Anyone experienced with 13 year old daughter, middle school drama and borderline eating disorder?

As usual, I turn to the Dope for a kickstart.

Twin A is going into 8th grade. It’s a really good public school that is 6-12, with less than 100 kids per grade, and requires winning a very over subscribed lottery to get in, and pulls kids from across the district. Trouble makers or kids that really don’t want to be there tend to get weeded out.

6th grade seemed to be all girl drama all the time. 7th grade was a bit better, and kidlet has a district therapist session every two weeks. Sleep issues made us go to the sleep clinic, and we were referred to a child psychology intake session at the Children’s Hospital 16 months ago, but my wife (who has depression and taking drugs) hates therapy and vehemently opposed any further psychiatry.

Eldest daughter clued me in on just how much anxiety is percolating thru Twin A’s veins. Long story short, we’ve finished 2nd week of 8 weeks of teen group therapy on recognizing/coping with anxiety (parents have a separate session at the same time). Need to complete the group before moving on to 1:1 if warranted. Twin A really likes her group, I’m learning a lot, and we’re working thru an anxiety treatment process and plan. Mom thinks it is useless, but we’re getting divorced so I no longer allowing Mom to be a blocker. The Anxiety group will not cover eating disorders but I got a referral today to the Children’s eating disorder program (with a long wait list).

Well, 6 months ago Twin A decided she wanted to become a pescatarian. I have no issue with that and when younger was pretty hardcore vegetarian and then loosened to pescatarian for 10 years. Twin A is now trying to cut out the seafood, which is stressing Mom out and inconveniencing our lifestyle. Twin A also yesterday explained that she understands intellectually one of the big drivers is to “take control” but she’s not about to be bulimic or anorexic (education has worked on raising up those issues I guess).

Twin A, Twin B and eldest sister went camping in Banff for a week earlier this month. We generally ate breakfast and dinner at the campsite, but also a couple of meals in town and on the road.

Very pronounced food avoidance that has gotten worse this summer. Every meal in a restaurant or fast food had some form of “i’m not very hungery” “I don’t feel like eating” “I feel sick”. This included when we made a special stop at A&W which was running a national ad campaign about their veggie burger. She didn’t finish the burger, picked at some fries, and only had a sip or two of the root beer…and that was probably her best eating. Breakfast would be one egg and a strip of veggie bacon. Dinner would be partially eaten small portions.

She enters what she eats into her phone “to make sure I get 2,200 calories per day.” So, at best she is tracking calories to hit the minimum, which I suspect is also her maximum. She does snack several times a day, but no longer makes a couple of eggs after school like she did 6 months ago.

She skipped lunch at school a lot I found out belatedly. She doesn’t like to wait in line, and also claimed if she ate then would feel sick in PE.

Twin A and I agreed 2-3 months ago that she would eat something at regular meal times. I make her breakfast in the morning. Portions are getting smaller. She used to have at least an egg, small glass of milk, maybe so yogurt or toast. Now its more like one piece of toast and small glass of milk. I make sure she has granola bars, instant Pho, apples, etc at school. Sometimes she will take her lunch to school but usually not.

Last night, she made fried rice for Twin B, herself and me. I made vegetables and a tofu mushroom dish. She at a small rice bowl of fried rice, 3-4 chunks of broccoli and said she was full. I told her we have a serious problem, she rolled her eye multiple times but listened a little. Tonight she ate a modest amount of pesto pasta, a more regular helping of cauliflower, and a couple of chunks of tofu.

That’s pretty long winded. I’m concerned and it’s getting worse. There’s almost too much eating disorder stuff on the interwebs, so turning to the SDMB for experienced suggestions and a useful website or three. As always, thank you in advance.

Stay on top of it. Sounds like you’re doing everything right. I would imagine trouble between you and Mom are not helping. Not to mention drug use.
The lil’wrekker had food control issues in early teenage. She never wandered into real bulimia or anorexia. But she did have body dysmorphia syndrome. She was tiny ( still is) but thought she was getting fatter as she grew, normally. I talked and talked and talked, right through the eyerolling and ‘oh,Moms’. I hope y’all can hang on til you get to the food group therapy. Good luck.

