Teen Eating Disorders - Thread 6

[myrtleWilson]

Hello everyone, and welcome to anyone looking at these threads for the first time..

Here is a link to thread 5 www.mumsnet.com/Talk/eating_disorders/4360801-Teen-Eating-Disorders-Thread-5

We've seen such an increase in young people facing eating disorders and these threads are testament to that.

With that in mind, we thought we'd try to include at the start of each thread some resources that have helped us along the way to date. No one resource will be a panacea but hopefully this list will be a useful starting off point for any newcomers and a reflection for others. It is our first go at sharing a list of resources on a thread so it won't be perfect!

www.beateatingdisorders.org.uk

anorexiafamily.com/?v=79cba1185463

www.youtube.com/evamusby

www.youtube.com/channel/UCa7G1P5WQopVMc9qTSP_lgA

www.orri-uk.com

www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/eating-disorders/overview/

www.stgeorges.nhs.uk/wp-content/uploads/2019/01/Junior-MARSIPAN-Risk-Assessment-Framework.pdf

I don't think calorie recommendations are useful for anyone really as like you said it varies so much depending on age, activity levels, body build, genetics, metabolism etc.

I have been MIA for a bit as DD ended up in hospital 2 weeks ago due to fainting and getting a head injury. Even a stern warning from Doctor has not put a stop to anything.
I am so sorry I have not read everyone elses posts but I will go back tonight and re read when I finish work later.

We had her at docor this morning and she is now 48 kg, she was 60 kg in April. She is 5 foot 7.5
We also have booked an ED coach and a nutritionist privately so she went yesterday for the first time and said she will go again. She cried for the whole session and admitted to the coach that she is terrified of eating. This week all she will eat is strawberries and low fat yogurt and maybe some ham. As she is 18 and an adult now, we cannot force her to eat, is is heartbreaking.

Had her at our GP this morning who has taken her bloods, weight etc and has advised that she thinks she may need anti depressants just to get her through this part until she starts engaging properly with eating disorder coach. She also told the gp ( when prompted by a question about suicidal thoughts) that she would never harm herself but she wishes that she could just go asleep and not wake up :( I don't know how to feel. Are antidepresssants the right way to go?

We are obviously going to continue the private coaching and the nutritionist along side her taking anti depressants but I am very scared for her as I have read such bad horror stories about anti depressants.

@Snuggleworm I'm sorry to hear about all that, so worrying. That's how my dd initially presented, with huge weight loss over a very short amount of time, she was actually overweight to start with and was trying to lose weight and it just spiralled very quickly.

In relation to anti-depressants, she was already on AD for moderate/severe depression anyway, prior to the ED. I have read that Prozac is often used for ED treatment, such as purging, not sure really as my dd developed all these behaviours whilst on it, so I don't think it's any miracle cure- but I do think myself that sometimes having a window of not feeling so down does allow you to work on yourself, I'm on a low dose anti-d myself for anxiety, having never taken them before and it's been fantastic to just get relief from that and allowed me to work on relaxation and meditation.

I am not expert on AD or ED though so I'm just describing my own experience, it could be worth getting input from ED coach or psychiatrist on that, we have a psychiatrist overseeing prescribing with it issued by GP which is more reassuring (although obviously worries about young people on ad's etc).

It's also worth remembering that if she lives at home, you can still help her and learn how to support her recovery from ED even if she is an adult, in that presumably she has to abide by house rules (like be polite most of the time, take turns with chores) so it could be seen as an extension of that. I get your point though, my dd is 17 and it is difficult as she's extremely independent and could just get up and leave home, so I have to go a more collaborative route than if she were younger and more of her life were really dependent on me.

I've said on here that I've found the Maudsley ED book on skills for carers really helpful for ideas on where you might gain some traction and if nothing else, it gives a good intro to the current thinking on ED and the stress on families, you may feel less alone reading it and being on here.

My dd has left home by the way for a few days, so this is not a theoretical worry- is your dd at uni?

@Snuggleworm I am sorry to hear you have been having such a difficult time.

