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

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EASL
All: some guidance/ideas please. We are in month 4 of diagnosed AN and have weekly sessions with CAMHS plus D has once a week private therapy. D’s Weight never dropped below 90% height/weight. Weight has mostly stabilised but at a low number - currently 92%. Ds mood and stability have greatly improved and she recognised this is due to consistent eating (currently 2200 cals/day). She has expressed her terror at putting on weight and also expressed how feeling thin is sometimes the only thing that gets her through the day as it is the only thing she feels positive about. 

She understands (mostly) that the activities she isn’t allowed to do are because AN has removed them. HOWEVER we are having enormous difficulty moving forward on weight gain - her fear is so intense and she knows she’s ‘ok’ at the moment and willing to stay as is. 

How do I help her to see the fear as solvable? 
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scaredmom
Hi EASL,
When I understood that I could not take away the fear and that we had to push through the fear, that was a game changer. The fear makes us scared too and so we may not push them to eat. I was scared to death about the fighting etc... I thought I had to be the nicest mom and make it easier for her. That simply was not true. We can support them when fearful but we have to let them feel it. It will not be easy but a necessary step to move forward.
Otherwise you may be stuck as not wishing to rock the boat. Really it is not a normal fear is it? To be scared of not feeling thin? So try to push up the calories and arm your self. (Distress tolerance) 
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
I agree with scaredmom, you cannot take away the fear. It is like someone is afraid to use a lift/elevator. It does not help to tell him it is safe. The only thing that helps is to get him in the lift and show him that he can do that. About a hundred times 🙂. It is exposition therapy. Same is needed here.
Watch Eva Bungee video again to understand that better.

They often have a magical number in their head that they do not want to cross, here it was 50 kg (it is quite often that number no matter how tall they are, that is communicated in the bad AN sites that they should not cross that). My d was totally convinced something really bad will happen when she cross this number and so she fought us like hell. We changed to blind weighing then and she did not know when she crossed that number and this was the end of that discussion. Today she knows that she crossed it but is relaxed about that.

Does she know her weight and intake and how much she gains each week? Can you stop giving that information?
We do not talk about intake and weight and calories at all here now. And she is totally relaxed about her body and weight and does not even want to know it.

"also expressed how feeling thin is sometimes the only thing that gets her through the day as it is the only thing she feels positive about"
That is not normal to think so and this shows that additional weight is needed to start brain recovery and to occupy her brain with normal teenage stuff again.
Keep feeding. There is light at the end of the tunnel.
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EASL
My D does not know her weight she also does not know what the change is week to week. We say up/down or neutral. It has taken me many weeks to become 'calm' when the news is down but I am there now - not satisfied with down but I see it as just one data point and know when can have a different one the following week. She is good with 3 meals a day plus a small snack. She eats all foods and is accepting of supervised lunches while at school. This is the first week she has been honest about her fear so on one hand I see that as a positive that she could articulate the fear however she is in the 'rabbit hole' of data trying to convince me where she is right now is ok - she has energy, not so prickly, etc. I know its not and I know she needs to gain and I am fearful of causing distress. 

