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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WeRnotdone
My daughter is 17 and slowly recovering from her 2nd relapse of anorexia. It seems to me each one tends to be worse then the one before. In this 2nd relapse which started in January she started cutting herself and became suicidal. I did not know that could happen with eating disorders. The cutting lasted a week and she ended up going to a center to monitor her for a week on her dark thoughts. From January to May it has been a struggle to get her to eat enough and she has maintained a low BMI. She also over exercises. I make sure she eats enough as much as I can even going to school to make sure she ate her lunch there.
  She is seeing 2 therapists one for family based therapy the other an individual therapist. Our family based therapist we have been seeing for over a year but she is now an hour away because during her illness we had a relocation for my husband's job. The individual therapist she has been seeing for about 3 months and is recommending a treatment center, a couple of months ago I would have been more willing but my daughter is slowing making progress. The one area that she is stalled on is weight gain. She is tall 5'9" and moves all the time she has to eat a lot to gain weight. We are doing to best we can but I am wondering if she would progress faster and have a better chance of recovery in a treatment center. I don't want to send her to one but her new therapist seems to think it would help her greatly. I know it would not cure her and we will have to watch for for a long time. What are your opinions on a treatment center as far as helping people with eating disorders make better progress?
D Diagnosed with AN age 15 around 9/2017. First regression close to WW wanting to eat healthier. 2nd regression started self harm with inpatient stay for suicidal thoughts. 18 now and fighting to get out of 3rd down slide.
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mtkmbc4
It is such an individual thing, but for my daughter, it has been absolutely necessary to involve higher levels of care. Have you considered a partial hospitalization (day treatment) program? 
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WeRnotdone
Yes, I have considered partial or outpatient treatment. My daughter’s psychologist recommends a treatment center out of state. We live in a state where they can decline treatment at 14.
I hate the thought of her being 10 hours away. The treatment center the Dr. recommends is suppose to be good. I would ask if anyone has been to the center but not sure if it’s allowed on site.
I have been caring for my daughter for almost 2 years. Getting her to her target weight has been a big struggle. She hovers at the low end of a healthy weight.
D Diagnosed with AN age 15 around 9/2017. First regression close to WW wanting to eat healthier. 2nd regression started self harm with inpatient stay for suicidal thoughts. 18 now and fighting to get out of 3rd down slide.
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Kali
Dear WeRnotdone,

What care to seek for a loved one with an eating disorder is so individual and it really depends on the state of the person.
Suicidality and self harm are certainly symptoms which must be taken very seriously and can be reasons to seek residential care.

Some parents will tell you that residential care was the beginning of remission even though their child did not come home cured, and others will tell you that it wasn't as helpful as they had hoped.

My advice would be to research your daughter's options carefully and then discuss with her team. Look for evidence based treatment and centers which practice open communication between their team, the patient and their families. If you want to name the facility here that you are considering that is fine, and there is also a part of the message board which has parent reviews of treatment centers, if you want to take a look there for any feedback about the places you might be considering.

