therapy or other guidance re: stopping anorexia in its tracks

[Anonymous]

What do you mean she was always at the "high end"? Because the high end on the chart is basically overweight for almost all kids unless the kid is short and you said she was not. You now say she is at the low end of normal. What does that mean? 1%, 10%, 20%? Is it possible that since her mom was with her all the time that her mom did realize her child was at the high end of the weight range and possibly was told by the doctor her child was overweight?

I will have to agree that it's normal for eating patterns to change in the middle school years. I recall that I stopped eating lunch in those years and did try several diet plans because I was truly chubby. Lasted about 6 months each stint and I was very serious. I never did go back to eating lunch even in high school though. I think it was because lunch was so early in the day sometimes - 10am - and I just wasn't hungry at that time.



NP here- are you even reading this thread?! Your experience and this girls is not apples to apples. STFU



Yes I am reading the thread. I am reading from a stepmom who doesn't actually have children of her own, who sees the child on occasion and has never been willing to ask her DH to step up and parent.


It's OP. Not sure why I'm bothering to respond to some of your points, but I will in case it encourages you or others to provide additional helpful info.

1. Between the ages of 7 and 12, she had always measured very high for height (think 85-95 percentile for her age). She had also measured anywhere between "more than average to borderline high" for weight (between 70-85%). It seemed to me that she would be at her heaviest immediately before a big growth spurt in height. And I don't know if muscle actually wears more than fat, but I've heard that said and it would make sense to explain her historically "heavier" weight (by numbers but not by looks) since she has always been extremely athletic looking. Like I said--from visible body type, she's always been what I think anyone would think of as "normal/athletic." No one except her mother/grandmother has ever thought of her as chubby. Nor would anyone have thought she was scrawny. I personally don't believe that "diets" (i.e. major calorie restriction or skipping meals) are appropriate for still-growing bodies; you appear to disagree based on your own experience, which is fine. But she objectively didn't NEED a diet. She's now a few months away from her 13th birthday. She started her period about 6 months ago. At this week's dr visit, she's down in her height percentile (down to around 70%), which Dr said was normal given her age and having started her period and genes on her maternal side. But she's down to the 15% percentile in her weight. She doesn't look malnourished thin. But she is definitely now a "skinny" girl when she never was before. I'm not pretending to be a Dr. I don't know if this is normal shifting/developmental changes or not. Dr. didn't seem concerned based on numbers. And I would have been perfectly happy to accept that assessment if it weren't for all the odd/unhealthy behavioral eating changes and the self-hatred she has recently revealed. It's those behaviors and thoughts that make me worried. As a budding teenager, if she wants to give up eating Nutella so that she looks a particular way in her skinny jeans that makes her feel good about herself, I'd be perfectly fine with that. But that isn't at all what is apparently going on. And she isn't giving up lunch because she "just isn't hungry." She admitted that she's not eating because she despises herself and sees herself as worthless and fat when in fact she is not.

2. Mom isn't "with her all the time" nor do I see her "on occasion." You have some preconceived notions in your head that bio mom has custody or something that just isn't true. The two families live in the same town and we have split time/custody 50/50 since DD was 7. As many families of divorce understand, over the summers, schedules get strange and weird. Kids go to camps or activities (as they should). Trips to see other family members on two sides, etc. This summer, for the first time in years, bio mom actually took DD on a long vacation with her (which I was thrilled to see). So over this particular summer, I saw her much more sporadically than normal. But I still saw her. And at every one of those times, she would eat normally in front of me (but has now admitted to not eating normally at other times including the long chunk with mom). Now that school is back, we are back to normal 50/50. I don't see her on occasion. I see her constantly (although not as often as I wish I could).

3. I doubt a Dr has ever told Mom DD was fat. Because she has never been fat. But it certainly hasn't happened since DD was 7, since I'm the one who always takes her to the Dr. '

4. "I am reading from a stepmom who doesn't actually have children of her own." Thanks for that. That's really helpful. I'm a significant part of raising this child. Several times a year, she asks DH if he can "talk" her bio mom into giving us full custody. Awhile back, DD MADE me accept the fact that she wanted to call me "mom" (and which a family therapist advised me to allow). It's clear that she thinks of me as a parent so I don't know why the fact that she didn't come out of my vagina has anything to do with my ability/capacity/or duty to help a child who looks to me for help when she is in need.

