Help me help my daughter defeat ED
March 10, 2016 2:50 PM Subscribe
Does anyone have personal recommendations for reputable eating disorder treatment facilities anywhere in the US and/or individual therapists with eating disorder expertise in Boston or the Washington, DC area? Details inside.
My daughter "Ann" is struggling with an eating disorder that she developed over the past year. She is in her final semester of college in the Boston area. Her campus-based therapist (whose focus is eating disorders) has been supportive and helpful. This therapist referred Ann to a local ED treatment facility. Ann was very enthusiastic about beginning her recovery journey at this center, beginning with their intensive outpatient program, transitioning to inpatient once she graduated, if necessary. Unfortunately, the first session was a disaster. She was unable to finish her meal in the required 20 minutes and was forced to drink a can of Ensure. ((aside- are we not taught that eating healthy includes slowly eating and enjoying a meal?)) Ann was very upset and dropped out of the program. She had such high hopes that the program would help her and is devastated. Ann will continue seeing her campus therapist twice a week until she graduates.
I am now searching for an inpatient treatment facility for her and the reviews are not encouraging: horror stories of patients being isolated and prevented from speaking to family, forced to take medication, lack of promised therapy sessions, uncaring and/or hostile staff, use of punitive measures to encourage compliance, to name just a few objectionable issues. Many reviewers stated that they left their respective facilities in worse condition than when they entered. I desperately want my daughter to recover from this dangerous addiction and get the help she needs. She is not physically fragile, and weighs within the normal guidelines for her height, but emotionally she is suffering a great deal. I'm scared for her.
I am hoping that I can obtain some resources from you, hive mind. I am looking for names of reputable treatment facilities that you have knowledge of being successful in the treatment of eating disorders, where patients are treated with respect and where they are helped to recover. My daughter wants to get better and is willing to do the work to do so in a supportive environment.
I am also seeking referrals for individual therapists in the Boston or Washington, DC area, who specialize in counseling those with eating disorders.
Throwaway email: help.me.defeat.ed@gmail.com.
Thank you.
My daughter "Ann" is struggling with an eating disorder that she developed over the past year. She is in her final semester of college in the Boston area. Her campus-based therapist (whose focus is eating disorders) has been supportive and helpful. This therapist referred Ann to a local ED treatment facility. Ann was very enthusiastic about beginning her recovery journey at this center, beginning with their intensive outpatient program, transitioning to inpatient once she graduated, if necessary. Unfortunately, the first session was a disaster. She was unable to finish her meal in the required 20 minutes and was forced to drink a can of Ensure. ((aside- are we not taught that eating healthy includes slowly eating and enjoying a meal?)) Ann was very upset and dropped out of the program. She had such high hopes that the program would help her and is devastated. Ann will continue seeing her campus therapist twice a week until she graduates.
I am now searching for an inpatient treatment facility for her and the reviews are not encouraging: horror stories of patients being isolated and prevented from speaking to family, forced to take medication, lack of promised therapy sessions, uncaring and/or hostile staff, use of punitive measures to encourage compliance, to name just a few objectionable issues. Many reviewers stated that they left their respective facilities in worse condition than when they entered. I desperately want my daughter to recover from this dangerous addiction and get the help she needs. She is not physically fragile, and weighs within the normal guidelines for her height, but emotionally she is suffering a great deal. I'm scared for her.
I am hoping that I can obtain some resources from you, hive mind. I am looking for names of reputable treatment facilities that you have knowledge of being successful in the treatment of eating disorders, where patients are treated with respect and where they are helped to recover. My daughter wants to get better and is willing to do the work to do so in a supportive environment.
I am also seeking referrals for individual therapists in the Boston or Washington, DC area, who specialize in counseling those with eating disorders.
Throwaway email: help.me.defeat.ed@gmail.com.
Thank you.
Have you already worked with McLean? They're the only place outside of Ohio where I've actually met people who attended and they really felt better quickly. Even the guy with OCD thought they were amazing, and he started out thinking he didn't need treatment at all.
Eating disorders are particularly awful, though, in terms of how long the struggle lasts. The trouble is that you can never escape food. So please, try and be patient.
posted by SMPA at 3:11 PM on March 10, 2016 [4 favorites]
Eating disorders are particularly awful, though, in terms of how long the struggle lasts. The trouble is that you can never escape food. So please, try and be patient.
posted by SMPA at 3:11 PM on March 10, 2016 [4 favorites]
My heart really goes out to you and your daughter. Anorexia is a terrible thing to deal with.
Is it possible to give the outpatient clinic another chance? Of course she is balking at the treatment -- it's going against absolutely everything she believes right now, whether she wants to get better or not. Battling the mental aspect of this disease is really tough. Also, it's not unlikely that she will find fault with every place you try, because recovering from ED is incredibly difficult and it's a lot easier to blame the program and skip around "trying something new" than to get better.
