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

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sunny6
We have been grappling with our teen and ED for 2.5 years.  While we saw some improvement 1.5 years ago, the ED has never fully been quiet.  We have tried for the last 9 months to add about 2 to 3 kg more in weight as we feel that is really where our child needs to be.  The two ed therapists we briefly saw insist our child is wr and yet, the behaviors continue.  There is a reason why we haven't been able to get that last bit of weight on, but they can't seem to get to the idea that full recovery is possible.

We have tried ED coaching and DBT therapy, and everyone says the same thing...they are stuck.  Our child wants recovery but can't take the advice in the sessions and apply it.

Recently, the behaviors have gotten as bad as they were when they were first ill.  Yesterday was just the perfect example.  Child had an after school activity and we told them that we would do snack, part of lunch and supper when they come home.  They came home and claimed that they ate everything while they were at the school function.  After twenty minutes, we managed a small snack, but it was clear that they hadn't eaten much of their meals yesterday based on low anxiety. Their response was that while they acknowledged what we said, they didn't agree to it so they weren'tgoing to comply.  Anytime we challenge it, our child becomes irate and is starting to flat out refuse.  The anger has been very high the last few months.  They fight us on everything we do or try.  We have been yelled at, cursed at, and told we are not helping and the other day threatened to kill us if we didn't back off (which we know was the ed reacting as we had just caught a behavior).

We want to take our child out of school as we are seeing the behaviors a lot as we challenge them throwing out school lunch, gain lost weight from two weeks ago, and manage behaviors.  We want to try to work with them at home for a week or two, but the medical doctor is in the old school camp of ed treatment and doesn't think it is necessary.  We fear that residential is where we are headed as we just can't get the behaviors and lying under control and we believe they need someone sitting with them as they eat and talk about the irrational thoughts and help them through.

Any suggestions on what we should do?  There is nothing that motivates them either.
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Enn
I know it has been a hard journey for you. I would really pull out all the stops that you can right now to get on track. Intensive treatment may be needed (residential). You  know what you have done and how it has worked or not.  Remember that every child needs what they need. It is not a failure to require a higher level of care, it is figuring out how to navigate the system and supports that your child needs to get the job done properly. You have done so much good for your child. 
Sending my best,
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
sunny6 wrote:
 Yesterday was just the perfect example.  Child had an after school activity and we told them that we would do snack, part of lunch and supper when they come home.  They came home and claimed that they ate everything while they were at the school function. 

Any suggestions on what we should do?  There is nothing that motivates them either.

i would suggest requiring the snack to be eaten before the after school activity.  ("When you have finished the snack, you can join the activity.")  I realize that this involves the inconvenience of meeting the child in between school and the activity.

I understand that you have been fighting a long, hard fight to help your child avoid residential treatment.  If residential ends up being necessary, there will be no after school activities, and no at school, either.  So, what may sound harsh is actually relatively minor compared to the sacrifices of residential. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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deenl
Hi sunny6,

I really feel for you as my son was one who was never motivated by any consequences to eat. Actually, he has always been very independent and stuck to his guns if he felt in the right, regardless of any carrots or sticks. Most of his childhood, talking and logic were the techniques that worked best and helping to discipline/guide him. Both of which are totally useless with ED. So I had to think back to the other, more subtle, methods that we used. And I realised that, in our case, unspoken expectations, a atmosphere conducive to the behaviour we required and as a last resort the promise of an absence of nagging worked well. These will, in all likelihood, be different in your case but you do have a lot of knowledge about your child. It did take me quite a while and lots of trial and error to figure out what we did almost intuitively and subconsciously. Maybe it is worth discussing with their dad or someone else close to you to figure something out?

Either way, many, many parents have had to figure out their own path as I realised when I asked for ideas when Magic Plate and Life Stops Until You Eat don't work.I was inspired by all the variety of approaches that parents had taken. Even when I could not copy exactly what they had done, I tweaked it or just used their determination to find a way help me to keep going and find my way.

I know that in our case, our son was not able to eat a single meal without supervision for two years and four years in most of his meals are still supervised. For some of our kids it takes a long time and if one way is not working then we do need to change things up. For us, it was a month in the local hospital that allowed me to set the conditions to support him to recovery.

If we can help you with any brainstorming, please let us know. 90% would probably be useless because describing our loved ones and situation in the medium of the internet is very difficult but it could perhaps give you a start of an idea that you could develop. Or it might be best to do it with the people in you life who know you all best.

