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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jobe
D16 is recovering from years of sexual abuse at the hands of her childhood best friend's father. Happened age 7-11, she disclosed at 15. Lots of depression, stealing, cutting, and emerging ED. All trying to cope with horrific trauma. She confided in a therapist last summer at 15 after a suicide attempt and entry into an intensive outpatient program for trauma, and that therapist reported as required by law, but didn't warn D that what she was disclosing was getting into the area of being reportable. So the reporting came a s shock, D was just beginning to open up about what happened, and the pace of her disclosure was taken out of her hands. 

Talking about what happened to police and prosecutor before she was ready re-traumatized her....nightmares made her afraid to sleep, daytime flashbacks and even "seeing" her perpetrator everywhere. Out of control anxiety, she dropped out of school, dropped out of therapy, and started to hate her body and her appearance and severely restricting eating.

I tried to get firm with her about eating but all behaviors got worse. We learned that with C-PTSD, which she has, being in control is key to recovery. Because her abuse happened when she was out of control. Reconnecting and learning to trust are key, as well as letting the traumatized person control their own recovery. So hard to step back and watch the train wreck.

We told her that we love her too much to watch her die from ED, and that when we saw she could not keep herself healthy we would step in and residential was an option. Lots of pushback. I think her symptoms just got so bad she wanted to try meds again. She had dropped taking the SSRI and a med for nightmares because it didn't work. But she hadn't been on them long enough, consistently enough or at a high enough dose.

She finally decided she wanted to re-try therapy and meds, and is allowing me to manage her meds, which is a big step forward. She rejected three therapists at one meeting. Now we have a Nurse Practitioner she likes and so do I. The nightmare med requires BP checks and she is eating again, I think to get her BP up so she can increase her dose to a level that will help. Her nightmares are horrible (reliving her abuse) and her sleep is very disordered, falling asleep at 5am and sleeping late. So she's motivated to eat in hopes of getting relief from nightmares. Our relationship is much improved and she is reconnecting with me in a big way.

Which brings me (finally) to the point. She has been very down and cut again yesterday for the first time in a long time. I have read that with trauma you do not want to remove a coping mechanism without replacing it. I am wondering if ED was a coping mechanism and now that she is eating she has reverted to cutting. Or if gaining weight is causing the anxiety that leads to cutting.

We've been through DBT and she does use some strategies but probably needs coaching. She's resuming therapy in June, and will be meeting with a nutritionist as well, so will have a team around her: nurse practitioner, therapist and nutritionist.

Long road, and I'd love any input from caregivers who are managing trauma recovery and ED.
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teecee

Hello and a warm welcome from the north of England. 

My D has just completed EMDR which is actually used successfully for trauma, including sexualised trauma. 

My Ds life has taken a dramatic turn for the better and has normalised eating as a result. 

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teecee
Jobe apologies, I see you already know about EMDR. 
re your questions I do believe ED is a negative coping mechanism. I talk to my D about gaining positive coping mechanisms To deal with her anxieties. She is practising a lot more self care to attempt to deal with it but tells me the shift in her mindset is the ‘self care element’ as self care doesn’t have to be an activity but a way in thinking. 
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Foodsupport_AUS
I am sorry to hear that your D is still struggling with her previous trauma along with her eating disorder. 

Like teecee I agree that sometimes not eating/restrictive eating  is used to help someone feel better, and in that way it is maladaptive coping mechanism. For many however it is a response to feelings of distress and anxiety, thoughts about food and weight - in that respect is could be seen as a normal response to those thoughts. 

I don't think anyone is in a position to say what role the eating disorder is playing for your child, but all "coping mechanisms" which are unhelpful always need to be addressed for long term health. I think it unlikely that it is a one for one switch like most things in life, by example someone who is using alcohol as a coping mechanism may learn several new helpful strategies to help, someone who has multiple issues, may use a smaller number of strategies that are more useful. 
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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jobe
Teecee, I am so glad EMDR was so helpful for your D. Was she fairly stable before? Was she addressing a trauma? Our providers are telling us that she is too unstable for EMDR just yet, as indicated by the flashbacks, nightmares, and hallucinations of her perpetrator. We tried something that is supposed to be similar but gentler, Lifespan Integration, and that was too intense for her right now. She has spent so much effort trying to forget what happened, that reprocessing it is just too triggering for her right now. They say she has to get better at her coping strategies first (the positive ones), as EMDR could re-traumatize her. What was your D's experience?
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teecee

Hi Jobe
no she was not addressing a one of catastrophic trauma like your D. She had certain life experiences that caused traumatic emotions to manifest so when she recalled those instances she was triggered and took her right back to the incidents every time. She couldn’t get past them.

