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

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strawdog
I've been doing a lot of thinking this week with how d is progressing. At a BMI of 20 and with a lot of the Eating Disorder behaviours diminishing is it time to start addressing her cormorbid conditions? She has suffered from mild to moderate social anxiety since she was at Primary School. I'm also starting to think (after reading a thread on here) that she may have Alexithymia. So why do I think the time might be right to address these - well as far as food is concerned she accepts everything we put in front of her and eats what we give her. She has been away on a trip with her sister and has eaten 3 meals and 3 snacks each day and had a meal out which she has eaten.However this week we have had some setbacks - at first I thought it was ED coming back but now I think it's her anxiety causing the problems. Firstly she was invited out for a meal with a friend - she really didn't want to go but did int he end. She ate a meat dish with no carbs and managed a sorbet. However you could tell she wasn't comfortable after - very quiet and ED like. Said she felt very full and struggled with her evening snack. But this time last week she had a meal out with her sister and ate meat and carbs with no problems. Why the change? Social anxiety with being out with her friend rather than family? Then today she has a friend's birthday and is away all day and then working this evening. I tried to talk to her about what food was going to be eaten when but I got barked at that it was just going to happen OK but I don't know what! At first I thought this was ED but then I thought about it and she would always get very irritable and tense if she was going to a social gathering - so it was her anxiety making her the way she was rather than ED talking to me? 

Then I read about Alexithymia and thought - YES that's her as well! :

Alexithymia is characterized by difficulties identifying feelings and differentiating between feelings and bodily sensations, difficulties communicating feelings, and a concrete cognitive style focused on the external environment. Individuals with eating disorders have elevated levels of alexithymia, particularly difficulties identifying and describing their feelings. A number of theoretical models have suggested that individuals with eating disorders may find emotions unacceptable and/or frightening and may use their eating disorder symptoms (i.e., restricting food intake, bingeing, and/or purging) as a way to avoid or cope with their feelings

