The importance of the family in addressing eating disorders
What strategies have you used to adequately follow dietary and behavioral guidelines during treatment?
What strategies have you used to adequately follow dietary and behavioral guidelines during treatment?
Routine helps a lot in the day-to-day life of the whole family, and you should do your best to get the affected person into this routine. In our case, we tried to always follow the same schedules, even on weekends, to prevent, for example, him from skipping lunch because he had had breakfast late.
We had to eat six meals a day : breakfast, mid-morning snack, lunch, afternoon snack, mid-afternoon snack and dinner. The snack (or "tente", as we called it) could be a juice, a decaffeinated coffee with milk, a drink or, we had even gotten to eating sweets! This routine, which our daughter and I knew, had to be followed at all times and was non-negotiable, although at first she always tried. It helped me a lot to schedule all the meals in advance so that we could follow the instructions given to us by the center. We couldn't make single dishes, we always had to prepare a first course, a second course with accompaniment and dessert. On the other hand, she always ate with someone, and everyone at the table ate the same thing as her, so she couldn't compare. She couldn't leave anything on her plate, but we adapted the reasonable amounts she could eat, considering that she had six meals a day.
At all times we complied with the instructions of the health staff at Itaka (Mental Health Area of the Sant Joan de Déu Barcelona Children's Hospital), without any possible negotiation with my daughter regarding food, since this disorder shows you that you have to stand firm at all times and not give in as parents, no matter how much pity you feel for your daughter and the situation she is suffering.
At home, we divided up the pre-meal duties . My husband cooked according to the hospital professionals' instructions (the meal had to contain protein, carbohydrates, and vegetables) and I set the table. And we moved meals from the kitchen to the dining room so the three of us could eat together.
Once we had the dishes ready for the three of us in the kitchen – it's important to note that the whole family ate the same thing , which wasn't the case before – we brought them to the table at the same time. No dish came out before the other, so that my daughter wouldn't anticipate mealtime.
After eating, I wrote everything down on a checklist that the hospital had provided us. Ultimately, what gave me the most security was to follow the professionals' instructions at all times, without questioning them at any time.
When your daughter refused to follow the therapeutic instructions, what did you do to keep your temper?
When your daughter refused to follow the therapeutic instructions, what did you do to keep your temper?
At first it's difficult, because you don't know enough about the disorder yet and everything comes to you again. Later, I understood that it wasn't my daughter who was acting like that, but the "bitch", as we call her at home. A lot of patience, trying to talk, explaining why we had to follow the guidelines – although sometimes I had the feeling that I was talking to a wall – and counting to 10, 20, 30... and infinity. And never giving in , because I was clear that if I let my guard down, I had lost it.
I would let it go when we got into a loop that was leading us nowhere, only to emotional exhaustion, and then I would go back to it. I trusted that there were times when my daughter listened to me , "the hottie" was absent and understood everything we were saying: that we wanted her to be happy and that, to achieve that, she had to follow the guidelines of the professionals to heal herself. Many times, however, she couldn't and my husband would step in, and that's how we did it.
We also took advantage of the demanding and perfectionist trait that characterizes people with OCD. My daughter was, and is, so disciplined that if they told her she had to follow the guidelines to have more permissions, for example being able to go to school alone (small milestones that were set to motivate her), she almost always did it to the letter.
When we were at home and she refused to follow the therapeutic instructions, I tried to reason with her about why she had to eat (later I realized that it was impossible due to the disorder, since the one talking was not my daughter), and the result, at first, was always the same: we ended up arguing.
In order not to continue arguing with my daughter and not lose my temper, my husband and I agreed that the best thing for both of us would be to take turns and not exhaust ourselves both at the same time .
I understood that there was no point in reasoning or arguing, and in the end, I simply followed the therapeutic instructions, and if she didn't eat when she was home on weekends, we applied the protocol and took her to eat at the hospital.
However, it is impossible not to lose your temper when faced with an eating disorder.
Why is it important not to focus everything on food? How can it be done?
Why is it important not to focus everything on food? How can it be done?
Food is not everything, there are also obsessions, such as order, perfectionism, having many jobs to fill all the time and thus not thinking about yourself or connecting with your feelings, etc. It is difficult to cheat.
I remember that my daughter was always looking for jobs, she was given the opportunity to learn how to sew, and it was an obsession, every day when she came home from school she would sit in front of the sewing machine, then it was manual work, and so on, a lot of activities.
We had to stop this frenetic activity, so that he could learn to do nothing and have time to think.
