Our daughter has anorexia and we’ve just started family-based treatment. Our therapist told us she needed to turn a corner with weight gain soon or hospitalization would be inevitable. When I asked the therapist about a meal plan she explained to us to go with instincts and feed her what I thought was the correct food. My concern is that she can only eat very small amounts and feels extremely sick afterward (I realize her body is not used to having food so therefore the sickness is partially physical but most likely also mental). I am very concerned that the amounts I am feeding her are in not adequate to start weight gain. My question is should I be having her eat more? Or is it okay to initially concentrate on stabilizing her weight? I know that this is something I should probably ask her therapist but don't want to do so in front of her! My other concern is that she seems to be getting more depressed (before treatment began she did not appear to suffer from depression).
Scott Bullock, MSW, LISW-S responds:
I feel this is one of the toughest problems next to, "How do I make them eat?" For FBT to be successful, your daughter needs to gain. Stabilization will not promote recovery. Most patients want to continue to eat their safe food which typically is not calorie dense. You have to find meals which are calorie dense, so your daughter does not feel overwhelmed. The “Catch 22”, however, is that most patients do not want to eat calorie dense foods, which then gets you into the other problem of getting your daughter to eat. At the Lindner Center of HOPE, we recommend what we call “HOPE shakes”. This includes one cup of premium brand ice cream, ½ cup heavy cream, and one carnation instant breakfast mix. This gives the patient close to an extra 1000 calories in one drink. Along with her regular meal, this should make a difference. You can also do things such as adding extra butter, putting cream cheese in mashed potatoes (which is good no matter what!) along with many other creative ways. You would probably be successful with any Paula Dean recipe!
In response to your second question about the depression, I would say this is a good sign. This may sound confusing, but try to remember that the brain is malnourished and starving, so it is not functioning appropriately. The brain is composed of 85% fat. I always tell parents that if things seem worse initially, then they are doing a good job. If the patient seems happy and cooperative, then the eating disorder is finding a way to survive. The depressive symptoms will decrease with weight gain. Then a psychiatrist can evaluate for the need of an anti-depressant if there are still depressive symptoms after re feeding has occurred.
Scott Bullock, MSW, LISW-S
Mr. Bullock is a therapist at the Lindner Center of Hope. He has more than with 17 years of experience in the treatment of adolescents and adults and is undergoing certification in family-based treatment. Read more about Mr. Bullockhere.