She has really struggled at the CAMHS meetings to express her feelings and talk things through. So I feel if she does have this condition and with her anxiety should we now be pushing to get these addressed - otherwise I feel she will always be vulnerable to rebounding back to ED if she gets anxious about certain situations. She has college this autumn so will be meeting new people and teachers - there will be trips away for her course and so on. 
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sk8r31
Regardless of whether you put a label on it, your d certainly sounds like she has anxiety issues that pre-dated the ED.  Our d did too, and it was only in hindsight, and dealing with the HUGE anxiety during refeeding and beyond that we thought about how d had been as a kid and prior to ED.  She did exhibit anxiety symptoms and high sensitivity to uncomfortable physical sensations (screaming in the car when her back got 'too hot' as a toddler, when her brother was fine, that kind of thing).  We did have an individual counselor for d, along with an FBT-trained therapist that we worked with as a family.  The individual T focused on helping d manage her anxiety.  It was a good fit, and the two therapists actually worked in tandem with other ED patients, not just our family.  They communicated well with one another, as well as with us as parents.  It really did help our d manage her anxiety that was not only about eating.
We never focused a lot on how d was feeling about ED, and she still doesn't much like talking about that period in her life.  However, she is quite open with feelings and can express her anxiety or anger or happiness quite readily about anything else. 
We did do a fair bit of 'exposure therapy' to get her ready to go away to university in the summer before she left...inviting people (my friends mainly) that she didn't really know over for coffee or a meal, eating out frequently, letting d eat out with friends frequently.  Encouraging whatever we could to help her be able to manage in a totally different environment, eating in a cafeteria and meeting many new people.  I am a big fan of 'exposure therapy', and think that it really did help our d in many other aspects of her life as well.
I would 'go with your gut' and look for support and help to aid your d in managing her stress and anxiety in social situations, and especially as they relate to eating out with others.
Sending warm support 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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strawdog
Thank you that’s helped me make up mind to push for some additional counselling for her anxiety. 
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strawdog
Yes definitely agree. The funny thing is I think she knew it was going to be too much of a challenge for her. She would have happily have not gone out to eat with her friend - was looking for an excuse. 
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debra18
When my daughter sees other people eating a lot, it is stressful for her. She knows what to eat and will eat the same amount as always but for some reason seeing people eat a lot in social events makes her feel like she is the one that ate a lot.
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Mamaroo
Same here Debra, especially while during refeeding. She got much better at around a year post WR and it was continual expose to social situations which helped.
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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ValentinaGermania
My d was born with anxiety - social and other. And although this was not really correlated to AN I can tell you that today she is in best state ever than she was ever before RE anxiety. Let time to its work. Let brain recovery start. Try to work on these anxieties like on fear food. And I think you will see it fade away slowly.
Keep feeding. There is light at the end of the tunnel.
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strawdog
Hopefully you are right Tina. It certainly makes it harder to work out what is making her behave the way she does when things go badly. Yesterday I was public enemy no.1 but today she’s calm again and it’s been quite normal. Was it all anxiety yesterday as it was a social gathering for a friends birthday, was it an extinction burst and ED was in the house? Hard to tell and with her inability to express her feelings and emotions she’s not going to know herself and if she does she’s not going to be able to tell us. I guess whatever it is - the medicine is the same - try and stay calm and keep the food coming!!
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debra18
Can you see any patterns of triggers?
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strawdog
No clear cut ones. Could be social anxiety as she’s had a few things on this week - meal out with a friend and a friends birthday party gathering. Yesterday was stressful as she didn’t really know what she was going to eat and when so that was stressing her (and is!) out. But that’s her anxiety - she always needed to know what was happening where and when.  Could be she was away in London last week with her sister and enjoyed some independence and now being home with dad watching her is annoying her! Or it could be hormonal. 
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ValentinaGermania
There are 1000 reasons for her behaviour and I can tell you that even healthy kids with no ED but puberty around behave very strange sometimes so try to stop all this questioning and searching for whys and what ifs and just stay calm and try to get through. It is a rollercoaster. You will sometimes find out what triggered this or that behaviour and you often will not find out. It can be food. It can be hormons. It can be bad hair day 🙂.

Blame it on puberty and ED in addition and do not take it personally. My friend was enemy nr. 1 very often with her healthy kids in puberty 🙂. Next day you are best friends again.

Social anxiety gets better by exposition. They are so unsure how to behave at that age and these AN kids have some issues that are kind of autistic. They often cannot "read" the emotions of others and always think that everybody thinks bad about them. They often cannot stand big crowds of groups with more than 5 people. They often have problems with peers of same age but can cope better with adults and older students. I could make a long list...🙂
Keep feeding. There is light at the end of the tunnel.
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Elibean1
Hey Strawdog,

my D12 v v similar. Diagnosed ARFID by Camhs but she and I both think it was starting to morph to AN and she does have poor body image - just wasn’t actively linking restricting to it. 

Her eating is much improved and she has no fear foods as such (never did, other than bean sprouts in case she choked).  But she too has been anxious since infancy, and it’s clear she has unusually high sensitivity to sensory stuff.

No restricting at home. But travelling yesterday she couldn’t eat much at all: high anxiety, loud crowded places, fear of flying, new places, jet lag. Exposing her slowly to scary things (school tests, social situations, travel eg) is as important now as anything food related because not eating is the end result coping mechanism when she has no other - but we’ll never drop the importance of adequate nutrition again!

If she gets into negative energy, her ED will eventually be triggered again. So we try to prioritise regular 3x meals plus snacks but close behind and sometimes alongside is counselling for anxiety (with an ED and ARFID aware psychologist) plus exposure when possible.

Today, still jet lagged, she’s flown for 8 hours, eaten (not enough but we supplement in snacks) twice in restaurants which she has always loathed due to sensory/anxiety issues, swum in the sea...and is beaming with pride. Yesterday she was terrified, but got through it and is reaping the reward!

