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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Alwaysthere
This is my first time in any online forum, so I hope this helps...

My younger sister has AN and she's had it for probably 10+ years. She's now in her thirties and has started to get help, which is great. She sees a therapist, dr, and nutritionist. I'm so proud of her for finally deciding to take the right steps in addressing this, but I'm struggling with how to help her myself. She's not completely open to talking to me about her therapy sessions and when I ask how her day is going, because I know it's a day by day kind of feeling, she gives me a vague answer a lot of the time. However, on the flip side, she has said that the best thing for me to do is to acknowledge that this is important and just be there for her whenever she does want to talk about it. She keeps telling me she has a great team in place helping her work on things, and that I don't need to try and fill those shoes. 

I understand what she's saying, but from everything I've read, family support is crucial in the recovery process, so I don't like having to keep silent about it and only talk about it when she brings it up... which is getting less and less often. I know she doesn't like to talk about it because she doesn't like seeing us upset and says that only stresses her out more. So... how do I help? My instinct is to tell her I can't pretend it doesn't exist anymore. I'm not saying I need to bring it up during every conversation, but not bringing it up for weeks at a time doesn't feel right either. According to her husband, she's struggling with certain aspects, mostly not being allowed to exercise and not gaining additional weight. If I know all these things are stressing her out, I want to help and not just fill our conversations with random, "how was work today" topics.

I'd love to hear from a professional how I should navigate this. My sister and I have always been extremely close, so there must be more that I can do then just sit by and wait...

Thank you


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scaredmom
hi Alwaysthere,
Welcome to the forum. How wonderful to want to help your sister. I am pleased she has a team to help her. I have a child with Ed and really cannot speak as a sibling to an adult with ED, although I can give you some thoughts from my perspective. Family support can mean number of things. I don't think you need to be her caregiver as that is what she has told you. I think having you by her side is crucial as you show her a life outside of ED. How about just hanging out and doing sisterly things, like a spa day or a movie or crafts? She may feel more comfortable not discussing ED as she is working on that with her team. 
I don't think you need to be silent about it, but you can tell her you will support her in anyway as you are able. I hope she and her husband are doing well. Ed can be hard on any relationships, marriages too. 

I am not a professional of course, but I think being her sister and loving her and doing sisterly things will be helpful. It can allow her to have her relationship with you as she works on her ED. A safe soft spot with you could  be very comforting. She may just need a place with you that does not involve ED. 
How was her ED handled years ago? How are you doing? Are your parents involved too? I can only imagine how hard it is for you to see her struggle. I hope you have support as well. 
 This site is for siblings of those with ED.  I do hope it is helpful to you.

https://www.kymadvocates.com  
Welcome again!
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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Foodsupport_AUS
Welcome to the forum. It is great that your sister is finally seeking assistance for her eating disorder. 

Families are often an important part of treatment, though that can also include close friends and partners too. Practical things that family can do include being available for meal support ( if needed) or just being a sounding board for distress. My daughter has been ill for 9 years, and although well on the way to recovery still needs some care. At the same time since she is an adult this is markedly more hands off than it was some years back. I want things to change so much faster than they do, but really am obligated to sit back and jump in as needed. 
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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Kali

Dear Alwaysthere,

Welcome. How nice that you have reached out to find out how to be there for your sister.
Supporting a family member with an eating disorder can take many forms.

Accepting her for who she is and loving her unconditionally. Listening to her carefully. 

Encouraging her to stay in therapy/treatment and to see a medical doctor so her health can be regularly monitored. Supporting and encouraging her if she needs a higher level of care.

Learning how to become a good meal support and eating with her. The goal is to normalize eating. Distracting her while she is eating with conversation or any other way you can think of in order to help minimalize her anxiety around food.

Reading as much as you can about eating disorders and becoming knowledgable about them. 

Expressing your concerns to her and asking how you can best help her. Try to remain really calm when you talk about it, since she has mentioned that it stresses her out to see her family members upset.

