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

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This is my first post which seems like an important step in itself.

After 4 months as an in patient, 13 year old D has now been home for 3 weeks. She is wr, back at school with all meals supervised and limits on activity. We are all learning as we transition from InPatient to CAMHS approach.  CAMHS is now taking us through stage 2, and is encouraging unsupervised snack at school.  D is keen, we are scared.  D wants everything back asap and meal supervision is making outings with friends difficult, although we are doing everything we can to have friends over, take her and her friends to movies etc. I have noticed a few things creep in, like pushing for incredibly precise timing - "can we pick friend up at 5:05?", questions being raised around some food items, and of course huge frustration that she does not have the same freedom as her friends.  Almost all discussions on ED related topics create a big outburst ...

We know we need to start to experiment to slowly transition some aspects of responsibility, perhaps pouring milk on her cereal is a good start.  We also know that D reacts to every suggestion of a step by step approach.  And of course we are terrified to go backwards.

Any thoughts on starting phase 2 (?)

renew, rejuvenation, regrowth

Thanks toothfairy
Welcome to the forum, and good job getting your d to wr! You are doing wonderfully. 

The main thing to know about Phase two is that it will likely take a long time! And it should, because yes, you don't want to go backwards, so you want to take a small step forward and make sure it's successful before taking the next step.

I agree that a first step should not be unsupervised! That is just asking for trouble. If she is ready for a first step, make it one you can help her with if necessary. Pouring her milk at breakfast, choosing one of two equal snack options, serving herself dinner, choosing the timing of a snack (not more than 4 hours later than the previous meal of course).

If and when she starts doing snack at school, you could have her facetime with you when having it. Our d had a lot of trouble having a tiny snack at school, because "other kids don't have snacks".

You also really don't want to put your d in a position where she can't be honest with you. If she misses a snack, ed may not be able to tell you, and if you ask if she ate it she will have to lie, and that will make relations between you harder. So again, when she starts unsupervised snack, you can encourage her to have it, and make it clear that she's expected to have it, but it I wouldn't actually ask afterwards if she's had it. If she did, you didn't need to ask, and if she didn't, you won't get a straight answer anyway.

It takes a while after wr to even start brain healing. And at age 13, your d is going to need to keep gaining weight fairly quickly to get through puberty. Best try and reiterate that, because d's ed won't like it. Wr done'st mean stopping weight gain, it just means it slows down.

Also, you are the one on the ground doing the main therapy with your d--feeding and supervising, so you are the one best able to tell when d is ready for a next step. Our therapist pushed me sometimes into letting d take more responsibility, and sometimes this was good, because it's scary and sometimes I didn't want to! But other times I pushed back, because I knew d wasn't ready. In other words, listen to the advice of your team, but make the decisions yourself.

And do feel free to ask lots of questions, and again welcome!

D diagnosed with EDNOS May 2013 at age 15, refed at home Aug 2013, since then symptoms gradually lessened and we retaught her how to feed and care for herself, including individual therapy, family skills DBT class, SSRI medication and relapse-prevention strategies. Anxiety was pre-existing and I believe she was sporadically restricting since about age 9. She now eats and behaves like any normal older teen, and is enjoying school, friends, sports, music and thinking about the future.
So glad to hear D is home from the hospital and able to continue recovering at home. Phase 11 looks different for everyone based on age and length of malnutrition. I don't think that WR is the magic reason to start phase 11. There are other factors involved.

First of all, since D was in the hospital she learned to abide by their rules and terms. Has she had enough time to learn that at home yet? Transitioning between hospital and home can be a loop hole for ED to try to test boundaries. D's reaction to ED discussions to me show that she still has a way to go in recovering and letting you still take the reigns. Also, she's only 13, which is young. Most 13 year olds don't have complete control over their daily food decisions. 

Letting her pour her milk on cereal is a great start. Grabbing her own snack is also great, but beyond that, I would supervise for a long time until you are assured that those ED tricks are completely in the rear view mirror. If she's not handling that well, that is ED's way of saying she's not ready and still needs you making those decisions for her.

My D was 12 (14 yo now) and because of puberty and her continuous growth (over 8" in ht and 70 pounds in 2 1/2 years!!!! YAY!!!! ) we are still working on gaining weight and upping her calories. I can easily tell her now to add some oil to her soup and she will do it without hesitation but that took a long time to get to. We also still coach her if she goes to a friends house to eat. She still naturally errors on the side of too little food because she has no hunger/fullness signal. We know she needs our help so we have constant dialogue about food and she is compliant. 

My guess is that you will also be playing catch up with growth (physically, mentally and socially) so plan on this being your new normal until she's done growing. It's a lot of work but worth it in the long run. It's certainly easy to want to hurry into this phase and leave ED behind but trust your gut. If she's not ready, take it slow until you feel the timing is better. 

Stay Strong and Persevere! 

Daughter diagnosed with anorexia at 12 in 2013 without having any image issues/concerns about calories or exercise. Hospitalized - 3 days. FBT at home along with outpatient therapy - 16 weeks. Recovered/weight restored - 4 years. Still gaining and growing but has no hunger signs yet.  
Definitely go slow and don't feel the need to enter a phase if you don't think your d is ready. For a long time after weight restoration, my d still couldn't choose her own food, it made her anxious. She wanted to get better, but it was just easier for her to trust me to make the choices. Very slowly she started to pick things on her own, like snacks, meals at restaurants. IF she didn't choose enough we let her know.

Lunch supervision at school is a tough one. For us, we never supervised d at school lunches. We used the scale to determine if she was actually eating and she was. She would always bring back her lunch box each day with the empty food wrappers inside so I could see and her sandwich crusts. Sometimes she didn't eat something and I'd ask why and we'd make up for it.
Welcome, Spring.

You have gotten great advice already; I just want to add one small idea I learned here. My d always blamed me for things that were actually Ed's fault, like, in your d's case, frustration that she doesn't have as much freedom as others. (We can easily see you didn't just arbitrarily decide to monitor her every bite for no reason, but that isn't so obvious to them when they are still ill.) What I learned here is that when she would complain about lack of freedom, etc. my reply would go something like, "I'm really sorry. It sucks to have an eating disorder. I'm going to do everything I can to help you through this as quickly as possible."

YOU aren't the problem - ED is the problem. I don't know if pointing that out will help your d, but I know it helped ME keep my sanity. 

You're doing great so far!! Keep up the good work. xx

"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
So much wonderful advice - THANK YOU
My advice would be to take it slowly. I imagine, without meaning to sound too negative, that ED is very keen to try and drag D back into a lapse/relapse. Like others have said, maybe let her choose between 2 snacks, or choose a sandwich filling at lunch.

If she is that desperate to do things herself, make sure that you supervise her really closely, like if she's pouring her own cereal and milk, watch and encourage her if you have any doubt that she hasn't given herself enough. 

Maybe agree with her that you will take back control if you have to encourage her to give herself a bigger serving more than twice in a row (or if your pushing her to have more gets frequent generally, or if any ED behaviours reappear etc.)

It's tricky ground you're walking on, but go with your gut, don't listen to ED's pleas, and you will be ok. You're doing a great job!