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

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kangamum
I find myself again asking for help. D, now 17, was in strong remission for a year . She is engaged with school, has close friends and still laughs a lot. We signed  a green, yellow, red light relapse contract (put together by me from a Sarah Ravin example) about 8 months ago. About a month ago we recognised some ED behaviours and last week asked her to fill it in. She ticked some red light behaviours (insight) and the GP confirmed she has lost a little weight. For the first time she asked GP not to tell me the weight. She still looks to be at a healthy weight with chubby cheeks and tummy. This week she has avoided some meals, lied about what she has eaten when she is out with friends, and has not completed most meals. She will ask for and demolish a double quarter pounder McDonald’s meal or a nachos smothered in guacamole and sour cream though. 

At the same time we have found out that she has been smoking marijuana for at least a year, and her brother and his gf have been smoking with her (they are mid-twenties). They have now told us she has also called them when on ecstasy and possibly once LSD. We had a discussion about this together with her trauma counsellor and she was very hostile though later apologised for being rude. She refuses to make a commitment to not smoke though says she does not plan to take anything stronger as she doesn’t enjoy the effect. This could be a lie to keep me off her back. I have provided her with fact sheets, stats etc about the risks as per the advice of a family drug helpline.There is a family history, fraternal grandmother, of schizophrenia. We are planning to only drip-feed her allowance to her rather than all at once into her bank account. She has no job, only school.

She has struggled with a very low mood for some months, though she kept this from us, has PTSD, and her doctor has increased her dose of fluoxetine (Prozac). Her doctor noted the link between low mood and her restricting. She has previously SH, though not too badly and has struggled with suicidation. She sees a wonderful trauma counsellor once a week, with some resistance at times. She is dressing increasingly goth, and says controlling the way she looks really helps her deal with her internal struggles. She has told me she is experimenting with BDSM, bisexuality and polyamory. She says BDSM has been a wonderful way to experience trust and empowerment and is often not sexual for her.

The GP suggested we see a specialist ED counsellor as well, her previous excellent one is about to have a baby but has recommended another. We have our first appointment in a couple of weeks. I haven’t yet told her as we are drip-feeding our strategies to her at the suggestion of her trauma counsellor who advises to avoid giving her shocks due to her PTSD. So everything has to be gently rolled out over time. As I am a band-aid ripper this is hard.

Where do I go from here? We have to re-introduce magic plate, police her for drug-use, ensure she attends counselling sessions, and enforce the relapse contract which means full disclosure of relevant medical information.

I am interested especially in Tina’s experience of working with a contract with an older teen. What consequences are effective for others? Thanks as always for this place where there is so much experience and kindness.
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Enn
many have used contracts. 
Here is a thread. I hope there is something helpful there for you.
https://www.aroundthedinnertable.org/post/contractssamples-and-ideas-9471610?highlight=contracts&pid=1301889667
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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Enn
Here is another:
https://www.aroundthedinnertable.org/post/recovery-contract-ideas-please-9929025?highlight=contracts&pid=1306256291
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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Foodsupport_AUS
Sorry that you have needed to come back here. It sounds like things have gone significantly backwards. It is good that she has some insight into her eating issues, but it also appears that there are numerous other issues at play. I don't really have answers for you, just throwing a few thoughts out there. Is she open to following her contract and increasing her intake of food with perhaps more supervision rather than just magic plate? If you do go to magic plate would you also go back to school supervision?
Your plans of drip feeding allowance, drug supervision, and counselling, with disclosure of medical information sound good. What do you think you will do if she refuses to comply with this?
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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Enn
Sorry meant to answer your post with a bit more substance, but had to get dinner on the table.
i think you have a very sensible approach. 
Dealing with ED and teenager stuff can be challenging. I think keeping vigilant for her safety regarding drugs and getting back on track with an ED counsellor will be helpful. Financial leverage in your case sounds crucial for her overall safety. 
I am sorry it is so difficult right now.
All the best,
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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sk8r31
Hi Kangamom, sorry you have a need to be back on the forum, and hoping that the peer support community can be helpful for you this time around as well.  It sounds like you have some good supports in place already for your d, and a basic strategy going forward.  I hope that you also have support for yourself, as this journey can truly deplete one's emotional & physical reserves.

