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

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Hendrixt
I am always sad and quite terrified to read members’ posts which include descriptions of their children engaging in various degrees of self harm and even suicide.  So I had been feeling quite lucky that, up until now, we have not had this problem with our D. 

She was diagnosed AN in May, having been restricting since January and for the last two or three weeks has been hovering around weight restored at the lower end of her healthy weight range.  Her mood is much improved after four months of solid re-feeding and when she occasionally has a low mood she bounces back pretty quick and is back to her old self.

Her eating has been good of late, we still supervise all meals and are keeping the calories up but she is just having a bit of a setback after restarting school.  This week she had her first weight loss for a number of weeks but whilst we are in full control of eating I think we can rectify that and we were expecting that the return to school might cause a blip. 

However, tonight she disclosed that she has been scratching her arm when feeling anxious, mainly at school.  She says that she does it until it really hurts and then stops and it usually leaves a red mark which disappears. Obviously, this is quite a low level of self harm and I almost feel people will think it is a tiny problem compared to what some parents have to deal with but I find myself feeling quite panicky about it as I don’t know anything about how to deal with self-harm.  

We’ve tried to reassure her that it’s a common reaction to anxiety, to not feel ashamed about it and to try to come and talk to us when it happens.  This was an on the spot reaction to the disclosure that she made as I haven’t done much research about self harm, but I feel we should be taking some more positive action to prevent it from getting any worse.

I’m wondering if anybody has any experience of tackling self harming behaviours at an early stage and nipping it in the bud before it has got worse? 
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Foodsupport_AUS
This is definitely a behaviour that is very common. My D also started with scratching but unfortunately it did elevate to much more serious forms of self harm. So I can't say that I can offer you advice to nip it in the bud. I was also aware of this at an early stage, and like you tried to focus more on why she felt the urges to self injure rather than that the behaviour itself was bad. 

There is evidence that the urges can get stronger closer to weight restoration and certainly that was the case for my D as well, and then continued for several years. 

There are a number of threads that have addressed this previously if you search. 

The best advice that most give is to reassure and not make the behaviour itself shameful. To discuss less harmful ways to self injure or divert when the urges arise - examples include shredding paper, scribbling, using a rubber band and flicking, holding ice cubes till they melt etc.. Some will find this helpful, others not so much. My D has had extensive therapy with a psychiatrist and part of that included ways of reviewing those urges and learning to deal with the emotions that led to them more constructively. She has not self-harmed for around 6 years.

Edited to add: self injury can be a precursor to suicidal behaviours though most of the time it is not. Clearly this needs to be  assessed carefully. 
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
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Hendrixt


The best advice that most give is to reassure and not make the behaviour itself shameful. To discuss less harmful ways to self injure or divert when the urges arise - examples include shredding paper, scribbling, using a rubber band and flicking, holding ice cubes till they melt etc.. Some will find this helpful, others not so much.

Hi food support. Thanks for the advice. Sorry to hear what happened with your D - it’s got to be one of the worst things to watch your child damage their beautiful body. My wife told her we would get her something to put in the pocket of her school blazer (sounds like it’s mainly happening at school) to manipulate- maybe a stress ball or something. 

My D has had extensive therapy with a psychiatrist and part of that included ways of reviewing those urges and learning to deal with the emotions that led to them more constructively. She has not self-harmed for around 6 years.

Edited to add: self injury can be a precursor to suicidal behaviours though most of the time it is not. Clearly this needs to be  assessed carefully. 


We are under CAHMS in the UK so I’m going to let her therapist know   Her mood in general is much improved firm the early days of  refeeding  so hopefully it’s not going to get to that level.
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tina72
I think it is great that she told you and it was her way to ask for help to stop it and she came to YOU! What a great compliment!

First aid: I would ask her in what situations she does it and for school you could give her a stress ball to knead when she feels the urge to scratch her arms. Now in the cold time of the year you can ask her to wear long sleeves that cannot be easily rolled up (if she does not wear a school uniform there).
You can make sure she has nothing available to scratch herself with like scissors, paper clips (that was what my d used) and compasses.
Target must be to stop it by making it impossible but if she uses her finger nails you can only ask her to keep them short to avoid that.

If she does it at home a punching bag might help (here it did).
Keep feeding. There is light at the end of the tunnel.
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Hendrixt
tina72 wrote:
I think it is great that she told you and it was her way to ask for help to stop it and she came to YOU! What a great compliment!