Planning some things to do together and spending time with her. Museum visits, spending time outdoors, or any other things that she might be interested in. Sometimes people with eating disorders can become socially isolated because the disorder becomes so central to their lives and spending some time with you doing other activities can help to remind her of all the other rewarding things there are to do and experience and why it is important to fight for recovery.

Recognizing that it is hard to have a sibling who is ill, and seeking support for yourself if you need it.

Wishing you and your sister well,

Kali

Food=Love
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Mamaroo
Hi Alwaysthere, and welcome from me as well. You are a great sister and she's lucky to have you.

You've already got some great suggestions, I can just add a couple. If the exercise was a component of her ED then she might need to replace it with something else. You could take her to art classes, that is something which you could do together, it would give her a sense of accomplishment and she would be able to meet new people there. When het dr allows her to go back to exercise you could suggest yoga,  another thing you could do together, it is great for thinking the body,  but doesn't burn a lot of calories. 

I remember in the dark times, it was nice phoning up friends and family who were not aware of my d's illness as I could just have a normal conversation with them. In those minutes ED did not exist and I could feel that everything was going to be alright. Maybe sister feels that she is confronted with ED so many times that she just wants to forget about it when she's spending time with you. So if she doesn't want to talk about it, just leave it and show her how great life is. 
D became obsessed with exercise at age 9 and started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. View my recipes on my YouTube channel: https://www.youtube.com/channel/UCKLW6A6sDO3ZDq8npNm8_ww
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mommiful
Hi, Alwaysthere,

I'm a mom supporting a young adult daughter who has been dealing with anorexia for 7 years. We used FBT when she was younger with only partial success, despite years of trying. We're now finding that she does better with her taking full responsibility for her recovery and with us in support roles. There has been a learning curve for me to figure out how to support her without undermining her ownership of her recovery. I hope some of my observations might be relevant to you and your sister.

My first recommendation would be to watch Tabitha Farrar's YouTube channel. She's a recovery coach who recovered on her own as an adult after years and years of anorexia, and she touches on a lot of the issues that come up especially for people who are trying to recover after a long time. Now that I've been following Tabitha for a while, I find that I'm less often totally blindsided by what's going on for my daughter. (It used to be that whatever I thought she was struggling with at a particular moment, it was almost certainly something entirely different I had never thought of. Now that doesn't happen so often.) Tabitha has a few videos relevant to your situation: 
  • How can I best support my partner with an eating disorder?
  • Parents calling you out on restriction
  • Using my brother for FBT?
  • Asking for help from family
What's going to be an effective way of supporting your sister really depends on your sister. Tabitha has a section in her book Rehabilitate, Rewire, Recover that walks individuals in recovery through the process of lining up their supports and deciding who they want in what roles. You might want to take a look at this for some ideas.

Lots of people talk about meal support as a way to help. Don't be surprised if your sister does not find that helpful. When there is a long history, it can be difficult not to fall back into old patterns around the people we know best. For instance, maybe your sister has been pretending to eat well, but actually  piling a heap of salad under her other foods to make it look like more, or getting rid of part of her food, or purging, or exercising more in the days leading up to a meal she has with you, or eating less than usual in advance. In this case, she's probably better off turning to someone else for meal support. My daughter has found it's easier to eat well with people she doesn't know as well, especially at restaurants. (Of course, this can also be used as an excuse not to eat together when not eating enough. Double-edged sword.) The other piece of this is performance eating. The individual in recovery wants so much to please the people in their life, to show how well their doing, to relieve those people of the stress they have put them through over the years. This leads to once again using those tactics to make it look like their eating better than they are. It also leads to thinking of recovery as something they're doing for their loved ones, when they need to be doing it for themselves. As long as they're doing it for someone else, the appearance of recovery is more important than real recovery.

Some people find it helpful to call or text with a friend during a meal, just prior to a meal, or just after a meal. If someone else is fixing a meal, especially a particularly challenging one, it might help to take your sister out somewhere before the event. Go for a drive right before Thanksgiving dinner. Some people also find it helpful to be around someone immediately after eating. Go out for a movie after dinner. 

