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

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Reply with quote #217
Hi, I would like to share the challenges I hv with my D.
Some background:
D was 14 when she started exercising and reducing her food in-take in late Jul-12. We brought her to see GP and a nutrionist. Nutrionist came up with a menu plan to help her gain weight. However, she wasn't eating the right amount. By late Oct-12, she weighed 34.4kg and was admitted to hospital. Discharged in mid-Nov-12 with a weight of 37.8kg. We started Maudsley treatment and on weekly basis, her weight was like a yo-yo. And there were the usual screaming, abusive language and fighting. By mid Dec-12, she weighed 38.9kg.
We wanted to give her a break and make her happy, so decided on a one month holiday overseas to visit family members and friends (I am a migrant; moved to Australia when D ws 8 yrs old). This was against T and Doc approval. Was a bad move, when we return from holiday, her weight was 36.3 kg. It has been a month since we return from the holiday, she has gained only 400 g. It is a very slow gain.
Met up with D and T; D says she has to gain weight faster in order to fight the ED. Also, we had differing view with our T on the way the sessions were conducted; We felt that the weekly session with T wasn't of any value add; it's always talking about what happened at home, and hardly any fresh ideas coming out of the sessions. The sessions primarily focus on feeding. My D hardly spoke a word during all the sessions. My wife, I and D got very upset after each session. After every session, we (my wife and I) usually feel guilty of not doing enough and D gets angrier and more determined to resist more food after each session.
Everyday, my wife and I struggle with getting my D to eat the right amount. My D eats, but in small quantity. We had tried the 'parents take control of the menu' approach, but failed. She refused to eat. She screamed and cursed. We stopped her from going to her room, use of her phone, etc. She sat in a corner and sulk. After a day of struggle, she agreed to a menu plan that includes 2 glasses of Sustagen (day and night). As we were then eager to get her to eat more, we agreed to the plan. The plan provides about 1300 cal. With resting at home, she will be able to gain, but very slowly.

Last week, we agreed with T to stop the sessions for a while. Doc (head of the refeeding team) agreed and ask us to focus on refeeding, with a closer to an intake of 2000 cal. daily. Since we had agreed to the 1300 cal amount with our D, we have difficulty increasing the daily intake to 2000 cal. She will not touch her food at all should we decide to increase.
I am really stressed out and in dilemma: to continue with the current agreed menu, she will gain weight, but VERY SLOWLY. however if we (me and wife) were to take back control of the meal and come out with a new menu, she will definitely fight and will adamantly refuse to touch her food. D even says that she rather go to hospital than facing us. She hardly talk to the rest of the family members, and keep herself in the room. I worked on her current agreed menu and modify a bit to come out with a 1800 cal intake. I then tried talking to her about the new menu plan, and told her that the D advice on the need to increase the calories in-take. She refused to talk; I subsequently sent her an email; and her respond was :" you don't know nothing about cal; you got it all wrong", and " she says will increase to 1800 cal and will send me an email on what she will take". That was yeterday; I am keeping my fingers-crossed she will act on it, or am I foolish to negotiate with my D (or ED?!). Today, she is still eating based on the old menu plan of 1300cal. Should I take control, and be prepared to 'fight' with the ED, and take the risk that she will not eat for the entire day? (we had such experience when we 'push too hard').
Colleen in the great Pacific Northwest, USA

"What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease."
Alexander Pope, 1688-1744
Welcome, Highhope,

I'm so sorry you've had to find us, but I hope you'll find us helpful to you and your family.

The first thing I always recommend is that the parents educate themselves about the current science of eating disorders.  Do you have "Help Your Teenager Beat an Eating Disorder" by Lock and LeGrange?  This is the most useful book for refeeding at home.  I also like "Eating with Your Anorexic" by Laura Collins and "Brave Girl Eating" by Harriet Brown for their clear parents'-eye views of what refeeding really looks like. Very readable.

I'd also recommend reading around the FEAST site.  The ATDT Hall of Fame is full of good wisdom by parents who've been through this already--you'll find a lot of your questions might be already answered there.