We did use a contract with our 17-year-old for nutritional rehabilitation, and then drafted a second contract a year later when she went off to university.  We had support drafting the first during our stay with the 5 Day Multi-family program at UCSD.  Our local therapist gave feedback on the second contract a year later.  This professional support was quite helpful, as it really was more of a collaborative approach with our d at 17.  We did have her buy-in, as she was very motivated to go away to university.  Tapping into what is motivating for your d will be a big factor.

A specialist ED therapist sounds essential, and in fact, you will have a larger team due to trauma/PTSD & med management.  Coordination and communication amongst the team will be so important, and it may be a task that you will need to be on top of, to make sure all parties are in good communication.

I don't really have much to add, other than I am sending warm support.  Knowing that you have successfully managed nutritional rehabilitation previously must be empowering; you were able to help your dd before, and I've no doubt you will be successful again.  This time around, you will need a bigger support system and safety net in place.  Hang in there!
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
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Mamaroo
Sorry you had to find your way here.

It seems ED and risky behaviour sometimes go together. I told my girls that we have the 'addictive' gene and that they should refrain from dieting, smoking, drinking, gambling and using drugs. I'm very glad to hear you have such a great relationship with your son that he would confide her drug use with you. Can you speak to him and ask him not to do drugs with your d and maybe even to discourage her from taking it?

I would start again with taking control of her food and instead of paying her an allowance, pay her for completing her meals and snacks. And yes, drip feeeding her allowance is a very good idea. 

Sending you lots of hugs 🤗🤗🤗🤗
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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kangamum
Thanks everyone. I'll make a plan with GP, ED counsellor and trauma counsellor to get and keep her on track. She has accrued enough hours to get her drivers license (120 in Australia!) but has been avoiding it for some reason so will make that an incentive to work for. Then as she will have to use my car that can be the carrot, and the stick. I am not keen on offering financial compensation for eating, as what really motivated her last time was my agreement to, and paying for, facial piercings!! Not excited about going for more of that as she appears to have given up on me ever letting her have more.
Will keep you posted on progress, wish me luck 🙂

One thing that has been happening is she is sleeping an awful lot during the day if not at school, and will not wake up to eat. Any suggestions? She point blank refuses to wake up until she is ready. Will have to add that into the plan I think...
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Mamaroo
kangamum wrote:
Thanks everyone. I'll make a plan with GP, ED counsellor and trauma counsellor to get and keep her on track. She has accrued enough hours to get her drivers license (120 in Australia!) but has been avoiding it for some reason so will make that an incentive to work for. Then as she will have to use my car that can be the carrot, and the stick.

That sounds like a brilliant idea!

kangamum wrote:
One thing that has been happening is she is sleeping an awful lot during the day if not at school, and will not wake up to eat. Any suggestions? She point blank refuses to wake up until she is ready. Will have to add that into the plan I think...

My d would also sleep through the whole weekend, but we have things on Saturday and Sunday mornings, so I just open up the curtains half an hour before she needs to get up. Maybe check if she is fast asleep or just sleepy. If fast asleep, try and get her into bed earlier the night before. If just sleepy, you can giver her an ensure or shake while she is still half asleep. Just tell her to sip this and then she can go to sleep again.
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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ValentinaGermania
kangamum wrote:

One thing that has been happening is she is sleeping an awful lot during the day if not at school, and will not wake up to eat. Any suggestions? She point blank refuses to wake up until she is ready. Will have to add that into the plan I think...


This is ED that wants to avoid eating. I woke her up at 8 a.m. no matter if it was weekend or holidays to get breakfast. She could roll over again after that but eating the meals and snacks at the fixed times was not negotiable.
How do you manage to get all the food in and keep her blood sugar level constant when she sleeps the whole day?
Keep feeding. There is light at the end of the tunnel.
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ValentinaGermania
kangamum wrote:

Where do I go from here? We have to re-introduce magic plate, police her for drug-use, ensure she attends counselling sessions, and enforce the relapse contract which means full disclosure of relevant medical information.


Yes. All of that. Back to no negotiation police and drugs are very dangerous for ED patients as they get addicted more easily than others. Strict rules. No discussions. That is needed for a long time...mine is nearly 20 now and if she would refuse a snack today I still would keep her from leaving the house without having eaten before (that does not happen at the moment because she is at a very good recovery state now and has insight but in case it WOULD happen we would do that again).

kangamum wrote:
I am interested especially in Tina’s experience of working with a contract with an older teen. What consequences are effective for others? Thanks as always for this place where there is so much experience and kindness.


