therapy or other guidance re: stopping anorexia in its tracks

[Anonymous]

Anonymous wrote:Potomac Behavioral Solutions

Maudsley trained therapist there:

Joanna Marino, PhD
Licensed Clinical Psychologist
Director
Potomac Behavioral Solutions
2001 Jefferson Davis Highway, Suite 211
Arlington, VA 22202
571-257-3378

[Anonymous]

OP, since you need to get your husband on board, if he is willing to let you take his daughter to a therapist, I would suggest one of the Maudsley trained ones listed above. He might agree to that more quickly than to taking her to an "eating disorder clinic".

These therapists will help him to see that this is a full blown problem and get him to action. They are used to doing this.

I cannot stress enough the importance of action now. Take time off of work if need be. The earlier you intervene the easier it is to turn around and your step daughter is showing signs of it already being full blown. But she is still quite young and time is on your side.

[Anonymous]

Anonymous wrote:
She is refusing to eat anything before lunch time. Says it makes her feel nauseous. Ok. I don't usually love bfast either. But I get the sense that it's more than that. Then at lunches and dinners, the girl who loves food is ordering food but only eating like 3 bites of it. Continuously says she doesn't like it. Or there's something wrong with it. Etc. Again, lots of kids exhibit this picky behavior normally but this girl has always had the palate of Anthony Bordain. After 2 days of it, I confront her about it. She admits she isn't eating on purpose. That she's lost a lot of weight from not eating and so she wants to keep doing it. It's a long drawn out emotional scene about how fat she is. How she longs to be "perfect." It's clear from the convo that she does not see the truth about her body and sees fat where this is none. She also points out people who are heavier or the same and says they're perfect but she's a fatso. Simultaneously, she pointed out extremely skinny looking people and would idolize them. Family (including DH) has a 3 hour conversation about it all and it felt like real progress. But hours later, I catch her pinching a tiny bit of skin on her stomach and telling herself how fat she is. That kind of thing. Every day. Crying in the dressing room while she shop for school clothes. Obsessing over what others look like. Obsessing over herself. Also I am fighting with her at every meal to eat her food (and she was already ordering very small amounts). We had a week of "serious long talks" where she cries and says she understands and will do better but the behavior wouldn't change at all. Simultaneous to this, I take her to her first yoga class. It was a very positive, loving, amazing studio. She loved it and I thought maybe the positive self-love messages were helping. She wants to go every day. It's hot yoga. We go to the 60 min. Then she wants the 90 min. She gets anxious and angry if I say we should do some other activity. In class, I see her pushing herself like she's training for a marathon. We come back from vacation and she wants an unlimited class pass so she can go to yoga every day. She starts talking about what other activities she can drop so she can do this. DH thinks it's great because.... how can yoga be bad for you? But her behavior seems compulsive and almost obsessive. Hard to describe without taking up everyone's day but in a period of a week, I feel like she's developed an obsession. Then I find out she's dropped an elective in school that she LOVED in order to take gym class every day. Plus she's on an athletic team with 2 practices a week plus games. Anyway, so it's mostly 1.) Skipping meals; 2.) barely eating at meals; 3.) what appears to be an almost compulsive drive to exercise that has come out of the blue; 4.) body dismorphia and incredibly negative self-image. And the intensity of all this just kind of showing up on our vacation was overwhelming and concerning. I'm completely exhausted. And I am very worried that I'm watching behavior that, in a matter of months, will have her in the same place as her older cousin.

What's weird is that, at least during vacation, she was very open about it. I couldn't believe she would tell me what she was telling me. She told me she was thinking of going vegan b/c "that makes it ok to not eat most foods." To sit and fight with me at restaurants that she was only going to eat 1/4 of whatever it was that I had ordered for myself. She was constantly talking about her body in the worst terms possible. A lot of the behavior seemed... really manipulative or attention-seeking to me. I'm aware that many anorexics engage in much more secretive behavior (like her best friend throwing away food behind people's backs). I sometimes felt like saying we were going to sit in the restaurant until she ate a normal amount of food was just ... giving in to this weird manipulation. But to not give in would be to let her starve all day. So... it's a lose-lose proposition and I clearly need professional advice on how to appropriately respond to these circumstances. She just started 7th grade. She packed her own lunch--a handful of peanuts in a plastic bag. That was it. So, obviously I will need to supervise lunch packing but how do I know if she's going to eat it? So I start weighing her every day and then take things away from her/punish her if she drops below a certain amount? This all seems like insanity to me but I also have heard that this stuff can just grab hold of people and not let go. Like drug addiction. I mean... if she was doing "a little bit" of heroin, I don't think I would be overreacting.

