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[quote=Anonymous][quote=Anonymous][quote=Anonymous]Your SIL is mentally ill. She has at least one psychiatric condition, an avoidant restrictive eating disorder, and likely others, depression, etc.

She does not need to be on board and the focus needs to be moved off her as some kind of gatekeeper.

BIL needs to take charge of his heath and pass on the Captain Crunch. He needs to provide healthy food to his daughter and get her therapy for her own developing avoidant restrictive eating disorder. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089271/

One person's mental illness does not need to and should not be allowed to drag down 3 people. If he eats healthy and lower carb (protein and veg NOT pasta w/jarred sauce w/sugar in it) he may reverse own diabetes, esp if he takes up exercise. He should also get himself into counseling and see if the messages from Al Anon resonate, there are Zoom and phone meetings. If he has the money he should order healthy meal delivery for 2.

The mentally ill are unlikely to change. Think hoarding and the like. He needs to focus on what HE can control, himself and at least attempt to support the well being of his child. Her being groomed into an eating disorder by a mentally ill parent is not it. CODA may be another resource that could help him see the need to detach with love and knock off the enmeshment. His child cannot be getting proper nutrition.

Only once he and the child are healthier and have made progress in therapy should SIL's issues be focused on. She may need inpatient treatment, at minimum a qualified psych eval and outpatient treatment plus likely meds. https://psychcentral.com/eating-disorders/avoidant-restrictive-food-intake-disorder-symptoms#symptoms Even for ARFD she is on the extreme end. https://www.eatingdisorderhope.com/blog/effective-treatments-adults-arfid
https://www.reddit.com/r/ARFID/comments/aqua62/can_you_have_arfid_and_be_overweight/

Even depression in a parent can have significant effects on kids, he really needs to step up and shield her. He may well be depressed and overwhelmed himself, thus the need to get support and an actionable plan re: HIS physical and mental health first. Oxygen mask. Since he has asked for help, start there.  [/quote]

OP here. This is one of tho most helpful posts Ive seen. I had never heard of avoidant disorder prior to today. By the way SIL has a shopping addiction and is a hoarder too. I will read up a lot on this and will send him this info.  [/quote]\

OP, you ALL need the focus needs to shift off SIL and onto BIL's own mental and physical health and the developing eating disorder and other mental distress of the child.

ONLY when they are both healthier and stable should the SIL be focused on.

Oxygen mask.

SIL is mentally ill. That CANNOT be allowed to drag down 3 lives. He needs to help himself to be able to help anyone else. Since he has asked you and DH for help, start there.

If he has insurance coverage for it, a program like https://www.virtahealth.com/ or https://mylevel2.com/ could be ideal, both have strong track records and there is education, remote monitoring and social support.

All of the ways that your SIL's severe mental illness manifests are just that. Continued focus on her changing while the daughter's mental health is tanking as well as the physical and mental health of BIL is CRAZY. Please tell me you see that. The enmeshment needs to end and triage start.

BIL needs to manage his OWN mental and physical health. He needs to get his child help stat. THOSE are the things he has complete control over and is responsible for. Support him there. He has asked for help, start with him and niece. He may also benefit from Al Anon and NAMI but ONLY once he has an actionable plan for own physical health and once he has therapy in place for himself and eating disorder therapist for DC who is knowledgeable about ARFD, contact link above for resources in his area. He can't save anyone if he is not getting healthier himself. He also needs to model that for DC. He also needs to get DC targeted knowledgeable help. Her being independent might be a child who has been more or less left to raise herself. Once she has individual treatment in place she may also benefit from Alateen meetings. Growing up with a severely mentally ill parent is very difficult and she needs to learn to separate in a healthy way and not use her mom's disordered behavior as a role model. An nutritional deficiencies need to be addressed ASAP.

Focus where change is possible. He needs to take care of himself and lead from the front. Next, your niece urgently needs help as she seems to be developing mental illness herself or imitating ill behavior.

You do realize that your SIL is very mentally ill and may never change, don't you? So making the well being of 2 additional people contingent on a mentally ill person not being mentally ill is crazy too? Oxygen mask for BIL first - something like Virta or Ozempic STAT. An ARFD therapist for niece. Those can be gotten in place very quickly and BIL needs a therapist with experience with mentally ill spouses, maybe NAMI will have some referrals or the link above may have suggestions for BIL too. SIL may become interested in help if others in the family are changing, or not. But, she cannot drag down 2 others, esp a child, who may have nutritional deficiencies and who is becoming disordered and perhaps isolated herself. She needs every support to live a life different than her mother and to be free of or have a plan to manage mental illness herself. Support your BIL but keep the focus on him and the child FIRST. The whole situation is very sad, but, he seems motivated to change and he has support in you and DH, plus he is employed and has insurance. That is all enough to at least start to save himself and DC. Every effort needs to be made to give her the option of living a life that is broader than her mother and mentally healthier. Maybe have her come visit for a few weeks of respite and a chance to see what a healthier family looks and feels like? [/quote]

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