My dd 16 is seeing a psychiatrist in September to look at medication as she has a history of self harm and overdosing. I think it is worth trying whatever they suggest for your dd. I know that ads literally saved my life as a young adult and I sometimes wonder if my teens would have been less awful had I been prescribed them.

I very rarely come off my ads - ttc, pregnancy, breast feeding and various other times just to see what happens. They allow me to function, work and socialise; without them I can’t engage with the world at all.

they do have side effects and for the first few weeks can make you feel worse not better so your dd will possibly need extra support during that period.

@Snuggleworm did she eat in hospital? How long did they keep her in?

Snuggle you can force her to eat, in fact you have to in order to rescue her.

I would make the food and put it in front of her, use whatever leverage you can to get to eat (phone, money, driving her places) and lots of distractions when she starts to eat.

Come up with a meal plan for her based on 3 meals plus 3 snacks a day with food she used to enjoy before the ED.

The longer she restricts and the more weight she loses the harder recovery is.

If she is able to the Tabitha Farrah books are good to read for older teens.

Thanks everyone for getting back.

No she didn't eat in hospital but did have tea and toast when she came home.

We literally cannot force her to eat. She ate a few strawberries and a lowe fat yougurt yesterday, 2 cup of coffee with almond milk and a small salad with cucumer tomato and that awful processsed ham.

I am getting so much conflicting advice now at this stage that I am overwhelmed with it all.

Also re leverage and distractions, she doesn't care what we take away from her. She pays for her own phone and prob would not care if we took that too. we have told her she is not allowed to go to a festval this weekend and she doesn't care about that either. It is like she has given up

What did they keep her is hospital for? Surely that's a duty of care for them to ensure she eats before they discharge her?

Baby steps here. This is so difficult. I'm having to be careful with every word that comes out of my mouth. I feel like the balance can easily be tipped either way very easily. I can't mention gaining weight as she freaks. I just say we're concentrating on eating well regularly to not lose anymore weight and stay out of hosp. I feel this enormous pressure all the time not to upset her, to just be happy that she eats, not to praise her and make her feel bad. I'm learning not to get too relaxed when we have a good day.

On the plus side I took her to get her hair done on Monday. A lovely cut about 6 inches off with some layering. It was so long but very damaged. I called the salon beforehand and said not to mention weight or looks. Sadly they said they're very used to this with young girls and actually have training on dysmorphia and what not to say to clients etc. The stylist was absolutely lovely with her. Then I hekped her do a subtle semi permanent colour in a slightly lighter shade. She's been spending ages this morning washing and styling it and I can hear her chatting to her friend on the phone. I can see that doing 3 + 3, even if she's still at the lower end of calories intake at around 1800, is having a good effect on her mental state. We're up from around 1200 6 weeks ago and keep trying to up by 100 per week so I feel she's doing well.
Again, I'm not getting too relaxed.

@Snuggleworm I am so sorry. This is a really tough place for you and your DD at the moment.
Your DD is so very poorly. And it's a terrifying thing to witness and feel so powerless about.
She has lost 12kg in 4 months. A fifth of her body weight. The effect that is having on her mind is radical. She has given up. She has given up her autonomy to her illness. Her life. All the things she loves doing. She isnt 'not bothered' about the festival. Its just easier for her to give it up than fight this illness.

You know that diet is unsustainable. She will lose more weight. Her heart will fail.
You have to get her proper medical intervention. She should never have been released from hospital not eating.
If you feel like you can't make her eat then maybe try as @Whyisthishappeningtous says to up her calories a bit every day. Instead of using leverage make a deal that if she eats x new thing this week and another next etc etc you will offer some form of 'reward' ...
I don't know. Mayb3 that won't help but I am just so heartbroken for you. Please call Beat or another charity for help if you can't get anywhere with the health service.

