My 12-year old daughter was diagnosed with anorexia in late January. She was immediately admitted into the hospital, and from there to a family-based eating disorders program. After spending 3 weeks as an inpatient, we were able to bring her home. She has really done very well at home as we have continued our appointments initially on a weekly basis, and now on a bi-weekly basis. She has been able to maintain her weight, add back "normal" 12-year-old activities, and we are really very proud of her. Here is our problem: she continues to be bound to a schedule of eating her meals and snacks throughout the day, which is making it difficult for the rest of our family to be flexible, have more freedom, and enjoy the wonderful progress she has made. In addition, she is continuing to have difficulty being willing to try different foods at different times. I love my daughter, would do anything for her, and want to support her, but it is SO hard sometimes. I'm so tired of always having to worry about what might set her off and I'm anxious to get back to the more fun-loving times we used to be able to have that didn't revolve around what to eat and when. Is this a typical recovery? Do I just need to continue to be patient? Are there any other suggestions or advice you can give me? Is it ok for us to be firm with her about our expectations and point out how hard this is for the rest of us, too? Your advice would be greatly appreciated.
Kara Fitzpatrick, PhD responds:
It is wonderful to hear that your daughter and your family have made such excellent progress. Setting up routines for normal, healthy intake help most families tackle the initial stages of renourishment efforts. Unfortunately, these routines and structures can sometimes take on a life of their own and prevent full adjustment to flexible eating and a view of food as something to enjoy, rather than something to plan. As a family-based practitioner, I often work flexibility into therapy to assist families with exactly the concerns you present here. Truly “normal” eating requires a measure of flexibility both around timing as well as around types of foods that we eat. To that end, I really enjoy implementing “planned flexibility” tasks in treatment. For example, if a family had difficulty eating out due to rigid eating patterns, we might make such an outing the focus of a therapy session, though such discussion as: giving plenty of warning time, allowing the patient to choose the restaurant and going over the menu carefully to pick a meal that is agreed upon by parents and patients. When this is successful, we might focus on greater flexibility such as providing less time of warning before an outing, not choosing meals prior to going, choosing new restaurants or allowing other family members to choose where a meal might occur. These can be made fun and can also address expected areas of difficulty, such as vacations, leaving for college or holiday meals. Areas for implementation may be large (such as eating at restaurants) but may also be somewhat smaller, such as creating flexiblity around the time of a meal or even placement of a meal (at the dinner table, but in a different chair) or food type (waffles instead of oatmeal). Planned flexibility “experiments” can be excellent for engaging siblings they are often are quite expressive about ways that they see the eating disorder continuing to have a hold on the individual and/or other family members and likely can provide models for what normal flexible eating habits look like.
Kara Fitzpatrick, PhD
Dr. Fitzpatrick is a psychologist working with Eating Disorders at Stanford University/Lucile Packard Children's Hospital and serves as clinical advisor to Maudsley Parents. She is widely trained in a variety of models for treatment and performs research in applied clinical treatments for adolescents and neuropsychological factors associated with eating disorders.