Warm wishes,

D
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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sunny6
Thank you for your input and advice.  It has gotten to be too much here.  Our child constantly is trying to get out of the house to avoid eating and being watched.  We weighed today and more weight is lost with increased food.  We were placed on a wait list for a facility and told our child that they have the choice to ccome out of school now to work on this at home or go to a facility.  They are refusing to come out of school and are insisting on going out today to eat without us.  They have a coach who was anorexic and has recovered and is well known for her success.  Our child says well my coach said to do this or that and you aren't letting me try.  We believe that while our child tries, they are using this as an excuse to get away from us and not eat.  We just can't continue the fighting in this house.  They agreed this morning that they will go to programming in 3 weeks if they can't figure this out.  We explained to then the size of snacks they need and what they have to do since they have a higher metabolism than normal people.  We just don't see this working, but we know the LSUYE isn't working here and is causing them to become out of control with everything else.  We explained that any more weight loss will mean longer in programming, but they are insistent.  We made then verbally state that they will go and they will keep themselves safe if we have to take them.

What more do we do?  Everything in me feels that this is failure and that we are letting down our child and letting ED win, but this cannot continue.  We have about 2 years before our child is an adult and we need to see progress as we haven't gotten anywhere of significance in the last year.
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MKR
Sounds like reasoning may not work at this stage yet!  These debates tend to go on forever, when the answer should be, I hear you, but just eat this. Eva Musby has a good guide on how to stay on point.

I admit it is frustrating that the child could not simply see the obvious. Good on you for being blunt about spelling out consequences. The big worry is the risk of further weight loss in the coming 3 weeks before the admission. You surely have the power to set down more rules, like if weight gain doesn't happen, then the phone is taken away.  Where does your child get money for eating out?

Even more importantly, sport:
Are you able to speak to the coach? Ideally, all training should stop until the weight loss is reversed. @KLB has a thread on sport during refeeding. Weight loss is a big No.
Mum's Kitchen

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

After everything you have been through, I agree it is time for a shake up. A restart, refresh, start from scratch..

It is not a failure. The time you have already spent on ED counts it really does. You and your child have learned what works and for sure what does not. This is the next step. That is all it is.

No advice here. You are in the thick of things and you know your situation best. I support you. 

🌱

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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LaraB

Hi in case it helps, we have been pretty stuck here for a while and feeling “out of control”. I am now trying what Eva Musby calls the art of the “compassionate persistence” approach, and it seems to be having an effect.

Here what that has meant is starting out with hope and determination that my D will fully recover; thinking back about what has worked before and trying that again; not being afraid to take back “support” - eg it has felt “Impossible” to sit with my D for a snack for some time due to high resistance, but I know this is what she needs and I am gently making this happen. 
I am avoiding “consequences”, like confiscation of phone, and trying to work with my D. I am more trying to demonstrate to my D that I have confidence in her ability to recover. That might seem a bit subtle and sorry if I am not explaining myself well. 
I am trying to be calm and loving and compassionate and understanding and practising “non-violent “communication. 

As posters above have said, different things seem to work for different people. Wishing you strength as you work out what is best. Xx

 

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ValentinaGermania
sunny6 wrote:
Our child constantly is trying to get out of the house to avoid eating and being watched.  We weighed today and more weight is lost with increased food. 


They all try that. This is the time now to stay at home and to be on bed rest if necessary. Use your parental authority. Without your allowance and without money and ticket and bike they go nowhere.

sunny6 wrote:
We were placed on a wait list for a facility and told our child that they have the choice to ccome out of school now to work on this at home or go to a facility. They are refusing to come out of school and are insisting on going out today to eat without us. 


This is nothing they can "decide" or "refuse". It is not their decision. You are the parent, you are in charge. In Austria a child died recently because the parents let her (age 13) decide if she wants to go to the hospital or not (no AN, another illness). The parents are now send to jail because it was their charge to take her to hospital although she did not want that. AN is a life threatening disease and no decision to wear the red or the black shoes.

sunny6 wrote:
They have a coach who was anorexic and has recovered and is well known for her success.  Our child says well my coach said to do this or that and you aren't letting me try.  We believe that while our child tries, they are using this as an excuse to get away from us and not eat. 


If that coach says something that interferes your parental authority and your child loses weight because of that this needs to stop. This coach is not the parent.
I would have a really serious talk with that coach. If she is really recovered she should help you and tell your child that she needs to do what her parents say...


sunny6 wrote:
We just can't continue the fighting in this house. They agreed this morning that they will go to programming in 3 weeks if they can't figure this out.  We explained to then the size of snacks they need and what they have to do since they have a higher metabolism than normal people.  We just don't see this working, but we know the LSUYE isn't working here and is causing them to become out of control with everything else.  We explained that any more weight loss will mean longer in programming, but they are insistent.  We made then verbally state that they will go and they will keep themselves safe if we have to take them.