EMDR did take her back to those times and brought back the suicidal feelings so we had a really bad week around xmas time as she dealt with those thoughts again however she worked through those with the help of the therapist and came through it.

In terms of stability she was very up and down and in a loop of positive and negative behaviours so there were periods of a few weeks of normal living but then really low moods for a week or two .... She came to us as she was desperate to recover and was willing to try anything. I suppose she had that motivation to overcome the fear that was holding her back in the loop. 

I suppose the therapists skill and the support you are able to give will determine how she copes. I asked my D if she felt she could have had EMDR a year ago and initially she said yes but then in reflection stated she probably would have found the suicidal thoughts too hard to overcome as she had buried those prior to EMDR. 

May be a little time may be prudent. My D was 15/16 when diagnosed with AN and is now 18. She’s able to deal with her emotions a lot easily now. The EMDR has been life changing for her. She eats a balanced diet now and is living what appear to be a normal life. I am still watching and still worry about exercise becoming compulsive again in the future but for now life is completely normal so I’ll take that. Xx

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deenl
Hi jobe and welcome.

I do not have experience within my family of the combination of childhood sexual abuse and eating disorders. But I do have experience of a family member who was abused as a child, one who has/had an eating disorder with suicidality and self harm and also someone with C-PTSD. So I will do my best to describe what I have observed.

All those situations take a very long time to resolve, with periods of progress and periods of regression. Any one alone is a dance of two steps forward and one step back and I think a combination together is one very complicated dance.

One of the effects of malnutrition in people with the biological tendancy to restrictive eating disorders is that restriction calms their emotions as described in this article on negative energy balance by Cynthia Bulik. 
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... the biological reality that the physical experience of negative energy balance is fundamentally different in people prone to anorexia. The starvation state is alluring to them, not because it signals weight loss, but because it is anxiolytic. That means that negative energy balance actually confers a sense of calm on their otherwise unsettled biology. What makes the rest of us more anxious makes them less. 

Obviously, the emotional burden of childhood sexual abuse feels overwhelming. The blunted emotions of the malnutrition make this feel easier to cope with. When there is an increase in nutrition this can mean that there is an increase in the intensity of the emotions. I am speaking in generalities though. If your daughter shares with you, it is worth talking about this with her in order to understand what her personal experience is.

In practical terms this can mean that any treatment plan (even the one you do at home before you get to meet up with all the relevant professionals) has to be flexible and be able to prioritise the ED or the abuse depending on the phase. My own personal opinion is that you cannot deal with one fully and then the other, treatment must be intermingled and dependant on how the patient is physically and emotionally.

Obviously, life threatening behaviours will always be top of the priority list. So, what can you do to keep her safe? When my son was actively suicidal, I looked at many of the suicide prevention sites and learned the warning signs. One of the surprising ones was that a sudden improvement in mood can be a sign that someone has made a decision attempt suicide and is relieved to be out of the confusion. This was the case with my son. We also did the usual checks around the house, removing medications, chemicals, sharps etc. He was never left alone in the house. The car was always parked facing the hospital and well fueled, keys in a parents pocket. My phone was either in my pocket or charging beside my bed. The windows and doors of the house were locked, even during the day in the worst of it. I was of the opinion that I could not eliminate 100% of the risk but I could make it as difficult as possible and increase the chance of getting him to hospital asap if he made an attempt. I kept repeating that I loved him, I would not let him die and that we would find a way through.