My d was 17 at diagnose and we did the contract when she turned 18 about 2 months after WR.
We wrote down what we will do for her (pay for living, insurances, phone, university, buy a car for her and pay for it etc)
and what she needs to do for that (eat 3 meals and 2 snacks, see GP when WE think it is necessary, get weighed regularly, maintain her weight (as she was grown out that was more easy than with a moving target) and - most important here - sign the legal papers that we get informed by the doctors and can talk to them when she is 18.
We worked mostly with incentives. The car was a big one and is our best friend. She knows that when she would refuse a meal or snack she is not allowed to drive. So car key is the first thing she would lose and she will never risk that beloved freedom 🙂.
We pay for university and one part of the contract is that she must stay at home for a gap semester and we will stop to pay for university when she loses more than 2 kg (and does not regain them in the next 2-3 weeks).
We pay for phone and it is clear that we will stop that if she does not work together with us.

And so on.
What incentives could you use? Is she financially dependend? Who pays for her school, phone, living at the moment? What is important for her? What is she keen on?
In case she cannot make good decisions with money I would not pay her for eating, but maybe you can get her with clothes, or money for a prepaid phone contract, or something else. Give me some more informations and I can think about some ideas.
Keep feeding. There is light at the end of the tunnel.
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kangamum
I just had a session with her trauma counsellor who, without disclosing what d has told her, let me know in no uncertain terms that driving is not a good incentive for d at the moment. She also has suggested grounding (not letting out of the house) for 2 weeks if we find she has used any drugs (including alcohol) and not allowing her to sleep over at anyone's house. This is because d is talking a lot about not caring about herself or anything and is at risk of SH.

So she absolutely loves clothes, and expresses herself through fashion. She told me recently that being able to control how she looks through clothes is extremely important to her. So that's a definite incentive, perhaps an agreed amount she can spend on clothes online if she complies for a week? Month?

As I said before the main incentive for her would be me allowing and paying for piercings, but I really don't want to go down that path. She already has 3 in her nose and in 3 each ear. She really really wants to get her tongue pierced but we spent a lot of money on braces for her teeth, and the tongue piercing might affect the plate she has in now. But that would be a major incentive for her I know.

She loves music and going to gigs to see live bands. These are usually punk bands, she loves the mosh pit. I am worried they are also places where she will be able to use drugs easily. Perhaps offer to buy tickets to major bands if she complies for a longer period? 3 months maybe (cost about $200/ticket)

We pay for absolutely everything. She lives at home, still at school, we pay for her phone, internet, clothes, allowance. food etc etc etc. She has no money without us. She has signed a relapse contract which says she agrees to us having medical information, but before she turns 18 in May 2020 I will look into what that document is in Australia.

Just writing all this has given me good ideas.  Thanks for your great advice Tina.
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melstevUK
Hi Kangamum,

You have been given great advice by the others and it sounds as if you have good supports and strategies in place now. 

My question is, what does your d want to do when she leaves school? Her present behaviours are very much a part of teenage experimentation as well as ed related. It can be helpful to discuss what she wants to do with her life and define hopes and dreams so that she can see if what she is doing now is going to ensure that she gets the future she wants.  

It is always worth looking at the bigger picture of helping her through a stormy adolescence full of angst and lack of self esteem and keeping in mind the kind of person you want her to become a few years down the line: a happy and confident individual pursuing her dreams as a responsible member if society. Helping her to see that bigger picture and expressing confidence that she will come through the illness and this difficult transition might give her a different focus. 
You are doing a great job, though -  well done for that.
Believe you can and you're halfway there.
Theodore Roosevelt.
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ValentinaGermania
kangamum wrote:
I just had a session with her trauma counsellor who, without disclosing what d has told her, let me know in no uncertain terms that driving is not a good incentive for d at the moment. She also has suggested grounding (not letting out of the house) for 2 weeks if we find she has used any drugs (including alcohol) and not allowing her to sleep over at anyone's house. This is because d is talking a lot about not caring about herself or anything and is at risk of SH.


Really love that. This counsellor seems to know what he/she does. Grounding and no outings seems to be needed at the moment. Put away all sharp things and check her room (twice). Leave doors open or hang them out. Do not leave her without supervision if any possible.

kangamum wrote:
So she absolutely loves clothes, and expresses herself through fashion. She told me recently that being able to control how she looks through clothes is extremely important to her. So that's a definite incentive, perhaps an agreed amount she can spend on clothes online if she complies for a week? Month?