I agree with Tina about puberty and fast changing teen brains being a major part of the whole puzzle our lovely kids are - who they are is still emerging, I guess our job is to see, accept and support whatever they present us with (and not lose our marbles along the way - in my case at least!!).

xx
Elibean
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Allyson_1
I have a similar question/issue with comorbidity of anxiety & depression.  Her initial diagnosis was AN & reactive depression & anxiety.  She is "WR" after gaining 25 pounds & is at a BMI of 20.5.  She is on prozac 20 mg/day for the anxiety/depression.   Although eating pretty well (some push back on finishing every bite), she is still suffering.  She isolates herself in her room, still avoids friends, could not cope at a meditation camp and had to come home after 4 hours.  Did not follow through on summer plans for activities.  She is not independent at all.  I have to suggest all activities and make her get out of the house. We had an individual therapist working with her along side our FBT but it doesn't seem she made any progress in learning & employing coping skills so we are looking for a new therapist.  I don't know what else to do.
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ValentinaGermania
It took about a year after WR until my d was back to a normal social life. I had to force her to get out of the house and to see friends like fear food 🙂.
It is exposure therapy. The more she does it the easier it gets. Make "play dates", ask her to join you for shopping (you "need" her there for xy). Do not leave her alone in her room with AN thoughts around. AN isolates her, your d inside does not want to be isolated.
Keep feeding. There is light at the end of the tunnel.
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strawdog
Allyson_1 wrote:
I have a similar question/issue with comorbidity of anxiety & depression.  Her initial diagnosis was AN & reactive depression & anxiety.  She is "WR" after gaining 25 pounds & is at a BMI of 20.5.  She is on prozac 20 mg/day for the anxiety/depression.   Although eating pretty well (some push back on finishing every bite), she is still suffering.  She isolates herself in her room, still avoids friends, could not cope at a meditation camp and had to come home after 4 hours.  Did not follow through on summer plans for activities.  She is not independent at all.  I have to suggest all activities and make her get out of the house. We had an individual therapist working with her along side our FBT but it doesn't seem she made any progress in learning & employing coping skills so we are looking for a new therapist.  I don't know what else to do.


Do you consider that the anxiety/depression led to the AN? I guess sometimes we just don't know. My theory is that my D's inability to express her feelings and emotions during a difficult time (bullying at school, exams, general Social Media pressures) led her to seek comfort/control in limiting food intake and exercise - it was a world she had control over. I must say her anxiety issues are a lot less extreme that your d's and I have grateful she does go to the beach with her friends and does go to social gatherings - yes they do cause anxiety but she goes. What I think we need is someone just to outline why maybe she ended up down the ED road and how to stop any future triggers causing a relapse.
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melstevUK
I think there are a few things going on here. There is no doubt in my mind that ed children have a more sensitive physiological reaction to stress and anxiety than other people. I didn't have an ed but before I started taking an SSRI, if I heard a car beep behind me when I was drivingI had exactly the same response physiologically as if a man with a knife had jumped out at me in a dark alley..I had no control of this reaction, known I believe as the startle reflex. My therapist said that there are people who have a very flat affect and therefore don't react bodily in the same way. It is a very unpleasant way of living and an SSRI helped. When I am feeling particularly stressed I take beta blockers as well. I have no shame, it is just the way I am .
On the other hand, I believe that social anxiety can be helped by actively teaching skills. You enter a room full of people you don't know so what do you need to do. Fake confidence,ok discreetly look around, go to get a drink and see if there is someone else standing alone who you can approach and smile gently. Things like that. Hold your shoulders back so you stand tall and look poised. If you are shy, just ask the other person questions. Most people love to talk about themselves. 
You don't need a therapist to teach these things. We have all been there in our youth so as parents we just need to share our experiences for the most part. 
In terms of eating out, it takes an incredible amount of effort and focus just to eat what is required without having to think about other issues. In the early stages of recovery, it helps to look at restaurant menus or try and find out what food there might be at a certain family event, then help our children make choices beforehand so they are prepared. 
It takes years before someone recovering from an ed who experiences anxiety issues can hold everything together and finally enjoy being out in a relaxed way.
We have to look at every  aspect and cover all eventualities, and love, support and teach our children how to cope. It is a slow journey.
Believe you can and you're halfway there.
Theodore Roosevelt.
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Mamaroo
Allyson_1 wrote:
I have a similar question/issue with comorbidity of anxiety & depression.  Her initial diagnosis was AN & reactive depression & anxiety.  She is "WR" after gaining 25 pounds & is at a BMI of 20.5.  She is on prozac 20 mg/day for the anxiety/depression.   Although eating pretty well (some push back on finishing every bite), she is still suffering.  She isolates herself in her room, still avoids friends, could not cope at a meditation camp and had to come home after 4 hours.  Did not follow through on summer plans for activities.  She is not independent at all.  I have to suggest all activities and make her get out of the house. We had an individual therapist working with her along side our FBT but it doesn't seem she made any progress in learning & employing coping skills so we are looking for a new therapist.  I don't know what else to do.


