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

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verytired
So we're in year 6.   (Shout to all of you fellow long timers.)  Our daughter is feeding herself most of the time - we do part of breakfast (a super high calorie smoothie) and we sometimes portion out dinner cause sometimes we portion out for the entire family.    Still very rigid eating patterns although she's eating out with friends more often.

We've agreed with the therapist that she needs six months of completely independent eating and maintaining her weight before she can leave for college.   The therapist has been great helping us - explaining that we need to see six months of her being able to make a decision to eat more if she drops a bit of weight.     

So we're trying to figure out some specific rules - as much for husband and I as for her.   I know we'll be tempted to give in on this one.   And our therapist has impressed on us that we need to worry about trending behavior.    So the first rule is she can't lose any weight three weeks in a row.      However, mathematically, she could still follow this and lose weight in the long run.   I feel like there's some formula we could apply that we could all agree to which would reflect a downward trend over a longer period of time.    It may seem like we're overthinking this, but I think super clear rules are going to help all of us.   Maybe it's just setting a lower limit - if you every fall below x weight, that's it.      Any advice on this?

We want to start now so she has a few weeks of practice under her belt where there's no consequences before we start the official count down in March.    I'm not super hopeful, although she is putting in some effort.   She took seconds at dinner on her own for the first time in six years the other night - ok, it was just a spoonful of salad.   I'd love to say she then said "Mom, I really like this salad.", but it was really her forcing herself to do it.

On a side note, I could just curl up in a ball in bed thinking of her "failing" in March while college acceptances are coming in, plus facing the long summer and then fall, when her friends head off on their adventures.   Our therapist reminded us that if she "fails" in March knowing what's riding on this, that is very, very interesting information and tells us where she's at.
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MKR
Hi @verytired ,

After 6 years, do you think your daughter is motivated enough to recover? Sounds to me you all want her not to be left behind when her friends "head off on their adventures". Would staying at home for another year or two be difficult for her?

If she is really keen to go, you can support her gaining weight until she leaves, to create a buffer. The first weeks in any new place are very draining on the mind and body. And while you are at it, you can encourage her to a few challenge foods, by saying "I know you can do it."

As for the possible long-term weight loss, you can record the weight at the start and agree to do checks every month when you go and visit her. And same action can apply where there is a downward trend. 

Of course, in practice it's a slightly different story, but these just some suggestions. 
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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ValentinaGermania
verytired wrote:
So we're in year 6.   (Shout to all of you fellow long timers.)  Our daughter is feeding herself most of the time - we do part of breakfast (a super high calorie smoothie) and we sometimes portion out dinner cause sometimes we portion out for the entire family.    Still very rigid eating patterns although she's eating out with friends more often.


Sounds like there are some of ED behaviours left. Can she chose between two snacks and will not chose the less caloric one? Can she plate herself good portion sizes? Is she snacking in between meals and eating sweets and crisps and fast food too? Any fear food left? Is she truely WR for more than a year?
If you say no to one of these questions, she might not be ready for college in my eyes.

verytired wrote:
We've agreed with the therapist that she needs six months of completely independent eating and maintaining her weight before she can leave for college.   The therapist has been great helping us - explaining that we need to see six months of her being able to make a decision to eat more if she drops a bit of weight.     


That is a good decision but I personally would not only concentrate on the number on the scale. State, not weight alone. She should be free from ED behaviour for at least 6 months (better 12).

verytired wrote:
So we're trying to figure out some specific rules - as much for husband and I as for her.   I know we'll be tempted to give in on this one.   And our therapist has impressed on us that we need to worry about trending behavior.    So the first rule is she can't lose any weight three weeks in a row.  However, mathematically, she could still follow this and lose weight in the long run.   I feel like there's some formula we could apply that we could all agree to which would reflect a downward trend over a longer period of time.    It may seem like we're overthinking this, but I think super clear rules are going to help all of us.   Maybe it's just setting a lower limit - if you every fall below x weight, that's it.      Any advice on this?


We have a contract here with our d (she was 17 at diagnose and 1 year WR when she went to University at age 18 and is 20 now).
No moving out in the first year. Half schedule in the first years. At least 3 days in the week she needs to eat at home.
She needs to eat 3 meals 2 snacks (we never had 3) and she needs to eat at least 1 warm meal in the cafeteria every day.
She needs to maintain her weight. A 2 kg weight loss means 2 weeks to turn that around and if not a gap semester at home to refeed her.
She needs to see her GP regularly for weighings and blood and other checks and keep us informed about the results.
WE pay for all but that is what she needs to do. Super clear and strict rules helped a lot here. We had no relapse in the last 3 years (knocking on wood).
You pay the bills so you can set rules.

verytired wrote:
We want to start now so she has a few weeks of practice under her belt where there's no consequences before we start the official count down in March.    I'm not super hopeful, although she is putting in some effort.   She took seconds at dinner on her own for the first time in six years the other night - ok, it was just a spoonful of salad.   I'd love to say she then said "Mom, I really like this salad.", but it was really her forcing herself to do it.


