Please help - my workmates 10yo DD has been diagnosed with anorexia

[postingforafriend]

I've namechanged so that my workmate doesn't know my regular posting name. And posting on her behalf here at work.

Her 10yo DD has always been an obsessive sort of personality and about a year ago she became obsessed with exercise after an initiative at school. That led into her controlling her eating and she's been eating less and less for the last year and now is very thin and withdrawn. The only thing she seems to get any enjoyment from is exercise.

My friend took her to the doctor a few weeks ago and had a referral to the hospital, but it wasn't coming through and then an old friend saw her DD and suggested they take her to A&E. She was referred to the eating disorder clinic from there and given an eating plan and told to go away and get on with it, but that if her DD didn't gain weight she'd have to be admitted. It's the Royal Free so they should know what they're doing I'd have thought. They have also said they can't offer the DD any psychological help until she has gained weight... But that seems back to front to me

My friend is at a loss as to how she is supposed to implement the eating plan, she has been given no advice about how to actually get her DD to eat, that's kind of the whole problem.

She just at a loss really what to make of it all and doesn't know what to do (apart from trying to get her to eat) she's not been told how to do that though.

Does anyone have any experience of this, or advice, or anything that might help?

Thanks

[mathanxiety]

Yes at this stage any food is 'healthy food'.

[fuschiagroan]

When I was given my eating plan, it said three meals and three snacks. Completely unrealistic imo. Even when I didn't have an ED I did not eat 3 meal and 3 snacks a day.

I think up to a point you do have to let her decide when and what she eats. EDs are basically all about control. If she feels that someone is trying to control her she will rebel, whereas if she is not put under pressure she may well decide to have a little something myself.

My exDP used to get so frustrated with my eating and size. I felt he was trying to control me, that he was only pissed off that my boobs weren't big enough, even that he wanted to make me fat so no one else would want me. He would lose patience and say things like 'I am going to take you out to dinner and you are going to EAT' (he couldn't cook, so had to take me out!). I just dug my heels in even more and took satisfaction out of eating one bite and leaving the rest for the waiter to clear, just to annoy DP because he'd tried to control me. Whereas if he'd just left me alone, or sat next to me and eaten something snacky whilst watching telly, I'd have probably eaten something. It stopped being about the food and became about the control.

Also, when I was younger, being very thin was the only way I felt I could get my parents to really listen to be/be concerned.

btw I was never very very thin, not gasp-to-look-at thin.

Smoothies are good, because they seem like just a drink but are deceptively high in calories. If the DD is only 10, she probably hasn't worked out about calories so use that. Some soups, especially Tesco's Finest fresh soups, also have quite a lot of cream and butter in. Try to get her to drink juice where possible instead of water.

[POFAKKEDDthechair]

Yes it is about control, and self worth, and family dynamics. But it can take hold so deeply and so rigidly that I am worried about offering any personal anecdotes or advice, although I know that might make your friend feel more supported in the short term. I just feel they have to get the best possible professional care and nip this as quickly in the bud as possible. I feel the longer it drags on the more dangerous it becomes. I really feel time is of the essence here to get the very best professional help and not let the NHS dilly dally or pussy foot around.

[POFAKKEDDthechair]

didn't mean to imply that your advice from experience is not useful fuschia, rather than I worry about the dd not getting the right professional help as quickly as possible.

[postingforafriend]

Yes totally take your point there pofaced.

[POFAKKEDDthechair]

Sorry for multiple posts, just thinking. In your friend's shoes the first thing I would do is get family therapy with someone v experiences in the area [does the maudsley approach include family therapy?] I really feel very strongly that strageties targeted at the dd alone will not work without proper and rigorous family therapy, that might need to go on for years. A two pronged approach is needed - strategies to get the dd to eat and personal therapy, and family therapy too.

[giraffesCantDanceInBrokenHeels]

has she spoken to b-eat?

[MadameCastafiore]

Maybe your friend could take her child back to the doctor and try to get referred to the local CAMHS Crisis Team - she could go to see an assessment team and maybe get funding that way for private care through the NHS if they think her condition is serious enough.

