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

Welcome to F.E.A.S.T's Around The Dinner Table forum. This is a free service provided for parents of those suffering from eating disorders. It is moderated by kind, experienced, parent caregivers trained to guide you in how to use the forum and how to find resources to help you support your family member. This forum is for parents of patients with all eating disorder diagnoses, all ages, around the world.

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Hendrixt
Hi All. I am new to the forum so please excuse any clumsiness. 13yrs D had anorexia for 5 months diagnosed a month and now into 4th week of re feeding, accessing FBT through CAMHS in the UK. D is now eating nearly 90% of the 6 meal a day plan [established prior to receiving CAMHS involvement]  with the odd meal not completely finished. We have the clear the plate rule so each unfinished meal leads to meltdowns but we push through these and still insist that the meal is finished. On those few occasions that the ED has decided the meal wont be finished we have been unsuccessful despite compassionate but persistent and firm prompts to finish. D has now developed a routine where, once she has decided to finish the meal, she immediately runs straight upstairs and locks herself in the bathroom, stating that she will not come out until the food has been disposed of. The lock is not an issue as it can be operated from the outside but she sits against the door so we don't want to risk hurting her by pushing the door against her. We are sure there is no purging and no risk of self-harm at this stage. We have thought of taking the door off [which would mean taking off all upstairs doors as she could just go into another room] but we wondered whether anyone has come up with a strategy to avoid the child getting into the room in the first place - yeah it's a long shot but thought I'd try.
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sandie
I think you sound like you are doing an amazing job getting 90% of meals in at this stage. Well done. And well done to your D too! We have not had issue you describe as usually once we get to table, she eats meal but have had to spend hours sometimes talking to her to persuade her to come to table. If it is just odd meal not completely finished, maybe you don't have to worry so much.......i suppose you could talk gently to her outside bathroom door for period of time. Have you seen Eva Musby's resources- book, website which describe some approaches. Xx
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Jojo2271
Hi Hendrixt and welcome to the club no one wants to be in !
Loads of wonderfully supportive people here.
First thing..well done at refeeding at home and getting 90% in. It is soo sooo hard.
I would want to know exactly what does she mean by the 'food disposed of' ??? that implies purging, hiding it up sleeves ect and flushing it down loo or exercising in bathroom .
Is she having steady weight gains ? if yes then maybe she just needs the time away from the dining table after meals...but this needs to be in your line of vision and definitely not in a locked bathroom.
I can only sympathise, as fighting the ED behaviours especially early in re feeding is utterly exhausting, you feel your walking on egg shells , you dont want to disrupt what fragile progress you are making etc etc.
I would try to talk to your d about this at a safe good point, so not around meal time or while she is in the bathroom. try to pick a calmer moment and ask her why she needs to do that, explain you need to keep her safe and she needs to either let you in with her, or she stays with you somewhere else.
I read recently on another thread that some parents allow a very slow, gentle 10 min walk after meals ..if your d is not dangerously low weight maybe that might be something ? it is a balance between using precious calories needed for WR vs calming her after eating ...a supervised very gentle stroll might not wear of many calories.
Or yoga ? when i was trying to re feed at home ( and now when d  on home leave) i did yoga with my d after meals.
I used adrienne yoga on you tube and there was loads of 10 min sessions, we chose the ones for anxiety and for calming ...
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Hendrixt
Hi Sandie - yes Ive read all the Eva Musby stuff and when D is in the bathroom we give her plenty of empathy and support without giving in to the ED. We can usually calm her down, talking to her, but the stalemate remains.

Jojo – thanks for your kind words. By ‘disposed of’ I mean that she knows the food is still on the plate waiting to be eaten while she remains in the bathroom and the ED is demanding the food is ‘got rid of’ before D will come out of the bathroom. I’m sure there is no hiding or purging.

Over 2 weeks she’s had a 0.6KG gain. Usually following a meal she likes to sit in on the sofa with mum & dad, cuddling and watching TV, so I think our measures to handle post-meal anxieties or not a problem. The flight to the bathroom only occurs when the ED has decided the meal will not be finished and is a strategy to avoid any further attempts to prompt her to finish the meal.