It sounds like your d is involved in her meal plan, or that she is aware of the calories she is taking in.  This can make changing things very challenging as that calorie-counting and obsessiveness is a symptom of the disorder.  1200 calories is a weight loss diet--a person in a coma needs 1500 calories just to support life.  Even getting to 2000 calories will not put weight on her.  Many of us need to get 3000-3500 cal in to see a good weight gain (1 kg/week).  I know this sounds impossible, but if you can get 1200 cal in, you can get 3000 in--really.  We have all been where you are and found skills here that make this work.  Really!

Getting nutrition normalized and getting her to her healthy weight is the first step in recovery, so there is every advantage to getting this done ASAP.

Many of us here have found the Magic Plate concept very useful.  We plan, cook and plate the child's meals.  Her job is to eat them.  It's helpful to keep her out of the kitchen while you prepare meals and snacks.  ED wants to hover and make sure everything is as low calorie as possible--ED is a nuisance in the kitchen!  It should not be her job to portion her food if you are in charge.  Her job--her ONLY job--is to eat 100% of what you put in front of her.

And how do you do that?  You're obviously getting the same refusal that most of us get.  Here are some very good links from the Hall of Fame:
How to get a stubborn anorexic to eat

Basically, sitting with your child, staying calm, waiting out the emotional storm and requiring her to eat.  "LIFE STOPS" until she eats--that means no school, no friends, no anything until the food is gone.

I don't want to swamp you with information.  If I could swamp you with anything it would be HOPE.  There is great hope for recovery here.  You sound like a great dad.  I believe in you and your wife and your ED-kicking abilities!
Colleen in the great Pacific Northwest, USA

"What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease."
Alexander Pope, 1688-1744

We wrote this for people in exactly your situation.  I remember being overwhelmed and Colleen telling me that I was not to want/ask/plead/beg about the correct amount of food being eaten.  I was simply required to.

Mother, wife, farmer, C of C and M Productions
Dear Highhope,

sorry life is so hard at the moment.  It is so hard before regular meals and snacks are established - it takes a while in our experience, but once firmly in place the resistance isn't quite so strong.

Your therapist could well be right just concentrating on food so early on in treatment, it is unlikely your D would benefit from any talking therapy when she is malnourished.  My D did not speak to her therapists early on, would sit in hostile, stony silence.  ED felt threatened.  Life was always difficult after a therapy session, again the eating disorder had been challenged.  Try and think of it as a positive, although I appreciate how hard it is.

I would not negotiate with your D over food.  We never talked about calories and we never let her in the kitchen.  As others have said, read around this forum, take all the advise on offer.  There is only one way through this and that is increasing calories and get the weight on.  My D is so much better since weight restoration - it has been one battle to get there but you can do it !  Early on I would get annoyed when people kept saying " get the weight on and quickly",I thought there must be more to it than that.  They were right. early on that really is the priority.

Keep reading, keep asking and stay hopeful.  You will come out the other side.  Good luck. xxxx
Thanks all for your advice and kind words of support.
Yes, I have read the "Eating with your Anorexic". I understand I need to take charge, but it's scary. I am so afraid of having the ED rearing its ugly head. The last time we tried, she was so angry, that instead of eating the agreed amount, she refused to eat at all! She abused us, kicked and beat, and knocked herself against the wall. We took away her phone, ipod and computer. She remains in the couch for the entire day, not eating ; and seeing her in that situation, I asked her to have a slice of bread. She refused and went to bed, empty stomache. She hated us and when I gave her the ultimatum of hospitalisation, she was 'happy' to go (rather than seeing our face). We were all set to bring her to hospital, but I was reluctant as I know it's the parents responsibility. 
I wish I have the strength and patience to take back control and apply the 'magic plate'. Is it that my wife and I are not strong enough to apply Maudsley method?
Please do not think you are not strong enough to apply the Mauldsley method.  This illness robs us all of our self-confidence at times.  It is normal to feel you can't do it early on - I often felt like you do and would become very distressed when she hit herself against a wall, spat at us etc. But I faked confidence.  I was very strong in front of D but would collapse in private.  I was fortunate and had good support - make your therapy team aware you are struggling and see what they suggest.

Unfortunately all the kicking, biting etc will be in vain if you do not follow through with food.  The ED is showing all these behaviors because you are threatening it and your D is incredibly anxious she will have to eat.  But only through regular nutrition will these behaviors diminish - try and see it as a positive, you are winning.