Think about a point system for every day she ate without complains. Maybe one meal is worth xy dollars. Think about short time incentives, one months is too long. Best is to get an incentive every day to keep them going.

kangamum wrote:
As I said before the main incentive for her would be me allowing and paying for piercings, but I really don't want to go down that path. She already has 3 in her nose and in 3 each ear. She really really wants to get her tongue pierced but we spent a lot of money on braces for her teeth, and the tongue piercing might affect the plate she has in now. But that would be a major incentive for her I know.


I would not pay for that too. No money for self harm and I think piercings are near to that...🙂

kangamum wrote:
She loves music and going to gigs to see live bands. These are usually punk bands, she loves the mosh pit. I am worried they are also places where she will be able to use drugs easily. Perhaps offer to buy tickets to major bands if she complies for a longer period? 3 months maybe (cost about $200/ticket)


Gigs seem difficult to me. You cannot know what she does there and who she meets there, drugs are a problem and alcohol too and normally that takes more than 2 hours so difficult to do between meals and delayed meals and snacks are no good idea at the moment. What about music downloads?

kangamum wrote:
We pay for absolutely everything. She lives at home, still at school, we pay for her phone, internet, clothes, allowance. food etc etc etc. She has no money without us. She has signed a relapse contract which says she agrees to us having medical information, but before she turns 18 in May 2020 I will look into what that document is in Australia.


So this can be part of your contract, that you for example will continue to pay for her phone but cut internet when she refuses to eat.
Same with the other stuff. They often think it is for free to get all the things paid but they need to learn that they have to do something to get paid for as in the rest of their lives when they have a job.

Ask a laywer if needed what papers you need in your country when she turns 18. Here that is a paper every adult person should have that gives another adult the allowance to speak with the doctors. We have that also for the inlaws and for hubby if someone has an accident or a heart attack.

Carrot and stick worked well here in the last 2 years. We nearly never needed the stick (only once I had to threaten with something because she delayed lunch at university and came home in a very bad state and wanted to leave again to see friends without having eaten before - no way that would have happened).
Keep feeding. There is light at the end of the tunnel.
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kangamum
A lot to think about here, thanks for all the sound advice. We’re all in a bit of shock that we have perhaps found ourselves back at the refeeding stage. I found out this afternoon at the doctor that She has lost 1.1 kgs from WR (don’t know how long that has taken) and lost another 400gms last week (could be a normal variation) but looks like a worrying trend to me. It has been almost a year since we last weighed her weekly. The few times we have weighed her in the last year (probably 3 times) she was stable at 70kgs (BMI 23). We have just had dinner and she refused most of it. Said it was my fault she’s not eating cause I’ve said she has to go to ED counsellor. Poor kid looks like she was really struggling. Tomorrow I will deliver the new plan to her with the trauma counsellor.
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ValentinaGermania
Any weight loss of an AN patient in combination with ED behaviour (refusing dinner there) needs to be taken serious.
It is ED talk that this is your fault because you said she needs to go to the ED counsellor.
My d would now be very afraid and scared of a weight loss and ask me for help how to get that back asap. That would be recovery behaviour - to accept there is a problem and wish to change it.

Go back to short term weighings and add food again and I am sure you will get back on track. It is maybe just a blimp.
Did she grow? Mine grew 1,5 cm at age 18 after not growing for 4 years before...this also happens.
Keep feeding. There is light at the end of the tunnel.
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Mamaroo
I'm glad the counsellor picked up on the cons of driving, she sounds like a gem! Paying for clothes sounds like a good idea for me as well. I would add that you pay and that you won't hand over cash. A weekly incentive is better than a monthly one. Depending what you can afford, you can give her a gift card (Myer, Target) every week or if she wants to buy online, you can do the checkout with PayPal. In this way you're sure where the money is going.

As for paying for gigs, maybe you can start smaller. These days a lot of coffee shops have live bands and we go to a church where the band brings the congregation to its feet. Local councils also have music festivals, but just check it out, because there might be alcohol and drugs there. 

Follow your gut with the piercings, I agree with you not to get a tongue piercing as it may make eating difficult. I know it is very fashionable for young adults to get piercings and tattoos, but maybe you can offer to pay for a haircut or have her nails done. They beauty of it is it doesn't last and then she has further incentives to have her nails and hair redone. 

Good luck with your appointment today
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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