I think I was hoping that with continued nutrition her rational sense would evolve a bit more and it would be easier to break through for weight gain - wishful thinking I'm sure. Our next appointment is in 5 days - and I expect her weight will be neutral/down even on 2100 cals a day - so then she'll need to address that as her current weight is the 'floor' for the few activities she's allowed.
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scaredmom
Just to let you know to get weight gain in my d we had to go to 4500 cal minimum. At 2100 per day that seems a bit low.
Is there something we can help you with to get it up? 
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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EASL
I know we need to up the calories - however D has not agreed to do that and I do not see how I can 'force' the issue. She has very effectively backed me into a corner where she eats 2100 cals a day - via 3 meals - all with us and if we disturb that I believe she will stop eating. She has said how frightened she is to gain weight and asked for help - but I'm not sure there is "help" and she's using that as an excuse to not gain.
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scaredmom
Ok I see that and I can sure what we did. I could never let d or ED agree to any changes in food. I did not necessarily force her but took privileges away. Her phone time with friends the short walk and kind the block etc...
It went against my collaborative parenting to set firm eating rules in place and I had to do it. To get her better I did have to become a benevolent dictator (mamaroos terminology that is so apt for ED)
i don’t pretend to know what you can and should do for your d I can only share what I did, and if it helps you that is my intention. 
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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EASL
I appreciate your ideas. I think I'm low at the moment because I feel trapped at our current place. I explained to D that she is currently at her "floor" for weight - she doesn't know the number, but if it drops the remaining 2 privileges she has will be taken away - I think that slightly frightened her. I also explained that to regain the other things she would need to be on a path to "healthy" - I wanted her to see it a more than just weight gain - talking, being a part of the family, etc. I think she may, for the time being, decide that she can't do that. 
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Foodsupport_AUS
It seems pretty typical for someone with AN to say the would like to get better but they don't want to gain weight. My D has been saying the same thing since she first got ill.  That being said many of us without ED would say almost the same thing - "we don't need to gain weight".

If your D is consistently eating 2000+ calories a day it is unlikely she will become "medically unwell", the problem is she may not recover. No one actually knows what weight it takes to get someone to full recovery, or at what weight someone will be truly "healthy" . Nor do we know how many calories lead to recovery. 

What does seem to be accepted though is that restrictive behaviours become habitual  - the longer they go on the more they become wired in. After a while the eating disorder settles in. We also know from many studies that in general the faster weight gain occurs (ie. higher intake) the faster people seem to get better. Many on here have found that their children seemed to turn a corner suddenly when they reached a higher weight. Lastly there is a lot of research suggesting that most with restrictive eating disorders and also those with binge eating often have to return to whatever weight they have been in the past plus a bit to get to recovery. 

You mention your fear of your D stopping eating altogether. That to me suggests that her ED is in charge of all of the behaviours and that needs challenging. 

It seems that by accepting the status quo you are accepting the possibility that she may or she may not get better. Arguing with her that she needs to gain weight is a hopeless task. On the other hand - you can just go down the path that restrictive eating is going to lead to her remaining ill - and find a way to push that boundary. Three meals and at least two snacks seems to be an accepted minimum - no restricting and generally the more the better. 
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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tina72
EASL wrote:
I know we need to up the calories - however D has not agreed to do that and I do not see how I can 'force' the issue. She has very effectively backed me into a corner where she eats 2100 cals a day - via 3 meals - all with us and if we disturb that I believe she will stop eating. She has said how frightened she is to gain weight and asked for help - but I'm not sure there is "help" and she's using that as an excuse to not gain.


She will never agree to that and she does not need to. It is meds like chemotherapy. The food must go in to start brain recovery or that will not start and the ED will become chronical. It will not be possible to see constant gain with that little intake and she will need to eat at least one snack more, the gaps between meals/snacks should not be more than 4 hours.
You do not need to "force" that. Just plate more food. More in portion size and more calory dense food.