https://www.aroundthedinnertable.org/?forum=189312

warmly,

Kali
Food=Love
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ValentinaGermania
My first question would be what have you already tried to stop exercising and how can we maybe help with ideas to up her meal plan so she will gain weight faster?
If you can stop exercising (that is needed in most cases in AN recovery) and get more food/calories into her then maybe IP could be avoided. How can we help you?
Keep feeding. There is light at the end of the tunnel.
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Enn
There are so many different options available to you. It is so individual as stated by others above. 
If you feel comfortable naming the place they have suggested, then others may give their experience. 
Like Kali notes, read about each program in depth, send them questions if needed as well and ask here. 
All the 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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WeRnotdone
Thank you all for your advice and responses. The Treatment Center suggested by my daughter's psychologist is Eating Recovery Center in Denver Co. I have read a lot of mixed reviews online I will also look on this websites reviews.
I know I have made many mistakes through this disorder the main one was not knowing what I was dealing with in the start of her illness. There is a family history and when she first went on a diet at 15 and she seemed to be going too far and pacing everywhere I had her seeing a nutritionist, and therapist and she got worse her thyroid levels were dropping and her phosphate levels and hospitalization was recommended no one mentioned at the time any family based therapy. A Dr. suggested reading Brave Girl Eating and that helped me understand what I was dealing with, We also started the Family based treatment which after 2 weeks of hell, she settled into the routine and did well. When she reached the low end of a healthy weight her medical Dr said she didn't need to see her anymore but she would need to continue therapy. That started the first relapse. She was still exercising with me I exercise regularly and for me it is my mental health savior so I thought it would be for her as well. In August 2018 she was coming out of her relapse and we relocated and she started at a new school. She was doing well excited to be back in school I went to make sure she ate her lunch I was still supervising meals. She got a boyfriend made some friends. Then around the holidays she was so moody, fighting all the time wanting her space. I thought it was normal teenage stuff. I had also made the mistake of not starting up therapy after we moved she was doing well and the thought of starting all over with another therapist was too hard. In January when she became dark I was not even sure it was the eating disorder, I found out after she was at a treatment center for the dark thoughts that it was her eating disorder. The center she was at was well known for eating disorders however, I was not impressed by her treatment there. She was not in the eating disorders unit but I had told them about her history. She lost weight the week she was there.
Since the end of January, I have been trying to get her back to her set point weight. It has been extremely difficult especially since with this relapse she was so angry and hostile. It has been painfully slow she has stopped exercising and tells on her disorder. I was told by the psychiatrist where she stayed for suicidal thoughts that as much individual therapy as possible would be best since she is an expert at dodging and weaving in big groups. I have her seeing 2 individual therapist and a nutritionist.
I feel like she has made good progress over the past 4 months and I would like to continue to help her but I feel pressure to get her to her goal weight so she can have a more normal senior year at high school and hopefully go to college. She is shy and I worry about her getting lost at a big treatment center.
The main things she does now is moves all the time, not exercising just never sits. She has started eating more this week because she does not want to go to a treatment facility. She has OCD, has from a young age and probably depression too. I have antidepressant for her but she does not want to try it. Our family history has not responded well to antidepressants.
I am up all night debating if sending her to Eating Recovery Center would help her progress. Thank you, Amy
D Diagnosed with AN age 15 around 9/2017. First regression close to WW wanting to eat healthier. 2nd regression started self harm with inpatient stay for suicidal thoughts. 18 now and fighting to get out of 3rd down slide.
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debra18
Is there an FBT therapist that can give you more support there? I am glad they are knowledgeable about FBT where you are . I am in NY and nobody had heard about it when my daughter became sick . It is a common mistake to stop treatment too early. It's not your fault. We all make mistakes. Does your daughter drink shakes or smoothies? This is an easy way to get in a lot of calories to move toward the right weight. Some people also spoke highly about the 5 day program California. Maybe they can help you get on track.
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sk8r31
I would also suggest that you contact either UCSD or UCSF and inquire about their 5-Day Multi-Family Intensive program.  It might be enough of a kickstart to get you all on the best possible path for a strong recovery.  Don't dwell on the would-have, should-have, past events.  I urge you to really empower yourself to find the best possible treatment option for your d and your family.
The UCSD program was a lifesaver for our family after our then-17-year-old d had been ill for 3 years.   You might want to call the program and speak to an intake specialist or therapist to see if this would be a good fit for your family.
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
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mtkmbc4
If your family can manage it, I’d encourage you to not consider geographic distance when you pick her treatment. I second the idea of the 5 day intensive family program. 

In reference to ERC in Denver, I have had two very well respected eating disorder specialists (often named on this board) recommend ERC for my child should residential treatment ever be necessary. Each family has to consider all the options. 
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WeRnotdone
Thank you for the advice. What is the 5 day intensive family based therapy? Is it a University I contact about it?
D Diagnosed with AN age 15 around 9/2017. First regression close to WW wanting to eat healthier. 2nd regression started self harm with inpatient stay for suicidal thoughts. 18 now and fighting to get out of 3rd down slide.
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sk8r31
Here is the link to the University of California San Diego 5 Day Multi-Family Intensive.  There is also a sister program at UCSF which you can check out as well.  Sometimes the dates available for one or the other is more convenient.  
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
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Enn

The 5 day intensive is at the University of California San Diego campus. The link is below and they have sister program at San Francisco Campus.

Here you go:
http://eatingdisorders.ucsd.edu

Here are some threads from the past to help you too.

https://www.aroundthedinnertable.org/post/young-adult-treatment-ucsd-or-erc-6773570?highlight=erc&pid=1282693615
https://www.aroundthedinnertable.org/post/i-need-to-pick-quick-erc-or-childrens-denver-8491265?highlight=erc&pid=1295546042
https://www.aroundthedinnertable.org/post/thoughts-about-erc-or-rogers-memorial-10112148?highlight=erc&pid=1308556596
https://www.aroundthedinnertable.org/post/our-journey-at-ucsd-eating-disorder-center-9605022?highlight=ucsd&pid=1303004009
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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Enn
http://eatingdisorders.ucsd.edu/treatment/adolescent-programs.html
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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Jordana
I called UCSD about the week long intensive program and they said they are not offering it until August this year. Though you should call yourself. I, too, am looking into different treatment options for my daughter. She is in a more punitive ED inpatient facility in Virginia and might need another place. She has mood disorder, OCD, and anxiety with a suicide attempt last October and self harm, all before the AN appeared.  I was recommended ERC in Denver also for her or Laureate in Kansas by a top ED expert at UNC. I just talked to https://eatingdisorderspecialists.com/  They support parents at home with food completion, and they support the home treatment team. 
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Mamaroo
Welcome from me as well.
When she had the relapse, was she close to her WR target? It is very common to see a spike in anxiety when the WR target is close, we call it here extinction burst. My d was so anxious I begged our hospital to take her as an in patient (we don't have residential here), but they just said to keep on feeding her. 