5. I've "never been willing to ask her DH to step up and parent"? I've done everything I can to do that--including 2 years of couples therapy for the first years of our marriage. It's clear that I will be refocusing on that now as part of this issue as well. I talk to him everyday about his daughter. Every day. Part of wanting to find a good referral is because I think having another professional say her thoughts/behavior aren't "just a phase" and are hurting her will definitely help me turn dad around. He isn't a terrible person. I'm guessing lots of parents of kids with ED didn't take immediate action and/or didn't immediately notice, let alone believe, that their child was suffering from such a serious illness. So yeah, I wish/hope DH will "step up and parent" more. I also wish bio mom would . And so do all of DD's friends' parents who have known the woman for years and have tried to intervene in various ways about her parenting. But I can't "make" them change. So what do I do? Just walk away from this man, whom I love? Trust me. I've thought about it more than once over the years. It SUCKS to be a stepmom who is raising someone else's child but who can't raise her the way they would raise their own kid. It has led to many conflicts with DH. But I can't possibly be the only step-parent who feels frustrated/sad/angry by that dynamic and whose marriage is strained by that weirdness. But even on the worst days in my marriage, which are fortunately not all that frequent, do you know what has actually made me stay? THIS GIRL WHO CALLS ME MOM. I shouldn't bother to be responding to this but I can't believe you think I haven't "been willing to ask." Show me the magic wand I can waive to change other people. And the only other alternative would be to just give up. I hope you aren't suggesting that because I have somehow been unable to make DH or Bio Mom more attentive/involved parents that the right thing for me to do is just walk away from this kid who obviously needs me. I won't be doing that.

[Anonymous]

Anonymous wrote:

Between the ages of 7 and 12, she had always measured very high for height (think 85-95 percentile for her age). She had also measured anywhere between "more than average to borderline high" for weight (between 70-85%). ..... (snip) .....

At this week's dr visit, she's down in her height percentile (down to around 70%), which Dr said was normal given her age and having started her period and genes on her maternal side. But she's down to the 15% percentile in her weight. She doesn't look malnourished thin. But she is definitely now a "skinny" girl when she never was before. I'm not pretending to be a Dr. I don't know if this is normal shifting/developmental changes or not. Dr. didn't seem concerned based on numbers.

OP, what happens in malnutrition of a growing child is that first the weight percentiles drop, then the body stops growing in height. A drop in height percentile all by itself might be developmental/normal adjustment. But since it is coupled with a SIGNIFICANT drop in weight percentile, that is a BIG HUGE SIGN of malnutrition. Your stepdaughter's pediatrician is very misinformed.
By comparison, my child's pediatrician was pretty blase about my child's very slow drop over the years in weight percentile, but the moment his height dropped as well, she started to get alarmed, as it was coupled with his very slow weight gain over the years plus my comments that he never seemed to eat anything. The drop in height percentile was what did it. He has always been about 40th %ile for height and dropped to 30th%ile.

I urge you to not worry about responding to criticisms of your parenting on this anonymous forum. Don't waste a single second more reading here or trying to justify your self or your actions to them. You are absolutely correct in your instincts and feelings.

Have you had any success finding an eating disorder clinic or therapist to assess your stepdaughter?

[Anonymous]

"Because of the potentially irreversible effects of an eating disorder on physical and emotional growth and development in adolescents, because of the risk of death, and because of the evidence suggesting improved outcome with early treatment, the threshold for intervention in adolescents should be lower than in adults."

Eating Disorders in Adolescents: Position Paper of the Society For Adolescent Medicine

http://www.jahonline.org/article/S1054-139X(03)00326-4/pdf

https://www.sccgov.org/sites/cac/Documents/training/EDOBeyondtheBench10.pdf

[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.

Wow. This advice is about 20 years out of date. I know others have commented on this, but it is such a dangerous attitude it bears to be refuted again. A child with an ED has a disordered brain and can no longer think clearly for herself. She absolutely needs someone to intervene or "control the outcome"

Wishing the best for you and your stepdaughter, OP.

[Anonymous]

OP: You mention a FAMILY THERAPIST above. Is that someone you can contact for advice about how to get DH on board? Can the family therapist talk to him?

[Anonymous]

One of the criteria for requiring hospitalization for an eating disorder (as opposed to treating on an outpatient visit) is for the child to be 75% or less of their ideal body weight.

A 12 year old who is usually about 75th%ile for weight would weigh about 112 pounds.

If she falls below 80 pounds, she'd be 75% of her ideal body weight.

