Does my DD have an eating disorder?

[BoofTheFloof]

Before I start I need to preface with the fact that I know she has some disordered and unhealthy eating behaviours-I'm just wondering if it qualifies as an actual eating disorder?

DD is 16. She has always been very slim due to having no interest in food and playing sport daily, including long distance running. She's been like this since she was a very small child.

About 18 months ago she got a long awaited and much needed ADHD diagnosis, and the medication has really helped her. Unfortunately it also further reduces her appetite.

As part of the ADHD diagnosis she saw a therapist who said she had mild body dysmorphia- she's a very pretty girl at the bottom end of the bmi chart and genuinely believes she's unattractive and chunky. She likes being slim and will prioritise that over food which is easy for her as she really isn't fussed about eating. (She is very similar to my lovely MIL who has never weighed more than 8 stone in her life but is still sporty and active.)

Over the summer when she wasn't doing school work she went off her medication and tried to eat more. She increased her weight from 6 stone 12 to 7 stone 3 (at 5 foot 4") and was pleased, and in the green bit of the bmi chart. However now she's back at school she's stopped eating lunch as apparently she worries if she eats a big meal and then tries to restrict the next day to balance it out. It's not helped by the fact that she's surrounded by girls who are worried they have gained weight and who talk about losing it constantly.

She does eat. I make her a big breakfast each morning (poached egg, sausage, smoothie) and she's fond of some foods and I'm relaxed as long as she's getting calories. She's just has a reasonably large Mexican quesadilla, nachos, chips and 2 churros for dinner. She doesn't have the need to control herself or her environment that I associate with anorexia, but I am aware that worrying about eating a big meal when you're the weight she is is isn't normal.

I'm keeping an eye on things, but after nearly 2 years of mental health disruption as we sorted out the adhd and the negative self worth caused by her late diagnosis I'm also loathe to start her on more therapy if (for example) she's just active, likes being slim and is prepared to occasionally restrict food to achieve this (again, this is how my MIL has lived her entire happy and successful life so whilst I don't necessarily agree I cannot argue that she's been damaged by it. The only time I remember her upset was when chemo made her put on weight and none of her clothes fitted. She lost her hair and her breasts but got back into a size 8.)

So I suppose my question is- so I need to do more and worry more?

Skipping meals, restricting food intake and believing you're fat at a low weight.

This is an ED. Or the start of one. Please get her therapy ASAP.

I never had therapy before now (48) because it wasn't well known about back then. Ive suffered for more than 30 years.

Anorexia is unbearable. At times my life has barely been worth living. It doesn't go away without therapy. It could also get worse.

You sound like a lovely caring mum. Your DD is very lucky to have you.

If she is still having therapy for the ADD, could you contact her current therapist and take it from there?

If not, don't wait for NHS. It will take an age. If you can afford it go private.

I think she could well be on a slippery slope towards an ED. And I would say her weight is worryingly low and it wouldn’t take much more weight loss to trigger full blown eating disorder thoughts and behaviours.

There is a thread for the parents of teens with ED’s. Come and join us, we are a friendly bunch and it’s a really supportive place.

www.mumsnet.com/Talk/eating_disorders/4279530-Teen-Eating-Disorders-Thread-4

DD (15) was diagnosed with Anorexia back in May. And my DS has ADHD and takes medication for it. So we see first hand the affect it has on his appetite. To the point that we actually supplement his food intake with Fortisip drinks. Just an observation here but I can’t imagine DD being able to successfully recover from an ED if she ever had to be on those meds. The two are absolutely not compatible.

@Rollergirl11

DD (15) was diagnosed with Anorexia back in May. And my DS has ADHD and takes medication for it. So we see first hand the affect it has on his appetite. To the point that we actually supplement his food intake with Fortisip drinks. Just an observation here but I can’t imagine DD being able to successfully recover from an ED if she ever had to be on those meds. The two are absolutely not compatible.

