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

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We have an almost 14 year old ED daughter with pre-existing ADHD, anxiety and some OCD. She was diagnosed with anorexia 3 months ago. She is currently weight plateaued (despite a very high calorie diet - still working hard on this) and is about 3-5 kilos from the target weight range.

After some very trying periods with extreme anxiety episodes (involving the police!), we had been proceeding more calmly for a few weeks until we increased the food intake significantly to try and beat the plateau. She is hating the (very minimal) changes in her body and now considers herself "obese". She is managing to go to school most days but every meal and snack has now become an immense battle ground with a period of screaming, tearing at herself, kicking and swearing, running around, trying to self-harm with her nails and threatening other harm, screaming before she settles down to eat (which she usually does do after about 15 minutes) and then about 30-45 minutes of the same after meals.

Our family is absolutely exhausted by this and it is having a massive toll on my two older daughters, as well as my health and my husband's sanity. 

What we are really struggling with is whether we need to tolerate all these symptoms as an inevitable result of extreme anxiety OR whether we should be firmer with her that, whilst we recognise her extreme pain, we expect her to step up, confront her anxiety and move through and we will not sit there trying to calm her any longer. The reality is that there really is nothing that we - or any medical professional - can do for her at this stage other than continue to feed her - we have tried some medications to no avail. Apart from feeding, the only way through the anxiety is for her to keep pushing through and that is something only she can decide to do. Right now, there is definitely part of her that seems to enjoy giving into the drama and the screaming and the attention - you can see it when she stops screaming, looks around to see if anyone is watching and then starts screaming louder.

So, would it be appropriate for me to start being much tougher around what our expectations are of her in terms of not screaming or acting out when she is with the family? I'm not sure I have many options in terms of sending her to her room (she won't go) but I can refuse to sit beside her and comfort her and I can get on with my jobs without looking concerned. I can also tell her strongly that it is OK to be anxious and to ask me to cuddle her or sit with her, but it is not OK to take that anxiety into a tantrum.

I'd really welcome your thoughts 🙂 Thank you!
whether we should be firmer with her that, whilst we recognise her extreme pain, we expect her to step up, confront her anxiety and move through and we will not sit there trying to calm her any longer.

This is what I did.  My daughter had a spot she would go to if she started getting out of control until she could regain control.  Get the food in and then distract like crazy.

I can also tell her strongly that it is OK to be anxious and to ask me to cuddle her or sit with her, but it is not OK to take that anxiety into a tantrum.

Great thing to tell her.  For me I would see my daughter in inpatient programs and whenever she was out in public eat without the drama so I knew she could do it at home too.
When my daughter had tantrums I told her a few words like, "I don't tolerate this behavior." After some time she stopped doing it.
I also think you should try to stop that and tell her that it is not acceptable and needs to have consequences. Some parent here said to their kid "it is an eating disorder and not a rudeness disorder". We did not tolerate extreme behaviour. She was send to her room until she calmed down (she had a punching bag there to get rid of all that anger and frustration).
Keep feeding. There is light at the end of the tunnel.
There are two parts to this. It is common as they become weight restored to find their emotions become stronger and often they can seem overpowering. This makes sense as their brains start producing more serotonin in response to improved nutrition, but their brains have increased their receptors in response to the previous deficiency. So I think understanding their emotions are powerful is important, that being said we all at times have to control those powerful feelings and thoughts and they do too. They need to let that anxiety sit with them rather than to respond to it. So  as others have said, kicking, screaming, being out of control is not appropriate - they need to check these feelings. If we can ask toddlers to use their words, we can ask teens too. 
D diagnosed restrictive AN June 2010 age 13. Mostly recovered 10 years later.  Treatment: multiple hospitalisations and individual and family therapy.
Hi Tahirua,

Emotional dysregulation is a well known symptom of both ADHD and ED. I wonder if it was one of your daughter's ADHD symptoms prior to ED. It is speculated that people with ADHD can experience emotions more intensely than others and with the impulse control issues it is difficult to control their expression. Even if it was not and issue previously, it could be that she was able to muddle along when she was just dealing with ADHD and anxiety but now with ED on top, it is all too much for her. Another thing to look at is the ADHD meds, if any. Many ADHD kids can experience a rebound when their meds are wearing off. Not to mention that stimulant medication often suppresses appetite Ã°Å¸ËœÂ²

My ED son does not have ADHD but when he was losing it we would stay totally calm but disengaged. I would write in my diary, read a book or check my phone. We did stay close by and stepped in when he self harmed but other than that it was just a question of riding out the storm. We choose to accept these meltdowns as symptoms of the illness and did not have any consequences for them. For my son, they were completely out of character and disappeared once he was getting regular and sufficient nutrition.

DBT is a therapy designed to help those with emotional under control to learn skills to help. It has been used with ED for quite a number of years and is now starting to be used with ADHD. Is there a facility offering a course in your area? It seems like it would kill two birds with the one stone!

Warm wishes,

2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, no progress. Medical hosp to kick start recovery Feb 2016. Slowly gaining at home, seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. 2018 growing so fast hard to keep pace with weight. 2020 Off to university, healthy and happy.
  • Swedish proverb: Love me when I least deserve it because that's when I need it most.
  • We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.
  • If the plan doesn't work, change the plan but never the goal.
  • We cannot control the wind but we can direct the sail.
Agree with all that has been said above; strong emotions ramp up closer to WR, in response to the increased seratonin with nutritional rehabilitation.  Our d also had anxiety issues that were present prior to ED, and which increased during refeeding.  We were able to use meds to help with the anxiety, but also had a T that d worked with on skills to deal with the anxiety.  Some of these were fairly simple; using a squeeze ball when extremely stressed for example, or calming music.

Other things that you might consider are directing the physical outbursts in a safer way, such as punching a pillow, or as has been suggested, designating a 'safe' place to calm down.

If there is a fear of extreme self-harm or physical attacks on the family, then calling authorities or taking d to hospital should be considered.

Sending warm support,
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
Thank you so much everyone! All these suggestions and ideas have been super helpful. I'm really feeling like this is the breakthrough point for me. I'd been condoning a whole lot of dreadful behaviour as part of the ED/ anxiety, and now I'm clear that this is a "baby tantrum", we are all a lot happier! 
Good to hear that you feel better now and that you found a way to manage this! Keep going and she will be better soon.
Keep feeding. There is light at the end of the tunnel.