First aid: I would ask her in what situations she does it and for school you could give her a stress ball to knead when she feels the urge to scratch her arms. Now in the cold time of the year you can ask her to wear long sleeves that cannot be easily rolled up (if she does not wear a school uniform there).
You can make sure she has nothing available to scratch herself with like scissors, paper clips (that was what my d used) and compasses.
Target must be to stop it by making it impossible but if she uses her finger nails you can only ask her to keep them short to avoid that.

If she does it at home a punching bag might help (here it did).


Thanks Tina - hope you are well. We've asked her when she does it and it seems it's all happening at school, which doesn't surprise us and that is where she is most under stress. We're considering getting teachers to keep an eye on her but are a bit cautious at the moment as the teachers, though well meaning, have previously been a bit clumsy in dealing with her ED behaviours. We are going to alert the main point of contact that we have in the school though. Today we're going to look on the internet for some sort of stress reliever/manipulator that she can keep in her pocket and she has agreed that might be a good idea. They are in school and are required to wear their blazers (jackets) at all times, even in class, so she wears ling sleeves anyway, but with it being a blazer the sleeves are quite wide and can be pushed up.

At the moment she is not showing any signs of using an implement to hurt herself but we will monitor her very closely for this

Thanks as usual for your very helpful advice
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tina72
Thanks for asking, we are VERY well, just came back from first holiday with really NO AN on board and we have seen so much progress in these weeks we are totally happy. I would dare to say 100 % recovery now but I am still alert.

Although I might risk to get torpeded by the mods here again: Have you checked her cortisol level? Cortisol is a stress hormon that is normally high at the start of refeeding but should get back to normal levels with time. In some cases it does not due to Vitamin B 12 deficiency for example (that was the case here too).
The moment we put the cortisol level down the moment her stress management was WAY better than ever before in her life. She is now much more relaxed about grades and doing something "wrong" as ever before.
Keep feeding. There is light at the end of the tunnel.
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deenl
@Tina It is not our intention to torpedo you, or any member, but the moderators feel it important to address medical information factually. We were actually contacted by an endocrinologist (a doctor specialising in metabolism and hormones) to say that testing would be inappropriate. It may, of course, be that practices differ in different countries and it is always best to discuss medical issues with your own doctor. 
2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, stable but no progress. Medical hosp to kick start recovery Feb 2016. Slowly and cautiously gaining weight at home and seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • Swedish proverb: Love me when I least deserve it because that's when I need it most.
  • We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.
  • If the plan doesn't work, change the plan but never the goal.
  • We cannot control the wind but we can direct the sail.
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Hendrixt
tina72 wrote:
Thanks for asking, we are VERY well, just came back from first holiday with really NO AN on board and we have seen so much progress in these weeks we are totally happy. I would dare to say 100 % recovery now but I am still alert.

Although I might risk to get torpeded by the mods here again: Have you checked her cortisol level? Cortisol is a stress hormon that is normally high at the start of refeeding but should get back to normal levels with time. In some cases it does not due to Vitamin B 12 deficiency for example (that was the case here too).
The moment we put the cortisol level down the moment her stress management was WAY better than ever before in her life. She is now much more relaxed about grades and doing something "wrong" as ever before.


Ill check this out with our doctor Tina. She’s due to go for some bloods - thanks for the advice as usual 
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tina72
deenl wrote:
@Tina It is not our intention to torpedo you, or any member, but the moderators feel it important to address medical information factually. We were actually contacted by an endocrinologist (a doctor specialising in metabolism and hormones) to say that testing would be inappropriate. It may, of course, be that practices differ in different countries and it is always best to discuss medical issues with your own doctor. 


I knew that this will happen 🙂.
Here in Germany/Europe it seems to be different and our GP tests that with all his ED patients. The testing is even paid by the health insurance.The endochrinologist we went to see because of her bad dexa scan also asked for this as part of the actual blood testing next week. Different doctors, different meanings. See 2 and you get 3 different opinions 🙂.

A swiss protocoll for ED labs is also demanding to check the cortisol levels.
https://d28lcup14p4e72.cloudfront.net/4830/4553653/Laborparameter%20Essst%C3%B6rungen.pdf

I will not post the medical publications about this here again, if someone is interested in it you can contact me privatly.
And of course, ask your doctor about it. You need to do that anyway because you cannot test that alone 🙂.
Keep feeding. There is light at the end of the tunnel.
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