Ok, second life threatening behaviour is eating/ drinking too little. I told my son the exact same as you told your daughter, that I would do whatever it took. Your daughter seems to be very motivated to avoid in-patient treatment so this is something that you can use to support her. You are in a collaboration together to ensure that she eats enough nutrition to keep her out of IP. You are there to keep her safe and well. You will be there to support her when the anxiety is high.
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I tried to get firm with her about eating but all behaviors got worse. We learned that with C-PTSD, which she has, being in control is key to recovery. Because her abuse happened when she was out of control. Reconnecting and learning to trust are key, as well as letting the traumatized person control their own recovery. So hard to step back and watch the train wreck.

Personally, I do not think that it is so black and white. When we got firm with our son it caused him to stop eating completely. So I had to find a way to get him eating without being so firm. Leaving him in control of what he ate would have meant his death (my son was so malnourished that this was a constant risk for a number of months)  If you would like, you can read what help us and many other parents stories on this thread. I believe that my son had so much terror of food and was in such a panic that he needed us to be very calm and soothing with him. He needed me to let him know (in very few words or he'd flip out) that I had this, I would keep him safe, I would get him through. I refed him on safe foods for a year or 18 months because he could not tolerate the stress of fear foods. 3 meals, 3 snacks on the dot of the agreed time, in a room separate from the rest of the family, with a parent to support and ensure that he actually ate were essential.

Ugh, the self harm, I found very, very difficult. I did step in when it was extreme and it would often end up with me, him, his dad if he was not at work in a sobbing heap on the ground. However, we got better at dealing with even that. We removed obvious tools that would cause bad self harm. We, dad and I, learned to stay calm in the moment and leave our sobbing until we were lying in bed. If the harm was not terrible, leaving him alone often de-escalated the situation. If we intervened with the little stuff it often escalated. In other words, we picked our battles. DBT was not available to us, unfortunately but we did what we could to encourage other coping mechanisms. In our case, improved nutrition reduced and eventually eliminated the self harm and suicidality. There is some evidence that low glucose levels in the brain can increase the chances of a self harm episode therefore, regular meals and snacks throughout the day are very important.

One of the things I am wondering is how familiar you are with the tools and skills of DBT. Within DBT treatment, a safety plan is drawn up. The one your daughter previously made is out of date as she does not have the support of the therapist there. Can you and she update it together in a way that allows you to remind her to look at her plan in a moment of stress and difficulty. Can you learn about which distress tolerance skills she found the most useful? If you know them then you can help her practice them in the heat of the moment. I simply got myself a book and I love it, use lots of the skills myself. DBT encourages people to practice their skills even when calm so that they are easier to implement in a moment of distress and pain.

As regards the sexual abuse, I know that for the person in my life, feeling safe at home and with the boys/men of her family was crucial to her. All family members can help to make home and the family circle a safe little nest where your daughter can relax and recover. Can you ask your daughter, the family, therapist etc what little actions might helfp? This person's experience was somewhat similar to your daughter's in that the abuse happened when she was 8/9 and she did not disclose it until she was 15. There was a very intense period around the time of disclosure, then it faded to the background, then the foreground, then the background with the intensity diminishing each time and the periods where it was in the background getting longer. It seems to me that the issue came back to the foreground for two reasons 1. subconsciously she was at a stage where she could cope with another round of healing 2. something internally or in the environment meant that it could not be ignored any longer. 

There is very often undeserved guilt felt by people who have experienced childhood sexual abuse. One of the most healing sentences I have ever read is "Children look for love and affection,they do not look for sexual abuse" It does not matter that a child might have danced around in their knickers during a water fight at their friends or wished they could marry their older, hero-worshipped cousin or sat on someone's lap for a hug or any of the 1000's of loving, innocent actions kids do. 100% of the responsibility rests with the abuser. It can take years for the heart to believe what the head logically knows.

One of the best things that parents can do is to express how NORMAL reactions are, let them know that it is temporary, you have full confidence that they will get there, that you are beside them to support and hold them up as they go through the necessary healing. "Yes, honey, you are experiencing intense feelings now. I've read/heard from survivors and I know that this is very, very common at this stage (at this stage, during this phase are great expressions for indicating a temporary state whether in ED or abuse recovery). I can see that this is hard for you. I am in awe of how you have coped so far so I know you will get through this phase too. I am here to keep you safe. I there anything special that I can do?" You might also make a suggestion or two about what would help. Please remember that you are trying to help them through all the painful, difficult healing they have to do, not to help them avoid it. (Although temporarily setting something aside for a day, for a few months, depending, can really help pace recovery because both conditions are absolutely emotionally exhausting to deal with.

