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

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Allyson_1
My 15yo daughter was diagnosed with AN 14 months ago.  Best we can tell from her accounts is that she'd been restricting since 7th grade (12yo). She's been "WR" since last June. We did FBT at home, anorexic pediatrition psychiatrist for anxiety meds maintenance, one on one therapist & nutritionist have all been part of the team.   Last spring we switched therapist & nutritionist bc I thought she needed to gain more weight andshe ended up very angry after each therapy session. She's been at a higher weight  (a BMI for what it is worth of 22.5) for 6 months.  She still suffers from anxiety (I think related to high school academics (she has developmental vision issues which make reading & writing & processing more difficult & school work takes considerably longer for her than her peers)).

She seems to be holding fast to being an anorexic or anorexic in recovery as her identity.   She almost seems stuck in and relishes a persona of someone who is ill and in need of a lot of support.  She stills sees a therapist & nutritionist & neither know how to help her battle this persona as someone who is sick. She mentions her anorexia or being ill often to people who know she's been ill and others at a drop of a hat, almost trying to work it into the conversation.  I fear this will tax her friendships.  Have others experienced this?  Has anything helped them shake this identity?  She is not super passionate about anything in particular.  She rides horses once a week & is in the school play but isn't passionate about either.
Thoughts on identity & continued anxiety welcomed.
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Foodsupport_AUS
For my D this gradually disappeared over time, a long time. She used to become very upset if I used her illness at all in the past tense. This was even four to five years in. I knew that she still had not fully recovered at that stage as she still had significant ED thoughts but they were markedly less than in the past and her health was much improved. Nonetheless she was suffering enough that she felt the need for others to know if her illness was mentioned that she was still ill. She did not choose to share it with everyone, but it may be your D is getting some sort of positive response out of doing this. 

My D now refers to her illness in the past herself. As she has slowly but surely recovered her need for recognition of ongoing suffering has diminished. It may well be that your D is still having a lot of ED thoughts and needs you and others to know that although she appears better physically she is still mentally struggling - that she needs you to support her still. 
D diagnosed restrictive AN June 2010 age 13. Initially weight restored 2012. Relapse and continuously edging towards recovery. Treatment: multiple hospitalisations and individual and family therapy.
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Torie
I have to wonder how sure you are that she is well and truly weight restored.  Since she apparently went down the rabbit hole at age 12, she will probably need to be at a significantly higher weight than she has been before.  As you may know, the most common mistake made by clinicians is setting wr too low.

Have you plotted her growth history on mygrowthcharts.com or similar? 

We have all found that this is a marathon that takes much, much longer than any of us expected.  It does feel like they are holding on to their illness, but many times with enough food and time, this too does pass. 

Keep swimming. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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ValentinaGermania
It is really hard to say whether she really identifies with that or wether she learned that she gains attention with that topic 🙂.
I would be interested to hear how her behaviour about food and eating is. Is she eating normal and does she enjoy eating? Is any AN behaviour left?
Keep feeding. There is light at the end of the tunnel.
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Allyson_1
Thanks for responding. She is eating pretty well. I still plate her food but she eats almost everything without complaint. Sometimes she leaves just enough to provoke a comment from me to finish up. Sometimes she’ll ask for more. She eats all of her lunch at school with her friends from what I can tell. From November 2018 until June 2019 I drove 45 minutes every day to eat lunch in the car with her. So this year is real progress.
She is not as good at completing snacks at school and still has ED thoughts. It is funny about her continuing to identify as ill to get attention bc all she gets is my attention. I’m no longer working outside of the house and devoted the last 14 months to getting her better. Maybe that’s the problem?
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ValentinaGermania
Allyson_1 wrote:
It is funny about her continuing to identify as ill to get attention bc all she gets is my attention. I’m no longer working outside of the house and devoted the last 14 months to getting her better. Maybe that’s the problem?


I just thought that because you wrote that: "She mentions her anorexia or being ill often to people who know she's been ill and others at a drop of a hat, almost trying to work it into the conversation."