Just want to add that you are only 4 months after diagnose and it is very early days. It is too early to see recovery at that point and it is too early to allow her any food related decisions (re what and how much to eat and how much snacks). She cannot make healthy decisions in that state and it is your job to help her by doing that for her until she can do it herself again.
Keep feeding. There is light at the end of the tunnel.
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EASL
Thank you all. You’ve given me some strength. Tonight I am going to tell my daughter that I am done listening to the ED and from this point forward I will be setting the meals and snacks and she will need to trust me. If she tells me no then I will explain the other option is private in-patient treatment. I’m deliberately being hard nosed as my other two children (both younger) are demonstrating anxiety and issues and I’m done with ED as a bully. My daughter has two major fears - putting on weight which I’m asking her to let go and trust me and people at school finding out about ED. I’m hoping playing fear 2 against fear 1 will allow her to make the right choice. I was intimidated by ED but now I’m angry and now it’s messing with my other kids. If you feel you can - send me positive thoughts.
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scaredmom
Of course! You got this supermom!
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
EASL wrote:
Thank you all. You’ve given me some strength. Tonight I am going to tell my daughter that I am done listening to the ED and from this point forward I will be setting the meals and snacks and she will need to trust me. If she tells me no then I will explain the other option is private in-patient treatment. I’m deliberately being hard nosed as my other two children (both younger) are demonstrating anxiety and issues and I’m done with ED as a bully. My daughter has two major fears - putting on weight which I’m asking her to let go and trust me and people at school finding out about ED. I’m hoping playing fear 2 against fear 1 will allow her to make the right choice. I was intimidated by ED but now I’m angry and now it’s messing with my other kids. If you feel you can - send me positive thoughts.


I think it is a great idea to use fear 2 against fear 1. You can also tell her that you are an expert now as you have read all the expert literature (you have) and talked to families of recovered ED patients (you have) and that you are now totally convinced that quick recovery is best and that this will avoid that people in school get to know what is going on.
Is there something she is very keen on you could use as incentive? We had points for every finished meal and 1 day all meals finished without complain was one driving hour for her driving licence. She was keen on having this new liberty and we promised to pay for driving licence for doing blind weighing and to buy a car after 6 months maintaining weight. This incentive was very good as it was clear that she was only allowed to drive at good blood sugar and well nurished or she would be dangerous to other people in traffic.
Keep feeding. There is light at the end of the tunnel.
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Mcmum
Good on you!  Once you decide to stand up to the bully, you have made great progress! 
This is a battle and it is one that ed cannot win. Sending you lots of strength and courage.  You can fake it to make it.  You are protecting all of your kids here and this is the most important thing you will do. You CAN do this.  You are tougher than you think! Lots of hugs xx
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Ellesmum
Sending strength, it gets easier the more you stand up to ED, I used to picture a monster sometimes who was trying to sink it’s claws in my girl, that helped a bit.  

Faking confidence is a a huge part of this, deep breathes needed, I used to kind of shake myself down, breathe and mutter ‘right, I’m going in’.   
Ellesmum
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Jojo2271
You can do this. 
You have survived four months, you have got your d eating and her weight stabilised, as in it has not been a downward spiral. 
You have already done so much... Don't doubt you can do this next part too. 
There are loads of great tips as well on here for adding calories to existing safe foods. 
Sending strength to you and your d
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EASL
Talk done. Response as expected. But I’ve delivered message and will now see what tomorrow brings. 

Her only response was to say she wants to wait and discuss this with her team at CAMHS on Tuesday. I declined to wait 5 days. I doubt she will eat for me tomorrow but I know I will try. 

Feel like the the next step should be me giving lots of food and being empathetic. 
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tina72
"I declined to wait 5 days." It is great that you said that. Big signal.
You should also make clear that YOU decide and not cahms and that cahms is there to support you.
Please ask cahms to tell her that YOU are in charge for all decisions or she might try to trick you out against each other.
Keep feeding. There is light at the end of the tunnel.
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EASL
All:

Thank you so much for the support. This process is so unpredictable - this morning I feel very strong and have a clear sense of what I need to do - and can do. While it now seems so obvious and straight-forward I'm surprised it took me so long to feel this way - but that is looking back and I'm now moving forward. My aim for the next 5 days is 2500/cals a day and then moving up to 3000. I have a few questions to help me hit this target. On average, D eats 6-700 cals per meal so we're already almost always at 2100 cals - I could try to up the quantities a bit but I'm keen to get in another snack each day. We give her a post dinner snack - its usually about 200 cals and is 2 pieces of shortbread with a glass of milk. I need to get another snack in - and here are my questions:

1. She's away from home from 7:45 until 5pm. Ideally a snack at 10 would be good - even if it were 100/150 cals. Do I ask the school to "administer" this for a short while?