This is worrying. The medication has made such a difference to her mental health and has improved her grades from steady 4/5 to 8/7/6, which again has been amazing for her confidence. She's refusing to see any more therapists. "Therapy fatigue" apparently. I've agreed that if she manages to stay over 7 stone for the next couple of months then we will talk again but if she falls below then it's back to therapy, I'm fortunate to have great health insurance through work which gives me some flexibility. I've also said that if her weight falls then her running needs to stop. She can't run 5 k three tines a week in what she's eating. She's agreed to have a bigger breakfast, a protein shake snd a snack at lunch, and will try to eat lunch. I'm also making her favourites for dinner.

I'm honestly at a loss. I'm just so fucking sad. Two years of anxiety, depression, self harm and suicidal thoughts were behind us, and she was so much better. Happy. Stopped harming. Feeling emotions again, interacting with family and friends, got a lovely boyfriend, doing well at school. I was able to focus more on DS for the first time in years and now here we might be again. It's like every tine she might be happy her mental health sabotages it.

I've looked at the teen eating disorder thread and I don't think we're there yet but who knows. I'm going to lurk for a while.

She doesn't have the need to control herself or her environment that I associate with anorexia

Yes she does, you said:

"Now she's back at school she's stopped eating lunch as apparently she worries if she eats a big meal and then tries to restrict the next day to balance it out." That's the controlling bit.

It's difficult as the ADD meds my DD is on are an appetite suppressant.

They help with school but I wonder how much longer before the consultant decides she's lost too much weight.

Is your DD having regular height/weight/BP monitoring?

@RandomMess

It's difficult as the ADD meds my DD is on are an appetite suppressant.

They help with school but I wonder how much longer before the consultant decides she's lost too much weight.

Is your DD having regular height/weight/BP monitoring?

She is. They're apparently not worried yet as she didn't weigh a lot before she started them so in total she's only lost a few pounds in nearly 9 months of being on them. She's just never been interested in eating. One doc I took her to actually tested her for gastroperesis and whilst she didn't meet all the criteria she does have very slow stomach emptying which means she's rarely hungry at the best of times.

@HelloDulling

She doesn't have the need to control herself or her environment that I associate with anorexia

Yes she does, you said:

"Now she's back at school she's stopped eating lunch as apparently she worries if she eats a big meal and then tries to restrict the next day to balance it out." That's the controlling bit.

True. I suppose I was more thinking of the perfectionist tendencies you often see. She's definitely not there! She is quite controlled in other sciences of her life though and she's always been massively strong willed.

I was anorexic many years ago, had a councilor who was useless, but I’m just about ok now. Do have issues when under stress though.I now do weigh far too much though!

Is she having regular periods? If she wants to keep her running up she needs to feed herself properly and that’s sometimes a good benchmark.

When I was struggling to eat with anxiety I found upping my weekly mileage made me get serious about having enough calories, though I appreciate that’s a different situation. A fasted 5k is nice to run. A fasted half marathon is utterly miserable.

The problem is that now so many disordered eating habits are considered normal. And people only see them as a problem if and when the person becomes too thin.

She is consciously restricting what she is eating to lose weight/maintain an unhealthy body weight. She has an eating disorder.

@Verbena87

Is she having regular periods? If she wants to keep her running up she needs to feed herself properly and that’s sometimes a good benchmark.

When I was struggling to eat with anxiety I found upping my weekly mileage made me get serious about having enough calories, though I appreciate that’s a different situation. A fasted 5k is nice to run. A fasted half marathon is utterly miserable.

She's still got regular periods. She looks the picture of health. She is on the smaller side- since being a baby she's consistently tracked 40-50 percentile for height and 10th for weight and it's never been seen as a problem. She grew, competed in running and hockey at a high level, had periods, all good. We just though this was how she is. She's the image of my MIL who is also 5'4" and weighed around 7 stone even after the birth of 2 kids. She's still less than 8 stone now and lady captain at the golf club and still very active. However DDs weight is slowly slipping. The 10th centipede as ok. The third (where she is now) is worrying. She's also never missed meals before. I could understand not eating much, but not eating at all is a big problem.

@Lasttimeneveragain

The problem is that now so many disordered eating habits are considered normal. And people only see them as a problem if and when the person becomes too thin.

She is consciously restricting what she is eating to lose weight/maintain an unhealthy body weight. She has an eating disorder.