OP said her stepdaughter was now about 15th percentile for weight. For a 12 year old that's about 75 pounds. Already OP's stepdaughter would qualify for hospital admission.

https://www.kartiniclinic.com/eating-disorder-resources/for-referring-providers/hospitalization-criteria/

According to the AAP* patients who meet any one of the following criteria should be re-fed in hospital rather than an outpatient setting (other criteria may pertain, clinical judgment required):

<75% ideal body weight, or ongoing weight loss despite intensive management

Refusal to eat

Body fat <10%

Heart rate <50 per minute daytime; <45 bpm nighttime

Systolic pressure <90

Orthostatic changes in pulse increase >35 bpm (AAP suggests 20 BPM; we find this low threshold impractical) or blood pressure decrease >10 mm Hg (AAP suggests 20 mm Hg)

Temperature <96 F

Arrhythmia

I'm sorry to be blunt, but there's not really a lot of time to fool around with couples therapists and getting DH on board here. This child needs proper medical evaluation and she DID NOT GET IT from her pediatrician.

[Anonymous]

I'm not saying OP should stop getting DD to a therapist right away. I would get her there without telling DH and certainly not bio mom. But eventually, as those with experience have said, having support from the family is usually important to a successful outcome. It's critical that DH get on board at some point.

[Anonymous]

Anonymous wrote:I'm not saying OP should stop getting DD to a therapist right away. I would get her there without telling DH and certainly not bio mom. But eventually, as those with experience have said, having support from the family is usually important to a successful outcome. It's critical that DH get on board at some point.

OK, I'm not arguing that point. But an experienced family based therapist (special type of therapy geared specifically towards eating disorders) is going to work with the family to help them provide the support they need to support the child to eat. A marriage therapist is unlikely to have a lot of knowledge about eating disorders and bad help is worse than no help in that case, especially if the marriage therapist takes the attitude that anorexia is caused by overcontrolling parents and urges stepmom to "stop being the food police". That will only make things harder.

[Anonymous]

I agree but since he's so tuned out, if he has a trusting relationship with at least one therapist, that professional might have some influence with him. I would implore anyone who has any kind of sway with DH to help me get him to understand. I'm not suggesting the family therapist counsel the ED.

[Anonymous]

Op here. I can't tell you how much I appreciate your dialogue and thoughts and recommendations. I've spent the last few days perusing websites, watching videos, reading, etc. Thank you, thank you.

I did in fact reach out to previous family therapist on the theory that maybe she'd be the appropriate person to help me get DH on board and/or she might weigh in on the "who should I take DD to see first--a generalist who deals with the fuller panoply of teen anxiety/depression issues, which I'm guessing DD is struggling with--or straight to ED specialists." Took awhile to hear back from her office. She's on maternity leave and not available to give opinion. So the quest continues... I also frankly wanted to give it a few more days so I could check-in with DD in person, not via texts, and see how she's been doing with food/thoughts since school started. Also still working on trying to bring DH on board and have been working on all of that while absorbing info from FEAST, etc. which I never would have found without you all and researching how to interview specialists etc.

I fully comprehend that DD could be lying to me about any/all of her conduct/thoughts but last night we had a 2 hour convo. She says she ate 3 meals a day, told me in detail what it was and it was good/healthy/normalish. All a huge relief to hear. But I do tend to have a cross-examination style with her (which I've been trying to do LESS of recently) and so follow-up questions reveal that while she ate, it made her feel awful. That she cried in the bathroom after lunch b/c she hated herself for eating. That she misses the feeling of "lightness" and "happiness" that she gets from fasting and only eating at dinner. Asked her about throwing up and she admitted that she just recently tried to do it (on vacation with bio mom) but that it was really hard and gross and so she hasn't been successful at it yet and it's easier for her to just not eat than to do that. How long she had been skipping meals (all summer). That she feels she can't quit on her own. That she feels it getting much worse all of a sudden. Talked about the new exercise compulsions. So many frightening but important things for me to know about where she is right now. God I love this girl's courage to tell me stuff like this. I really do.

