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

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Kelly2897
My daughter has a history of RAN with purging. We have been at this for 2.5 years.  She’s weight restored and is no longer purging or compulsively exercising .  She eats everything we give her but not a bite more.  She has a hard time ordering in restaurants-she’ll always choose what she thinks has the fewest calories. I know that if we left food choices up to her she wouldn’t eat enough.  I don’t know how to move forward-does she need more time?  Should we be challenging her more?  She’s 16 and a junior in high school so the question of college is looming.  
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ValentinaGermania
So first question - as always 🙂 - has she really been weight restored? How did you calculate it? And did the weight increase in the last years due to growing and development as she is not grown out yet? Was there any growing and female development? Is periods back in a normal way?

It is very much possible that your d just not underweight for BMI but on too low weight for her personal body to get brain recovery started. How long has she been WR? More than a year? It takes long to heal all that damage to the brain. Normally brain recovery starts slowly about 4-12 months after WR but only if they have been on a really good weight. Many professionals set target weights too low and keep patients in a circle with that.

Will college mean that she needs to move out or can she go to college and stay with you? If yes, I would only allow that if she is in a good state. If she needs to move out, I personally would not risk that at this state, then a gap year would be good to consider. She must be in a very stabil and good state to move out or you will see a relapse within a few weeks/months.
Keep feeding. There is light at the end of the tunnel.
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Enn
Welcome!
I do hope you find the support you need to help your d.
You have done really well. I know purging can be so difficult. 
It does take a long time. I do think you may need to challenge her bit by bit. 
It depends which issue you want to start with, I guess. Is it eating a bit more? Then try that slowly. 
As for restaurants I would suggest that you choose a good meal for her a few times and show her what a good meal would be. My d will now eat safer foods at restaurants but I still challenge her. She will eat high calories meals like steak or pasta or pizza, but I have had to tell her to choose something else and help her out as required. We are over 2.5 years as well but my d is 14. I do still pick most meals for her but she knows now what to have if out with friends. 
Does she have her periods? 
I am glad you found the forum. Please let us know how we can help you. Either advice or just a hug and kind words s are abundant here.
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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Torie
Hi Kelly, and welcome.  It's really great that you have gotten her weight up and have stopped the purging.  I'm sure that involved a lot of heroic parenting.

I agree with Tina that we often find our kids need more weight than anyone expected for brain healing.  And also more time.  Another ingredient is a very gradual approach to handing back responsibility for eating enough.  For example, some will ask ED-kid to pour their own milk.  Not enough? That's okay, we can try again tomorrow.  Not enough tomorrow? THat's okay, top it off and try again tomorrow.  Still not enough third day?  That's okay; I guess we aren't ready for that yet.

Please feel free to ask all the questions you like - we're glad you're here! xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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Kelly2897
Her weight is 15 pounds over what the doctors said was “weight restored”. She now weighs about 5-10 pounds more than she did when this started and hasn’t grown in height (did all her growing early, went through puberty very early). Her periods returned about 15 months ago and have been consistent.  She’s been fully weight restored since August of this year-so only about 3 1/2 months.  She went through a lot and I feel she needs time to heal and be a “normal” teenager for a bit but her therapist says if she’s not moving forward then she’s not getting better.  My daughter is aware that we will not allow her to go to college if she’s not able to fully eat and she desperately wants to be able to go so I keep thinking that will motivate her-but it hasn’t.  She just seems very scared to make the next step.  

As for stopping the purging, heroic parenting wasn’t enough-she takes Naltrexone.  For anyone else out there struggling with purging, it has been a huge help.
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Torie
Kelly2897 wrote:
  My daughter is aware that we will not allow her to go to college if she’s not able to fully eat and she desperately wants to be able to go so I keep thinking that will motivate her-but it hasn’t.  

It is great that college is out there as a motivator.  That was a huge help for us, too, although as you know, motivation is not everything as they simply cannot will their brains to heal.

It sounds like the weight is likely high enough.  Yay!  Are you seeing small signs of progress in her thinking?  Maybe she has eaten one extra almond or something?  It seems like it takes forever.  Some find that keeping a journal or chart can help them see small progress that otherwise goes unnoticed - it is a little like watching our kids grow up - hard to see the changes when we are always with them.

Keep swimming. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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ValentinaGermania
So 3 1/2 months WR is really early days. Wait another 6 months and try to work on anxiety about the next steps. Is there any fear food left? Can she serve herself already?
Weight sounds good. Periods sounds good. But time is really not enough for brain recovery. It takes at least as long as they restricted...