Dad concerned in the moment of when she would say/do these things but just thinks saying things like "you look great. eat your food" is enough. And privately he tells me I'm way overreacting and that this is all "normal for her age." We returned from vacation and went to her pediatrician who basically rolled her eyes at me. Because she's still in the range of "normal" height/weight. Which is true. She was always in the high range and is now in the very low range, but sure. The chart says she's normal. But she WON'T be normal with another few months of this behavior. And more importantly all this negative self-image and terrible eating habits seems like it should be addressed. Dr. did the same thing Dad does. "Hey, kid. You need to eat good, healthy meals. You're not fat. OK?" And gives her a pat on the head. It's like... they want to wait until her skin turns sallow and her bones are protruding and she's too weak to do anything before anyone gets concerned??? But maybe I AM an alarmist. It hurts me to hear her say these terrible things to herself. I keep telling her that she would never let someone else say those kinds of things to a friend so why does she do that to herself? DD has agreed that she'd like to "talk to someone" and that the decisions she is making for herself are "bad." So I'd at least like to do that. But since neither mom nor dad will be really supporting this, and she's so young, I'd like to find a place near her school that she could get herself to instead of just heading home to do homework.

Your stepdaughter has many signs of anorexia: Dropping from a high percentile to a low percentile for weight is NOT NORMAL or healthy in a teen. Has she actually lost weight yet? Also not normal. OBsession with gym class and yoga. Looking skinny, not eating. All signs.

YES you are correct it is like she is addicted to a drug. There is a drug some people's bodies create (seratonin?) in response to calorie restriction and that's what she is getting addicted to. Kind of, anyhow.

YES how you treat this is you need to make her eat. You don't just pack her lunch. You SIT with her and Breakfast lunch and dinner while she eats. Many people have had to leave work (FMLA) so they can stay home with their child (or go to school with them) to be sure they eat everything. If they won't eat they need to go inpatient to be treated and it is very expensive but if you need to do it to save her, of course you will do it.

I'm so sorry but the idea that she could just go to a therapist's office after school instead of doing her homework is not at all realistic. Not for a girl who is already exercising compulsively and has dropped so much on her weight percentiles, who is actively restricting. She is very likely going to need a LOT of parental support to gain. Family based therapy (NOT family therapy) will teacher her family how to require her to eat. It is very hard and labor intensive on the parents which is why the best time to get started is right now.

[Anonymous]

https://www.youtube.com/watch?v=63cjsp-ejmU&list=PLyWPOnIcibFP8ztPqmR4FVmKOyQh3rqnz&index=4

[Anonymous]

Usually the parents, a controlling Mother, that contribute to the onset and worsening of the disorder. So take a look in the mirror and at your post trying to "control" the outcome. Great place to start, your own behavior towards your daughter.

[Anonymous]

Anonymous wrote:Usually the parents, a controlling Mother, that contribute to the onset and worsening of the disorder. So take a look in the mirror and at your post trying to "control" the outcome. Great place to start, your own behavior towards your daughter.

No.

Of course OP is trying to control the outcome of her stepdaughter starving herself. The outcome of starving yourself, is death. Of all mental health disorders, anorexia has the highest fatality rate. Of long time sufferers, 20% die. If your child had cancer, you would try to get her the treatment she needed.

