DD (24) is suddenly, shockingly thin

[SandrenaIsMyBloodType]

DD24 has joined us on holiday in Spain. It has been clear since Christmas, whenever we have seen her, that she has been losing weight. However, she usually wears quite baggy clothing. It is clear now that she is distressingly thin. I would be shocked if she were not underweight.

She is autistic and has ADHD for which she takes medication which definitely suppresses her appetite. Aside from the fact that she is not drinking alcohol, her behaviour around food seems normal.

If anyone has any advice on how to approach this, I would welcome it. I am very interested in what NOT to say too.

DH’s mother died from anorexia in her 40s after a 20 year illness and he is understandably completely beside himself with anxiety. It is my responsibility to stay calm but every time I look at her I feel panic.

Are you close to her Op?

i think so but her autism can lead to her having some pretty fixed ideas and, while she will always listen to me, she will sometimes be unwilling or unable to consider a different point of view

How does she feel about her body/ current weight?

It's really common for asd adhd to suffer from ed. It needs to be part of the ed assessment imo.

But to the point. That else is going on in her life. It will be a symptom on control as she is out of control somewhere else.
Does she work go uni etc
Is she in a bad relationship
Is she secretive about food and do you find uneaten food hidden.
You can go to BEAT for advise and also the autistic girls network.

Don't push her to eat. That won't help. Offer good food and no comment if she won't eat.

Ed in autistics needs a different approach so maybe look at emdr for her to tackle underlying trauma

All autistic have trauma as living in our society is bad enough and anything else on top is huge.

It also could be that her ADHD meds are at a too high dose if it’s suppressing her appetite too much.
I would want her to speak to her prescriber about it, I’m not sure if you would feel comfortable suggesting that to her.

How long has she been on meds for adhd? Did the weight loss start when the medication did? Or has she had an increase?

Bulimia ?

I’m going through similar myself with dd17. She was 77kg last April when she started adhd medication and she’s now 66kg . I was shocked on holiday last week when she came out wearing last years Bikini and it was hanging off her. I didn’t want to upset her on holiday so waited until we were home and got her to weigh herself. She’s very tall and seeing her every day I just hadn’t noticed the weight loss but I feel awful about it. For me it’s easier as she’s at home so we’re discussed it and she’s going to eat a proper balanced breakfast before her medication every morning. Then it’s a focus on small regular meals and snacks. She’s 2kg from the underweight scale and I’m very aware of it and want to nip this in the bud. She’s going to text me weekly with a list of her current favourites for when I go shopping. I’ll be making boxed salads for her to keep in the fridge as a grab snack. She can deffo be obsessive about food, she will eat one thing on repeat until it makes her sick. Is such a minefield.

i really hope you can help your daughter op. It’s scary regardless of how old they are.

She’s been on the Elvanse for a couple of years. No recent increase in dose. The weight loss has occurred since Christmas. She acknowledges the weight loss. She simply doesn’t see it as a problem. I don’t think it’s bulimia and I think she genuinely eats normally when she’s with us but I do have the perfect opportunity to quietly observe for a week now while we are eating and living together in close quarters on holiday.

If I had to guess, I think her executive dysfunction, which is quite severe, means that shopping, cooking and cleaning up after herself feels overwhelming and so she often doesn’t bother. I think she has been leaning into the appetite suppression side effects and I think she’s enjoying having lost weight - probably from a sense of control and also from an aesthetic point of view (although this would have to involve a degree of dysmorphia).

Does that sound plausible?

She sees her consultant psychiatrist prescriber online as she moved away for work. Does anyone know what would happen if I alerted her prescriber and suggested that she insist on a face-to-face appointment before issuing a repeat prescription?

DD really relies on her ADHD meds to do her job. It would make her very anxious to think that she could lose them. It might also be enough to make her want to put on some weight though. Obviously I don’t want to have any kind of conversation that could be construed as me “threatening to report her” in some way.