Mine did not grow from age 14 to 17 but then after refeeding she grew about 1,5 cm at age 18. There can happen a growth spurt even at that age.
And to be honest, mine had a hard time ordering in restaurants up to about 1 year after WR. Oder for her, that is o.k. at that state, she does not need to be able to do that now. She can learn that later. We practised all that in the 3 months before she went to University. Eating in the cafeteria, where to get snacks, what to eat there. You have time. There is no need to hurry.
Keep feeding. There is light at the end of the tunnel.
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Foodsupport_AUS
Welcome to the forum. It sounds like you have done a great job getting her to where you have so far. It does take an enormously long period of time, which is exhausting for all. At only weight restored a few months I would be surprised if she was doing more than you describe. They are of course signs that ED is still well and truly in the background even if not out in front. It will take time for her to challenge those thoughts and ideas and for her to be able to trust herself in choosing to eat, and eating enough. 

It is all very well the therapist suggesting that if she is not moving forward she is not getting better, however change happens incredibly slowly over months and years not days and weeks. Is it worth you writing down a complete list of what you see as persisting ED behaviours? Once you have done that you could work on challenging one tiny bit at a time. As with most of these things it is often worth starting easy and working your way up the ladder of challenges, be that having an extra handful of nuts, choosing what she wants rather than what ED wants at a restaurant. Each tiny step forward is one towards recovery, but it will not be easily seen until you can look back over months and see how far she has come. 
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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Enn


I am glad to see this endorsement of naltrexone. I hope others see this and consider it for their kids as an option. 
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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Barberton

Hi Kelly2897,

Thanks for asking this because my question is similar.

My 13 d has had AN for 2.5years and while she is momentarily maintaining her weight (not letting is drop any lower) I know that's not ideal. I have also allowed her autonomy in making her breakfast and snacks. My intention is to create a relaxed environment around food for her while gently reminding her to eat not only enough but a little bit more. Sometimes I can tell that she needs me to step in and make a decision for her, but for the most part, I let her take charge and challenge her as needed. But am I really helping her? I get exhausted at the thought of serving her every meal and then getting in a fight with her because I've made something she doesn't like (which is just an excuse). I want her to feel that she has some control and to know that she is safe to push the boundaries of her fear as she can. But as time marches on, I worry that I'm letting her eating habits set in. 

Will I regret not taking a firmer hand in feeding her every meal? In other words, am I kidding myself that trying to get her to eat what she needs to under her own steam is just prolonging the agony for us both?

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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Kelly2897
If given the chance, my daughter will always choose what she believes to have the least calories.  Therefore, she doesn’t have a lot of autonomy when making food choices.  Except when we go out to dinner, I make the choices. She does make some of the food herself with me supervising.  Does your daughter make good choices?  Is she at a healthy weight?  Mine would do anything to save even one calorie.  She would still not eat if we didn’t say she had to. Two and a half years into this battle and I still see signs of the beast trying to worm his way in...but every meal is not a battle, she no longer compulsively exercises, and we are able to laugh at the dinner table again.  I see signs of hope and signs of ED-now we wait for hope to win and ED to fade away forever.
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ValentinaGermania
My d recently told me that she is not counting calories any more. She still knows all the calories of each item in her head but she says it does not bother her any more. So now, more than 2 years WR, she will chose what she likes and not what is less caloric. It really takes a lot of time for the brain to recover.
Keep feeding. There is light at the end of the tunnel.
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PurpleRain
Valentina, that's great! I'm so glad for your D
13 yo d started to eat "healthy" September 2018, she had a growth spurt a bit later, followed by tummy bug. She started restricting breakfast and school lunch in January 2019 (that we know). We succesfully refed at home.
I have found inner strenght, patience and compassion that I did not know I had.
Never retreat, never surrender
keep feeding
 
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Barberton

My d is not WR, but she's not far off and she does make good choices. She just needs to eat more of those good choices. I've taken the approach that I have because at 13 she is going through all of the typical teenage developmental issues too - friendships, independence, etc. So I try to be the rock, not the steam roller. If I keep telling her she's not doing well enough at eating, she takes it as criticism (which it is) and rebels against me. So instead I try and be there to challenge her thinking (which we can only do because her thinking is clearer). I tell myself that I want her to be able to manage this difficult thinking when she is an adult, so I have to take the opportunity to train her now while I can. But I also know that if I don't help her rewire her thinking - which can only be done by eating more - then there's no recovery. 

I have moments when I want to say, "You just need to gain 4 more kilograms" because she is so diligent at completing tasks, but obviously I won't. And doing things like taking her phone away are not the right motivator. So I just don't really know how to get her over this hurdle. She thinks that she's doing ok by maintaining her weight, but can't understand that she's actually still losing weight. She doesn't know her numbers, so it's not like I can show her the graph. Not sure what to do next.

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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ValentinaGermania
"If I keep telling her she's not doing well enough at eating, she takes it as criticism (which it is) and rebels against me."