OP has been poorly served by the child's pediatrician, who has outdated information about the seriousness of this mental health illness. Unfortunately some pediatricians do not recognize the signs of anorexia until a child is at 1 or 2% weight for age. This is nonsense. A child who has always been 75th %ile weight for age who is dropping to 5th %ile can be suffering all the health and brain effects of anorexia. And if you wait until they hit that 2nd%ile and are having heart troubles they can land in the hospital for a lengthy stay, and their anorexia has had time to become entrenched and much more difficult to treat.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Usually the parents, a controlling Mother, that contribute to the onset and worsening of the disorder. So take a look in the mirror and at your post trying to "control" the outcome. Great place to start, your own behavior towards your daughter.

No.

Of course OP is trying to control the outcome of her stepdaughter starving herself. The outcome of starving yourself, is death. Of all mental health disorders, anorexia has the highest fatality rate. Of long time sufferers, 20% die. If your child had cancer, you would try to get her the treatment she needed.

OP has been poorly served by the child's pediatrician, who has outdated information about the seriousness of this mental health illness. Unfortunately some pediatricians do not recognize the signs of anorexia until a child is at 1 or 2% weight for age. This is nonsense. A child who has always been 75th %ile weight for age who is dropping to 5th %ile can be suffering all the health and brain effects of anorexia. And if you wait until they hit that 2nd%ile and are having heart troubles they can land in the hospital for a lengthy stay, and their anorexia has had time to become entrenched and much more difficult to treat.

This was my thought, too. It is very scary that this pediatrician is operating under such a huge misconception that it is the child's behavior, not the child's current weight, that is the concern.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Usually the parents, a controlling Mother, that contribute to the onset and worsening of the disorder. So take a look in the mirror and at your post trying to "control" the outcome. Great place to start, your own behavior towards your daughter.

No.

Of course OP is trying to control the outcome of her stepdaughter starving herself. The outcome of starving yourself, is death. Of all mental health disorders, anorexia has the highest fatality rate. Of long time sufferers, 20% die. If your child had cancer, you would try to get her the treatment she needed.

OP has been poorly served by the child's pediatrician, who has outdated information about the seriousness of this mental health illness. Unfortunately some pediatricians do not recognize the signs of anorexia until a child is at 1 or 2% weight for age. This is nonsense. A child who has always been 75th %ile weight for age who is dropping to 5th %ile can be suffering all the health and brain effects of anorexia. And if you wait until they hit that 2nd%ile and are having heart troubles they can land in the hospital for a lengthy stay, and their anorexia has had time to become entrenched and much more difficult to treat.

This was my thought, too. It is very scary that this pediatrician is operating under such a huge misconception that it is the child's behavior, not the child's current weight, that is the concern.

Yikes. Bad editing by me in my response post. <...It is very scary that this pediatrician is operating under such a huge misconception. It is the child's behavior, not the child's current weight, that is the concern.>

[Anonymous]

Usually the parents, a controlling Mother, that contribute to the onset and worsening of the disorder. So take a look in the mirror and at your post trying to "control" the outcome. Great place to start, your own behavior towards your daughter.

OP here. Whoever wrote this... it was a stunning punch in the gut. It really was. I've been checking back to my post for 2 days to absorb the community wisdom and referrals on something that is worrying me sick. And your post felt shockingly cruel.

I have frequently felt, in the past 6 years I have been in this child's life, that I'm the only real adult. That I'm the only one who pays attention to her. Who ever notices when she needs help. I'm the only one who has ever taken her to the doctor or other providers to deal with strep, with pinworms, with lice, with a broken finger, with whatever was bothering her. Mom and Dad? "Yeah. It's probably nothing serious." I am the one who asks her if she's done her homework before giving her an answer about whether she can watch tv. I'm the one who talks to her about how to treat her friends nicely. I'm the one who has set "rules" for her cell phone use when she was handed a $500 smart phone at 9. I'm the one who gave her a bedtime when I met her when she was 7 and she was an out-of-control, sleep deprived monster. I was the one who insisted she take showers when she got her 2nd bladder infection in 2 months at 8. You're right. ALL of this behavior is, in fact, controlling. Very controlling.

