, it is still a presence in our home and is frightening.

I keep saying it's about hunger, the t keeps talking about emotions. We'll get there eventually.....

I am glad for you. And if b/p begins again, by all means do what is suggested here and supervise, supervise, supervise....

All best to you in your d's continued recovery. XO

Francie

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JDOuellette
Weight suppression is a big driver of bulimia symptoms. My philosophy about this is that our kids aren't going to die from eating or weighing too much. My daughter got well about 4 kilos over the most she "should" weigh. Surgeons don't remove as little of a cancerous tumor as possible - they remove the whole thing and with a WIDE margin. Fat phobia and thin bias in eating disorders treatment is deadly. I would up calories and weight. https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-016-0111-5
Jennifer Ouellette
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MKR
Hi Petelly,

Yes, listen to your gut instinct!  Set your own goal weight because you can see first hand the effects.  Plus you want a buffer for any growth spurts.

Some ED therapists do not reveal the weight nor the target weight to an AN child, especially not aged 14. My experience is that talking numbers reinforces the ED. But I admit that in the beginning I weighed my 14-y-o D at home and kept saying, "Help us get to the Magic 5 (meaning 50 kg and over). I wanted her on my side because ED is the opponent, not my child.

Good news that your girl is on board and willing to get free from this cycle.  It is true that teeth suffer. Or worse, depending on the volume of binge. I came across a warning video on bulimia on YouTube and saw in many of the comments beneath that people stopped bingeing after seeing it. But luckily, you are now well on the path to safety, yay!

It may help to explain to your daughter that weight will be at first put on around her tummy, before the body distributes it. This is to also protect her vital organs and restart periods (if there was a break). So nothing to fear, all will be well.

All the best,

Z ❤❤
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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MKR
Oh, also the hoarding of food - comes with AN. Something about malnourishment awakening our bodies' ancient instinct to deal with scarcity of food.  Hoarding and sometimes stealing (not necessarily food). 

My daughter was happy to surrender all food and put it in the kitchen pantry. No drama, just looked embarrassed. Then started hoarding new snacks.  When they piled up again, we gave the whole lot away. I needed to reassert myself as the feeder. In my house, I am the parent, Miss!
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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