My 15 year old daughter has been receiving intensive outpatient treatment at an eating disorder clinic for seven months. My husband and I have also been going for 7 months (family counseling, family support groups, etc), as well as monitoring her eating, and helping her stick to an eating plan. She has gone from 95 lbs to 115 lbs. which is an acceptable weight for her. The clinic has been "stepping her down" from 3 days, to 2 days to 1 day of treatment, as she has gained her weight. Now that her weight is acceptable, they are talking about exiting her from the program.
My daughter is scared to death to leave. She feels that the clinic is a safe place and she cries whenever she thinks about leaving. Her mental state is still very impaired. She has started bingeing and seems to have very little control and she also purges. She constantly talks about how fat she is, and how she hates herself and she is just filled with self loathing and disgust. I am so worried about her, and don't see how the clinic can think she is ready to leave. I know that the eating disorder recovery is more than maintaining an acceptable weight. I want her to get better psychologically too. What can I do?
Kara Fitzpatrick, PhD responds:
Reasons for release from residential and inpatient treatment programs vary, but ultimately the goals of learning to eat and maintain healthy behaviors in everyday life are critical behaviors that must occur for one to be recovered. The transition from any “safe” environment to an environment in which one has been filled with eating disorder thoughts and behaviors is always challenging. Skills learned in her intensive program may be hard to “generalize” or use quickly and easily at home, school and in everyday life. That is one way that parents can help: creating an environment that does not allow the eating disorder to take control.
There are several critical areas where you, as parents, can help your daughter continue this eating disorder fight. The first is to continue to assist her by monitoring meals and making certain that she is eating regular, nutritious meals that assist her in keeping her weight-restored status. Parental monitoring of intake, even when your child is weight restored, can be critical to keeping weight gains and assisting your daughter in eating flexibly and normally in the home. The second is to create an environment in which binge eating and purging behaviors are not acceptable. Families may need to have a higher level of vigilance around binge eating behaviors, interrupt binges, and even take more drastic steps such as removing binge trigger foods or managing meals. Methods to prevent purging can include monitoring after meals and preventing the use of unsupervised bathroom time. These are only a few strategies families might use, or need to use, to help with adjustment in the home, school and other settings. The goals are to provide an environment where your daughter’s anorexia is not in charge and slowly transition toward greater independence. She has obviously thrived in an environment that provides a high level of support and your family can work toward mimicking these aspects at home.
Of course, recovery can and should continue outside of intensive treatment settings. We encourage you and your family to discuss appropriate referrals with your daughter’s current treatment team to find outpatient providers who can assist you with continued adjustment. Finding a family-based therapy provider to assist your family with maintaining nourishment either alone or in conjunction with an individual therapist who might continue to provide your daughter with the support she needs to overcome her eating disorder. Finally, remember that recovery occurs over time and the effects of renourishment efforts on behavior and cognitions typically lag well behind actual weight gain. By helping your daughter remain stable in her weight, you will help her continued psychological as well as physical recovery.
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.