I never wanted my own children. But I fell in love with her father, and almost simultaneously fell in love with her, but I had no intention of trying to be her mom until I realized how badly she needed one. Dad isn't a bad guy. But he's an absent-minded work-aholic. I don't know mom well and frankly don't feel qualified to judge why she fails to parent well. It appears from afar that she was also basically emotionally and physically neglected as a child but grew up in an incredibly privileged situation so it doesn't seem as obvious or as abusive as it would have seemed if she had been raised in a different neighborhood. (She was taught she didn't need to bother to flush her own toilet b/c there are people you pay for that. So she STILL doesn't flush it. She doesn't live with her own full-time live-in staff anymore but she still doesn't flush. She lives under the theory that "someone else will come along and do it" b/c it's gross and she "shouldn't have to.") Sorry, but someone who was raised like that and continues to live in that kind of bizarre mental space isn't raising a child well in my opinion. I know I am being judgemental but telling a 6/7/8 year old that you don't care when/if they ever go to bed or ever eat or ever shower isn't good parenting. Not when they can't perform in school, they punch people when they're mad, and they're getting bladder infections. So yeah. After I married dad and moved in, I loved this little girl so much that this over-achieving, too ambitious/busy to ever want/have kids, turned into a mom over night. I set a bedtime that was mostly adhered to unless there was a good reason not to. I set some "safety" rules on cell phones I created from 10 hours of reading on the internet what other parents have done. I fed her regular meals. I made lunches. I changed jobs and make way less money so someone would be home and/or not working in the evenings. I pick kid-friendly vacations. I spend hours talking to her and doing things SHE likes to do. I learned to pretend to be interested in hair braiding and Dance Moms and those stupid cat books and memes and skinny jean shopping. I set rules like "we don't ever say I hate you in this house" and "kindess first" and gave her chores, which increase in number/intensity ever year she lives in my house. She she went from a 7 year old who smelled and who was a jerk and who was disruptive in class and who punched people and still peed in her pants to a mostly straight A, friendly, nice kid with lots of interests who didn't punch her way out of her problems and who seemed calm and happy. Maybe not every kid needs some "controlling" to be a happy, functional kid. She did.

And now I feel with every bone in my body that she's in trouble again. And no one is listening. And I am desperately scared for her. But Dad googles "how to tell if your child is anorexic" and sees things like "is she dramatically underweight?" and "has she missed more than 3 periods in a row" and feels satisfied that his beautiful, straight A daughter is a-ok b/c the answer to those particular things (right now) is no. It's fair to call me controlling if I want to do everything I can do/need to do to help her be the best person she can be. I love her madly. I don't care one iota what that person looks like. Or does. Or likes to do. I just care that she's healthy and happy. And she's neither. AND SHE'S ONLY TWELVE. I'm terrified. So part of me really really wants to tell whoever wrote that to FUCK OFF. And the other part of me is writing to say thanks.

Because, you know what? Of course I'm part of the problem. OF COURSE I AM. This kid is stuck in a weird family dynamic. And I'm a part of that everyday. How I respond to all of that weirdness. How I respond to her. What I say. What I do. And if I'm being honest, I would admit that ... since I frequently feel like I'm the only one who notices what's going on with this child that I have become hyper vigilant, which isn't fair to her. She and I have very open honest conversations (usually) and she has told me on multiple occasions that I "see everything" in her. And that there is a really great side to that. I know when she needs new pants or a hug or a new rule or surprise cupcake or whatever. And she has told me for years how great it feels to have someone pay close attention. How loved and safe it makes her feel. But last year, she told me that it's a little too intense that I notice everything. That maybe sometimes I notice TOO much. That I can tell when she's lying about having a good day and I don't let it go. And I love that she has said that to me. And I have tried to do what good parents of preteens probably all struggle with--trying to back off as you watch someone who just barely learned how to wipe their butt properly to someone who is probably about to start having pressure to have sex. Try to give space. Try to give room for mistakes and bad judgement. Or just space for whatever. For being in a bad mood. For being rude. For being a bad friend. For getting yelled at by the coach for having a bad attitude. I've been working on just hugging her when she needs it and not controlling outcomes. And she basically had an entire summer out of my orbit. And it seems to me that she's fallen to pieces. And she is telling me she is unhappy and knows what she is doing is a problem and is asking me for help. So my immediate gut reaction is to get even MORE controlling. To force her to eat. To tell her that I will come to her school and watch her eat. And that if I see any more weight loss, she will be weighed every day and there will be negative consequences in her life and she will lose the things she loves (phone, tv, sports, access to friends, etc) if she keeps losing. Because I didn't know what else to do. And that's exactly why I posted. Because I have absolutely no clue whether this is just like when she was 7 and she needed someone to step in and give her structure and some rules to keep her safe and happy. Or if she needs something else entirely.