She told me she was only telling me the truth b/c I wouldn't stop asking questions and that she only ate this week b/c she knew I would be upset with her if she didn't and she's "afraid" I will stop loving her if she's caught lying to me about. Also terrified that, given how bad eating is making her feel in head (and even physically--says her stomach hurts when she eats) that she won't be able to keep it up. That she will go back to not eating and then I "will be mad at her" and stop loving her. Hurts so bad to hear her say she's afraid to lose my love. But I honestly think it's what's kept her sort of safe during the last few months/years while she's been struggling with this. Said she knew mom and dad would always love her know matter what ("I think they call it unconditional, or whatever" ) but she didn't feel the same about me. We talked about why that was. Because I'm not a bio parent. Because she can remember when I came into her life and she remembers "trying" to get me to love her. Because I wouldn't let her call me mom at first (I thought I was doing the right thing by trying to honor her bio mom!!!!! trying to recognize boundaries!!!! trying to not inappropriately interfere with bio parents' status/relationships!!!! ugh). Anyway. As sad as it was to hear it all, I'm so grateful to have even more details to share with a professional. To have more confidence that she definitely needs specialized help, NOW. She really wants the help and realizes she can't stop it/fix it on her own. She said she told her mom that she was having really bad thoughts about herself and that she asked me to get her someone to talk to and that mom said ok. Said she hasn't told bio mom most of the ED specifics but that's because it's hard to talk about AND bio mom doesn't ask questions like I do. In a huge turn of events, she also asked me to reach out to bio mom and try to get her to understand and on board with treatment idea. She has never wanted me to speak to bio mom. She has always actively kept us separated (ever since bio mom allegedly told her at 8 that her mom was going to invite me over and poison me). It terrifies me that I have to do this. All communications to bio mom have gone through dad for years. And I'm guessing this will bring so much stress into my life. But yes, yes I will.

She wouldn't let dad be a part of the convo. Said she could tell he didn't believe her. But I told her I would be sharing it all with him and not keeping secrets and she said that was fine. Sadly, the 2 hour convo with HIM at midnight last night didn't go as well as my convo with her. He believes that she is "wildly exaggerating" her conduct/description of feelings bc she is getting a lot of "positive attention" from me with every "lie" or "exaggeration" she tells. Says she's having normal teenage angst/self-esteem issues and then blowing them out of proportion to be manipulative and to milk me for every last drop of attention. That this is the emotional equivalent of a 3 year's tantrums. That he's not giving in to it and I shouldn't either. Look. I get it. I never parented a 3 year old so I don't actually know anything about the right way to respond to tantrums/inappropriate attention-getting behaviors. This feels like the same situation to him. I honor that. I managed to stay calm and not immediately launch into accusing him of being a bad parent (b/c that's never going to help any of us). And look... his emotional reaction to the manipulative qualities of this disease are somewhat rational. Her behavior DOES seem manipulative. "I won't eat unless you make me." I will eat but only 1/4 of whatever you eat." I was supposed to not be home last night to attend a friend's going away party. She told me she didn't want me to go. I told her it was important to me and this other person that I do go. But what ends up happening? She got "her way." She and I spent hours sitting on her bathroom floor talking about ED, etc. and I end up missing the party and staying home to be with her. (I also think it's unfair that she is basically blaming bio mom for "letting her get away" with not eating b/c mom doesn't happen to ask her the right follow-up questions, etc. and so doesn't know the extent of the problem. )Yep. I feel ED is manipulating me. And DH. And bio mom. AND DD. But I don't believe for a second that DD is doing it on purpose or that it's controllable or that the right thing to do is to ignore it/let her cry it out of her own/not give her attention/whatever. But what do I know about any of what is "actually the truth" of this situation. Anyway. I managed to keep convo with DH civil and to emphasize that I just see her hurting. And I see their relationship deteriorating. And that I just want to help my family. That I want to maximize our individual/collective happiness. That neither of us is a doctor and who the hell knows what is "actually" going on but that even if he is 100% right, that it sounds like DD needs some professional help to get past this kind of behavior/emotional difficulty. Because she gets a ton of positive attention (SILENT THOUGHT: well...from me at least) and if she isn't feeling like it's enough and she's coming up with crazy lies about trying to make herself puke up lunch to get more attention than it sounds like she needs SOME kind of help. End result: fine, you can get her to a dr even though I don't believe for a second that she really has an ED. Not perfect result but it's gets us to a place where I feel I can make appointments, and drive her to appointments, and pay for appointments without actively going against wishes of DH/bio father and now, apparently, even bio mom. So.....

PROGRESS! In just a few days!

My posts have been long. I feel selfish. But thanks so much for listening. I definitely feel like I'm doing the right thing. And you all have given me the courage/info/support/hard questions to support me to do it.

[Anonymous]

Hey OP, I just want to say that I went through some of these issues as a teenager and younger adult (in addition to restricting food and flirting with bulimia, I also did some cutting) and was depressed for years. My parents never probed, never asked questions, and I in turn never opened up to them. I remember my dad's sole effort as telling me he would stop paying for my therapist if I didn't tell him what I was telling the therapist. (So I quit therapy.) I think you're doing the right thing with the questions, and I'm betting my surly 15 yo self would have agreed.