I’ve talked to her when she’s been completely calm, at those times we only get a window of about a minute or two before she becomes anxious about talking and closes up. She says she does it to avoid eating the meal. She’s agreed to try not to do it, which is progress and I’ve suggested that if she can’t resist doing it she could allow us in the bathroom with her to keep her company but she’s not sure about that. I have already suggested she goes somewhere else but that wherever that is, she does not lock herself in as we need to make sure she is safe and not lonely.

Thanks for the suggestions about yoga – I will look into that


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scaredmom

hi there,  and a formal welcome from me too. 
Very good for getting 90% in!! It is hard to do that right at the beginning. 

Please read around the forum and the FEAST site for information as well.
https://www.feast-ed.org
We can share our experiences and offer some tips and feel free to use or discard anything you wish. 

A couple of things pop to my mind:
1: How to stop the locking away in the bathroom: take the doors off. This behaviour if you let it continue,  will be hard to extinguish later.  When ED takes an inch, he will take a mile. Many have had to resort to extraordinary and creative measures to ensure that the food gets in. 
I would discuss it with her in a quiet moment and tell her that is your job to keep her safe. 
2: when she does not finish all of it, do you then give what is missed in another meal or snack or a supplement to make it up?
Sometimes knowing more is coming or that she will have to have some ensure, may make her eat it all? 

Some have had to take all the doors off, locked windows for safety and to ensure that no food is thrown out, taken car keys away to prevent fleeing. 
Some have "pinned" the child in between the wall and the doors so that the child could not escape. 
I know she is trying to agree to eat everything and that is your real D inside, however getting agreement from her may not work. Her ED may be very strong sometimes and YOU will need to fight it for her. She may not be able to do that just yet. 

I found with my d we could not discuss anything about ED with her or her behaviours (she was 11 almost 12 at the time). We just had to be silent when she ate and even had to avoid eye contact. When she would throw the food, I plated it over and over again. When she ran, I took the food to her. 

How are you doing? 
Please ask all the questions you have. There is a load of experience and kind people here and we all wish to help.
Welcome, again


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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Hendrixt
Thanks Scaredmom.  Yes, the removal of all the doors, we have not ruled that out but as you suggest it may be worth talking to her about it which we have done. There hasn’t been an incident since we spoke to her but I’m not sure whether that’s to do with the talk that we had with her, we will find out soon enough. 

 We have been calling a halt to the situations after about an hour and a half when I have simply said okay we’ll leave it at that you’re doing well but the food you have missed will have to be made up in the next meal, and then we have made sure that we have given her something extra to make up for any lost calories. However I’m not sure that the fact that she would have to eat more food later stage had any impact, I suppose with some kids it just doesn’t. 

How are we doing? Well I suppose we are going from times of total utter despair to times when we feel more positive. Having only just started refeeding we have quickly realised that this will take over our lives completely for as long as it takes but that our priority, whatever happens, is to get our daughter to a healthy weight and we will do everything we can to make sure that happens, and if more extreme measures are required then that is what we will have to do. 
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sk8r31
A warm welcome from me as well...really great start you are making on this challenging journey!
Helping a loved one recover from an ED requires a steep learning curve; sounds like you are well on your way to getting a handle on getting food in and working towards nutritional rehabilitation as quickly as possible.  You may want to aim for a 1kg/gain per week...that is entirely doable, and it is preferable to get weight on as quickly as is possible.  It's going to be a struggle for your d, until she is back on her growth curve and her state improves...it can definitely take longer than one wishes, so getting weight restored as soon as possible is the goal.

The door may need to come off...but strategizing a Plan A, B, & C is a good idea.  You and your wife can decide together what you'll try first, and what you might do if the first option doesn't work.  There is a lot of trial and error involved in finding the best way forward for your d and your particular family.  Remaining calm and projecting confidence (even when you're quaking/raging/terrified inside) is the goal for you & your wife.  You've got this.  Your d is lucky to have you in her corner.  Wishing you well on this path, and happy to help as needed with any questions or concerns along the way.

One new resource I wish had been available when we were starting out with refeeding is a book by Lauren Muhlheim called When Your Teen Has an Eating Disorder.  It is practical and straightforward.  I've read it, and think it will be so helpful to those beginning this journey.