2. As in most schools, there are no nuts allowed. Suggestions for calorie dense but not big in size snacks would be appreciated. 

I have been singing Patti Smyth's song "I am the Warrior" all morning - I think my husband thinks I've lost it - but I feel good - and empowered. Let's just hope it works!
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tina72
EASL wrote:
All:

Thank you so much for the support. This process is so unpredictable - this morning I feel very strong and have a clear sense of what I need to do - and can do. While it now seems so obvious and straight-forward I'm surprised it took me so long to feel this way - but that is looking back and I'm now moving forward. My aim for the next 5 days is 2500/cals a day and then moving up to 3000. I have a few questions to help me hit this target. On average, D eats 6-700 cals per meal so we're already almost always at 2100 cals - I could try to up the quantities a bit but I'm keen to get in another snack each day. We give her a post dinner snack - its usually about 200 cals and is 2 pieces of shortbread with a glass of milk. I need to get another snack in - and here are my questions:

1. She's away from home from 7:45 until 5pm. Ideally a snack at 10 would be good - even if it were 100/150 cals. Do I ask the school to "administer" this for a short while?

2. As in most schools, there are no nuts allowed. Suggestions for calorie dense but not big in size snacks would be appreciated. 

I have been singing Patti Smyth's song "I am the Warrior" all morning - I think my husband thinks I've lost it - but I feel good - and empowered. Let's just hope it works!


You are doing great!
To be away from 7:45 til 5 without any supervised meals/snacks is very difficult as she will get very low blood sugar and heavy ED thoughts if she does not eat regularly every 4-5 hours.
No snack below 300 calories. You need to fight for that anyway so make the fight worth it.
To ask others to supervise is a risk as they would not know all the tricks and she can fake very easy that she has eaten. Can you come around in a break and eat the snack with her in the car park? Can you leave her at home until she gains constantly and is compliant with eating all meals and snacks?

I will be back with ideas for the snacks later, need to cook now 🙂.
Keep feeding. There is light at the end of the tunnel.
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Ronson
We do sides at tea time (garlic bread, naan bread - a strong bread theme). Then always a pudding and a juice - this brings our calories at tea time to 1300 approx. Then there is supper before bed of around 400 calories.  D has a small snack in the morning at school - popcorn or cake.  And lunch at school.  She also has an after school snack when home of crisps.  At 4.45 ish.  If you added the after school snack, pudding and side then this could bring up your calories 
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Ronson
We do sides at tea time (garlic bread, naan bread - a strong bread theme). Then always a pudding and a juice - this brings our calories at tea time to 1300 approx. Then there is supper before bed of around 400 calories.  D has a small snack in the morning at school - popcorn or cake.  And lunch at school.  She also has an after school snack when home of crisps.  At 4.45 ish.  If you added the after school snack, pudding and side then this could bring up your calories
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Ronson
For a while one of d friends would text me to tell me if d had eaten morning snack and what it was. D hated this but it did work 
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scaredmom
EASL wrote:
All:

Thank you so much for the support. This process is so unpredictable - this morning I feel very strong and have a clear sense of what I need to do - and can do. While it now seems so obvious and straight-forward I'm surprised it took me so long to feel this way


You ED powers have been activated! It can be just a slight shift in thinking or an event that makes it click. For me it was an event that happened to d very scary stuff and then I fought ED as hard as I could. 
Good for you! And I love that song!!
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
Quick idea:
There is a muffin recipe by great Laura Collins here that gives you 1000 calories with one muffin. That would be a good snack for school!
There are muesli bars for hikers that contain a lot of energy.
You could give her a heavy milk shake to drink if that is easier than eating.

Sometimes it helps to TELL them the snack will be supervised by someone to make them eat it.
Here the teacher was a former ED patient and that was a great superviser I can tell you!
Keep feeding. There is light at the end of the tunnel.
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