I do not think that you being at home for her is a problem at all. But I can imagine that she might like that care and attention from you.
" Sometimes she leaves just enough to provoke a comment from me to finish up."

Brain recovery takes time. If she is eating normal and you see progress I would just keep feeding and weight. Maybe ED thoughts and rests of ED behaviour will fade away in the next months. If not, think about giving some more weight gain. Some need to overshoot their previous weight to get brain recovery kickstarted.
Keep feeding. There is light at the end of the tunnel.
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Torie
If she is well and truly weight restored, you will probably see improvements in mental state very gradually.  There is no harm in increasing her weight a bit to see if that helps.  xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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Allyson_1
Thanks.

She's at the 74th percentile for weight & 80th for height at 5ft & almost 6in & 131 lbs. which is a BMI (again for what it is worth of 21.).I think this is a pretty solid state for her as she has held this weight for 6 months now. He original nutritionist & therapist said she'd be WR at 124lbs. I switched doctors bc I thought this was too low & her mental state was a mess. So we've seen a big improvement. At the same time, we slowly increased prozac for anxiety to a therapeutic dose or 60 mg/day.
Perhaps it is the last (hopefully) vestiges of the illness that is stubbornly hanging on where anxiety is high at times (pretty consistently 1 bad day every 2 weeks) and a kind of need to identify as an anorexic or an anorexic in recovery.

I'm just not sure how to help her move past this point & develop her healthy persona. (Although I realize this is now part of her history & like any trauma, is part of her- I just don't want it to be at her core).
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Torie
Allyson_1 wrote:
I think this is a pretty solid state for her as she has held this weight for 6 months now.

As you probably know, it is normal and expected that all teens will continue to gain a couple of pounds each year through the young adult years (mid 20s).

It seems quite common to see anxiety disorder as pre- or co-morbid.  We have found that to be a tough nut to crack, as it is unclear to me what exactly would help.  Many recommend CBT or DBT.  xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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Foodsupport_AUS
Allyson_1 wrote:
Thanks.

She's at the 74th percentile for weight & 80th for height at 5ft & almost 6in & 131 lbs. which is a BMI (again for what it is worth of 21.).I think this is a pretty solid state for her as she has held this weight for 6 months now. He original nutritionist & therapist said she'd be WR at 124lbs. I switched doctors bc I thought this was too low & her mental state was a mess. So we've seen a big improvement. At the same time, we slowly increased prozac for anxiety to a therapeutic dose or 60 mg/day.
Perhaps it is the last (hopefully) vestiges of the illness that is stubbornly hanging on where anxiety is high at times (pretty consistently 1 bad day every 2 weeks) and a kind of need to identify as an anorexic or an anorexic in recovery.

I'm just not sure how to help her move past this point & develop her healthy persona. (Although I realize this is now part of her history & like any trauma, is part of her- I just don't want it to be at her core).


I think in part the issue is that she is still not fully recovered. This illness affects them very deeply, she was all consumed by the thoughts when at her sickest and from what you say still has those thoughts quite regularly., from what you say daily. She is getting assistance with food at home, she has troubles eating her snacks. That is not to say she is not doing well for 14 months in of treatment. It sounds like she is doing really well. Down the track when she is recovered she will want to move away from it, it sounds to me that her not wanting to move away is telling you she still needs assistance. A short course for this illness is three years or so, typical is five when going to full recovery, with many others taking longer. 
D diagnosed restrictive AN June 2010 age 13. Initially weight restored 2012. Relapse and continuously edging towards recovery. Treatment: multiple hospitalisations and individual and family therapy.
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MKR
Hi @Allyson

I agree that WR is elusive and you may see benefits with more weight gain. I won't add to the great posts above on WR.

Just wondering, when you say your daughter likes talking about her illness. Sounds like you are also worried this is becoming her identity. I am sure she has many strengths you can help her develop and they become her identity instead - first to move her thoughts away from AN, and then to motivate her to recover. 

How is school accommodating her learning? I believe nowadays it is no longer based solely on writing and reading. Some kids are taught through projects, role play, audio, online maths. I hope the school has already considered ways of making your daughter keep up with her peers.
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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