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

69 replies

postingforafriend · 03/09/2010 10:06

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That led into her controlling her eating and she's been eating less and less for the last year and now is very thin and withdrawn.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 Confused

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 Smile

OP posts:
RidgewayLass · 05/09/2010 22:00

Nutella, big hugs. My own experience of in-patient treatment was 25 years ago. I'd like to hope things have moved on since then.

It sounds from what you say that the team currently looking after your daughter are not saying she has to be admitted. If that is the case, then I do think she is better off going to school (is it back to school tomorrow? is that going to be a problem?) and seeing her friends and family.

Great that she's getting help from a counsellor with her self-esteem. It's not clear from your posts if your daughter has told you what she thinks she is doing and why. An approach you could take would be: offer her breakfast, elevenses, lunch, tea, dinner and bedtime cocoa, let her see that you are writing down what she's eaten, but not fussing over each uneaten meal. So she knows you are concerned, but isn't getting any extra attention. Separately, in short sessions, ask her open questions about what she thinks she is doing and why. Pay close attention to each answer, take them at face value, and see if you can deal with them.

Don't know if this helps at all.

nutella1 · 05/09/2010 22:30

thanks hettie - i have been advised that this NHS clinic is the best way and will go tomorrow armed with questions. I am going to look into private family therapy (not sure we can wait until my daughter puts on weight)

starberries - my daughter doesnt want to grow up and doesnt want her body to change. she also was told at school to do lots of exercise and to eat healthily which she has taken to extremes. she definately knows she has a problem and really wants help and to have 'her old life back' which is half the battle I have been told. good to hear that your friends daughter is better. any positive comments most appreciated.

RidgewayLass · 05/09/2010 22:54

Nutella, if your DD says she doesn't want to grow up, ask her what aspects of growing up are bothering her. It might be she is anxious about getting a job, finding a husband, living by herself. If you can help her visualise a realistic future that she likes, then she'll be able to get to grips with it.

If she doesn't want her body to change, ask her if it is anything specific. Ask her what she liked about her pre-anorexic body that she wants to keep. If she likes to run and climb and turn somersaults, take her along to somewhere like a climbing wall where she can watch grown women doing all that stuff. Does she know what damage starvation will do to her body? Not just the risk of death (which can sound a bit overdramatic and remote until you are rather too close). There's the dry skin, the chilblains, the bone loss, winding up 3 inches shorter than you might have been, the hairy face, the bald patches, the varicose veins, the way cuts don't heal, the loss of short term memory... (Sorry I realise that might be upsetting for you, your DD really needs to know all that stuff. I hope she's not so ill as to have the worse ones yet.) Oh, and tell her to get well fast, like before Christmas and enjoy the next ten years of her life.

If she's saying that school told her to exercise and eat healthy, then she's bluffing. She knows starvation isn't healthy eating.

Hope this helps some.

nutella1 · 06/09/2010 11:53

thanks ridgwaylass - that is all good advice but to be honest nothing works. This morning I told her that she could die and that if she goes into hospital they will tube feed her (not very helpful I know but am desperate). She basically doesnt believe me about these things. Nothing I say encourages her to eat - the anorexia is just too entrenched.

Hello postingforafriend - glad you keep on popping up!!

RidgewayLass · 06/09/2010 12:15

Nutella, has your DD's consultant said to you "we will tube feed her"?

RidgewayLass · 06/09/2010 12:57

Sorry, had to run away from computer and posted a stump. What I was going to say was, I think it's a good idea for you to find out exactly what the team who are looking after your DD would do if they had to admit her. Perhaps have them tell your daughter, maybe she will believe them.

mathanxiety · 06/09/2010 18:41

Here's a piece from the Chicago Tribune that may give you an indication of an approach:

"Rather than emotional pleas, parents are asked to use empathic but firm declarative statements, such as "I'm no longer going to let you starve," "This is your medicine" and "I won't give up," said Katharine Loeb, an associate professor in the school of psychology at Fairleigh Dickinson University. She is also director of the eating and weight disorders program at the Mount Sinai School of Medicine.

During this challenging first phase, normal life stops until the sufferer eats. Parents may quit jobs, take leaves, cancel all social engagements. It's lonely and exhausting for everyone.

"It's a matter of wills," said Ranalli, who ate lunch with her daughter at school to make sure the girl wasn't throwing the food away. "As a parent you are stating, 'I'm not leaving, I'm not caving, I'm not negotiating. We are not leaving this table until you eat.'"

It would be helpful to emphasise the right here right now aspect of what is happening, and avoid any reference to what might happen in the future "IF..." My 9 yo DD will not do her homework because of me telling her she will never become a CPA if she doesn't finish her sentences and get started on her science, nor will she do it because I tell her she will become a bag lady if she doesn't do her homework.