Mentally my d was just as sick at WR than when she was admitted to ip. But fast forward 6 months with continued feeding and exposure to fear food and she was doing so much better, that no one would have suspected she had an eating disorder. Just keep on feeding and taking her out of the house. Sending you lots of hugs 🤗🤗🤗🤗
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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Fiona_Louise
Allyson_1 wrote:
I have a similar question/issue with comorbidity of anxiety & depression.  Her initial diagnosis was AN & reactive depression & anxiety.  She is "WR" after gaining 25 pounds & is at a BMI of 20.5.  She is on prozac 20 mg/day for the anxiety/depression.   Although eating pretty well (some push back on finishing every bite), she is still suffering.  She isolates herself in her room, still avoids friends, could not cope at a meditation camp and had to come home after 4 hours.  Did not follow through on summer plans for activities.  She is not independent at all.  I have to suggest all activities and make her get out of the house. We had an individual therapist working with her along side our FBT but it doesn't seem she made any progress in learning & employing coping skills so we are looking for a new therapist.  I don't know what else to do.


Hi, this just sounds like my son.  We started with the AN and now he hasn't spoken to me for 6 weeks, hasn't been to school since March, refuses to communicate with friends who have all reached out to him.  We are still refeeding, with snacks being a real battle.  We have reached a plateau and I can't see how/when he will recover.  Psych now saying he needs anti psychotic drug to help with anxiety but his anxiety only really shows itself when he leaves the house.
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ValentinaGermania
melstevUK wrote:

It takes years before someone recovering from an ed who experiences anxiety issues can hold everything together and finally enjoy being out in a relaxed way.
We have to look at every  aspect and cover all eventualities, and love, support and teach our children how to cope. It is a slow journey.


I would want to second that totally.
In year one my d could not socialise without help and had a hard time with eating out. We arranged play dates, helped her meet people, get out of the house, learn to eat in a restaurant. At age 17.
In year 2 (1 year after WR) it was way better but anxiety still high. We started to work on anxiety by slow increasing exposition and now in year 3 she is in best state about that than she ever was in her life. Can socialise, has made new friends at university, can use public transport, talk to strangers, phone someone she does not know to ask for xy and so on.

It was a lot of work to get there but I also think you do not need to have a therapist (it is great if you have one on your side but no big harm if not) but to try to remember how it was to be a teenager and think about how to learn to stand all those anxities.
Keep feeding. There is light at the end of the tunnel.
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debra18
You could try exposure therapy using a laddered approach the same as the eating. Start with an activity at the house with one friend, next that same activity at the friend's house, next that activity with one friend in a private room in the school, etc.
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