Warmly,
sk8r31
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
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Jojo2271
Aha.. Understand now. 
I think if you are getting the extra calories in at next meal without huge resistance that is brilliant. 
You could give ensure or fortisip to make up missed bit of meal  Perhaps in the bathroom 
It is fine line between challenging Ed behaviours and compromising of they are eating. 
You sound well on to it.. Amazingly strong. 
I am 11 weeks in, d in IP care and I am still in complete traumatised shock
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tina72
We had a similiar problem here, took away all door keys and had to lock dining room door until the meal was finished at some point. We had also front door locked and key in parents pockets. We made her sit between us for meals which made it harder to storm off. When she did we followed her with the plate.
Just to give you some ideas maybe.

By the way, a very warm welcome from Germany!
Keep feeding. There is light at the end of the tunnel.
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Hendrixt
Jojo we’re the same - life just turned upside down. Some meals are such a challenge. However this all turns out things will never be the same. 

Hi to Tina from here in the UK. These ideas are similar to some of the things we’ve discussed as we would like to prevent her from getting to the bathroom in the first place. Once she is in there I think the ED is more in control than when we are all in the same room. We’re looking at some sort of physical barrier but not sure how she will react as she is very aggressive, although she hasn’t attacked us yet. The room where we eat has only one more and it’s possible I could make it to the door before she does to present a physical barrier. However we’ve thought, if we put a lock on the door we may not get her into the room to eat the meal in the first place - so then she wouldn’t eat anything at all. 
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mtkmbc4
Sending support your way. I hope you can find a way to physically contain your daughter and keep her out of locked rooms. I know that in my house it isn’t possible to prevent escape from the house (entry/exit doors to the outdoors cannot be key locked on the inside—such a lock would be quite a fire hazard) and windows cannot be locked to prevent exit from the inside, only entry from the outside.

I’m hoping that your daughter will calm down sufficiently to make it safe for her to be in your home. It sounds like you are concerned about her becoming physically aggressive if you attempt to block her from fleeing your dining room. 
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Hendrixt
Thanks for the kind words M. Yes I do worry that if I physically stand in my daughters way, to block her access to rooms where she can lock herself in, she may attack me, something I want to avoid as I don’t want her to get hurt; for example it she was to try to strike me and I grabbed her arm this could hurt her. I think it’s best to avoid any physical confrontation if I can and not create a situation where it is more likely. 

I see you have greater difficulty in that you can’t prevent yours from leaving the house completely which must be very worrying. Do you have the same problem? Does your child access rooms which can be locked from the inside?
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tina72
Another idea is to just take away the doors of the rooms she "locks" herself in one after the other so she sees that she will not succeed with that behaviour.
If she gets violent I would tell her that I will call the police. That is not acceptable.
My d did not get very violent, mostly with words and screaming but not with physical violence. But I know kids that crashed nearly half of the furniture in bad days.
The food must go in and it must be clear that it will go whatever she does or you will have a terrorist in your house quite soon.
Keep feeding. There is light at the end of the tunnel.
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Tica
We started to anticipate when our d would do similar and one of us stood in front if the kitchen door so she could not leave the room until we decided she could- at first this resulted in amazing tantrums and amount of mess, but with persistence and endless replateing of food, this phase did pass. 
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Hendrixt
We haven’t had a locked in the bathroom incident for over a week now. How it worked. I spoke to her when she was calm and simply pointed out we would tolerate it. Also I sit on the edge of the seat potentially ready to jump up and stand in the doorway to prevent her getting to the bathroom. It’s quite clear from my posture that I am ready    Hopefully that’s solved that, for now anyway 
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scaredmom
That is great!
way to go!!
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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sandie
Well done. That's great. We have also found setting rules and being clear about what won't be tolerated can work really well - if both parents are united about them.
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Hendrixt
sandie wrote:
Well done. That's great. We have also found setting rules and being clear about what won't be tolerated can work really well - if both parents are united about them.