Keep going, have confidence, you can do it - truly.  But it will be ugly and distressing but unfortunately you have to go through this stage to get your lovely D back.  Keep posting. xxx

Highhope, welcome and my heart goes out to your family. It's so hard. Can I suggest that you just take one bite at a time? Don't think of anything but that bite.
Here's what I take away from your posts that I think might help you. 

I'd tell your daughter that there will be no more discussion about food. And bite your tongue every time ED natters away at you. I suspect all the ED negotiations is wearing you down. I always visualized ED as a deatheater from Harry Potter books, swirling around my house, trying to cut me down at the knees. It helped to visualize the ED in my D as something outside of her so that I could separate her ED behaviours, like the verbal and physical abuse,the spitting, the yelling and screaming, food throwing, and most of the all the endless talking to wear me down.

Perhaps you can write out your plan, and look at it before every meal or snack. Add some mantras, like food is medicine, life stops until you eat, brick wall ghandi, etc. And just play those over and over. I felt like I was having an out of body experience in early days of refeeding.  Once you have a plan and your boundaries are set, stick with it. You can modify as you go, but wait until after the meal.  

Follow through on threats to the hospital. Is there someone she will not cause a fuss in front of? We used grandparents, but not too often because the entire illness upset them.But we did put her in the car to go to grandmas to help support me to support her in eating. Can you go to the doctors office with a supplement? It's best to prepare ahead of time so that whoever you are using as your Plan B will help and not hinder.
Followup is so critical-like  a toddler who plays one parent off another to get what she wants. Stay firm, stay the course and make sure resistance is futile.

You really have to jump in and take charge. Think of it as the lifeline to your daughter. If you let go she's adrift.

Sending strength. Sometimes we are afraid to start something because we don't think we can do it perfectly. Don't worry about that. We've all made mistakes and would like to change what we have done in the past. Look to the future, one bite at a time.

5 years in active recovery; With many, many days of full nutrition and closed loopholes, insight, life experiences and brain maturity we are slowly loosening the safety net
hello highhope,
I'm sending prayers for you and your D. may a sugest a book for you, maybe you read it already? but I find it helpful for me and my son, so here it is : Skills-based learning for caring for a loved one with an eating disorder The New Maudsley method. by: Janet treasure, Grainne smith and Anna Crane.
I use the book as a guide a kind of bible I can refer to when I need it, it's filled with techniques to help us carers.
Don't give up, be strong.
Highhope you have come to the right place.  All of the advice you have been given already is spot on.  Yes, it's difficult.  Yes, IT WILL SAVE YOUR DAUGHTER'S LIFE!  Come back to the forum to vent, to get ideas, to tell us your victories no matter how small.  Because you should know if you do this...if you feed your daughter...you WILL have victories to talk about.  We've been there.  We've been sweared at, punched, told our cooking is crap and worn many different types of food.  Your daughter is in there and she needs help.  No amount of pleading, cajoling or bribing is going to do it.  She eats.  End of story.  You are very smart to threaten the hospital if she doesn't eat and now you just need to follow through on it.  If she's not eating, that might end up being the best place for her for a little while.  And then you'll need to arm yourself with information from this site and be ready to complete the journey at home.  One way or another, you will eventually have to do this at home, so if you can get it going and avoid the hospital, even better.  Don't discuss calories with your d or come to an agreement with her.  Her only job is to eat what you put in front of her.  And add, add, add calories wherever you can.  She does not need to know.  Sorry if I am blunt...some of us will be on this forum.  We all feel we're in a race against time and need to get the information out quickly.  You came to the right place.  If you compared recovery rates of people on this forum (those who are here and those who have gone) I'm sure they would be astronomically higher than the overall average anywhere.  Good luck!  You can do this!
97% recovered, living a full life
There is no shame in hospitalization or partial hospitalization to get feeding started with a difficult patient and/or for medical stabilization in the medically compromised. Please don't feel like a failure if you decide that it is best to take that route.

