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

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sunny6
I think we are done.  Our child has been wr for a year and a half with no further mental improvement.  In the last 6 months, the behaviors lessen for two weeks and then come back in full force.  We have gone back and forth on weight loss of a couple of pounds to weight gain.  We try to give back eating and have to take it away. We try to push up weight but that is met with more anxiety. 

Our child is so angry, resentful, sad, fights over meal plans, and has rages.  They refuse to follow a contract, blame us for all of their current issues with eating and now are threatening to live with someone else.  We removed sports as they can't maintain and yet no motivation to eat that extra to stay in an activity.

We are at a complete loss.  We are ready to let them go on their own with eating, wait for the weight loss and then have them placed in a residential program as no one will take them as a wr patient.  It is so difficult, as we know if we do this, there is a chance for si and coming back to school will be out of the question.

Therapists are divided on how to help at this point.  We are seeking a new opinion to try to figure this out.

What else do we do?
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ValentinaGermania
sunny6 wrote:
We try to push up weight but that is met with more anxiety.


I fear that is normal at that state and I suggest that your child was not on a good weight for his/her body up to now to start brain recovery. You need to increase the weight althought there is anxiety. It is not normal to be anxious of weight gain. That is ED. Sometimes it is only a few pounds/kilos that change the state. Plase ask your team to support you with more weight gain.

How old is he/she? I do not remember at the moment. Are you sure the target weight was correct (historical weight chart, overgoing historical weight, moving target when they are not grown out)?
Keep feeding. There is light at the end of the tunnel.
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sunny6
What we don't understand is that a year ago, we did see improvement in mood and behaviors.  But as the school year progressed, so did the anxiety and the behaviors.  Everyone insisted the DBT would take care of the anxiety and all would be better.  So, we really aren't sure we the spiral downwards.  We have been trying to push for more weight for the last few months only to get stuck in this dance.  We get close to pushing up and then down goes the weight and up go the behaviors and we are back to square one.
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ValentinaGermania
Is the metabolism increasing too much or are there unsupervised meals or why is the weight going up and down? Are you still with a meal plan? Is she still eating 3 meals 2 snacks? Any growth in that time?
Are the weighings blind or does she know her weight? We had that dance around WR when my d fought every single gramm to not get WR. We changed to blind weighing then and she does not know her weight any more for 2 years now and that changed everything here. I can add weight when I see she needs more because she moves more or needs to learn for a test and we have no discussion about that.
Keep feeding. There is light at the end of the tunnel.
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sk8r31
It sounds so challenging at the moment, and I appreciate that you are feeling 'done' and not sure where to turn next, or what to try.  As tina mentioned, what is the age of your child again?  That may help to determine what strategies to try next.

Tabitha Farrar has terrific blog posts, and also works one-on-one with clients.  This may be appropriate for someone who is an older teen or YA. 
It's really hard when the things that might motivate them, sports for example, aren't enough of a carrot...or they simply aren't well enough to be able to fuel for the extra activity, even though they might like to do it.

Deenl is my 'go to' guru on how to handle tough situations, and kids with extreme behaviours.  Might be helpful to check some of her 'super resistor' thread.

Sending you hugs & warm support.
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
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ValentinaGermania
I checked some of your former posts and saw there was purging going on. Where you able to stop that? Maybe the weight goes up and down because of secret purging?
Keep feeding. There is light at the end of the tunnel.
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sunny6
We believe the when the weight goes down, it is due to purging.  We monitor for 1 to 2 hours after meals, but purging can happen after 2 hours and at some point we need to send our child to school, so likely it is happening there.  Sometimes, it is hidden food in cheeks or down shirts.

We have blind weighed and they only know when weight goes down as the meal plan goes up, which causes a lot of anxiety.  

Our child is almost sixteen, so we have some time, but we really struggle with how we get so close and then we see this jump in behaviors without them knowing the weight.  
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sk8r31
In one of your earlier posts, you mentioned possibly trying some VR therapy.  I attended ICED (International Conference on Eating Disorders) in NYC in the spring & attended a workshop on VR with a number of researchers at Stanford.  It sounded very promising, particularly for those who have binge/purge behaviors.  It might very well be an option for distance therapy.  I will see if I can pull up some links, if that is something that might be of interest to you.
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
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sk8r31
Did a little more digging, & consulted a contact who worked with a VR research program at Stanford Children's Hospital this summer.  Still early days there, and likely not suitable except as a research participant for anxiety reduction.  Have you tried using the Headspace or Calm apps to help with anxiety? 
Sending warm support.
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
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Foodsupport_AUS
I am sorry that things are being so challenging at the moment. I notice you have posted a few threads over the last few weeks with similar questions. I do think keeping their weight up and maintaining it is going to be important in their recovery but also interrupting those purging behaviours is also essential. You did mention that you had tried contracting and this did not work - how did you come to the contract?  Some have found behaviour contracts really useful but I think their most important component is how they are written, agreed to and consequences put in place. I know that you have previously mentioned that you don't think UCSD is for you but I wonder if the contracting component of their week may actually be what you really need. If relatively accessible and potentially covered by insurance this may be a week that gives a lot of benefit for you?
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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ValentinaGermania
sunny6 wrote:
We believe the when the weight goes down, it is due to purging.  We monitor for 1 to 2 hours after meals, but purging can happen after 2 hours and at some point we need to send our child to school, so likely it is happening there.  Sometimes, it is hidden food in cheeks or down shirts.

We have blind weighed and they only know when weight goes down as the meal plan goes up, which causes a lot of anxiety.  

Our child is almost sixteen, so we have some time, but we really struggle with how we get so close and then we see this jump in behaviors without them knowing the weight.  


Purging needs to be stopped. That is really dangerous. If you cannot exclude that she does it in school then she must stay at home. No school until this problem is solved. School is not important at the moment. Health comes first.
Hiding food in cheeks: ask her to drink somthing after eating and show you the empty mouth. Hiding food in sleeves/shirts: ask her to wear shirts without sleeves for the meals and no pants with pockets. No napkins on the table. Some parents needed to eat with their children in bathsuits so hiding food is not possible. Think about what you can do to make this behaviour impossible.

If there is purging and food hiding going on she is no way on a good weight I think. This is still very powerful AN. You will not get more weight on as long as this behaviour continues. So you will need to do anything possible to stop it.

"We have blind weighed and they only know when weight goes down as the meal plan goes up, which causes a lot of anxiety."
Can you add to the meal plan without her noticing it? For example add more butter and cream to a sauce than normal? Put more fats into the milkshakes and smoothies? If you increase it with more slices of bread or something that is countable they can notice it, if you just increase the ingredience while cooking they cannot notice it. And what they don´t know normally does not cause anxiety.
Keep feeding. There is light at the end of the tunnel.
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