Grocery shopping can be a big issue for adults in recovery. It might be helpful for your sister to leave the shopping and cooking to someone else, like her husband. You might be able to help with that. Or maybe you could be available to her by text or in person to help her if she gets stuck in indecision in the store. My daughter has sometimes used me as a backup for her memory. She would feel clear about her objectives before she faced with a food-related decision, but when the decision point came, she would be in such a state of fear that she couldn't remember what she was doing. When this was happening, she started telling me in advance, then calling me to ask for a reminder. 

As someone who knows your sister since before her eating disorder, you can help her reconnect with her true, non-ED self. For people who have had an ED for a long time, the eating disorder has consumed all their thoughts and narrowed their lives during all that time. It can be hard to figure out who you are without the eating disorder, and that feeling of not knowing can engender a lot of fear. My daughter went through a phase when she asked me to reminisce about the days before the ED and help her see how she still has the same strengths she did as a child and she can draw on them to help her recovery and rebuild her life. It can also help to share some open-ended fantasizing about what directions she could go in once she is free from the ED.

Regrets about everything that was lost due to the eating disorder are another double-edged sword. Seeing everything that one has lost to an eating disorder can be disheartening. It's easy to get into an unhelpful, self-denigrating mindset. It's not just the obvious things one didn't get to do, the trips or events or accomplishments. What's harder to see, harder to look at and acknowledge, is the damage to relationships, connections, and personal growth. That can be both very painful and very motivating. Talking honestly and lovingly about the losses and regrets can be healing at the right moment. Letting your sister know that you are open to sharing her pain could be a gift.

At some point you may find yourself in a position where your voice may be one she can hear saying difficult things. Progress can be slow, and you might not be able to see some of the progress she is making, so don't worry if you can't see improvement right away. However, if, after a while, you get a strong feeling that she is spinning her wheels, you might want to bring it up by gently asking whether she feels she is still making progress or is starting to feel stuck. Her treatment team should be watching out for this, but it's good to have a family member looking out for her, too. Treatment providers can be lovely and kind, but also make mistakes. It's quite common that providers set target weights too low or focus too much on weight restoration as the only marker of recovery. Parents doing FBT often have to fight for higher target weights and don't see full restoration of a healthy mental state until their child goes well above the original target weight. When that happens with adults, they can wind only partially recovered and feeling stuck. Providers also don't always see some of the signs that anorexia has not left the mind: difficulty making decisions around food, planning everything around how she will work in her eating, standing all the time, strict routines that must be followed before eating, linking eating to what others are eating or exercise to others' exercise, feeding family members treats without eating any, hoarding/unwillingness to spend money, not sleeping enough/requiring self to be productive all the time. As a family member, you're likely to see the ways in which the ED is still ruling her life. The time may come when you can save your sister from a half-life of semi-recovery by calling her out on this type of stuff and asking her whether this is really the way she wants to live. In the mean time, try to respect her request not to ask her how it's going all the time. She will need to figure out a lot of difficult stuff, and it will take time and space without the feeling that her loved ones are constantly judging her progress. 


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sk8r31
Mommiful, thank you for writing such a lovely, informed and supportive post.  
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
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Alwaysthere
Hi Mommiful,

Thanks so much for your thoughts... 

All the comments everyone has written have been great to read. I'll be honest though, I'm still frustrated because for the most part I have to just trust that she's doing everything she can and that she is pushing herself to be outside her comfort zone, and I don't know if all that is actually happening. I think that's why I want to talk about it all the time with her... I don't live with her anymore, so I can't be there to know for sure if she's taking the advice of her team and doing what they tell her. If her nutritionist is saying, make french fries a part of your dinner tonight, for example, and she chooses not to do that, does that mean she doesn't want to change bad enough? Or, is that the disease? If I know I'm sick and the dr tells me I need to run a mile everyday to get better, even if I don't want to, or it's physically hard to do, I think I would still push through and do it because I know my health depends on it. But it sounds like ED are different? Is it a matter of willpower and just pushing yourself, or can she literally just not do it?