Sorry, but a spoonful of salad is no real second in my eyes. 🙂. A spoonful of pasta with sauce or another slice of pizza would be a good sign.
It is a good idea to start now and see if she can manage it so you would not give her false hope for college in fall.

Please think about a plan B. A lot of kids here had a gap year before they went off to college or university to make sure they are really ready for that. I think that is better then need to pull her out again after some months when she has made new friends there...
Keep feeding. There is light at the end of the tunnel.
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Foodsupport_AUS
I also wonder if the time line is a bit short for this. I truly understand the long journey you have been on so far. 10 years here. If the plan is for her to go away far from home without a risk of needing to come home during her first year she needs to really be well established at self feeding and maintaining her weight for  some time. It does not sound like she has hit true recovery yet.

Some thoughts - set a weight close to where she is that is an automatic not ready. 
If she loses a bit towards that weight she has X weeks to make it up. 
She needs to be able to choose enough to eat when eating out, when exercising, when schedules are not always conducive to eating regularly. All of these things happen at college and she needs to be able to manage through out. 

I know that my D was desperate to not take a gap year. She would not hear of it, she is stubborn as is the trait with so many of these kids. Here they don't have to pay for a university degree, they get an automatic loan so there was little one could do to stop her attending a local school. Despite that we practiced for a full 12 months before hand and it did take her six months to get things truly worked out. She can now manage things pretty well, but does eat to a plan of sorts. I don't expect my D to ever be able to eat truly without one, since she had terrible hunger/fullness cues way before ED. 
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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ValentinaGermania
Here are some great articles on that topic:
https://www.eatingdisordertherapyla.com/is-your-young-adult-with-an-eating-disorder-ready-for-college/
https://www.verywellmind.com/starting-college-without-ed-1138285
https://www.noodle.com/articles/advice-for-teens-going-to-college-with-an-eating-disorder
http://www.eatingdisorderhope.com/recovery/self-help-tools-skills-tips/college-life-staying-in-recovery-from-an-eating-disorder-when-going-away-to-college

Foodsupport is right, most difficult thing for our d was
a) eating with a lot of people around in the cafeteria
b) need to chose something caloric from the cafeteria meal plan (and sometimes the meal she has chosen in the morning was out when she arrived for lunch and she needed to decide new very quickly)
c) different schedule and delay of meals/snack due to delayed lectures sometimes
d) stress with transition, new friends, new challanges
Keep feeding. There is light at the end of the tunnel.
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mnmomUSA
We have "green light" weights, "yellow light" weights, and "red light" weights in a verbal contract we have.  At "yellow" light, she needs to get her weight back up....if not, I come and live near her and work with her to get her weight back up.  Fortunately, I'm retired, and her college town is only 3 hours away (with inexpensive Airbnb type places).  Red light is withdraw from college and return home.  We've never even gotten to yellow light.  Her weight HAS dropped (still in green light area), and she's quickly done the work on her own to get it back up.  She's doing great.  But, we had this plan in place "just in case."  Also, for her first year, I purchased tuition insurance.  You pay up front each semester and it's generally completely non-refundable if you withdraw.  I felt better knowing I could get it back if she had to withdraw.  This year, we are flying without it because she has done such a great job.  

Should also add that we had one semi-trial run period before she left for college. She did an 8 week European trip where she stayed with the family of my exchange daughter in Berlin.  The mother of that family was well aware of her illness, but still my daughter was without my constant support.  She did ok on that...losing only a pound or two, which I considered a good sign, given the unfamiliar foods and environment.  Last summer, after her first year at college, she lived the entire summer at a sleep away camp where she was the "drama director" (a title I loved...but really she did the theater program at the camp), and she came home a good 5 pounds heavier than when she left.  Impressive.  It was that summer that convinced me I no longer needed to purchase tuition insurance.  

