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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My daughter is 11 and has been in partial hospitalization treatment at an ED unit for about 5 weeks.  Her eating habits changed this past fall and a few months later when she began severely restricting food and her weight plummeted we discovered that she is anorexic.  She opened up and told me that she was having trouble with food, that eating made her very sad and it was hard to eat, especially certain foods that she considered to be unhealthy.  The treatment at the ED unit has been effective in that she is steadily gaining weight and getting close to her target weight and also through therapy we have learned the underlying issue is her poor self-esteem.  We already knew she had trouble with that, but now it's out in the open and she has identified it as the source of the ED.  We are fortunate that she is so honest with us.  My question is, now that we are beginning to transition her out of the ED unit, what is the best course for outpatient therapy?  The therapist at the ED unit is very good and my daughter trusts her but she doesn't think the talk therapy actually does anything to help the eating disorder.  What should we look for in a therapist for effective treatment of the self-esteem/body image/anorexic issues?  Also, what should we expect with home transition?  I am worried about how and when to return her to school.  She loves school and the school administration has been very supportive so far, but she isn't sure she's ready.

My other concern is medication.  She had some scary reactions to Prozac and Zyprexa and was taken off both, and is now on a low dose of Risperdal.  She hasn't had a bad reaction to it like with the other meds but she does have side effects, particularly with feeling hot and cold and very drowsy during the day.  The drowsiness makes her feel worse as far as depressiveness because she can't concentrate and just sits around at the ED unit unable to do her crafts or activities.  She and I do not think it is helping anyway and I wonder if I should have her taken off the Risperdal.  But there is the nagging what if question - what if she would be better off with it?  Any experiences with meds and advice would be helpful.
Thank you toothfairy and I will look at your posts.  We are in Northern Virginia in the Washington, DC area.  We have very good health insurance, have always been glad for that.  But we are finding it hard to find ED therapists within their approved list of providers - meaning we will probably have to pay mostly out of pocket if we chose our own, reputable ED therapist. Our insurance does not cover dietician services at all.  I am shocked.  We have the resources to pay, but I cannot believe how limited we are under insurance.   
Hi charlie400,

Welcome to the forum, though sorry you have a need to be here.  Hopefully, you'll find helpful peer support and good evidence-based information to assist you during this challenging journey.

In terms of health insurance and covered in-network providers, it might be worthwhile, once you determine who might be best to have on your 'team', to contact your insurance provider.  You can ask for a 'single case agreement' and a dedicated case manager to present your case to.  That is, if you provide good, evidence-based reasons why Therapist/Treatment provider A would be the best fit, and they are not in-network, you may be able to get them covered.  An insurance company is all about the $$$...they want to save it, and presenting them with concrete info about how they can do so by providing the best possible providers for your d may well result in full coverage.

We were able to do this with our insurance provider when we went to the 5 Day Multi-Family program at UCSD, which was out-of-network.  Originally, our company was only going to pay 60%, but did in fact cover the whole amount.  It is worth stating your case, with written info on why XYZ treatment would be best for your d.  With a case manager, you only have to deal with that one person, instead of repeating your 'story' countless times to various people at the insurance co.

As far as transition from IOP treatment to home, and transition back to school, your current program should have a transition plan.  That is an important piece, and I'd ask as soon as possible what they recommend.

Returning to school can happen in a variety of ways...full-time, partial days, online classes...really, whatever you think would be best for your d.  She is young; is there support at school for eating lunches?  Can you get in touch with the counselor/administration now and discuss this?  There are posts/threads on ATDT that talk about back-to-school transition, and what others have done.  You might find it useful to do a search on the topic.

One of the best treatment centers in the NE United States is the Children's Hospital in Philadelphia (CHOP).  Dr. Rebeckah Pebbles is highly respected in the ED field, and you might find it beneficial to consult with her about treatment professionals in your area.

Wishing you well on your journey,

It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
Charlie400-- Welcome, and I'm sorry you have to be here. I'm the D.C. area too, and wanted to let you know there is a newly formed local parent support group for parents and caregivers of ED patients that you may not yet know about (it's mentioned on the "Connect With Local Members" board of ATDT). The parents in the group (there are maybe 6-7 families involved so far) might be of help regarding local providers. Here's the info on the group in case you want to reach out:

Eating Disorder Family Support Group:A free and open group by families for families
We are a support group for families that are caring for a loved one with an eating disorder. We welcome parents, step-parents, spouses, and siblings to join us for mutual support.
  • Contact us at dc-edfs-owner@yahoogroups.com or call 301-404-0139
  • Upcoming 2016 dates:  3/18, 4/22, and 5/20 from 7-9pm
  • Meetings are held at Christ Lutheran Church, 5101 16th St. NW, Washington, DC

D diagnosed with AN November 2015 , the week she turned 12. Gaining slowly but steadily, fingers crossed...

Thank you for the advice concerning insurance.  Very helpful to know the process you described. I joined the DC support group recently and it has been very helpful.  I am so glad there is support among parents, we certainly need it.  No matter how much friends and family understand and support, there is no way to truly understand this disorder if you haven't been through it.  I am so lucky the school administration has so far been supportive and understanding so hopefully that will continue when she starts school again.  I have been concerned about the teachers, especially a male teacher whose class she loved, but she admitted that he often talked about childhood obesity in the class and even made fun of obesity and that was a trigger for her.  I don't have bad feelings toward him, his comments were made in ignorance.  I hope the teachers will be understanding though.  She wants to start soccer this spring and I also worry about that, and the coach.  He is a good person and not harsh on the girls, but I don't know if he'd understand this.  I also am not sure her physical health is optimal enough for her to play soccer as it is only a few weeks away and she is not fully weight restored yet. But I also don't want to take away something that may lift her spirits.

I would tread very cautiously with respect to a return to sports, particularly one as strenuously demanding as soccer.  There are a number of parents on the forum who have experience with soccer, and hopefully they'll be along soon to weigh in.

Return to exercise, though it might seem motivating and uplifting, really needs to be handled carefully, particularly as your d is still 'early days' in terms of weight restoration.  In addition, you'll need to be fueling her for growth and puberty, and that demands an extraordinary amount of calories...not counting for extras needed with a return to physical activity.

My d was a competitive athlete who needed to halt her sport, even though she loved it, and claimed to be motivated by the prospect of returning to it.  We tried a few times, and she just wasn't able to eat what was required for that huge expenditure of energy.  Needed to stop all but cursory activity, such as walks, for several months.  When she was able to return to her sport, it was not in a competitive capacity.  But at that point, it was a motivating factor for her to pursue recovery.  She was also a few years older than your d at that point.

This might be the time to help your d explore other activities that are not physically demanding....art, music, drama, photography, volunteering with animals etc.  My d was able to take a photography course, which was fun and which entertained & occupied her, along with a driver's ed class.  

As for the clueless teacher who made triggering remarks about childhood obesity...perhaps some information from the FEAST main website, such as the Family Guide series may be helpful to pass on.  Certainly, making your concerns known to faculty and administration would be helpful and appropriate.


It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
I just had a quick thought about meds-my d is on olanzipine and because it makes her drowsy she takes it at night.this means a good nights sleep for everyone.so anything that will make her drowsy switch to taking at night.cheers,