Please remember that there is always trial and error in finding the techniques and skills that help most in your family with all their individual characteristics and in your particular situation. Feedback, not failure is a favourite expression here. I think that when you are dealing with both conditions slow and steady steps in the right direction, once any life threatening situations are past, might be preferable to a ripping-the-bandaid-off-approach but you know the situation on the ground so trust your gut.

Although aimed at a general audience of parents with anxious children, I found the explanations and techniques in Freeing you Child from Anxiety by Tamar Chanskey to be very helpful for a parent in guiding their child/teen. I also really like Rewire your Anxious Brain by Catherine Pittman and Elizabeth Karle. It has exercises and explanations on anxiety that orginates in the cortex as well as the amygdala.

And, of course, don't forget to take care of yourself and your other loving relationships. This is an enormous task for any parent to do and will take much of your time and energy, no matter what professional support you and your family have. You have an terrible experience to process and to grieve about. It, too, will probably happen in phases whenever you are in the right time and space to do so. You cannot and should not sacrifice your health, your relationships with other family to the f****er who harmed your child.(Edit: just to clarify that this was a thought we used in our family to help us do difficult steps in the healing process. The abuse is all encompasing in the beginning, as is ED and slowly you get minutes, hours, days, weeks where your mind and emotions are just yours again. We found it helpful motivation to mentally deny him power over our choices and behaviours. It may not work for everyone) You will be able to hang in there for the long haul if you are well, both emotionally and physically. You will show your daughter the way back to normal life by living a somewhat normal life yourself, by showing her that the range of emotions, both easy and difficult ones, are a part of life and that even at the most difficult of times there are some teeny, tiny positives. Although, I am guessing that you will have to hold in your strongest feelings until you can cry in the bath, toss and turn in bed and scream parked in the car. You sound strong, calm and determined in your posts so I have a feeling that you are exactly the mum your daughter needs.

Wishing you continued strength and courage,

D

P.S. the person with C-PTSD found good benefit from EDMR as an adult processing childhood traumas
2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, stable but no progress. Medical hosp to kick start recovery Feb 2016. Slowly and cautiously gaining weight at home and seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • 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.
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sandytoes

Deenl, I would like to send you a great big hug. The above response was so very thoughtful and supportive. You’ve outdone yourself as a Moderator in this one. 


I believe Jobe will feel the love you poured into this reply. I felt it. Thank you. 

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deenl
Aww, thanks for those sweet words, Sandytoes. Much appreciated.
2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, stable but no progress. Medical hosp to kick start recovery Feb 2016. Slowly and cautiously gaining weight at home and seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • 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.
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jobe
Deeni, thank you for your incredible reply. Thank you for putting so much time into sharing your knowledge and resources with me. I know I will be referring to your post over and over in the coming days and beyond, to fully absorb it. It feels so helpful to be able to share this experience and get such valuable feedback and personal support. Sandytoes is right...I do feel the love you poured into your reply. This site is a lifesaver.
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Torie
I am among the many here who had to deal with cutting.  (Luckily here, not with trauma so  I can't speak to that.)   I tried to read as much as I could about the cutting, and my main conclusion is that it is not well understood.  Frustrating, because at least with AN, you know what your mission is.

Why is it so common that cutting appears along with AN?  Dunno.  But it is also common that when you slay ED, the cutting will also stop.  That's what happened here, and is reasonable for you to hope for that.

In the meantime, there are lots of suggestions (rub an ice cube, draw red line, snap rubber band, etc.) - I assume you have tried those.  They didn't work here, but hopefully something like that will help for your d.  I also assume you have removed all sharps as best you can.

It is so hard.  I'm really sorry you are faced with multiple complications.  Please feel free to ask all the questions you like. xx

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