The 6 month rule is a good one...at least.  My daughter had been weight restored and in good mental health for at least a full year before her Europe trip.  (For the record, my daughter is 20, despite what it says in my signature line...I try to edit it, and it keeps reverting to the age 18 line....so we are just about 7 years in at this point)
D, age 18, first diagnosed March 20, 2013, RAN, at age 13 Hospitalized 3 weeks for medical stability. FBT at home since.  UCSD Multi-family Intensive June 2015. We've arrived on the other side.  :-)  D at college and doing great!
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Kali

Hi Verytired,

There might also be another option. Is she perhaps able to apply to universities which are fairly close to home?
Maybe an hour or even two by commuting distance away for example? There is nothing wrong with going to school close to home although I'm not sure of course what is possible where you live.

Our d. tried a semester commuting an hour each way to school part time while living at home, to see how she would manage that. When we saw that she could do that we let her go further away and take on a full time course load. Sometimes trying to get them interested in their future, trying to replace the eating disorder with a life worth living and keeping them safe at the same time can all come together, and going to school nearby can be an option.

A trial trip is also a good idea to see how she would cope. Can she go away for a few weeks with friends or attend some kind of educational course for a few weeks away from home where she has to feed herself to see how she manages eating and weight wise? That would give you an idea about whether she is ready or not. We tried that at one point.

warmly,
Kali

Food=Love
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Torie
Forum member Hopefulmama was really helpful to me - do you remember her posts about requiring her d to take a gap year?  If not, it might be worth looking them up to help you feel a bit more comfortable with that idea just in case.  Her d of course hated the idea and fought back, but in the end, everyone including her d agreed it was really good her parents had required that.  I seem to remember that the d herself recommended a gap year to others, as it had clearly been the best solution for her.

Gap years have become much more common in recent years; many students now opt for a gap year for reasons unrelated to health. 

I'm not sure if you have older kids or not, but if so I bet you would agree that adjusting to university away from home is challenging even for those without ED.  

Finally, if you are thinking of tuition insurance, please be sure to read the fine print.  For one thing, I think they do not pay unless your d is ill enough to require hospitalization. 

COngratulations to you and your d to have made enough progress to even consider university away from home. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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ValentinaGermania
We also have the rule that she needed to chose a university that she can reach by public transport and stay living at home in the first years. I forgot to mention that.
Keep feeding. There is light at the end of the tunnel.
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needhelp
Hello - since I have a D close to your D's age, I thought perhaps I could maybe add something.  

First, I have to agree with a previous post - if she is not able to be "bribed" to meet her eating needs to go off to college, perhaps she truly isn't ready.  My daughter developed her ED while at college. She had to come home - but insisted she would not drop out or drop all classes.  She kept 2 or 3 (I don't remember)- and we ended up driving her each way (4 hours) for tests, etc.  But she was determined - and we found that a carrot to dangle in front of her was extremely motivating.  I think part of that desire was able to blossom when she got home - because getting to class - before I got that call to let me know what was going on - was a struggle.

 There was another suggestion to go some place closer. Colleges will often let you delay attendance with a medical issue.  If there is a community college nearby, or a branch of a larger school - that might work as a a good transitional year.  It is a lot to balance college and the change needed to overcome ED. Although my D eats independently, out with friends, etc. she still avoids the school cafeterias.  She prefers her apartment and preparing her own meals, or going to restaurants (and even grabs smoothies!).I add that because, I don't know where you are, but in the USA many schools require freshmen to live in dorms and use the school meal plan. The cafeteria can be very overwhleming, and also an easy place to just grab a tiny bite of this and that (my D did it by just getting a few baby carrots, some green beans, and plain lettuce - enough to sit sociably with friends and not take in any calories).

I know it would be painful to watch her friends go off to school, and reach that next milestone - it is important that you judge if you feel this would be a safe and successful step. Do you think having her friends go off would motivate her?  College has so many new adjustments to be made.  Does she have an activity or passion that she could join a club or team? I add that so that she doesn't get lonely and has a peer support system. It might also inspire her to eat (for my D's activities she needs to have a lot of strength).  One of the suggestions we followed (that we learned form this amazing site) was to arrange for our D to have a regular counselor when she got back to college. This way she had to meet with him once a week, and we had professional eyes on her. She did that for a semester. She also needed to Face Time us weekly (we needed to SEE her) - and we did  see her about every month.  I think a very strong safety net is vital. Her roommates and friends were also on board - so that was very helpful.  An important consideration for college is to make sure to minimize the alone time - because ED can really take over in those situations.

I hope this is helpful.  I would love for you to benefit from the challenges we faced, and from the wonderful advice we learned from this site.

Hugs : )
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