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

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I haven't been on her for a bit as we have just been working through things......rather unsuccessfully!

D (now 15) was hospitalised with RAN last May for 10 weeks. When released she did really well for first few weeks.

Since January her anxiety went through the roof and has now been prescribed an anti depressant and its making a huge difference, she's so much happier, calmer and even spends time with us!

Whilst that side has improved the eating appears to have gone majorly backwards. At the begining of December she was 46.50Kg and is now 43.35kg (BMI 16.9)

She is eating and not avoiding as such, just not enough. She's now rejecting the fortisips as the sweet stuff makes her feel sick, asked for some alternatives and she can't come up with some.

Her main issue has always been volume of food and CAMHS have identified a Vomit Phobia which they are trying to address. I have tried calorie dense foods in a smaller quantity but its just hard to get her to eat the volume. She also struggles eating first thing, so they suggested having a smaller breakfast and a larger first snack, which we have done,

Our main issue is school holidays as she will sleep in, which invariably means she misses first snack so has breakfast, then straight to lunch and when choosing herself doesn't tend to choose as much as she should, just the amount she wants. I work so hard to monitor 24/7. Have asked to go term time only but understandably they can't accommodate that, but have said I can run out and do breakfast/lunch etc......which will prob kill me !

We had a chat today about holidays as she's desperate to go away in the summer and I said I can't book anything due to the weight loss (last year we lost our holiday due to hospitalisation) and I need to see the numbers going back up before I even consider it.

She responded that I wasn't being fair as I was doubting her. I tried to explain that if we continue as we are in a few months she will be back to where we started. She responded that she just can't eat more food than she is now.

We are at CAMHS ED clinic for weight and BP every two weeks, so they are keeping on top of her but I just find they don't listen to what she has to say with her struggles, they just pigeon hole her into a category so she "must be skipping lunch/exercising" etc. infuriates me how they refer to RAN as "these girls". her mind set is very rigid with regard to how much food volume she will tolerate.

Feeling like I have failed her as I haven't been as strict as what I probably should have been but she's been so anxious, fighting over dinner is not going to help (IMO)
Have tried sneaking extra food in, baking brownies with extra stuff but she still loosing the weight.....all having opposite effect on me 😂

We have next weigh in a week on Tuesday and dreading it already, expecting the disapproving looks from the Dr!

I know I am very lucky as things could be much worse, but am frightened we are heading backwards again.....I feel we are looking down the rabbit hole.

Dad is not overly helpful (we are divorced) He has missed last two CAMHS family sessions and even though I keep him updated on everything the best response I can expect is "well that's not good".

Just needed to get it all off my chest, as worrying and its hard to talk to others about. Thank you for listening x
Hi mumofone,

I am sorry to hear that you are struggling again. It is such a rollercoaster with recovery, isn´t it?
My questions: Was she ever WR in that time? WHO choses what she eats? Do you still serve 3 meals 2-3 snacks?
My d was/is not allowed to sleep in on holidays or sundays. She has to get up for breakfast (a bit later than usual) and cannot skip a meal or snack or she would lose weight and have ED thoughts coming back soon. Are you working in the mornings? Can you wake her up before you leave to have a milkshake for example and then she can roll over again?

"We had a chat today about holidays as she's desperate to go away in the summer and I said I can't book anything due to the weight loss (last year we lost our holiday due to hospitalisation) and I need to see the numbers going back up before I even consider it."
I think it was good to say that. And you are not doubting her, you are doubting ED and she did not prove that she is able to gain weight on her own. Why do you think she said that? Is it possible that the weight loss is due to purging or secret exercising?

They all say they cannot eat more. My d says this even until now (o.k., in parts I believe that because she is eating same amount as hubby). But if they are required to do it and there is no other option they often prove that they can do it. Did you try psychological tricks like bigger plates and bigger bowls so the portion looks smaller? We serve still nearly all food in deep soup plates...🙂

"She's now rejecting the fortisips as the sweet stuff makes her feel sick, asked for some alternatives and she can't come up with some."
What about a home made fruit or vegetable smoothie with rapeseed oil/canola oil? If you make a green smoothie with lettuce this is not sweet. It looks healthy and is "in" here with young people and you can get 1000 calories extra with 2 glasses...