I do not really see that you gave LSUYE a real try. From what you wrote up to now I see you struggling to even get her to eat all meals with you.
They will promise the blue from heaven to avoid eating, so why should that change anything to wait another 3 weeks? You will only lose 3 more weeks...
Sorry to be so blunt but you need to fight that through.
Keep feeding. There is light at the end of the tunnel.
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Kali

Hi Sunny6,

So sorry you are stuck at this impasse. The last few kilos are often the hardest to get on. If you don't mind me asking, what is your child's height and weight currently? 

As with so many things with this illness, logic doesn't seem to work. When we were refeeding I actually stopped talking about weight completely. Not a word about it. Our d. went to the dietician once a week during that period, where she was weighed, and portion sizes and what she was supposed to be eating was discussed, and I checked in with the provider once a month or so to see if we were still on track moving in an upward curve. 

We also had a situation where LSUYE didn't work. In a broader sense that is what we had to do by placing our d. in a treatment center and pulling her from school and all activities, but before that when I tried to do LSUYE at home it was a dismal failure and we had similar situations, her doing everything to keep busy out of the house and avoid meals. 

What type of professional help do you have at the moment?

I spent the first 9 months running after her with a plate of food while she lost weight, and finally it got to the point where she had to be admitted. When she came home we found that we made more progress when I simply just served all the meals and talked about anything else besides the fact that she had to eat and ED and any consequences of not eating. Meals became a sort of safe space where I never talked about anything difficult but tried to make conversation about interesting topics, played some soothing music in the background, used nice dishes, used the time to connect with my daughter and put some flowers on the table. I also bumped up my cooking game and tried really hard to prepare meals that were delicious and looked good. This was of course AFTER she came out of residential treatment where she had been for 3 months. Somehow they made the point to her that if she didn't eat then she would die and after that things were better at home than they had been even if she was still obsessed with loosing weight and was not cured. It took a long time of consistent meals and there were times when it was one step forward and two steps backwards. It was not a situation, for us at least, where she was weight restored and then magically she became well. It took a long time and there was a comorbid depression.

Sometimes anger in a teen can be a sign of depression... has your child been evaluated for that? 

 

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 They agreed this morning that they will go to programming in 3 weeks if they can't figure this out.  

So this is a step forward. You have drawn a line in the sand, and you can follow through on this statement. 
You can wait the three weeks and then if there is no improvement, take the steps to make this happen. Perhaps even start looking into it now so that you are ready to move on it if they are not able to become more cooperative about meals during the time period you have described. 

One thing that we did when my d. came out of treatment (and I'm not suggesting that this can work for everyone but it did for us) was that we continued what the treatment center had been doing. After patients had been there for awhile and were weight restored, they were given a menu once a week and then ordered their weeks food. I should add that my d. was 18 at that time, so on the cusp of having to figure out how to eventually feed herself. They had a couple of choices for each meal and all meals had the appropriate calories. Before she left we met with the dietitian and she had our d. create a menu for home that she would want to eat by choosing 7 breakfasts, 7 lunches and 7 dinners. The dietitian vetted that they had enough calories and nutrients, and I brought that list home. So when she came home we sat down every Sunday afternoon, created a menu for the week, then I did the shopping and we stuck to it. I hung the menu on the fridge so that she could see. It helped me to organize things and it helped her to know what to expect. What I'm going to suggest is that perhaps you could think about which meals your child seems to be able to eat without too much fuss, and as long as they have enough calories, try to make a list of the meals to serve for the next three weeks. You don't have to share it with them at this point, but just be super organized and have the meals and snacks ready to be eaten. But if you feel that it can be helpful for them to know what the expectations are, go ahead and post a menu on the fridge and open a discussion about the menu with them.  I know that flies in the face of conventional FBT however it was something we did when our d. was weight restored or mostly weight restored. Also, talk to them beforehand about their schedule for the week and make sure that you leave enough time before they leave the house so that you can serve meals before, by planning the meal times and letting them know. I too remember those excuses about "I have to get to this activity" and then running out of the house. High school can be a very busy time. I did plan meals around our d's schedule since that is real life: as adults, we have things to do and need to get our meals in around some of those activities and eventually they will need to be able to do this. I know that there is a way forward which can lead to health for your child, and for repaired relationships in the family after this challenging time.

sending virtual hugs and hopes that they will be able to make progress.

warmly,

Kali

 

Food=Love
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sunny6
Hello.