@Snuggleworm I'm so sorry for what you and your daughter are going through. I'm not a parent, but an adult in my thirties who recovered from anorexia. I was very ill at your daughter's age. I hope I can offer some comfort. How much insight does she have into her illness and how knowledgeable is she? If she's OK talking to you about it, I would suggest sitting down with her and talking about the impact of starving on the brain. There was an (in)famous psychology experiment called the Minnesota Starvation Experiment where previously healthy men developed anorexic thoughts and feelings after being put on a starvation diet. In other words, starving your brain can make food become frightening, and the more you deprive yourself, the worse the anorexic feelings will get. Some sufferers believe that once they have enough therapy, food will stop being as scary and then they'll be able to eat. But without eating, it will be very difficult to benefit from the therapy, because starvation is like petrol on a fire where those thoughts are concerned. Does your daughter understand this? One thing I used to tell myself when I was in recovery was, "If it all gets unbearable, I can lose the weight again. But I owe it to myself to give this a chance. I'm going to finish my snack. My brain needs it. The only way out is through." Having this knowledge helped me to manage a little better at meals, but of course professional support was paramount.

The only other piece of advice I would give is show her that you can accept how dreadful she feels without panicking and rushing to 'fix' it. It can feel very lonely when everyone is rushing round trying to make you eat and appearing even more obsessed about food and calories than you are. Tell her you can see she's in agony, and you're going to keep her company and support her for as long as it takes to get better. Reassure her that it does get better. The fact that she recognises eating as a terrifying activity is actually a very positive sign - some people are in such denial that they refuse to admit they're afraid, or that there is anything the matter at all. Being able to name the problem and the feelings associated with it is such an important step, and it's great that she can do that.

Sending you both lots of love.

P.S. I took Sertraline when I was recovering and it really helped. There is a lot of scaremongering online about antidepressants and it makes me angry as a lot of it comes from unqualified people who pose as more qualified than they are (e.g. counsellors who have studied zero psychopharmacology, or people with non-clinical psychology degrees who use vague language to try and pass themselves off as clinicians). The truth is that there is no medication in existence that hasn't caused bad side effects for someone, somewhere, but that doesn't make it automatically unhelpful or unsafe. Antidepressants aren't a miracle cure, but they have their place.

DD1 absolutely had her life saved by Olanzapine. She was making no progress whatever before that and was about to have a Ng tube fitted. Fluoxetine was added and worked for some time. Unfortunately she has gone down hill and she was over the usual fluoxetine dose, so nowhere to go. We've switched to sertraline now.

@Whyisthishappeningtous that all seems very positive and 1800 calories sounds really good. I know what you mean about being afraid to say anthing. We are walking on eggshells.

@Lottsbiffandsmudge She was brought in to hospital as she hit her head when she fainted so they were more concerned about that at first. We were not kept in as such but in A&E for 13 hours on the Sat and then 15 hours on the Sunday, At that time when they weighed her she was 51kg and her BMI was 17.5 so to them it was not crisis point so no, they didn't see the need to keep her in even though I explained everything to them. They were run off their feet with "real emergencies" so sent us home and said they would send the results to my GP ( they still have not sent them) since then DD's weight has gone down to 48KG that is what it was yesterday in the surgery. They also took bloods and said the results would be back today but they have not had them back yet.

So in the meantime I got her in to see an ED coach who will work with her every week alongside a nutritionist who deals with ED also. We are doing this privately and I was lucky that the ED cach was a friend of my friend so we got an appointment. However, she said that if my DD continues to lose weight she will not be able to work with her. I explained all this to the doctor, the doctor who has sent my DD home on 2 seperate occasions in the past year saying her depression was just a bit of anxiety and told her to go for walks and try some deep breathing. Even when DD siad to her that she sometimes just wants to go to sleep and not wake up.

I emailed the doctor before we had the appointment advising that this had happened and that I wanted to document everything going forward. They saw her yesterday only after I documented evrything in writing. I also advised GP that we were prepared to go private so we would not be put on a waiting list.