Thanks Sandie - the other night, in the middle of a massive violent rage, she actually threatened to go and lock herself in the bathroom. I reminded her that I told her that was not allowed and she remained where she was and did'nt carry out the threat. Amazing that she stuck to it despite having totally lost it. She didn't finish the meal though ðŸ™„. however it's good that we've somehow managed to close off that particular avenue to the ED without resorting to extreme measures, for now anyway
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scaredmom
I found too once I gave her my expectations and reminded her in the moment she halted
that behaviour.
my d threw a lot and when I reminded her that we do not accept any violence she stopped.
i remember a plate being held up in the air with food and  I said ‘we do not throw here. That is not acceptable. She put it down and then said - I really hate you!’ That was Ed and she needed me to put the rules out there so she could tell ED ‘see its my mom it is not me. She needed me to take blame for keeping ED at bay she did not have the strength. I am not sure if that makes sense, but d needed an out with Ed and I had to give her that out. 
Any  intolerable behaviour ED or not should not be accepted. ED can make us question ourselves and what we would or would not accept under normal conditions.
Keep strong and keep going!
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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sandie
We had weeks of violence- mainly directed at me where shoving/ slapping me was becoming normalised. It has more or less stopped now once H said it was unacceptable. It was important for us that H make it clear what would not be tolerated. H had previously been saying things like " ah love- don't hit your mother" in a quiet appeal. We needed to step up and be very firm and determined. Sounds like common-sense parenting I suppose but Scaredmom you are right ED does make us question ourselves as family-life is transformed into something unrecognisable, and parents may need to take on different roles than they are accustomed to.
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Hendrixt
I totally understand what you say about her needing you to give her an excuse to stand up to ED and I hadn’t thought about it like that. I think the way you say it has an impact, if you’re strong an confident. I spoke to her quite firmly during her rage, but I didn’t loose my temper. What strikes me is that, before she was ill and had normal teenage melt downs I wasn’t very good at dealing with them and would sometimes loose it a bit. Since she’s been ill I have not even come anywhere near loosing it, I’m quite calm when I speak to her no matter what she throws at me, including plates. But I’m not even trying to not loose my temper which amazes me as her behaviour is far far worse than her previous normal teenage strops. All I feel inside is sorrow and sadness for her, also fear that the meal is not going to be finished.
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scaredmom
Aah it seems you have figured out how you need to respond to ED and it is working! 
It took a 180  degree shift in my parenting to make things happen in a calm but forceful manner. 
Some kids respond to that and some don’t.
Remember too that if needed,  IP and other more intensive programs may be necessary. 
It is not a reflection of our parenting if things don’t work at home, it is a reflection of the severity of illness within them. 
We all find our way and i am always so impressed at the creativity. 
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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tina72
Hendrixt wrote:
I totally understand what you say about her needing you to give her an excuse to stand up to ED and I hadn’t thought about it like that. I think the way you say it has an impact, if you’re strong an confident. I spoke to her quite firmly during her rage, but I didn’t loose my temper. What strikes me is that, before she was ill and had normal teenage melt downs I wasn’t very good at dealing with them and would sometimes loose it a bit. Since she’s been ill I have not even come anywhere near loosing it, I’m quite calm when I speak to her no matter what she throws at me, including plates. But I’m not even trying to not loose my temper which amazes me as her behaviour is far far worse than her previous normal teenage strops. All I feel inside is sorrow and sadness for her, also fear that the meal is not going to be finished.


I really admire you that you can stay calm and not loose your temper in these situations, it took me months to learn that and I am still sometimes not good at it.
So when ED is done and normal life is back I suspect you will handle that "normal teenage behaviour" like a rock!!!
Keep feeding. There is light at the end of the tunnel.
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Hendrixt
The threat of IP is what’s keeping me driven scaredmom 

sandie I cant really take any credit as I’m definitely not the parent of the year - far from it  - it’s just that I don’t have the slightest temptation to loose my temper, so I don’t have to control it but I can fully understand how it could get you as the behaviour is so awful. I think it’s because I read so much about the disorder when she was first diagnosed. For the first few days I was up till 3 and 4 every night reading (I am a slow reader as well/ and not really that clever). After what I read I can feel nothing but pity for her, definitely not anger. 
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