I will check out the youtube channel though and see if that helps as well. I really do appreciate all the advice and I will keep digging to learn as much as I can.

Thank you....


mommiful wrote:
Hi, Alwaysthere,

I'm a mom supporting a young adult daughter who has been dealing with anorexia for 7 years. We used FBT when she was younger with only partial success, despite years of trying. We're now finding that she does better with her taking full responsibility for her recovery and with us in support roles. There has been a learning curve for me to figure out how to support her without undermining her ownership of her recovery. I hope some of my observations might be relevant to you and your sister.

My first recommendation would be to watch Tabitha Farrar's YouTube channel. She's a recovery coach who recovered on her own as an adult after years and years of anorexia, and she touches on a lot of the issues that come up especially for people who are trying to recover after a long time. Now that I've been following Tabitha for a while, I find that I'm less often totally blindsided by what's going on for my daughter. (It used to be that whatever I thought she was struggling with at a particular moment, it was almost certainly something entirely different I had never thought of. Now that doesn't happen so often.) Tabitha has a few videos relevant to your situation: 
  • How can I best support my partner with an eating disorder?
  • Parents calling you out on restriction
  • Using my brother for FBT?
  • Asking for help from family
What's going to be an effective way of supporting your sister really depends on your sister. Tabitha has a section in her book Rehabilitate, Rewire, Recover that walks individuals in recovery through the process of lining up their supports and deciding who they want in what roles. You might want to take a look at this for some ideas.

Lots of people talk about meal support as a way to help. Don't be surprised if your sister does not find that helpful. When there is a long history, it can be difficult not to fall back into old patterns around the people we know best. For instance, maybe your sister has been pretending to eat well, but actually  piling a heap of salad under her other foods to make it look like more, or getting rid of part of her food, or purging, or exercising more in the days leading up to a meal she has with you, or eating less than usual in advance. In this case, she's probably better off turning to someone else for meal support. My daughter has found it's easier to eat well with people she doesn't know as well, especially at restaurants. (Of course, this can also be used as an excuse not to eat together when not eating enough. Double-edged sword.) The other piece of this is performance eating. The individual in recovery wants so much to please the people in their life, to show how well their doing, to relieve those people of the stress they have put them through over the years. This leads to once again using those tactics to make it look like their eating better than they are. It also leads to thinking of recovery as something they're doing for their loved ones, when they need to be doing it for themselves. As long as they're doing it for someone else, the appearance of recovery is more important than real recovery.

Some people find it helpful to call or text with a friend during a meal, just prior to a meal, or just after a meal. If someone else is fixing a meal, especially a particularly challenging one, it might help to take your sister out somewhere before the event. Go for a drive right before Thanksgiving dinner. Some people also find it helpful to be around someone immediately after eating. Go out for a movie after dinner. 

Grocery shopping can be a big issue for adults in recovery. It might be helpful for your sister to leave the shopping and cooking to someone else, like her husband. You might be able to help with that. Or maybe you could be available to her by text or in person to help her if she gets stuck in indecision in the store. My daughter has sometimes used me as a backup for her memory. She would feel clear about her objectives before she faced with a food-related decision, but when the decision point came, she would be in such a state of fear that she couldn't remember what she was doing. When this was happening, she started telling me in advance, then calling me to ask for a reminder. 

As someone who knows your sister since before her eating disorder, you can help her reconnect with her true, non-ED self. For people who have had an ED for a long time, the eating disorder has consumed all their thoughts and narrowed their lives during all that time. It can be hard to figure out who you are without the eating disorder, and that feeling of not knowing can engender a lot of fear. My daughter went through a phase when she asked me to reminisce about the days before the ED and help her see how she still has the same strengths she did as a child and she can draw on them to help her recovery and rebuild her life. It can also help to share some open-ended fantasizing about what directions she could go in once she is free from the ED.