"So I just don't really know how to get her over this hurdle. She thinks that she's doing ok by maintaining her weight, but can't understand that she's actually still losing weight. "

Maintaining the weight at age 13 is not healthy, she should grow and develop and gain weight and she will need until her mid 20s.
I see a lot of ED thoughts and behaviour there, Barberton.
I do not think it is criticism when you tell her that she does not eat enough. If she needs to take meds for cancer and would refuse to do, would you see that as criticism if you tell her she must take them??? I think you would sit besides here and make her take those meds whatever it needs....because it will safe her life. Food is her medicine and she must learn that.

Keep feeding. There is light at the end of the tunnel.
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Kelly2897
It’s such an irrational illness-they truly cannot recognize the behaviors for what they are-an attempt to not eat everything they need.  My d would negotiate endlessly until I just stopped giving her any choices.  I think it’s the fear of feeling guilty about making a “wrong” choice (as dictated by ED) that prevents her from being able to make truly healthy choices (or just regular choices, not whatever has the least calories).  
Now that she is weight restored I’m struggling to figure out how to adjust her meals to weight maintenance instead of weight gain. She still needs way more calories than my other children and I’ve heard that she will continue to need this for a while.  
I wish there was a protocol-like there is for cancer or diabetes. Instead I feel like I’ve been told to find a cure for her.  We see a therapist, a psychiatrist, and a pediatrician.  We saw a nutritionist but she greatly underestimated the amount of calories that were necessary.  Her behavior has declined over the past month and she didn’t get her period this month after getting it for 15 months straight-even though her weight has remained stable.  So again I ask myself-what now???
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Torie
Hmmm sounds like she may need a little more weight?  I can't remember how old she is, but perhaps her body wants to fuel a growth spurt (which usually requires growing out before growing up).  Or maybe it is just the passage of time as it is normal and expected (and for our kids, necessary) to gain a little weight each year until the mid-twenties and bones get denser and organs mature.  Just thinking out loud ... xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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ValentinaGermania
Keep feeding. She might prepare a growth spurt or periods stopped again for other reasons. Periods come with enough leptin in the body which is a hormon that is in the body fat. If there is not enough body fat there are no periods. Mine had her periods back very early at a ridiculous low BMI and then had them for about 3 months and then it stopped again for almost a year although she was on a much higher weight then. We needed to keep feeding and to keep adding up to now. She does not gain now any more on the same intake that she had during refeeding because her metabolism inceased. And she is happy with the addings now as she does not fight it any more. But she still needs a lot of fat to feel good and have no ED thoughts. One meal skipped and I would bet ED will be around within a very short time...

Haha, Torie, I knew you would beat me on that topic!
Keep feeding. There is light at the end of the tunnel.
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Barberton

Thank you VG for the cancer analogy. You are right and I just need to take a firmer approach, ie full FBT, not half-assed FBT.

"I wish there was a protocol-like there is for cancer or diabetes. Instead I feel like I’ve been told to find a cure for her."
Kelly2897 I feel exactly the same as you! 

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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ValentinaGermania
It is really as serious and as life threatening as cancer. And food is their chemotherapy. I personally think it is really important to fight ED with all power and to get rid of it 100% to see a good outcome. If you accept ED lurking around the house he will have a foot in the door as soon as you open it.
We ALL wish we could have that protocol, Kelly2897, you are so right with that! And we all wish that the professionals would treat our kids with the same power and consequence as a cancer patient. There are more kids dying of EDs than of cancer (at least in Germany). So here having an ED is even worse than having cancer...
Keep feeding. There is light at the end of the tunnel.
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Barberton

Just an update - My d communicates with me through letters and notes and she left one for me the other morning in which she asked me to take over serving her snacks as she feels she needs permission to eat more than she has been. So I guess we were both thinking the same thing - that we needed to push through the next phase of discomfort towards recovery. 

 

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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PurpleRain
Wow that sounds fantastic!
13 yo d started to eat "healthy" September 2018, she had a growth spurt a bit later, followed by tummy bug. She started restricting breakfast and school lunch in January 2019 (that we know). We succesfully refed at home.
I have found inner strenght, patience and compassion that I did not know I had.
Never retreat, never surrender
keep feeding
 
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ValentinaGermania
Barberton wrote:

Just an update - My d communicates with me through letters and notes and she left one for me the other morning in which she asked me to take over serving her snacks as she feels she needs permission to eat more than she has been. So I guess we were both thinking the same thing - that we needed to push through the next phase of discomfort towards recovery.



Wow, that is really great! Tell her you already have planned to do that so she will not feel guilty about that note and start today! Great that she can say that through the notes!
Keep feeding. There is light at the end of the tunnel.
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MKR
Barberton wrote:
My d communicates with me through letters and notes 


Wonderful that your daughter is keeping the bond between you. And that you are able to read it for what it is.  This is one of the first tips I picked up from Eva Musby's book and have been on the lookout for the little signs of connection. So happy for you two. Hang in there, your child is coming back!
Mum's Kitchen

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