@SandrenaIsMyBloodType

The consultant should be motoring weight and blood pressure regularly, I have to submit my DDs every 4-6 months. You are correct that the medication could be stored if the Dr feels it’s causing issues so I would suggest that she tries to gain little weight to ensure she keeps her supply. Also maybe look at ways to reduce stress around purchasing/cooking etc. precooked olive food shops, ready meals, pot noodles ( not the best but better than nothing) etc

Yes, her weight should be checked by the prescriber, tricky if online, do you think she's giving false readings?

You've identified the problem with executive function, how can you support her - meal plan weekly together, online groceries, batch cook at weekend and easy stuff during week?

Can you/she afford an executive function coach?

But enjoying how she looks when so thin is concerning for an eating disorder, so if it continues you may need to alert someone?

Same boat here. Mine was losing weight at a steady pace and happy about it. My DD’s consultant gave her a cut off weight and told her if she went below that he would have to stop meds. That knocked some sense into her and she’s become more sensible since.

Any signs of type 1 diabetes?

No signs of diabetes. I am certain she is giving false weight readings to her psychiatrist.

The good news is that after 2 days together, I am reassured by her holiday eating. She’s tucking in normally at mealtimes as having ice cream snacks etc.

The weight loss is sufficiently rapid and significant though that it could only have occurred due to a massive and unhealthy reduction in food intake but I do now suspect this is rooted in executive dysfunction and medication side-effects. She clearly feels more body-confident and I don’t want to take that from her- but this cannot be sustainable.

I think talking about the risk of her meds being withdrawn may well have some cut-through. She mentioned in passing today that she is not menstruating which also presents a way in, I think.

Mine has stopped meds over the holidays and is eating much better (but upset about her weight now but she knows it will drop off once meds restart). Is that an option for yours?

If she's happily eating it does sound like it's more about having to meal plan, shop, prep , tidy. I wonder if one if those prepped meals companies would work for her? Simmer, prep kitchen, even cook. They seem fairly nutritionally balanced too , but you would need to talk to her

Some medications used to treat ADHD, particularly stimulants like can lead to weight loss as a side effect due to appetite suppression.

Are you watching out for her going to the loo within an hour of eating?

My work colleague did this and I went at the same time and could see her feet under the door as she was facing the wrong way to throw up her meal. She came out all happy and I didn’t hear anything so clearly shes regularly doing this regularly and quietly and has normalised it.

Not really. She’s 24 and needs the meds to perform well at work.

Yes. I did wonder about this and it’s been helpful to be sharing a villa together for a week. We’ve all been in such close proximity that I can be sure.

Thank you. I could see this working and may suggest it when the time feels right

I have ADHD and have suffered from ED for over 30 years. I think they do go hand in hand sometimes.

Is she using the bathroom immediately after eating 'normal/healthy' meals?

It's difficult as ED services will focus on her BMI. If it's under 14 she is hospital weight which means inpatient or sectioning with 1-1 RMN. Or even 2-1. Though beds for this very very scarce. If it's above that but below 17 they may offer outpatient.

But it's a psych ward. Absolutely you lose all autonomy. So if she goes too far they will force feed her and lock her up.

I hope you can try and speak to her and see if there's things going on that are stopping her from eating. The sad thing is you're stomach shrinks and you do feel like you don't need to eat, and almost get phobic of it.

I wish her well and hope she isn't going to get that unwell.

In my experience, someone with AN does not eat normally. If she eats well during meals, keep an eye on her bathroom use. Purging usually happens in the first 30 mins after a meal .

If she is not pushing and eating normally, I would suggest a med review for the ADHD and also getting a general health check just to rule out that nothing else is going on which is totally unrelated.

3 meals and 3 snacks a day. Observe how she responds to meals. If food avoidant seek help in regards to eating disorder. If she’s unintentionally lost weight a nhs nutritionist/dietician might help, along with a meds review.