We have a few kids at work who are on eating plans and it is a little a day but very very structured - you let them decide what they want to eat and they will eat nothing - you gradually work on their mind whilst keeping to the eating plan and when they turn a corner no matter how slightly they have to increase their calorie intake - it is a long slow process and one that I firmly believe works.

Sadly I think anorexia is something that you are never really cured of - it will rear it's ugly head when things in life get hard or when you feel particulaly stressed but as long as you see it as soething of an enemy and not a friend to rely on you are halfway there. Sadly it still is my friend sometimes!!!

[mathanxiety]

Initially, Maudsley involves the family in feeding the person with anorexia, and there is a training element there, as the refeeding of the family member is considered the most important to get under way first.

Then the component of family therapy kicks in when the family member has been allowed some freedom to regulate her own eating (which happens after she has gained some weight and is no longer fighting the idea of eating).

So yes, family therapy is a part of the approach, not in the initial stage though.

[nutella1]

Hi this is the mum of the daughter that has the eating disorder/anorexia (thanks friend for starting this up for me). I appreciate all your comments and now have a burning question. I am finding it really hard to get my daughter to eat (unsurprisingly) is it better for her to be in hospital where the eating disorders team can provide support and tube eating if neccessary (we are being treated as out patients at present). We are not being offered therapy until her weight increases. pls advise

[fuschiagroan]

I think going private is the best way, because the NHS now seem to have this mindset that you must get to a healthy weight before any counselling or therapy can be done, and that is just daft and the wrong way round. My friend who is a psychotherapist is of the same view.

I am still below the minimum BMI for health (so if I wanted to get counselling on the NHS they would probably still not give it to me) but my brain still functioned/functions well enough for me to get a first class degree and hold down a taxing full-time job, so I'm sure it could cope with counselling

[fuschiagroan]

Sorry nutella I had not seen your message. I can't comment on inpatient stuff, I was never severe enough for that. I think it can be avoided though. Maybe you could get a private counsellor who specialises in EDs?

[postingforafriend]

Hello nutella! Glad you've registered I think it's good if you're here as you can answer questions etc better than me (obviously!).

I'm off to bed in a mo, I hope that you get some ideas about what to do

[POFAKKEDDthechair]

Hi nutella. I too disagree with the putting on weight first then therapy after approach, because the putting on weight can be so incredibly difficult and is psychological in its root. Yes cognitively one may be functioning less well the more underweight one is, but insisting weight gets put on first can be pretty futile. As I said what I'd personally do is immediately find the best professional private care combined with family therapy. If that is not possible then admitting her to the clinic may be the other route, but I am worried about her being forced to eat, her feeling betrayed and that instilling a long term refusal in her even more, that has happened to some people. But I don't want to put you off the NHS help - maybe things have moved on.

I can't emphasise enough though that communication between you and your dd, facilitated by a professional, is key at this stage, if she is refusing to eat what you are offering her.

[mathanxiety]

If she's been obsessive before she developed the anorexia, then maybe the obsessiveness needs to be evaluated and treated (anorexia and obsessiveness can be closely related) so the refeeding could take place in the context of the treatment of the obsessive-compulsive aspect of all this? (Just going on the OP where mention of the obsessiveness goes, maybe this is not the case).

[Starberries]

Is she not frightened to death as a 10-year-old about going into hospital for this? Have you explained to her how much nicer it will be to eat just a little bit at home and whatever she wants rather than being tube-fed in a hospital round the clock where she can not control anything and will have no privacy?

That would always work for me - I once had an emotional issue (not eating disorder) and landed myself in hospital with it overnight, they wanted to admit me - I was about 14/15, scared the crap out of me and I worked on it slowly but surely at home.

Not suggesting you frighten the pants off her, but let her know realistically what to expect - cold, thin bed, unfriendly room without all her stuff, you can't stay there 24/7, no friends, etc.