Set and timed meals are absolutely standard practice at clinics, inpatient or not. She's not going to be able to avoid that.
~are we not taught that eating healthy includes slowly eating and enjoying a meal?
Well, yes. But your daughter is not ready to have that kind of relationship with food right now. Capitulating to her disorder is not going to be good for either of you. Please find some support for yourself, so you can best support your daughter.
posted by ananci at 3:28 PM on March 10, 2016 [4 favorites]
Is it possible to give the outpatient clinic another chance? Of course she is balking at the treatment -- it's going against absolutely everything she believes right now, whether she wants to get better or not. Battling the mental aspect of this disease is really tough. Also, it's not unlikely that she will find fault with every place you try, because recovering from ED is incredibly difficult and it's a lot easier to blame the program and skip around "trying something new" than to get better.
Set and timed meals are absolutely standard practice at clinics, inpatient or not. She's not going to be able to avoid that.
~are we not taught that eating healthy includes slowly eating and enjoying a meal?
Well, yes. But your daughter is not ready to have that kind of relationship with food right now. Capitulating to her disorder is not going to be good for either of you. Please find some support for yourself, so you can best support your daughter.
posted by ananci at 3:28 PM on March 10, 2016 [4 favorites]
Rules around eating meals are crucial for the beginning stages of eating disorder treatment. Time limits, clothing requirements, calorie minimums, eating unhealthy foods (pizza, cupcakes) - these are all common treatment tools at mealtimes at an eating disorder facility. Eating disorders must be confronted and their control taken away.
I would also echo Ruthless Bunny about not being able to trust what comes out of your daughter's mouth - it is not always coming from her, her eating disorder is speaking through her and if it is allowed to continue it will kill her.
posted by hepta at 3:52 PM on March 10, 2016 [8 favorites]
I would also echo Ruthless Bunny about not being able to trust what comes out of your daughter's mouth - it is not always coming from her, her eating disorder is speaking through her and if it is allowed to continue it will kill her.
posted by hepta at 3:52 PM on March 10, 2016 [8 favorites]
Commenting again because I realized I ended on a very negative note: your daughter can get help and get better. Support from family is such a crucial part of this process and your obvious empathy and concern for her over this issue is going to be a real asset to her going forward. I recommend you read some current literature on parenting children with eating disorders.
posted by hepta at 3:53 PM on March 10, 2016 [1 favorite]
posted by hepta at 3:53 PM on March 10, 2016 [1 favorite]
Have you read Brave Girl Eating: A Family's Struggle with Anorexia by Harriet Brown? She also blogged about her experiences on Psychology Today. She seems nice and may even be able to share some resources if you get in touch with her directly.
posted by smorgasbord at 4:25 PM on March 10, 2016
posted by smorgasbord at 4:25 PM on March 10, 2016
Much like most alcohol treatment programs require sobriety as a condition of treatment not just because alcohol is naughty but because the anxiety of being sober is the first thing you have to treat (and you need a clear head to get anything from treatment), eating disorder programs require food and behavior compliance because treating the anxiety is the first priority, and starving brains don't have full cognitive function.
The trigger is intentional and the calories are necessary. Getting past the anxiety is the primary stage of treatment, no other stages matter if you can't learn to deal with the anxiety, with all other issues being secondary at best. She doesn't have a little misunderstanding about eating slow healthy meals (though yes, she will undergo re-calibration training so she knows what proper servings of food look like, but that's not what's actually wrong). To oversimplify a whole lot, she has a phobia. You treat phobias with exposure - you have to, because you can't just sit around talking all day about "sometimes you have a feeling and you should then do a thing", you have to have the feeling and do the thing.
This is hard, because especially with eating disorder patients they'll go from zero to real measurable redline panic at the first confrontation with lack of control in a way that even heroin addicts generally don't. Every heroin addict walks in the door knowing what's about to happen is going to suuuuuuuuck, and ED patients tend to be "sucking is ABSOLUTELY UNACCEPTABLE unless it's the suck I create."
I think before you get her back into a program you might suggest (which is all you can do) that she work on just being able to withstand the prospect of discomfort and trusting the trained professionals to help her. Because the difference between a shady program and a fantastic program isn't whether there are food/clothing/scale/behavior restrictions from day 1, because they all do that, but whether there are good qualified professionals there to help her through the agony of the restrictions.
posted by Lyn Never at 4:53 PM on March 10, 2016 [8 favorites]
The trigger is intentional and the calories are necessary. Getting past the anxiety is the primary stage of treatment, no other stages matter if you can't learn to deal with the anxiety, with all other issues being secondary at best. She doesn't have a little misunderstanding about eating slow healthy meals (though yes, she will undergo re-calibration training so she knows what proper servings of food look like, but that's not what's actually wrong). To oversimplify a whole lot, she has a phobia. You treat phobias with exposure - you have to, because you can't just sit around talking all day about "sometimes you have a feeling and you should then do a thing", you have to have the feeling and do the thing.