Regrets about everything that was lost due to the eating disorder are another double-edged sword. Seeing everything that one has lost to an eating disorder can be disheartening. It's easy to get into an unhelpful, self-denigrating mindset. It's not just the obvious things one didn't get to do, the trips or events or accomplishments. What's harder to see, harder to look at and acknowledge, is the damage to relationships, connections, and personal growth. That can be both very painful and very motivating. Talking honestly and lovingly about the losses and regrets can be healing at the right moment. Letting your sister know that you are open to sharing her pain could be a gift.

At some point you may find yourself in a position where your voice may be one she can hear saying difficult things. Progress can be slow, and you might not be able to see some of the progress she is making, so don't worry if you can't see improvement right away. However, if, after a while, you get a strong feeling that she is spinning her wheels, you might want to bring it up by gently asking whether she feels she is still making progress or is starting to feel stuck. Her treatment team should be watching out for this, but it's good to have a family member looking out for her, too. Treatment providers can be lovely and kind, but also make mistakes. It's quite common that providers set target weights too low or focus too much on weight restoration as the only marker of recovery. Parents doing FBT often have to fight for higher target weights and don't see full restoration of a healthy mental state until their child goes well above the original target weight. When that happens with adults, they can wind only partially recovered and feeling stuck. Providers also don't always see some of the signs that anorexia has not left the mind: difficulty making decisions around food, planning everything around how she will work in her eating, standing all the time, strict routines that must be followed before eating, linking eating to what others are eating or exercise to others' exercise, feeding family members treats without eating any, hoarding/unwillingness to spend money, not sleeping enough/requiring self to be productive all the time. As a family member, you're likely to see the ways in which the ED is still ruling her life. The time may come when you can save your sister from a half-life of semi-recovery by calling her out on this type of stuff and asking her whether this is really the way she wants to live. In the mean time, try to respect her request not to ask her how it's going all the time. She will need to figure out a lot of difficult stuff, and it will take time and space without the feeling that her loved ones are constantly judging her progress. 


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Barberton
Alwaysthere,

Your example of doing what the doctor told you to because your health depended on it is sort of right, but not in the way you think. The ED thinking is telling a person that their survival depends on their doing the opposite of what is actually healthy. So it's probably not that your sister isn't committed to recovery, but that it is terrifying to her.

I asked my d to tell me when something was particularly hard for her. So throughout the day she might send a text message that says, "I ate my lunch and then grabbed a cookie on my way out the door and ate that too. Now I'm beating myself up over it." I can then send a message back saying, "That's great. You must have really wanted to eat that cookie. It's super that you listened to your hunger." Even if I didn't reply, the act of her being able to express those thoughts that would otherwise get stuffed back inside her has helped. Maybe that's a way you can help your sister?

I highly recommend Tabitha Farrar's material to help you understand ED more.
D fell down the rabbit hole of AN at age 11 after difficulty swallowing followed by rapid weight loss. Progressing well through recovery, but still climbing our way out of the hole.
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Alwaysthere
Barberton and Mommiful,

Thank you so much. In a strange way that does make sense. And I did watch Tabitha on youtube and I was genuinely blown away by the similarities she shares with my sister. It's never been about trying to look skinny for her, and it didn't start when she was 12 years old. The genetics and biology behind it is incredible... doesn't sound like the right word because none of it is a good thing, but it all makes sense if that's really what the brain is doing. I sent the link to my sister (hopefully that was ok to do) because I want her to hear this. I don't know what her therapist talks to her about, so if she isn't discussing the elements Tabitha highlights, I feel like she'd be missing out on an important piece to it all.

If I could just get her to open up more and do things like you mentioned, "text me when she's feeling out of sorts" I strongly believe that would help, but I can't force her to do that...
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mjkz
I don't know how close you live to her but you might ask if you could go to a therapy session with her and discuss these things with her and her therapist there.  It might help you reassure yourself that she is getting the care she needs and help you express what you would like to say in a safe environment.  I know when things go *ss over kettle with my daughter I will go to a therapy session with her and it helps to have a third party there to rephrase things in ways that my daughter can hear them.
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