You know the big picture, and the eventual consequences, but the anorexic is willing to take her chances. The big picture sounds like rhubarb rhubarb to her. And it won't happen to her anyway. An anorexic doesn't believe she is mortal or she wouldn't be anorexic in the first place.

It's important to separate in your minds, and in hers, the anorexia from the child. So associating the anorexia with something that is going to happen to her personally and physically is getting the two mixed up. She needs to understand that she feels the way she does about food because something in her brain is not working right and giving her thoughts about food that she needs to recognise as her enemy; she needs to learn to use another part of her brain to counter those thoughts. Initially she can use her hands, knife, fork and spoon to counter those thoughts. A ten year old is capable of weeing it in those terms.

Try to use the declarative statements and focus completely on the eating of this one meal that is before you on the table without referring to the IFs.

Initially you may be all sitting there til the cows come home. You can expect a huge amount of resistance, but you must persist. You may need some sort of reward system or some sort of timer system where she must eat for a certain period of time and/or eats what is served -- maybe initially anything high in calories no matter how unsuitable it may be for dinner (milkshake with protein powder, anything you can think of that would help her gain weight). It doesn't have to be a healthy snack. It just has to have a lot of calories. Time enough to discriminate among foods when she has gained weight and is learning to eat voluntarily.

You are going to be laying down the law here in no uncertain terms, while trying to keep your cool, focusing on the here and now, and not allowing the ferocity of the resistance to make you retreat.

mathanxiety · 06/09/2010 18:43

seeing it, darn

mathanxiety · 06/09/2010 18:49

Feast.org link here -- a selection of links to how to tackle this within the family. Feast.org is a family support group. The F stands for Family.

POFAKKEDDthechair · 06/09/2010 20:12

Be VERY careful if you are doing any sort of insisting on eating without therapy that the eating disorder does not turn into bulimia - many anorexics faced with being forced to eat turn to bulimia in secret to keep 'control'. It happened to a good friend of mine, a ballet dancer.

barley2 · 06/09/2010 21:55

Hello- I know that you've had loads of really helpful and well informed posts on this. I just wanted to add a positive perspective. I developed anorexia at around 11 and thank goodness my parents picked up on it quickly (yes I did fight against their help but now I am forever grateful to them). I started off with counselling and eating plans which helped in some way to keep me from becoming dramatically ill ( however I was pretty bad). After 9 months I was admitted reluctantly to an adult eating disorder unit and although it was to put it mildly a very traumatic experience it was what I needed and in the long term I think I needed the wake up call. I would advocate inpatient treatment because it is about giving up control which is what is so terrifying to the sufferer but necessary in the long term. To cut a long story short I was admitted 3 times over 4 years, not as bad as it sounds as I went to school and had a steadily healthier weight each time) and eventually 'recovered' at 16. I have put 'recovered' because I did later suffer from mild forms of OCD, but these were nothing compared to anorexia and kept in check by help from my GP. I can honestly say that food / exercise is definitely not an issue for me and I am now 33 with 2 children and a healthy state of mind. From experience of others the quicker treatment is given and the earlier the age the better the outcome but it will take time and be very tough for everyone. In terms of therapy I know that I responded well to what I think was a mixture of psychotherapy and cognitive behavioural therapy, which addressed unhealthy thought patterns. I really hope that your friend can get the right support quickly, I hope that knowing that it is possible to beat it helps especially if she has a loving family who are willing to keep fighting for her.

lorna3 · 07/09/2010 11:46

I don't have any medical advice, only personal thoughts but I felt I should share them in case tehy can help in any way. I really hope professional plan and your own support combined will get through to her.

Some things I really agree with that others have said:
Let her eat anything she wants whenever, have things to nibble; dried fruit (you can get all different sorts from the very dried healthy to the almost candied type), nuts, etc.
Try milk/milkshakes/icecream floats/soups so it's more like just drinking than eating.

Have distractions at mealtimes - let her read/watch films/have friends over/keep a conversation going about something light/interesting. Something that sometimes affected me was suddenly focussing on the sound of chewing and swallowing and thinking about how weird it was that I was putting food into a hole in my body.

Try to find out which food smells she really likes/doesn't like. When you're looking for an excuse not to eat that is one of the first things I think of. I think it can almsot become learned behaviour as I know I sort of imagine the smell of salmon and feel sick even when the salmon doesn't smell the same as I am thinking.

Making sure she knows that you will do every thing it takes alongside loving and supporting her may not seem like it is being taken in but I think at some level it will. "I will not let you starve" is quite a powerful thing to say.

I don't think that the school programme is an excuse. She has taken it too far but
I do think that such programmes sometimes do go overboard. As much as it's important to learn about healthy eating, electrical safety, farm safety etc, I was terrified by the videos we were made to watch on the subject of the latter two (to the point of nightmares and parental permission to be excused from further viewings).
I think sensitive children can really take the messages to heart, especially when issues are addressed in whole week long programmes with each lesson relating to it in some way. I can understand how she could become very invested in a programme and want to do everything that was said and do it really well.