Regarding your convo with DH, I can't relate to trying to parent through these issues, but I CAN relate to the frustration of trying to co-parent through other issues when the two parents aren't on the same page. When you guys have a chance to talk again, I might tell him that you are taking what he said to heart and considering whether this is manipulative behavior, but in turn HE should take to heart whether he is interpreting the situation in a way that is most convenient for him, i.e., downplaying it so that he doesn't have to commit to the work of trying to help fix it. My kids are younger with way less serious issues, but my DH does this sort of thing. I don't think it's a conscious decision, but I do think it may help to point out the possibility.

[Anonymous]

OP - so much of what your stepdaughter is saying sounds like my daughter in the throws of anorexia.

One of the hardest things to understand about an ED is how muddled the patient's thinking is. She is not trying to be manipulative. She genuinely is scared to eat, it makes her feel sick and she feels like portions offered are not normal when they are. Couple that with the fact that everyone is probably hoping it isn't an ED, and one can understand where your husband and ex are coming from.
Unless someone has been educated on this, it is a really hard disease to understand.

It must be so impossible to handle this when everyone is not on the same page. I would think a therapist specializes in ED has seen this same dynamic before and can help your family navigate it.

[Anonymous]

OP, I can't stress enough how wonderful of a parent you are. My daughter is much like the previous PP, very resistant to therapy and doesn't like talking. I feel like she'd do much better talking to someone like you who can ask questions and get answers. If you areplanning to make an appointment with a therapist and haven't done so already, I'd lie to once again recommend Potomac Behavioral Solutions for your step-daughter. The people there are wonderful. Please keep us updated! I hope your stepdaughter gets the help she needs. Hugs, OP.

[Anonymous]

Anonymous wrote:
I did in fact reach out to previous family therapist on the theory that maybe she'd be the appropriate person to help me get DH on board and/or she might weigh in on the "who should I take DD to see first--a generalist who deals with the fuller panoply of teen anxiety/depression issues, which I'm guessing DD is struggling with--or straight to ED specialists."

Please take her straight to an ED specialist.

How long she had been skipping meals (all summer). That she feels she can't quit on her own. That she feels it getting much worse all of a sudden. Talked about the new exercise compulsions.

OP once anorexia gets to a certain stage, patients can spiral further downhill very quickly in terms of physical health. Good that she is letting you know, but she is reaching out to you for medical help.

Sadly, the 2 hour convo with HIM at midnight last night didn't go as well as my convo with her. He believes that she is "wildly exaggerating" her conduct/description of feelings bc she is getting a lot of "positive attention" from me with every "lie" or "exaggeration" she tells. Says she's having normal teenage angst/self-esteem issues and then blowing them out of proportion to be manipulative and to milk me for every last drop of attention. That this is the emotional equivalent of a 3 year's tantrums. That he's not giving in to it and I shouldn't either.

OK. Tell him that a child can have cancer AND be wanting attention. A child can have diabetes and also be manipulative. That doesn't mean that they don't have cancer or diabetes that needs to be treated, though.

Her behavior DOES seem manipulative. "I won't eat unless you make me." I will eat but only 1/4 of whatever you eat."

This is actually AMAZING for someone with anorexia and it points to the fact that perhaps you may have an easier time helping her get better than other people. The whole problem with anorexia is that there is something inside these kids that is telling them not to eat, and the parents need to be stronger than that voice and force the kids to eat! If she's actually telling you she won't eat unless you make her -- that's a great start.

I was supposed to not be home last night to attend a friend's going away party. She told me she didn't want me to go. I told her it was important to me and this other person that I do go. But what ends up happening? She got "her way." She and I spent hours sitting on her bathroom floor talking about ED, etc. and I end up missing the party and staying home to be with her. (I also think it's unfair that she is basically blaming bio mom for "letting her get away" with not eating b/c mom doesn't happen to ask her the right follow-up questions, etc. and so doesn't know the extent of the problem. )Yep. I feel ED is manipulating me. And DH. And bio mom. AND DD. But I don't believe for a second that DD is doing it on purpose or that it's controllable or that the right thing to do is to ignore it/let her cry it out of her own/not give her attention/whatever. But what do I know about any of what is "actually the truth" of this situation.

A Maudsely trained ED Family Based Treatment therapist (NOT the same as a family therapist but someone with specific trating in family based treatment of ED) can help you deal with all of what you just wrote.

End result: fine, you can get her to a dr even though I don't believe for a second that she really has an ED. Not perfect result but it's gets us to a place where I feel I can make appointments, and drive her to appointments, and pay for appointments without actively going against wishes of DH/bio father and now, apparently, even bio mom. So.....

This is excellent!! Keep on!!

[Anonymous]

OP how is it going?