The doctor asked her a few questions and weighed her etc and said we would have to wait for the results of the bloods and then discuss anti depression medication. So when we got home, I followed up again with an email asking them what medication would they prescribing as I wanted to be fully knowledgable and research it myself. I then got an email reply from m the doctor saying that " she has looked at the guidelines and that no, medication will not be the next step" We have an appointment on Friday morning to discuss everything but I really feel like they don't have a clue either. I have tried to get her in to another doctors surgery but none of the doctors are taking on any new patients. We are in Ireland so doctors are not free or subsidised so it is €60 every time we go.

@ugifletzet Yes my DD knows everything about what she is doing to her body, she knows everything there is to know about nutrition as biology/science are her strong subjects and she is supposed to be starting university this month to study nursing :( I doubt she will be able to go now though. Registration is next Monday. The only bit of pull I have now is telling her that we have decided she cannot go to university if she doesn't even try to eat. I know this will really upset her as she has her heart set on this.

Today she had a punnet of strawberries and a low fat yougurt. A plate of cucumber and some blueberries and a protein bar. She really is trying.She also had 2 coffees with almond milk. I looked on the side of the carton and it says 46 calories per serving of almond milk so at least that is something at least.

I just keep asking myself, what happened? did something traumatic happen to her along the way. She was a very happy child until she started secondary school and that is when all her mental helath issues started but this is by far the worst thing that has happended to her.

I am also trying to work full time, thank God I work from home and my boss has been very understanding and my team all cover for me if I have to go to appointments etc. But how long will that last?

I keep doing so much research and and I am so confused, can I not just get her in somewhere privately without having to go through the GP. I just keep reaching dead ends. CAMHS in this country is supposed to be really bad as they are under resourced Cheers to our wonderful goddam government!!!

Thans again everyone for the replies and support.

@ugifletzet it's good to hear from people recovered from EDs. Are you completely recovered or do you still have blips?
@Snuggleworm I'm so sorry you're in this situation. My dd is starting uni in a couple of weeks. The big push for her recovery was that we told her in no uncertain terms that she wouldn't be going unless she was 100%wfh. That really pushed her to do everything she was being asked of her. She said it was blackmail but I would do it again if it was needed. Your daughter will hate you for it but she is obviously very poorly at the minute. Her immune system is also going to be recovered which won't be good for her course. I would imagine it's a very physical course and she simply won't have the energy to cope unless she eats more.

Also snuggle it's quite normal to go through the whole ' why had this happened ' questioning. I think all of us here have felt huge amounts of guilt - blaming ourselves and especially for not noticing earlier. I'm pretty convinced that my dd wouldn't have had these issues of it wasn't for lockdown but lots of evidence says it's a genetic thing and it just needs something to trigger it off. So then I blame myself that it's my genes she's inherited... and the guilt goes on.

Snuggle it's definitely normal to look at the whys and what ifs but ultimately it's not very helpful. Anorexia literally affects every nationality and doesn't discriminate on class, background, education or anything else. The only known cause of anorexia is weight loss.

You may have to think about having some time off work, I had to have two periods of leave to get my dd on track with the refeeding as it's a full time job.

Can you make your dds coffee for her and make it with full fat milk and double cream for extra calories? Likewise with the yogurts only buy full fat ones. It does sound like she wants to eat so I think you may face less resistance than you think if you take control of the food.

What exactly does the ED coach do? Unless they're coming to your house and coaching her through a meal I'm not sure what use they can be at this point. All your dd needs is food, food is her medicine.

Definitely use postponing uni as leverage, there's no way she'd cope doing her training now anyway (I'm a nurse and the training is full on.)

@NCTDN The last time I was in hospital was 2011 and I've been maintaining a stable healthy weight since 2016. I sometimes struggle with the thoughts, but it doesn't spill over into my behaviour. This past week I've been feeling pretty horrible re. body image (I had to take my photo for a work ID card and it's hard work convincing myself that I don't look like an overinflated beachball) but I'm eating normally and I don't overexercise. I had a lot of therapy to get to this point. I don't think I hate myself enough to relapse properly. The self-loathing was always the fuel for it and that isn't there any more.

