My d (at 14 yr) was diagnosed with AN in August of 2018 and she ended up in hospital for 10 days right at the start of an outpatient program (low ekg). Earlier that spring I noticed she was getting super anxious and we started to run together, me thinking it would help anxiety. This became consuming for her and her weight dropped 10 lbs and was accompanied by restriction. When she got out of hospital we started the outpatient program and re-fed her to their suggested weight and then they told us that she was ready for phase 2 and choices, and back to pediatrician to track for weight. The program wasn't helpful because they only did group therapy weekly and the facilitator was allowing an older girl to monopolize the conversation regarding her pan sexuality. My d was adamant about not going, and I thought we could maybe find a better solution too. If she did not do that group she was seen on a monthly basis by eating disorder psych. I wish I would have looked for outside therapist right then! Team decided to let her try to get her period at this weight because she felt like it was the right place (where she had started her period fall of 2017). I was skeptical!
She started playing HS basketball Nov 2018 then lacrosse in spring 2019 and maintained this weight within a pound up or down for the next year but never started menstruating again (she only had 4 months of spotting in 2017 then she stopped). Summer 2019 was difficult with no school schedule and me feeling like I had no leverage to feed her, she was choosing most meals and refusing some of her snacks). When she would dip a pound or two I would try to get her to eat more and she would go back up the pound or two. November 2019 the doctors said she needed to gain more weight (and gave a new range) before she was 16 and that they were worried about her bone density and the length of time without period. Test ordered and hormone levels checked. Bones were fine but she had low estradiol. Holidays, weekly weight checks with pediatrician, and then I researched and found therapist outside of our network to work with her weekly in late February. After 3 weeks of "seeing if she could do this on her own (back off mom)" therapist changed tactics quickly and suggested that we do a 3 week trial (if you don't gain weight you will need higher level of care). After the first 3 weeks (during covid, I blind weighed her at home twice but no dr visit, therapy on zoom which actually works well for her) I decided to bring her back to pediatrician. I asked her pediatrician to send a follow up note with instructions and when therapist, dr and I were coordinated she started to gain weight. Therapist pushed for higher level of care at start of this trial and just when she started gaining there was already a panel decision for residential treatment. D was deciding to gain weight, choosing food and eating sweets etc. Not a ton of freedom with what she was eating but feeling positive and encouraged. Now weeks later she has gained each week and as of last week was a pound off of new range. She was put in IOP an hour away but almost all on zoom. It has been 2 weeks while waiting for bed in residential and I am really conflicted. D just started doing the group meetings, psych and dietician yesterday for first time in the two weeks. She is so upset with me because she "was gaining" already and doesn't think she needs this. Her outside therapist is still tracking with her weekly in addition to these other appointments. I am really conflicted about sending her into residential treatment when she is gaining weight at home. This IOP is more concerned about her behaviors: eating 100% of plated food and actively participating in getting better in these zoom meetings. (I never required her to eat 100% when she was gaining initially when out of hospital so this feels weird to both of us) She does leave bits of food sometimes but is solidly eating 3 meals and 3 snacks and has been for 6 weeks now. She had been choosing well for herself before the IOP but lacked variety. I have expanded variety and she is managing that well too. I think she is angry about working hard and being told she is sick enough to go into this IOP or a residential program. Honestly this is the hardest I have seen her work this whole time. I also know that this is coming at a cost to all of us (H, 2 older siblings at home from college during covid and of course me...the one who does the work and takes the heat). I don't think she has an exercise compulsion although she is an athlete and enjoys exercise she has been willing to lay low and has been conservative on this front. She is constipated and has trouble drinking water because she is full. She might be in extinction burst or just really upset about being "threatened" to higher level of care when she is working hard but she does call me names and yell and is inconsolable at times. She feels alone. I want to comfort her but she won't accept right now. Huge toll on our relationship because we have been through so much to get to this point! On flip side she has been relating to dad and siblings in more positive way and seeking out friends on video calls so lots of plusses too.
I would like perspective on the decision to send her to residential (6 bed home, own room 4 girls there now age 12-17) or if we should keep on at home with the outside therapist and the IOP program. This is the first time in a year and a half that she has had a co-ordinated team and she was gaining weight before she got to the IOP. She is physically more sound than she has been in past 2 years and estradiol level on the rise. If she goes to residential she will step back down to this same program. After the things I have read here I am concerned about sending her away and then having her come back home! Also, this program will not take D if she doesn't want to go...which I am sure she does not! Any advice from people who have been through this is welcome. Sorry for the long ramble of details!!