One More Bite by Joy Jacobs

Getting on the same page

If you are part of a parent team trying to refeed your child, chances are that you’ve faced conflict with your spouse—over appropriate strategies, contingencies, meal schedules, foods, amounts…and the list goes on.   Regardless of the content of the conflict, the eating disorder loves to divide and conquer, to exploit parental conflict and take advantage of it.

Don’t let conflict with your spouse distract you from the long term goal—saving your child’s life.  If you feel that you and your spouse are in conflict too often, pick a calm time to sit down and privately discuss it.  By reviewing your areas of conflict (and agreement), you can develop an action plan for improving your teamwork and making you a truly united team.  This will maximize your chances for successful refeeding and hopefully help boot the eating disorder out of your family’s life for good. 

In Praise of Family Dinners

Laura Collins says it best.

Check out her essay on the healing power of the family dinner…..

http://eatingwithyouranorexic.blogspot.com/2009/04/i-still-believe-in-dinner.html

Go Scarlett!

Thanks to Scarlett Johansson for setting the tabloids straight and being a great size acceptance role model for young girls.  More authentic voices like hers may help to move our celebrity crazed culture back to some modicum of sanity.  Check out what she has to say:

http://www.huffingtonpost.com/scarlett-johansson

 

The Band Aid

Once you get into phases two, three, and beyond in FBT, whether you are a parent or someone with an eating disorder, you may start to see the ways in which the eating disorder acted like a band aid.  It covered a wound that may still need to be healed.  Once weight is restored and cognitive function begins to resume, it is possible to address and heal the underlying issues that may have contributed to the eating disorder.  Make sure you do this.  Stay steady with the food and healing can take place.

Brothers & Sisters

A new comment from “SJ Mast” was received on the post “It’s Your Turn” of the weblog “One More Bite”.

Question:
A question for you about vigilance with younger siblings with an anorexic sister. Oldest daughter anorexic x 2 years and now in recovery. Now 13 yr old sister who is very active in sports is cutting back at meals and not eating meat. Having gone through maudsley with older sister this raises red flags for us. Is there danger of somehow "creating" an eating disorder by insisting on full nutrition when maybe there is no real problem? Or is there more danger in doing nothing and it develops into a real problem? Daughter will not talk about it and accuses us of being oversensitive because of her sister. We fear making too much of an issue out of the food but fear more where it can lead.

Dear SJ,

Your dilemma is not uncommon.  It sounds like your intuition is telling you something is awry with your younger daughter’s eating.  As you learned by successfully using FBT with your older daughter, you must do your best to trust your instincts as a parent—they are usually right.  The challenge you face is navigating the confluence of several factors at once—changes in your daughter’s eating, a family history of AN, and the onset of adolescence.  If you are not at peace with the discussions you have had with your daughter (either the content or tenor), you might decide to take a more active role in her nutrition (e.g., insisting on adequate calories to support growth and a wide variety of foods, without necessarily dictating specific foods and amounts). 

It would make sense for you to be sensitive to eating issues based on your family’s previous experiences.  Rather than allowing suggestions of oversensitivity to dissuade you from pursuing this issue further with your younger daughter, it might be helpful for you to acknowledge that you do have concerns based on what you experienced with your older daughter and continue to insist (with a firm yet gentle approach) that the issue be discussed.  Remind your daughter that it is your job as her parent to ensure her health and welfare.  Try to work collaboratively with her.  Ask her for suggestions on how you can work together to ensure that she stays healthy and strong.  Let me know how it goes.

Mind Body? Body Mind?

Certain mind/body activities , such as yoga and pilates, may be beneficial in helping people in recovery regain a positive body image.  These activities can also be helpful in learning to manage and cope with stress and anxiety.  When my patients are ready, I often support and assist them (and their families) in learning more about these and other body/mind activities.   

Of course, the real challenge is in determining when is the “right” time to start exploring these activities.   

When was the “right” time for you or your loved one? How did you know?  Please join the conversation.

The Gift of FBT

Thanks to “runforjoy” for taking a turn at bat:

I am now 21 and have spoken with several other young adults who wish our parents could have used FBT. I was wondering if you have any experience using FBT with older patients. I'm also curious how families that used FBT help their children maintain recovery. What level of vigilance/control do they maintain when a child goes to/comes home from college?

Great questions!  I have used FBT with young adults who agreed to move home to live with their families in order to recover.  In fact, some of these cases have been among the most successful recoveries I have witnessed. 

Once undertaken, FBT requires similar levels of parental involvement, regardless of the age of the “child.”  FBT can be slightly more complicated with older children since both legally and in terms of life experience, young adults can (for the most part) come and go freely and cut off the treatment at any time (especially when the eating gets hard or feels overwhelming).  Younger children typically do not have the legal, financial, and other means to escape treatment in the same way that young adults do. 

I personally like to address these and similar potential barriers at the very start of treatment by having the family collaboratively develop “ground rules” about how these issues will be handled if they do arise.  Doing this from the very start of treatment not only allows everyone to start getting prepared for the challenge ahead, but also contributes toward addressing ambivalence about pursuing this path and developing concrete plans about how to incorporate the treatment into the young adult’s and family’s life—a life that is going to look radically different from the current day-to-day of all involved and will maximize the chances of successful recovery.

In my experience, FBT with young adults tends to be most effective when the young adult is clear that recovery no matter what is the primary goal.  At this point, the costs of the eating disorder have become so high (in terms of health, social life, education, career) that treatment compliance tends to be higher.

Runforjoy, I too wish for you that FBT would have been available to your family at the time you needed it.  I work with many teens who—without the benefit of experience-- resent the treatment; it will be so helpful for them to hear from someone only slightly older, who has been there, that this treatment can be a gift, not a punishment.

It’s Your Turn

One of the primary motivators for me to start this blog was to offer support to families utilizing (or considering) family based treatment.  So now…it’s your turn.  Please send your questions/struggles/suggestions my way so we can share the wealth.

(Please keep in mind that state and other regulations make it impossible for me to provide medical advice to you.)

Have You Filled Your Cup Today?

As a caregiver for someone with an eating disorder, you may at times find yourself exhausted, frustrated, angry, burned out,  or all of the above. 

In today’s New York Times, Jane Brody very wisely addresses the issue of caring for oneself when you are taking charge of someone else’s care. 

“Self-care is not a selfish act. It’s an essential act, because a caregiver who burns out, who becomes overly stressed, exhausted or ill, is no help to anyone.”

Check out her article for some great tips on filling your own cup.  http://www.nytimes.com/2008/11/18/health/18brod.html?_r=1&ref=health&oref=slogin

Pick one thing and do it TODAY.  Just because.

Yes We Can

Whatever your politics, may you find inspiration and hope in the story of Barack Obama.  His rise to the presidency is testimony to the tremendous power of family.

If you are fighting an eating disorder or helping a loved one in the fight, please reach out to everyone you can for support.   Parents in the midst of refeeding, please call on extended family to help you out with errands, provide respite care, or to provide a sympathetic ear.

You are not imposing. 

As said so simply by our future president (and repeated by Madonna and thousands of fans only minutes later at Petco Park in San Diego) “We are one.”    

When we combine forces, anything is possible.