@Snuggleworm Have you looked at Orri? They have an online program which could work for your DD. www.orri-uk.com/?utm_campaign=Eating%20Disorders%20%7C%20General&utm_source=adwords&utm_medium=ppc&utm_term=online%20eating%20disorder%20therapy&hsa_net=adwords&hsa_ver=3&hsa_ad=611426948297&hsa_src=g&hsa_mt=b&hsa_acc=8613226101&hsa_cam=1632005917&hsa_kw=online%20eating%20disorder%20therapy&hsa_grp=73334387678&hsa_tgt=kwd-361752371957&gclid=Cj0KCQjwjbyYBhCdARIsAArC6LL8RIn9NsG6ZAe--4lj67XfOJRKy-oUMwfmsMnOgMn8JrQXCqZXRf4aAsSnEALw_wcB

They also have a vimeo channel which has lots of helpful videos for both you and your DD (just search Orri vimeo).

Hello all - I am new here and am looking for advice for how to deal with (what seems to be) early stages of an eating disorder in my 14 year old daughter.

In a nutshell -

• She found lockdown 2 incredibly difficult and has been having panic attacks and a huge loss of confidence ever since (including giving up hobbies she previously loved)
• She has lost a significant amount of weight and clothes that were too small for her at 12 are now hanging off her. I recently bought her a new school skirt from Next and it was size 7-8 years.
• I don't know how much she weighs as we have no scales in the house (I would estimate around 6 stone??) but her waist measurement is 21 inches
• her periods haven't started yet
• she panics at meal times if she try to give her anything like a normal portion, she ran out of a cafe sobbing because she doesn't know what to order, she gets incredibly upset if anyone asks her what she is going to eat or has eaten
• she has gone vegetarian which further limits intake
• sometimes her lips and fingers are blue
• she cries (almost every day for last year) that she looks like a boy and she has no chest but any suggestion that she eat a bit more met with hysteria
• she is NOT, however, at death's door or in immediate danger - she is not passing out with exhaustion and she does eat three times a day with the family but very small portions

What have I done so far:

• Obviously talking to her at length for months now, expressing our concern, trying to find stress management techniques
• School are pretty useless, they are drowning in stressed kids - after a 6 months wait, she had an appointment with a school counsellor who led with 'Do you want to kill yourself?'. This freaked her out so much she has refused to go back
• Contacted country teenage mental health helpline who told me to take her to GP and get her weighed to establish if there is a 'genuine' problem

What should I do?

• She is adamant that she does not want to go to the doctor
• I keep thinking we should give it just another month and she will turn a corner. If she were less stressed, she would eat more and put on weight and feel less stressed. But so far, not working...
• I am concerned that if the GP weighs her and metaphorically sticks an 'underweight' label on her , this will cause issues for the rest of her life...Or encourage to eat even less in a perverse way??

Any advice? Try and nip in the bud? Or don't intervene yet?

Thanks!

@basilbrush sorry to find you here but there is a huge amount of support here.
My advice? Don't delay any longer. Don't give it another month. You need to take control and get her urgently to your gp. Demand that she has her weight, bp & bloods done.
Ask for an urgent referral to camhs and lay everything on as thickly as you can. Most gps aren't trained in eating disorders so you will really need to push for help.
Where in the country are you? You may be able to self refer.
I know your dd says she doesn't want to go to the doctors but inside she's probably screaming for help. The ED just won't let her admit it.
Keep posting on here - you will get lots of advice.

@basilbrush I agree to get intervention sooner rather than later, the reason being she may already have some health consequences from her weight loss which need checking so take her to the GP immediately on an urgent appointment, and ask for a referral into the eating disorders team near you- this might take a little while which is why it is very important to act now. Don't wait, and don't be afraid to tell your daughter you have to do this for her own safety and for yourself. If there are no issues, they won't take her on, if there are (as surely they are) then she needs help. It's harder with an 18 year old @Snuggleworm will tell you, or even 17, but at 14 there will be a lot of concern for her once she gets in the system, which is why acting faster is the way forward.