As Tina has said, if you can get her to stop exercising and increasing her calories, then she might be able to recover at home. A couple of mums here have daughters who stood all the time, Debra18 and Scaredmom come to mind. Here are some links related to standing:

https://www.aroundthedinnertable.org/post/standing-8318738?&trail=25

https://www.aroundthedinnertable.org/post/constant-standing-8721571?pid=1297122661

Mamabear's d also was compulsive exerciser. Here is a link to her threads:

https://www.aroundthedinnertable.org/post/unbelievable-progress-keep-going-5241668?&trail=25

https://www.aroundthedinnertable.org/post/insights-from-a-recovered-17-year-old-related-to-sports-8564614?pid=1296285238

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
WeRnotdone wrote:

I feel like she has made good progress over the past 4 months and I would like to continue to help her but I feel pressure to get her to her goal weight so she can have a more normal senior year at high school and hopefully go to college.


So first thing to do is to get food into her. She can not comply with any therapy or help as long as she is underweight and her brain in malnurished. How can we help you to get 3 meals and 2-3 snacks into her each day? How can we help you to up her meal plan so she eats enough and gains that lost weight before school starts again? Can you give us some ideas what she is eating at the moment and we can brainstorm with ideas? Are you cooking/serving aleady all meals?

WeRnotdone wrote:
The main things she does now is moves all the time, not exercising just never sits. She has started eating more this week because she does not want to go to a treatment facility. She has OCD, has from a young age and probably depression too.


Here my d had OCD before AN and some depression even before but I am not sure today if AN did not start much earlier than I recognized it. Anyway, AN and the malnutrition of the brain increases all depression and OCD. So anti depressiva would probably not help in her malnurished state at all. Food is her medicine. When the food goes in and the brain recovery starts the OCD and the depression normally gets better and you can work then on the rest that is left. Food must go in first.
Keep feeding. There is light at the end of the tunnel.
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WeRnotdone
Thank you very much for all your support and advice. My daughter eats about 3,500-4,000 calories a day with no exercise. She is 5’9” and a burner which makes it much harder for her to gain weight.
She eats 3 meals, 3 snacks and a carnation instant breakfast before bed.
I am going to hold off on the treatment center for a bit. The thought of going there is enough to help her work through her anxiety. I hate to use threats but it is the only thing that motivates her. Well money does too, I started offering her $5 to face a challenge, it’s working.😳 I hope she can gain and her brain heal soon. For all of us the process seems to take much too long. I also deal with burnout. All the anorexic debating all the wasted worry that keeps her from living her life it’s a kind of exhaustion many can’t imagine.
D Diagnosed with AN age 15 around 9/2017. First regression close to WW wanting to eat healthier. 2nd regression started self harm with inpatient stay for suicidal thoughts. 18 now and fighting to get out of 3rd down slide.
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ValentinaGermania
KLBs son has severe exercise compulsion and burns a lot too and he needs to eat more than 6000 calories to gain weight so maybe think about where you can add something. Is she eating enough fats? Fats should be at least 30% of intake so in your case min 1300 calories which is 130 g. That is a lot of fats.
Using threats is no harm when it works. We all did that 🙂. Using leverage is even better. If money works, why not? Why paid my d with driving hours for eating. Others spend huge amounts on online games or nail polish...be creative! Incentives work when they are no long term leverage and achievable.
Keep feeding. There is light at the end of the tunnel.
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Mamaroo
Ah yes, threats and incentives ....we used them as well. When my d didn't eat, I would start packing her bag for the hospital, and she would reluctantly eat, while complainling loudly. I gave my d points for every meal finished, around $2 a day, which she used on iTunes cards. I got very good at finding iTunes cards on special 🤭. Like Tina said, increase the fat content as it leaves a smaller footprint. My d drank ensures as well, it has double the amount of calories than other drinks for its size. Replace some of her milk with cream. Give her smaller portions of low density food such as fruit and vegetables and add more higher density foods such as chicken with skin, tuna in oil or potatoes and other starches with cream sauce. Nuts, juice and dried fruit are also great.
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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debra18
My daughter did not respond to incentives and consequences. But what worked for her was distractions and developing hobbies. She read books while eating and after eating, also art projects and games like bopit. She started taking piano lessons and I bought her hamsters.
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workingthrough
Just wanted to send a hug your way. She’s very lucky to have you - and you’re doing an amazing job. I hope this week ahead is a smooth one + she’s able to make progress and/or you’ll know what’s best. We were in limbo for months with higher treatment, it’s not an easy place to be. It would be so nice to have an easy button through all of this. You’re doing incredibly. Sending a hug your way. 
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