You're right about it being normalised. She's surrounded by friends who gained lots of weight during the lockdowns and are deeply unhappy for different reasons. They're restricting food (sometimes in silly ways) to lose weight and DD hangs round with them and it's not good for any of them. But her friend who went from an 8 to a 14 can afford to have the odd single fruit pot for lunch (although it's really sad she feels she has to). Dd needs food.

She ate a really small meal tonight as apparently she "didn't like it". Anyway I've just taken her a fish finger sandwich (with 4 fingers) and a kitkat, and pretended to look over her history while she ate it. It's all gone which is good.

Hi OP I'd invest in a copy of Help your Teen Beat an Eating Disorder by Lock and La Grange ASAP. It is brilliant and will give you the tools to help your DD. AN is the most pernicious illness and the ability for it to take hold at pace is terrifying.

You are doing the right things - food is medicine but as a PP says - any medication which kills the appetite is going to be a huge issue coupled with the fact that she is exercising so much.

I read the book cover to cover the night I downloaded it in despair - I knew instantly my DD was seriously ill. She's thankfully well again and happy but AN is always hanging around waiting to get its vile foot in the door. I couldn't have got her back on track alone - you need professional support- even if you go alone to start with.

@mustbemad71

Hi OP I'd invest in a copy of Help your Teen Beat an Eating Disorder by Lock and La Grange ASAP. It is brilliant and will give you the tools to help your DD. AN is the most pernicious illness and the ability for it to take hold at pace is terrifying.

You are doing the right things - food is medicine but as a PP says - any medication which kills the appetite is going to be a huge issue coupled with the fact that she is exercising so much.

I read the book cover to cover the night I downloaded it in despair - I knew instantly my DD was seriously ill. She's thankfully well again and happy but AN is always hanging around waiting to get its vile foot in the door. I couldn't have got her back on track alone - you need professional support- even if you go alone to start with.

Thank you.
I've just downloaded it. Thanks to everyone for their insightful comments and sharing their own experiences. It does appear that I may be underestimating the threat.

Do message me if I can be if any help to you

@BoofTheFloof do you mind me asking what medication she is on? There are also the non-stimulant drugs that are prescribed for people who can’t tolerate the stimulant based ones. They could always be an option if the weight loss becomes an issue.

Feel free to lurk on the teen ED thread. There are people that dip in and out and others that just post with questions and then us regulars who have DC’s with diagnosed ED’s. Use it for whatever you need.

They're apparently not worried yet as she didn't weigh a lot before she started them so in total she's only lost a few pounds in nearly 9 months of being on them.

But they might be more worried if you were to tell them you were concerned your DD was slipping in to disordered eating?

Ok, so I am going to look at it from a slightly different perspective. Big difference between disordered eating and an ED.
Your daughter is eating at least twice a day and by the sounds of it without too much bother. I’d be interested to know if she has any snacks or just eats enough to fuel her body which sounds like what she has always done.
You need to work out her weight for height as that is a more accurate way of tracking weight loss/ gain.
Bare in mind that it’s absolutely normal for teenage girls to discuss diets sadly more so now with the “perfect Insta “ world of photoshop.
What does your dd say in regard to restricting her food intake? It sounds like she hasn’t really changed over the years in terms of eating but has obviously benefited from her ADHD meds with very little appetite suppression which is great.
Your ADHD clinic/ nurse should be able to do a w4h for you.
If she is truly not restricting then having an agreed weight not to fall below is worthwhile agreeing on. As she is 16 she has consent to treatment or not so if she does not want to attend then can’t be forced( unless needing to go down the detained route which she sounds no where near)
I second the Family Based Therapy approach as mentioned above as that’s the Gold star for adolescent ED treatment. The parent is the expert on the child and the best placed person to help them.
Food is medicine.
She would not meet the criteria for a CAMHS ED referral ( in my NHS trust) with the amount she is eating at this time.
Again her w4f is crucial for this.
Love your approach so far , big hugs

[quote Rollergirl11]@BoofTheFloof do you mind me asking what medication she is on? There are also the non-stimulant drugs that are prescribed for people who can’t tolerate the stimulant based ones. They could always be an option if the weight loss becomes an issue.