Did you already try to add Benecalorie to her food? It is 330 calories with 44 ml. You can buy that via ebay in Europe.
Keep feeding. There is light at the end of the tunnel.
rollercoaster is one word for it!

Yes we are three meals/three snacks 2,500 calories.

She has a vomit phobia and hates being sick so she is defiantly not being sick and our house is like cardboard so if she was exercising we would hear it, she's also genuinely very lazy!

I try not to let her lay in too long at weekends because I want to have her meals and during the holidays I tend to encourage friends over as they will want to eat and she is pretty good when they are here.

Good idea re the plates, I will try that! thank you
hi mumofone, 
Sorry that things are tough right now. 
A few things as I read your notes:
1) I think you may need to fight through the volumes a bit. You got her this far and so now you may need to push a bit. An extra spoonful, cream in the milk, etc..
" her mind set is very rigid with regard to how much food volume she will tolerate." This is another part of her ED and needs to be extinguished despite the vomit phobia.  I imperceptibly added in a bit more porridge, or cereal or an extra piece of cheese and extra few bites or bigger slice of meat, or thicker slices of stuff so it did not look overwhelming until she did not notice when it was a significantly larger portion.
2) I agree no holidays as she is not well enough. It is not punishment, really you need to keep up momentum and holidays can side line that.
3)What exactly is she eating and can we help you get some fear goods in too?
4) My d does sleep in on weekends and knows then she has to get the other snacks and she does stay up late a bit so we can get all the meals (3 and 3) in
Or making sure she gets up in the morning on the holidays, eats and then can sleep again. The medicine has to get in. 
5)Are you sure she is not tossing out food/drinks? I was fooled a few times..

I think you have done and are doing a tremendous job with her. Keep up the good work
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)
Wondering if you could try what some have done successfully on the weekend, when your d wants to sleep in.  Wake her early, and give her a smoothie drink to sip while she is still in bed.  Then she can roll over and continue to sleep.  You can pack a wallop into an 8 oz glass, with cream, ice cream, some fruit & a bit of oil or benecalorie.  We seriously couldn't get a good weight gain going until we were able to get d to drink a daily smoothie.  She resisted like crazy...until after a couple of days of me laying out all the food she would need to eat as opposed to the smoothie, she gave in.  Never particularly liked it, but it became routine...sit on the sofa after dinner for 30 min watching a comedy show & drinking the smoothie....Some kids prefer to have that kind of drink first thing in the morning..you could experiment with timing.
And scaredmom is right.  Not going on holiday is not a punishment...it is simply the reality that health is not at the state it needs to be for a holiday to happen.

Sending warm support,
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
She sounds not dissimilar to my D12 who was diagnosed with ARFID rather than RAN, though she and I both think it was starting to morph as she has some negative body image stuff. Her main symptom was a fear of feeling/being sick and the nausea was caused by anxiety - so she was in a vicious circle. 

Camhs have been good, working on CBT for the anxiety whilst we at home stick to our version of FBT and high calorie 3x meals/snacks like you. 

With anxiety, it’s really important not to avoid - but to gently and persistently challenge the fear of being sick, by increasing volumes. I know this works, because D now only feels ‘sick’ when in highly stressful situations - her task now is to learn to eat and breathe (knowing she won’t BE sick) in situations like school, restaurants, before tests etc. No avoiding, but we’ve built up to this by starting on increased volume at home. It’s got easier and easier (not in a straight line).

We’ve also added incentive - she needed something tangible to work through the horrible anxiety, so 6 months of steady gain and stability will result in a puppy 🙂

I would think your D is also going to need help to push through her fears of vomiting in order to recover fully...it really can happen, hang in there!