What I've learned here is that the main thing is that, if you need a hospital or residential program, that it be one that involves parents daily in interaction and feeding. The focus of therapy should be eating, not unresolved family issues or interactional patterns. There may be such things, but they should be dealt with after weight is restored and the patient's mental health is improving due to some time at a good weight so that body and mind can heal.

Hospital/residential programs can be undermining and destructive. They also can be life-saving and affirming of the family. (See Nerdski's story for an example of both types of programs in their experience--one that was destructive, and one that has their daughter on a good track, eating well, and transitioning to home and parent-supported eating.

And, on violence toward me: I told my daughter I would call 911 if she ever hits me or throws things at me again. She believes me. She no longer hits or throws things at me. (She, however, is 8 ...)

"Hope is a wonderful thing ... but hope by itself is not enough. Hope is the reason to take action, to make a plan and then to change the plan when it isn’t working - over and over and over again if necessary." Hannah Joseph (Let's Feast Friday Reflection, "Just Keep Going," Friday, March 3rd, 2015)
When I first came to this forum I wondered too how I would get my D to eat,my situation is a little different but food phobia all the same.I thought how can I make her eat smething she doesn't like? Her doctor set me straight and made me realize.I told the Dr. that if someone tried to make me eat seafood( I hate all seafood)I wouldn't,I hate it, so why would I make my D eat what she does not like? She told me the difference is that I would eat seafood to save my life and she wouldn't do the same.Wow that really opened my eyes.I asked my D if she was trapped in a burning building would she eat meat to put out the flames an save her life,she said never she would burn to death first.I imagine that is the thinking of many with AN,the total fear so dibilitating that eating is sooo scary that they can't eat. Unfortunatly we all have to suffer to get our children to eat but I guess it comes with the territory.Best of luck to you  
Dear All,
Thanks a lot for all the advice and kind words of support. Very much appreciated.
Today, we had our weekly appmt. with doc. D gained 250 g in a week. Doc is not happy and is concerned with the small gain. Doc is asking for a 1kg per week, very much in line with all your advises. So, in doc's presence, I took the opportunity to gave my D 2 options:Either increase amount of food ( essentially more milk and fruits) or be hospitalized. I can see she was visibly shaken and her body language told me she didn't want to be in hospital. However, at the same time, she is not willing to have the additional food. So Doc agreed to arrange for her to be hospitalized when there is bed available over the next few days. Back home, she cried and asked what's wrong with 250g?
She tried negotiating the increase, but i firmly said no. She was very upset and skipped evening tea. She did have her dinner tonite, but refused to increase. My wife is concerned whether we are too harsh, after all she is eating and gaining weight. She is also worry that hospitalization has other not so-good consequences. My take is that if both my wife and I can't get D to eat more, then hospital is the only other option. Doc said D will have to be in hospital for approx 6 weeks to bring her to the normal weight. 
I prayed she will be able to accept the additional food when tomorrow begins. Our spirits are down, but will have to shoulder on....
High hopes, I'm really glad to hear that your doctor is backing you up on the weight gain.  250 g is not very much.

My d also was hospitalized to get weight gain started.  She was really miserable in the hospital, but it was hugely useful because a) it sent the message to her ED that this was serious, b) weight gain started with the supervision of doctors, and c) we used her fear of the hospital to convince her to eat after she came home.  We used to say, "You can eat here or you can eat in the hospital--that's your choice.  Eating itself is not a choice."  It made her really angry--but she ate.

Can I suggest something?  Don't increase her fruits.  Fruits have a lot of bulk for very few calories.  Head to our High calorie suggestions thread for recipes that really pack a lot of calories into a small amount of food.  It's much easier to face a plate with a smaller amount of food when you are terrified to eat. We call that having a small footprint on the plate.  She needs fats for brain healing and weight gain.  Serve her whole milk, not skim or 2%.  Lots of extra butter, olive oil and heavy whipping cream in everything.  Oh, and keep her out of the kitchen!
Colleen in the great Pacific Northwest, USA

"What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease."
Alexander Pope, 1688-1744
High Hopes, the most important thing for many of us is the total shift in thinking regarding this illness.  Many of us believe that if we push too hard for full nutrition, that we will lose what little gain has been made.  The reality is that until we push, the gains are an illusion that quickly dissolve under the weight of anorexia.  She will remain in this malnourished/mentally ill state, until she is restored to balance metabolically/neurologically with food.  Yes, it will seem as if she is getting worse...her behavior will likely be negative and difficult to handle.  There will no doubt be hours, days and possibly weeks of struggle that seem insurmountable, but it can be done, has been done, and must be done.  