This is so scary people. So scary. If I were religious, I would say that I pray that this isn't something you ever have to try to deal with. No parent should have to hear a beautiful amazing 12 year old tell them that they spend EVERY DAY thinking that they are the most hideous, worthless piece of shit in the world. I will do anything to help her. If that's controlling her, I will. I will do it without hesitation for as long as it takes or as long as I am legally able to do so. But I will also take hard long looks at what I do to contribute to her anxiety or depression or ED or whatever it all is. Thanks for the reminder that I'm part of the problem. It's something I need to keep in mind as I hunt for the solutions for her and for our family. And you're right that me saying I am looking for a solution is controlling. But she's too important to the world for me not to try to control the outcome. I haven't seen her in 2 days. Last night, she texted me if I knew anyone who had ever killed themselves. Well, I do. My brother. And I will not lose her. Not now. And not to THIS.

[Anonymous]

OP, thank god she has you, but I agree with everyone else, you have to act fast. I was bulimic for 17 years and oh how I wish I had a caring adult in my life when it all started. Also, a high percentage of ed kids have an underlying mental condition - OCD, GAD, ADD. She needs to be evaluated for those problems, too, which I assume the therapists who are experienced with these conditions know something about. Good luck. It's a truly shitty disease. She can beat it, but she needs the help of her family.

[Anonymous]

OP, you have done really, really good work in parenting this kid. You've given her the structure and sense of felt safety she needs--that any kid needs, really, but most especially a kid who faces the family dynamics you are describing. I think you recognize already that part of the work ahead for your girl will require the entire family to engage in therapy.

I just want to affirm you for rising above the judgmental tone of the previous poster. It's no small thing for you to acknowledge your part in a complex and difficult situation.

Good luck and best wishes to you.

[Anonymous]

Start with couples therapy for you and your DH so you guys can agree on a plan together. That would be my #1 stop.

[Anonymous]

Anonymous wrote:OP, you have done really, really good work in parenting this kid. You've given her the structure and sense of felt safety she needs--that any kid needs, really, but most especially a kid who faces the family dynamics you are describing. I think you recognize already that part of the work ahead for your girl will require the entire family to engage in therapy.

I just want to affirm you for rising above the judgmental tone of the previous poster. It's no small thing for you to acknowledge your part in a complex and difficult situation.

Good luck and best wishes to you.

Well said. I heartily agree with this poster. OP, you are such a blessing to this child and I wish you all the best. Ignore everything that doesn't help you get to your goal of a healthy and happy child.

[Anonymous]

Hi, OP: I'm the mom of a child recovering from anorexia. I want to reiterate the encouragement to go to the FEAST site right away, especially the forum, for advice and guidance.

I also want to reiterate that you ought to act very quickly to stop this illness in its tracks.

When my child fell ill, there was a very quick decline from seemingly normal health to very dangerous symptoms that ultimately resulted in hospitalization, only a few weeks after the diagnosis of AN.

Our pediatrician diagnosed the AN and sent us to the Donald Delaney eating disorders clinic at Children's (outpatient offices are in Spring Valley near AU, soon moving to Friendship Heights). Therapy, nutritionist, and physician were all at this location, and a six-day hospitalization at Children's hospital was necessary to stabilize her heart rate and jump-start nutrition. We were very pleased with all of the services we received and I strongly encourage you to contact Dr. Atkins at the clinic to have your child evaluated.

Best of luck to you and your family. It's a rough journey but my child has recovered beautifully thanks to a strong medical team, consistent and compassionate agreement between the parents, and (obsessive) diligence on my part to focus on the refeeding process.

[Anonymous]

She is so lucky to have you. I know it would be a lot easier for you to give up.

Hang in there.