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

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I am interested in hearing what others have found regarding CBT or other therapy, ancillary to and complementary to fBT. We are told by our aust. State government agency that because our 15 yold d is doing fbt no other therapy can be provided. Restrictive AN, 3 weeks IP in May, basically WR but in terms of ‘state not weight’ still very AN. We believe that depression preceded the AN, the psychiatrist has prescribed fluoxetine and olazpeine but is not doing anything but monitoring the bloods. Surely if d has subverted the healthy eating message some work could be done on redressing that and the root causes of depression? If one more expert tells me once WR happens it will all be ok I will scream....
Welcome to the forum, sorry that you have had to find your way here. FBT if done correctly should work on all aspects of care, including her mood, and other factors which may have led to her ED. During treatment the goal is to support her and then in phase three to work at pre-disposing factors. Things really will improve as her weight goes up but it does take some time. 
O2relax wrote:
Surely if d has subverted the healthy eating message some work could be done on redressing that and the root causes of depression? 
A lot of that subverting really will get better with the daily challenges of food outside of the "healthy eating message" and depression can also improve as time goes on. 

It is generally not advised to add different therapies like CBT or DBT at the same time. We were advised by FBT team (initially public and later private)  that all other psych practitioners would need to be put on hold with the exception of psych. assessment for meds. 
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.
Hi O2relax - Sorry I seem to have missed this thread. 

I noticed your current post on another thread, "Such a disparity in support, I don’t feel we have anything in Adelaide, Australia. After two weeks inpatient for low heart rate only CAMHS support is a psychiatrist who claims he is only there to ‘monitor’ the impact of meds eg olanzapeone, fluoxetine. She has seen him 5 times since May. The hospital referrred is to a private fbt specialist that costs $230 a visit (we do get some back on rebate) all that service does is weigh her and tell us to up the intake . I feel like we have zero suppport just them pushing it all back on the patents. Thanks to all at this site I check in daily for your support!"

It does sound like your d has received a shocking lack of support.  As your d is 15 (or 16?) it's especially important to drag her toward remission at a reasonably good clip.

It sounded as though your d likely needed to continue to gain weight in August - has she been gaining since then?  

My d is another where depression preceded AN so I was worried that WR would not be enough help for her.  But I also knew that she would have no chance to beat the depression unless she got to a healthy weight so I agree that is always the first step.  How is her eating now?  Please tell us a little more so we can try to help. xx

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

She is 15. We had had a referral to the state eating disorder service but she ended up with a resting heart rate of 30 before the appointment and ended up an IP in children’s ward. The hospital release as soon as medically stable. The state eating disorder service have advised she is not suitable for their programs because she is doing fbt with us. We were given the fbt book in hospital and a referral to the fbt psychologist but the fbt psychologist is not treating or talking to her for more than 10 mins in the 45 min session. I know this therapy is manualised and talks about a multidisciplinary team...what a joke! So it is all up to us, luckily the weight loss was not too bad, she is 5ft 2 weighs around 52 kg but we are struggling to get more on. We toss up between giving her the meals that retain her current weight and the fear foods.
Last weekend we called an ambulance due to a major breakdown and self harm and I felt embarrassed to tell the ambulance officer that the experts say ‘the only treatment she needs is fbt’. Our solution to therepy, we are buying her a puppy...I think it might be a state government failure for not resourcing child eating disorders.
I did find the butterfly assn carers group which meet monthly.and l learn a lot from this forum. Sometimes seeing that it could be worse, sometimes making a connection with the uncanny similarities described by other forum members. Thanks for your support it is really appreciated.
Hi O2relax,

"If one more expert tells me once WR happens it will all be ok I will scream"
It is not that easy and not all will be o.k. suddenly at WR but what they mean is that brain recovery starts with WR.
And that is true in most cases. I did not believe it either and we had to push our d a little over target weight set by IP but then 4 months after WR we saw a slowly change in mood and behaviour that got better with every months.

You write she is 15 and she is at the moment at about BMI 21. That means that she is still growing and developing a female body and that means she is not grown out at the moment. They need to gain some weight until their mid 20s so she is maybe not WR enough for brain recovery. Some here needed to get their children to a higher weight as expected to see brain recovery.

How was the target weight set? Where has she been on percentile through her life up to now? If she has been on 50% percentile for length and weight she needs to get back there. If she has been on 75% percentile that is your goal. Every body has a specific comfort zone for weight and you need to find hers.
Does she have her periods? Just one sign...

We tried to do Cbt before WR and it did not work because she was not able to engage. 4 months after WR it was not needed any more because depression and self harming faded slowly.

So I would try to make her gain some more weight (if you need ideas how, please ask) and wait some time. Normally it takes 4-6 months after WR to see brain recovery start.
AN is a long term illness. Normally you need the same time to get them back as they have restricted. In our case she was restricting 9 months and 10 months after start of refeeding she slowly started to come back.


Keep feeding. There is light at the end of the tunnel.
Hi O2relax - So sorry to hear about the ambulance trip.  Ugh. It is so hard when our kids are driven to self-harm.

It sounds like your d is at least close to weight restored.  Have you seen a reduction in ED behavior?  I think it is easier to treat premorbids once they have been weight restored for a while.   Would you like help brainstorming ideas to get a little more weight on her? xx

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