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Dr. Michael
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience:  Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
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Topic Anorexia Background Our daughter and family (hubby and 15 years twin girls) liv

Customer Question

Topic: Anorexia
Background: Our daughter and family (hubby and 15 years twin girls) live in Colorado. Girls are truly bright and exceptionally charming but, socially inept. At school they speak with no student, worried to raise hands, can barely muster courage to order anything in a store, afraid to approach people.

One of them is a controlling, and, brilliantly manipulative young lady. She can get her way with brilliancy. Mom, deeply involved with kids (perhaps too involved) but with “forgiving and inconsistent” approach.

We, grandparents, live in another state. July last year, while family spent time with us we noticed anorexic behavior of one girl. Parents, ignoring signals, remained in denial until September when major crisis erupted. The girl who lost about 27 pounds (reached 100 pounds), felt bad. Mom took her to Dr. and as pulse was 45 she was admitted to emergency room.

Girl was then admitted to Children's Hospital in for outpatient (half days) (to be contin
Submitted: 3 years ago.
Category: Mental Health
Expert:  Dr. Michael replied 3 years ago.
Hello. I believe I can be of help to you with this issue.

As you know, anorexia nervosa is a fairly chronic, relapsing disorder. I would hope that the treatment team ask to meet for a couple of family sessions to discuss and work out a plan for the daughter with anorexia to gradually eat comfortably without the sister present all the time. You mentioned that they wanted to do this step by step but it went nowhere. What was tried and what happened (if you know)?

There are no high schools I know of that treat eating disorders. However, there are some very good residential facilities where girls live in and continue their studies e.g., Avalon Hills ,Center for Change, both in Utah.

Relapses occur because the patient very gradually stops doing things psychologically that they learned to cope with stress and the myriad of emotional issues. Their individual therapy sessions may plateau or stagnate and most importantly, they begin to regulate emotions and stress through the maladaptive thinking and behavior patterns they fell into when they became anorexic. The same general principles of relapse are present in eating disorders as they are in drug/alcohol relapse, weight loss relapse, etc. Most simply, the patients stop doing the things that helped them begin to recover and when faced with new stress in their life, they gradually begin to fall back into old patterns of thinking and coping. Dealing with relapse is actually not a complex,new treatment, but a very patient, deliberate re visitation of what helped the patient recover, examining how they abandoned that behavior, ways of coping with stress and negative emotion, etc. The fact that the girl with anorexia appeared to be on a solid recovery path is a very good sign. Usually, it doesn't take as long to get them back on track when they relapse, if they have at least one good experience with a "recovery trajectory".

Let me pause here because I could ramble on and on; I want your feedback to make sure I'm answering your question.
Customer: replied 3 years ago.

Many thanks. Response helpful and in many respects confirms some of our knowledge, but knowing that anorexia suffering can produce an endless stream of relapses, in particular when dealing with control freaks, is unnerving.

Regarding separation of girls. They have been in same school, same class since kindergarten. Last school year only one attended school which provided some separation. This year again same school, thouhg not shared classes, but anorexic wants her sister to sit with her for diners.

Ttherapist recommended that the girls should sleep in separate rooms. They refuse. Therapist recommended that as first step the door of sleeping room be taken away so that they are not closed. Not done. To make things worse they keep comparing themselves to each other and find the other better at everything.

Will not go on and on and you can shed some more light this will be great. Thanks a bunch

Expert:  Dr. Michael replied 3 years ago.
The issue of sleeping together in same room isn't as significant as the waking hours dependency behaviors the girls engage in. It is in the waking hours that maladaptive dependency and unhealthy coping behaviors are learned. Once the anorexic daughter's eating and weight are again stable, the parents must enforce some graduated schedule for the girls eating apart, IF the anorexic's sister feels that eating together is a burden. If it is not a real burden, it is more improtant for the patient to simply remain stable with her weight, continue eating normally, etc. This stability will make her psychotherapy and other recovery work go much more easily. The schedule would involve the parents identifying strong incentives and using them to reinforce episodes in which the girls eat apart. I won't go into the details of how exactly to do this---a good psychologist would easily plan this out.

The parents can be coached to continue to find different and unique activities for each girl to be involved in so mutual comparisons can't be made as readily. As the girls get older, they will naturally evolve separate interests, groups of friends, etc., but the parents can accelerate this process a bit by actively encouraging it.

It appears that your grandaughter is obtaining services from very good therapists in a very good treatment program. I wouldn't consider an alternative placement unless it is clear that the relapse remediation attempts are not working. As I said, I personally don't think the sleeping issue is as important as the waking behavior events. I wonder if the parents are being as consistent, firm and focused as they might be in following through with treatment recommendations.

Are there other issues you would like me to address at this time?
Customer: replied 3 years ago.

You know, Dr Michael, there are always "other relevant and connected issues". But this will be taking it too far. You have fully responded to our questions and we express to you our appreciation and thank you very much

The Tals

Expert:  Dr. Michael replied 3 years ago.
I must say I wish every kid had grandparents like you.
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience: Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
Dr. Michael and 4 other Mental Health Specialists are ready to help you
Customer: replied 3 years ago.
Thank you, XXXXX XXXXX most kind
Expert:  Dr. Michael replied 3 years ago.
My best to you.

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