Yes, our child has been assessed for depression.  They have a DBT therapist, psychiatrist, physician and an anorexia coach.  We have been in IOP and residential about 1.5 years ago.

We do not allow sports unless they are in range.  Their BMI is over 24.5.  Up until a week ago, we required all meals to be eaten in our presence, but food still was being cheeked or purged.  ED has now found this great loophole of going out and saying that their therapy is about them doing this on their own.  We have been told we are not helping and not supporting by our child.  

I tried pulling out trivia games the other night at supper to try to help distract like we did after we first came out of the hospital.  The phones have been taken away in the past and they have had to stay home from school if they refuse to eat the day before.  Believe me, we have done the LSUYE program.  Right now, I would prefer not to get kicked or hit when I ask them to stay home and generally, after some angry words, I can get them to agree to eating when they return from something.  LSUYE has in the last 6 months only created intense anger.  

If you were to see our child, you would not believe they were anorexic; however, they are below their range and we have been playing this dance for about a year of in range, out of range, fight for 4 weeks, back in range for 2, and then back out.

I have tried being compassionate.  A good example was today.  We went out for lunch.  Child agreed.  They selected what was a reasonable meal.  Half way through, they felt they were done.  I explained that it wasn't enough and that they needed to finish.  It became a battle.  I explained that we know what they need and we are trying to support them so that they can stay here and not go to additional programming.  They ate a little more, but wouldn't finish.  Came home, ate snack, but we still have to do supper, which will be more due to the smaller lunch and it may or may not be a battle depending on the mood.  One can only be so compassionate when weight loss is happening.  I don't want them to have to make up more in treatment, but I am also trying to find a new way to make this work.  They are not more than 2 kg out of range and I am weighing regularly to ensure that we don't go back to 2 kg weekly losses they had when they were first sick.  Today, weight loss is more like .5 kg a week, so while it is loss, in the bigger picture, it is much better than 2 years ago in early recovery.  We just need to find a way to get past this fear and get above this.

I know this is slow, I just never expected the anger around support at this stage.  I believe we are all tired and all had hoped that the ED would have been a distant memory at this point.
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MKR
Just a thought - does your child ever stash food away anď then snack on it (See Tabitha Farrar's thoughts on hoarding). Because my D does.  I used that as a cue to leave some lying around. 

When she was severely underweight she used to throw things like peanut butter in the bin. Now she sneaks a spoonful every now and then, without realising or caring about the calories. Almost like a normal teenager. I am secretly happy about this so I just pretend to frown at the jar 😉.
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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sunny6
No.  Food is binned.  Never eaten when we aren't looking.
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Enn

I say go with your gut and first instincts about your situation. 

Remember we support you all the way! There is no right or wrong way with ED. I know how hard you have worked. I know all the thought and research you have done, looking back at your previous posts. 

I hope positive change comes soon!
💐

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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Kali

Dear sunny6,

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I know this is slow, I just never expected the anger around support at this stage.  I believe we are all tired and all had hoped that the ED would have been a distant memory at this point.

I know this is beyond frustrating and exhausting...but only thing we can do while slogging through the illness is to just keep going one day at a time. You have been doing everything possible to help them and to make sure that they have the best opportunities for treatment and care so that eventually they will recover. As they say, if you are getting flak you are over the target. So you must be doing some things that the Ed hates since they are so angry.

But for the moment, are there any self care things you could do for yourself? Yoga? Drinks night with friends? A day at a spa?

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Up until a week ago, we required all meals to be eaten in our presence, but food still was being cheeked or purged. ED has now found this great loophole of going out and saying that their therapy is about them doing this on their own

Are you aware of how often they are purging? Is their therapist aware? 

warmly,
Kali

 

Food=Love
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sunny6
Yes.  The therapist is aware.  It depends.  If they can restrict, then they don't purge.  If we go a few days with no restriction, then there is a purge.  A full purge of a meal isn't very frequent. Maybe once a month.  But they can regurgitate a portion of their meal with no effort when the anxiety is high.  That is more frequent and all the doctors that we have seen have stated this is anxiety and they need to work on their calming techniques.  Some days it works and some days it doesn't.  I agree on the anger, but how long does it last?  This intense anger has been going in for 9 months and is getting defiant.
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LaraB

Hi EvaMusby’s description of adolescent focussed psychotherapy might be worth a read. Apologies if you are already familiar with this X

https://anorexiafamily.com/aft-adolescent-focused-therapy-anorexia-afp-an/?v=79cba1185463

 

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