Feel free to lurk on the teen ED thread. There are people that dip in and out and others that just post with questions and then us regulars who have DC’s with diagnosed ED’s. Use it for whatever you need.[/quote]
She's on Elvanse 40mg capsules. She was on methylphenidate but that made her really jittery and anxious and she literally chewed the skin off her fingers. She tolerated Elvase really well. She described it as like someone cleaned out the muddle in her brain. The impact on her was remarkable from pretty much the first day.
Having said that I've just chatted to DD who cheerfully admitted to usually missing a dose on Saturdays which is her only day for getting up late. She said she likes sleeping in and then feeling hungry for lunch and dinner. Im a bit freaked out and have emailed her psychiatrist about whether this is dangerous. I'm not sure she can do this although she claims no withdrawal symptoms.

@giggly

Ok, so I am going to look at it from a slightly different perspective. Big difference between disordered eating and an ED. Your daughter is eating at least twice a day and by the sounds of it without too much bother. I’d be interested to know if she has any snacks or just eats enough to fuel her body which sounds like what she has always done. You need to work out her weight for height as that is a more accurate way of tracking weight loss/ gain. Bare in mind that it’s absolutely normal for teenage girls to discuss diets sadly more so now with the “perfect Insta “ world of photoshop. What does your dd say in regard to restricting her food intake? It sounds like she hasn’t really changed over the years in terms of eating but has obviously benefited from her ADHD meds with very little appetite suppression which is great. Your ADHD clinic/ nurse should be able to do a w4h for you. If she is truly not restricting then having an agreed weight not to fall below is worthwhile agreeing on. As she is 16 she has consent to treatment or not so if she does not want to attend then can’t be forced( unless needing to go down the detained route which she sounds no where near) I second the Family Based Therapy approach as mentioned above as that’s the Gold star for adolescent ED treatment. The parent is the expert on the child and the best placed person to help them. Food is medicine. She would not meet the criteria for a CAMHS ED referral ( in my NHS trust) with the amount she is eating at this time. Again her w4f is crucial for this. Love your approach so far , big hugs

She used to snack but has cut down. However she'll have a packet of crisps or a biscuit when she comes in from school. She eats a good breakfast and an adequate evening meal. It's school lunches that are her difficult time. She is therefore restricting in the day but is ok when I give her food she likes. Food has only ever been fuel for her. I have really clear memories of her aged about 5 giving away all her sweets in the playground. I naturally thought my PFB was a generous angel child so much more selfless than other children- until my very pragmatic mum pointed out that she was giving them away because she didn't care about the sweets but really wanted the friends! I do agree that we're not at full ED yet, but her eating is problematic for her and it needs to get more stable.

We've had a good chat tonight and weighed her. 5'4" and 7 stone 2. We've agreed that it can't fall below this and she'll try and add another pound or 2. I'm also watching her running and gym going.

DS is on methylphenidate. Elvanse is the other stimulant drug lisdexamphetamine. Intuniv is another ADHD medication that is non-stimulant. This one helps with loss of appetite.

DS only takes his meds on school days so always has Sat and Sun off and he’s never experienced any side effects with that. I’m sure your DD is safe to have Saturdays off.

I think it’s good that you are on the case and have open lines of communication with your DD. Stay on top of it. With my DD (15) it escalated very quickly. She is 5’3 and weighed 7 stone 5 pre ED. So quite similar to your DD. She tells me that she lost 3lbs without really even trying and then she decided to start restricting a bit more and a bit more. In the space of 3 months she was restricting to 500 calories or less a day, exercising daily (including running a 5k and a 7.5k every week) was down to a little over 6 stone, completely lost her periods and was in full on ED territory. She had a hospital admission and was diagnosed with Anorexia straight after. I think it happened so quickly because she is pretty petite as it is and just didn’t have the weight to lose. They say that certain people are genetically pre-disposed to ED’s and that the calorie/energy deficit “switches on” the ED. So just be mindful that it could just be the matter of a couple of pounds and then you’re dealing with the ED inner voice, thought process and behaviours. Scary stuff!!