[nutella1]

Thanks for all your comments - they are a real help. I am still really confused - should she be in hospital and helped to eat? should she be seeing an eating disorders therapist (despite eating disorders clinic advising not to see a therapist until she puts on weight). Incidently she is seeing a lovely therapist who is helping her with her self esteem. Should we take her out of the NHS clinic and go private? (though I have been advised that they are the best place). Thanks everyone.

[RidgewayLass]

Had a terrible experience with hospital so would advise against, think much better to treat within family to maintain longstanding friendships. Think it might be worth your friend reading up on Aspergers and girls - there are several books on the topic, there is now some thinking that some/many anorexic girls have Aspergers. She might recognise her daughter and that might help. Don't like the labels and there's a whole load of stuff around medicalisation of personalities and so on but once you've got a kid on the brink of hospital admission for anorexia it kind of gets beyond mere personality.

[Doobydoo]

As a Paed nurse would advise against hospital admission.Could well get weight up but what happens when she goes home?I agree with earlier poster who said 'time is of the essence'.I really feel for you.You say your daughter is seeing someone for her self esteem issues which is a good start but agree re it being a family issue too.

[hettie]

ok- you are going to get lots of differing advice from people who have had anorexia/ have had a dc with anorexia.....Really the specialists in an eating disorder clinic are the people to take advice from, only think of going private if there is a problem with waiting lists (private doesn't mean better qualified, many nhs psychologists also do private work so you may end up getting the same person, plus if you are not familiar with the whole area of mental health you mnay end up with some well meaning counsellor- and this is defo a disease that needs specialist highly qualified help).
Anorexia is hard to treat, anorexics are hard to help (hence so many reporting an ambivilant realtionship with profesionals) I'm afraid this is part of the disease- I'm so sorry it's awfuly hard for the families involved. Go back to the eating disorders clinc, voice these concerns and listen to what they have to say.

[Doobydoo]

Very good advice Hettie.

[Starberries]

Have been chatting to my friend who suffered from anorexia between ages 12-14 and was admitted to hospital by her mum at age 14 - she was really angry with her mum but she was more angry at the fact she thought she didn't have a problem rather than betrayal of trust.

She was also shocked when going into hospital realizing that people can actually die from this. Her question to you is that does your little girl see that she has a problem? Does she recognise that it's anorexia and it's not normal? If so, carry on treating it at home as she can get better with therapy.

If not, she would say to hospitalise her as she won't eat if she doesn't think there's anything wrong with it, iyswim. She says that your daughter will get over it in time (the betrayal of her trust issue) and will realise that as a parent you did what you had to do.

Has your daughter explained to you why she doesn't eat? Is it a looks/social thing? Or is it a phobia of food as in - doesn't physically like food? Or is it that she thinks she will become fat? If it's a feeling that she will be fat then she needs to be hospitalised as she won't ever do it on her own, and she can get the treatment there coupled with the counselling. If she feels it's a food phobia then you can get a private child psych to work with her on overcoming that.

[POFAKKEDDthechair]

I'm afraid to say Hettie at least in the past there were an awful lot of young women failed by the system - not simply because they are/were 'hard to help' but because they simply didn't get the right help. Of course there are some girls/women who have anorexia their entire lives and refuse all help however skilled it is. But there are many others who desperately want to get better and just have never found the right kind of psychological and practical help. It may be improving in the NHS - I certainly hope so.

Anorexia often affects intelligent young women who have impossibly high standards for themselves and have deep rooted communication problems within the family set up. Getting to the root of these problems is absolutely essential IMO. Forcing someone to eat often backfires and becomes a betrayal of trust, which is what I'm worried about.

I do absolutely agree though that nuttella must urgently get the right professional help and no end of anecdotes here will be as useful as targeting the right professional help ASAP.

[POFAKKEDDthechair]

Fanily therapy, nutella, with a professional skilled in this area, NHS or private, though private will be quicker. I would get a recommendation of an NHS professional and then try to see them privately, as a family. I think this is imperative.

[postingforafriend]

Just popping by to say hello