Does she have internet access? If she has any internet time unsupervised be careful she does not find any pro-anorexia sites where girls encourage each other.

I do think the idea of taking her to meet grown up women playing the sports she loves is a great idea. Also are there any clubs she could join to do sports and meet other children/teenagers who are healthy but also eating well in order to keep being active.

Do you think she might believe you about the effects of anorexia but at the same time doesn't want to believe it so is saying it's not true? Having the professionals really lay it out sounds like a good plan. Do they allow visits to the hospital or have any people who act as case studies who could talk to her about the reality?

Sorry for the long ramble, really hope you can make progress soon

mathanxiety · 07/09/2010 18:42

I agree 100% about the internet, Lorna3.

From Feast-ed.org, wrt the internet and anorexia:

'Because a common symptom of an eating disorder is a sense of exaggerated virtue around the behaviors, there are over a million websites and online communities of patients who share tips on how to conceal the illness and methods to maintain the appearance of health despite medical risk. These websites are considered quite dangerous and damaging by many in the eating disorder treatment community. These sites spread incorrect ideas about the illness, and promote a belief that an eating disorder is a "lifestyle choice." They also offer very disturbing photographs of ill people and extreme thinness - content that can be both validating and torture to sufferers.

Many families are shocked to discover their own child has created a "blog" or "online diary" with explicit information about his or her own eating disorder, and communicates directly with other sufferers. This use of the Internet to find "support" may seem natural and positive, but it is often the case that the comfort offered and received is for the eating disorder and not for the suffering person.'

Monitoring internet use might be necessary.

CheerfulV · 08/09/2010 14:03

Rhodes Farm was featured in that C4 prog, wasn't it? It's still available in parts, Part 1 is . I don't know anything about the issue, but I remember that programe from a few years back, and thought it might be of some help.

nutella1 · 08/09/2010 14:35

Hi - since last posting we have had a good meeting at eating disorders clinic at the hospital which has put all our minds at rest - they will amit (spelling?!) into hospital if necessary but told us that research shows prognosis is better if hasnt spent time in hospital. Also they reiterated her brain is not ready for therapy as too undernourished and that is a general consensus amongst other health professionals.

mathanxiety - thanks for your help - it is indeed a battle of wills and we have just started the approach that you recommend. It seems to be working - also taking the approach of 'prove to the hospital you can do this' as they will only let us go away for the weekend this weekend if she has improved a little (check up tomorrow and next day). so overall I am feeling very much more in control whilst learning more and more about this condition

Barley2 - THANK YOU so much for your positive story - I am so pleased you got better. Interesting that you found being in hospital helped you - I am not against it if the doctors think neccessary but they did say she needs to learn to eat at home not just in hospital and also needs as normal a life as possible. Also a friend who had anorexia at 10 (and is now a mum of 3) said she was in an eating disorders ward which was a disaster - competing with how little she could eat with others etc. If my daughter went into hospital it would be a general paediatric ward which might be less scarey? any comments barley2?

just to say - I have taken unpaid leave and am going to school at lunchtime and taking my daughter out for lunch which is working a bit better as lunchtime at school was very stressful for all involved.

keep posting - the support is great

RidgewayLass · 09/09/2010 12:17

Glad to hear that things are looking up. I would strongly agree with the approach MathAnxiety recommends - however tough you have to be to get your daughter to eat, it is less worse than hospital.

You referred in an earlier post to your daughter's "old life", and I wondered what has changed?

My mother, bless her, took me out of the school I had attended for 3 years and where I knew all the teachers and all my classmates. It meant I had to give up music lessons, orchestra and gymnastics. With the wisdom of hindsight, if I'd stayed doing all those things I'd have had a lot to look forward to and to get well for.

HTH

postingforafriend · 10/09/2010 17:33

Hi there, how's it going, are you OK? xx

OP posts:
nutella1 · 21/10/2010 12:21

Hi all - sorry I havent been able to update you. Your support was invaluable. Just to say my daughter has just come out of hospital after 4 and a half weeks (she was in a general ward where children came and went). It was an awful experience so she ate to come home which is the plan! she is doing really well - eating everything on her meal plan and we are now have therapy. It is early days and she is desperate for her old happy life back so I hope it wont be too long now. She is doing loads of crying and screaming which I have read is a normal reaction to resuming eating. I wish any other people experiencing this that there is light at the end of the tunnel and in fact in-patient treatment was the best option.

milokaimilo · 07/01/2011 23:32

My daughter is anorexic and was referred to the Springfield Eating Disorders Unit in Tooting, London.

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