We went out for walks a lot, but very calmly so as not to make too much physical effort, we didn't go up or down stairs, which was one of his obsessions, and we always tried to get him to hang out with friends, to socialize . We were lucky that he found a lot of support in his circle of friends .
He managed to reduce his perfectionism a bit , and worked in therapy on his obsession with order and his demands on himself and others. He also learned to be more tolerant and flexible . But there are traits he still has because they are characteristics of his personality, such as order, but in a healthy way.
All of this is part of the disorder, as much or more than the diet, it is the background that is not seen and that is more difficult and takes longer to cure.
Focusing everything on food only leads us to always be thinking about the disorder and to anticipate the moments of anxiety and stress that meals entail. A person with EAD has to face their fears five times a day.
We tried to leave the house and go to the seafront to walk (at a slow pace, of course); other times, we had tried to walk through a shopping mall and go shopping, an activity that was a mistake, because when my daughter saw clothes she got nervous. On other occasions, we tried to watch a movie or a series together, and only on one occasion did we go to the cinema. We also sometimes stayed with family, and, in our case, the person who helped us a lot was my sister-in-law and my nephews.
At that time, my daughter played basketball and had to stop for a whole season. As she recovered, she wanted to play again and we went to see her team on occasion, but very late in the process, as this disorder ends up isolating you.
Listening and expressing emotions is not always easy. What role do you think emotional management plays in the therapeutic process?
Listening and expressing emotions is not always easy. What role do you think emotional management plays in the therapeutic process?
That's all! It is very important to give them the tools to connect with themselves and listen to their feelings. Without this learning it is difficult to move forward. Making them believe in themselves, accepting their bodies and how they are, valuing themselves and increasing their self-esteem is the most important thing. Also fostering a critical spirit towards society and everything that is false.
Knowing how to manage feelings and show how they really feel, without having to pretend, gives them security and confidence. All this learning is long and requires a lot of effort on the part of the person affected. This is the progression I saw in my daughter during four and a half years of ups and downs, but in the end she made it, fighting.
Emotional management is key to the recovery of the affected person. Time passes very quickly and we always focus on work, studies, extracurricular activities, etc. And so the days pass, without dedicating time to ourselves and our family, and without expressing to the people we love that they can count on us.
However, when an EAT enters the home, time stops and the family is suddenly paralyzed. In our case, before the EAT, we did not often express our emotions.
The therapy we did every two weeks with families of people with some mental health disorder, not just ED, helped us a lot to identify our emotions at each moment and how to express them. At first I didn't understand why we had to get all the families together, but after a few sessions I was looking forward to Tuesday therapy, because I left the session with strength to face my daughter's situation , and I learned to connect better with her emotionally. I remember as an anecdote that at first she didn't want to talk to me in therapy, in fact, she sat next to her father and other people, and we even had to have a session with the therapists without the group.
In situations of stress or anxiety, what techniques have worked well for you to calm yourself down?
In situations of stress or anxiety, what techniques have worked well for you to calm yourself down?
When I was very stressed, I tried to isolate myself by going outside, taking a walk, talking to people who were not related to the situation; that way I would disconnect a little and come back with a backpack full of fresh air and more patience. Distress and anxiety are harder to bear.
I was lucky that we connected very well with a group of mothers from the hospital and created a WhatsApp group. In critical situations we would cry out for help and everyone would respond. When one of our daughters was going through low moments and we were anxious, we always found support. In addition, every Friday we would meet for coffee and talk about all our worries and anxieties. It was easy to explain things to them openly, because we were all talking about the same situations and we could understand each other without being alarmed. If you told a very good friend who knew nothing about eating disorders that your daughter was self-harming or other situations that were happening, she wouldn't know how to react; on the other hand, in this group of mothers, from our own experience, we could give each other advice on how to manage some situations.
Being able to talk helps you a lot and you feel supported in the long journey to your daughter's recovery.
In situations of stress or anxiety I did not use any technique to calm myself down, since as a mother of a girl with ED you do not have time to dedicate yourself. In my case, I experienced my daughter's mental disorder intensely 24 hours a day, seven days a week ; even when my daughter was admitted to the hospital, although it gave me peace of mind because they were treating her and it meant that she would recover, I could not stop thinking about it, I could not disconnect.
I didn't do any physical exercise, because it's one of those activities that if the person affected finds out you're doing, they want to do it too, and I couldn't due to medical prescription; nor did I practice meditation or any other relaxation technique, since I couldn't concentrate on anything other than the TCA . It's a time that, after six years, I try to remember little about –I suppose as a survival mechanism–, although it is and will always be present in my life.