You are your child's greatest advocate.  Learn and read and come here for loads of advice on how to get through this.  
What is "too harsh?"

I think too harsh is allowing my daughter to be dominated by a mental illness. It is not harsh to lovingly and firmly require full nutrition and have natural consequences for lack of compliance.

It is very very painful to see one's child suffering. And, to see oneself as the cause. Before we discovered the AN, I actually scolded my husband for giving Olivia too large a portion. She was so upset by a reasonable portion size that small portions seemed reasonable to me. It is natural to think one's child's reactions are reasonable, and to avoid making her suffer for no reason.

But, this is ED manipulating us. 

The only way to win is: no negotiating with ED. I'm not sure who said it, I think Dr. Kaye from UCSD, but "I don't negotiate with terrorists." ED is a terrorist. A 250 gram weight gain is terrific over a period of a couple of days. Not over a period of a week.

Also, fruit may be what ED wants, but it isn't what your daughter needs. It might be helpful to have fruit delivered in a smoothie so that it also includes some heavy whipping cream/double cream or other high-nutrient-value items.

Hang in there. This is the roughest part. Once the weight is on, it gets better, but it isn't over. Vigilence is required for a long time. We are still supervising meals 8 months since WR. This last few weeks, though, has been much better. Last night she struggled with dessert, but no meltdown. She acknowledged that "Mean Voice" was bothering her (she looked at me and said "It's" and wrote "MV" in the air.) I said, "shall I feed it to you?" She laughed and said, "yes, I'll be your baby." I fed her the rest of her brownie. Of course, she is just 8. But with eight months at a nice solid weight, she knows she doesn't want to go back to where she was, even if it is hard. She wants Olivia to be in charge, not MV.

Sending support,
"Hope is a wonderful thing ... but hope by itself is not enough. Hope is the reason to take action, to make a plan and then to change the plan when it isn’t working - over and over and over again if necessary." Hannah Joseph (Let's Feast Friday Reflection, "Just Keep Going," Friday, March 3rd, 2015)
Hello Highhope
You've had lots of wise words already and I also hear your fears about pushing too hard - we spent a year being scared of that.
I'm curious that you D put on any kind of weight with weight-reducing calorie intake. Do you think she might have found ways of tricking you?

I just wanted to note something that might help:
You wrote ''She was very upset and skipped evening tea. She did have her dinner tonite, but refused to increase. "
To me, that's a kind of success. You've been firm, in a way she's not accustomed to, and your fear, and your wife's fear, is that this might make her stop eating altogether, but she still had dinner. For us it was helpful to note all the times our D was eating when really, she could have refused. Every time we were firm on something, we had the tears and drama, but often that was just once. When we kept our position, she would manage the next time, and a new habit would form.
If you have the hospital as a fallback, you're in a good position to see how it goes with making firm requests, as the others have explained. It's not so scary when the hospital can 'rescue' you. We did well when we were in that situation - it took our own fear away.
The hospital might also be just what you need, and may give you time to learn-read-ask questions, and hopefully they'll give you practice so that you can take over when she's discharged. And I bet you could do with a rest from it all too, and recharge your batteries.
Wishing you lot of courage - these are not easy days.
Eva Musby, mother, author, produces lots of resources for parents at https://anorexiafamily.com and on YouTube https://www.youtube.com/user/EvaMusby/playlists
I feel your pain too. My daughter was hospitalized for a month. In that time I had the chance to educate myself and get my head together. We got her home a d that is when the true battle began for us....

Here is my blunt advice. You have to stop worrying about being too " hard" on her. You have to understand that her disease will prey upon your emotions to get out of eating at any cost. I would never talk calories or have her involved in the food preparation at all. Put weight on as fast as possible. Why make this hell last any longer than it has to? If 10 pounds could be gained in 5 to 10 weeks, why make it 20? It is going to be hard and exhausting no matter what. If you feel you cannot do the feeding and require all food be eaten no matter what, then treatment in a facility is a good option... As long as the food goes in. Changes in her mentality and her anger and anxiety will not go away until her weight is up and constant over time. There was a time I never thought I would see my true daughter again and with 25 pounds and a few months she came back to us.