This is hard, because especially with eating disorder patients they'll go from zero to real measurable redline panic at the first confrontation with lack of control in a way that even heroin addicts generally don't. Every heroin addict walks in the door knowing what's about to happen is going to suuuuuuuuck, and ED patients tend to be "sucking is ABSOLUTELY UNACCEPTABLE unless it's the suck I create."
I think before you get her back into a program you might suggest (which is all you can do) that she work on just being able to withstand the prospect of discomfort and trusting the trained professionals to help her. Because the difference between a shady program and a fantastic program isn't whether there are food/clothing/scale/behavior restrictions from day 1, because they all do that, but whether there are good qualified professionals there to help her through the agony of the restrictions.
posted by Lyn Never at 4:53 PM on March 10, 2016 [8 favorites]
McLean Hospital is absolutely cutting edge. It's a Harvard teaching hospital with really great treatment programs for adolescents and women, including eating disorders. They have inpatient and outpatient and in-between.
posted by primate moon at 10:06 PM on March 10, 2016 [1 favorite]
posted by primate moon at 10:06 PM on March 10, 2016 [1 favorite]
Nting the McLean Hospital program, although I suspect if she was with a good clinician in the Boston area, that's where she's already been.
She needs to go back.
posted by yes I said yes I will Yes at 2:30 AM on March 11, 2016 [2 favorites]
She needs to go back.
posted by yes I said yes I will Yes at 2:30 AM on March 11, 2016 [2 favorites]
Some comments from someone I know well who has done a lot of work with people suffering eating disorders:
Enthusiastically second the rec for Klarman Center at McLean. In DC, I'd hightail it to Baltimore for Hopkins. Their program is amazing and people come from around the country for it.posted by Chrysostom at 5:25 AM on March 11, 2016 [3 favorites]
MEDA is a terrific resource for patients and families. They may be able to help find a provider, as well as connecting you to educational resources on ED.
Beware the for-profit residential centers. They are, after all, for profit and this is a significant drawback. Also, they are not as well regulated as hospital based academic programs and can therefore employ some unorthodox "treatment" strategies.
Sad as it is, the Ensure story doesn't sound unusual. For many with ED, the primary goals of treatment are cessation of behaviors and weight restoration (if necessary). And taking too long to eat a meal is ED behavior, whether it's about fetishizing food, playing with it, or simply feeling afraid of the food. Ensure is commonly used to replace calories not consumed in a meal.
I would recommend Johns Hopkins Hospital in Baltimore, MD. Start inpatient and eventually move into the outpatient day hospital program. I know of several success stories over the years. The nursing staff is great and people do come from all over for treatment.
posted by maxg94 at 7:19 AM on March 11, 2016
posted by maxg94 at 7:19 AM on March 11, 2016
A teen I know is alive because of the Emily Program, in Minnesota. They have clinics in some other places as well. But I don't know if they have the approach you're looking for -- the teen is a family friend and I don't know all the details.
posted by The corpse in the library at 6:15 PM on March 11, 2016
posted by The corpse in the library at 6:15 PM on March 11, 2016
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Do not trust what your daughter tells you about her experiences. Anorexia, Bulimia and binge eating all come with the same host of bullshit any addiction does. Hiding consumption (or non consumption) of food, lying about quantity of food, and a whole host of other behaviors.
When you first enter treatment it is VERY uncomfortable. You're being asked to relinquish everything you embrace in your disorder. An eating disorder is a comfort mechanism, so you want to retreat into it when you're uncomfortable. To face discomfort without your usual coping mechanism is very difficult. THIS is why she left the treatment center. It is NOT uncommon to be requested to eat everything given to you in a required period of time in a treatment center. Anorexics will push food around on a plate and dawdle and whinge and whine about the food. Bulimics may do the same, mostly because it's not the food they want, and they also know that they'll be monitored to be sure they don't purge it. Overeaters may fiddle with the food because they're feeling exposed and judged. There are reasons.
Your statement, "we not taught that eating healthy includes slowly eating and enjoying a meal?" says a lot about how you view this process. Rather than trusting the counsel and experience of experts, you're making excuses.
Seek a support group such OA Anon (similar to Al Anon) so that you can be supportive without enabling.
Get into a support group, eating disorders are VERY difficult to beat and there will be many setbacks before one can be said to be in recovery.
posted by Ruthless Bunny at 3:07 PM on March 10, 2016 [22 favorites]