For me the most important moment was when I realized I needed to stop fearing Ed. Ed can smell that fear and will trick you. We needed to make Ed fear us.... To know that we meant business. My daughter later told me how relieved she was that we took over so her Ed could blame us.

Remember this disease has the highest death rate of any mental illness. That video is spot on in the above post. We have all heard it all. I had food in my hair, vomit on the table, the whole mess. Be the brick wall. Fall apart later when she is not there. It is hard hard hard. I had to envision myself in a war to save my daughter. Each meal a small battle with time they became more victories than losses. We are l here for you ...
Persistent, consistent vigilance!
High hope

My heart goes out to you. It is SO hard. A couple of things which helped me: re- feeding your child is saving her life and food is her medication - she doesnt have to like it. Secondly, negotiating with your d is actually negotiating with the ED. we found iit much less stressful to completely remove her from any contact with food - no food shopping, menu planning or participation in meal prep. Last of all, we really needed the therapist as a family to advise us on strategies and the ED tries hard to split parents and therapist. Some of the worst times we had were when the ED had weasels under our defences and caused aggro within the treatment team. Some of the best times were when our d finished her meal after a nightmare of Ed rant, abuse, running around the house etc. and there was almost a 'click' as our daughter came back into the room and we had scored against the ED. Maudsley is great and I wish you all luck in the world.
In the beginning of refeeding we did no fruits. D ate fruits before diagnosis by the bulk bagful. When we started refeeding we kept d out of the kitchen took foods out of containers in case she came in and used a lot on the high calorie thread. Just changing up what you do can help. For breakfast I served what I thought was gruel! It was cream of wheat in the smallest bowl possible- but it was cream of wheat with butter and gainer powder. D ate it because it was small. I also started giving her orange juice, a tablespoon at first and increased every few days. She now drink 10-15 ounces at a sitting.
Keep asking questions.
Ed is crafty and horrible and made h and I cringe in the beginning. Now we puff up our chests at it! And hope for the best. Today d came home from her GED school and felt sick because it was 6 1/2 hours since breakfast. We said, you need a morning snack and d said I do, I really do.
Wow what a difference time makes.
Slow and steady
High hope, youve had some great advice and there's little I can add that's new. When we refed our D I learned from here that you have to fake confidence every day. D wasn't allowed in the kitchen at all during food preparation, and never came shopping or did any menu planning. We took complete responsibility for food away from her. I would run her a hot bath and tell her to relax while I did dinner. You become a master at distracting techniques.
Our D gained a pound a week on 2000 cals, so it is possible although I know others have found they needed huge amounts more than that, particularly to keep up with growth spurts in younger children.
My advice would be to batten down the hatches, be absolutely resolute and don't negotiate with ED.If hospitalisation is the fall back plan for less than optimum nutrition, then so be it. You are fighting for her life so all the pain is worth it. Hang in there. You can do this! 
Sue Shepherd
Hi All,
It has been more than 2 years since I last posted. Since Sept-2013, D has been maintaining the minimal healthy weight range, with occasionally getting slightly below that. Throughout the 2years +, we weren't fully on FBT; with most meals, she was in 'control', except for lunch , where we packed for her.
She hasn't been talking to me for since 2013, and that makes it very difficult to support her both in terms of her physical as well as mental health. D will be taking her HSC (A Level) exams in October, and this I believe is a 'good distraction', though I am worry that she may be stressed out. Her mood has improved since 2013. No doubt her ED thoughts are still there. On one occasion at the doctor visit, D rated her own ED cognitions at 5/10 intensity. She still controls her food intake , though she has been adventurous enough to try out oily and fried food. However, her ED will try to 'balance-off' the intake, for eg. if she has noodles and chocolate cake for lunch, she will then have healthy salad (minimum or no carbo) the following day.
My main worry is that she is approaching 18 in Nov, and she will no longer qualify to visit the Children Hospital. I am concern what will happen, and what I can do if she turns 18 and is still not fully recovered.