Has she lost weight? Has she had a checkup (with a regular doctor) lately? If not, that might be a good idea, just to make sure she doesn’t have any physical causes (other than the anxiety) affecting her appetite.

Almost exactly like my daughter at that age, though she has always been a bread and milk-disposal unit. Those two managed to sustain her all these years. Now at 15 she’s open to trying out new things, thanks to peer pressure (hey, I was going to suggest that!)

Check to see if she’s lactose intolerant. All you have to do is cut out Dairy for a day or two.

I think encouraging her to do more of the cooking, including shopping and prep, sounds positive. It would get her thinking about food in terms of doing something for other people.

I’m not an expert by any means, though. It just struck me that it was a way to talk about food without focusing on the amount she was eating. It takes the focus off herself while also giving her an outlet for her need to control.

But like I said, I’m not an expert. My niece is just starting that age and I’m trying hard not let her see me noticing. Fortunately, she likes to cook, and is a sucker for the ice cream maker.

Is she on medication? My stepson lived on air for years due to his various mental health medications. My godson was the same way- his mom would take him off his ADHD meds on the weekends (she is a psych nurse and did this with full support of his doctor) so that he would have at least two days a week where he ate normally. Both eventually grew out of it, though neither could be considered big eaters.

She may also be going through hormonal changes that make everything taste wrong or disturb her appetite. She’s at about the right age, and not all of us wimmenfolk eat everything in sight when The Change happens. :slight_smile:

Maybe consider suggesting protein shakes as snacks? Blend up fruits, or veggies, or combinations with high quality protein powder and milk or juice, and at least she’s getting quality nutrients. You may not win the battle in quality, but you can fight a darn good fight in quality.

Appreciate the replies and keep 'em coming.

Twin A is turning into an accomplished baker. Although in the past couple of months, she has only nibbled on her creations (ex half a cookie) whereas previously she would eat a couple of cookies. She also likes to cook basics like eggs, mac n cheese, Chinese dumplings, fried rice, veggies, etc. Even with what she cooks herself, she is obviously eating much less than I think is “normal.”

There is obvious food avoidance. On our great Canadian road trip to camp in Banff, I was with her 24/7 and it was painfully obvious. Big sister saw the exact same thing and expressed her concerns. This is still borderline I think, but want to make sure she stays on the right side of the border. Dealing with anxiety will help and I’m sure it’s part of the whole challenge. I am seeking out professional help at Seattle Children’s but don’t know how long it will take. Their initial evaluation is actually two sessions with a psychological eval and a physical/medical eval.

Again, making sure she eats something at mealtimes instead of skipping. I make her breakfast so she has something in her stomach. Big sis is gone so I’ll be driving her and twin to school in the mornings, and that will give another opportunity to talk daily.

Would also appreciate if someone has a recommended book or website that you’ve used and found to be valuable…

My daughter is roughly the same age and has close to the same issues. If Twin A is not losing weight, I wouldn’t panic yet. Appetite can vary widely at this age. I do see a flag with the tracker, although 2200 calories is high enough that it seems that she’s being healthy.

Here are some things to consider:

Medications may be impacting her appetite. Take a look at her meds and side effects.

Drama in the household: My daughter went through a long period where she only wanted to be in her room, so she wouldn’t come out to eat. You may remember that my son is autistic. When he hits a rage, she hides. If there is any sort of unpleasantness going on the household right now, your daughter may simply prefer to be away from it rather than to eat with you.

Drama at the table: same idea as above, but specifically relating to meal-times. My daughter would feel ill at meal-times. Her anxiety would kick into high gear and she would leave the table.

Some suggestions:
Move up the timetable to get her into 1:1 therapy. It sounds like she would benefit. Her therapist would know better whether or not she has an eating disorder, but you should get in front of this now.

Focus on her health and not her eating. Talk to her about staying healthy. If she’s genuinely not hungry, well, that happens. If she’s leaving the table or avoiding the family because of fights or tension, give her the option of eating later or in her room. Once you have a plan, drop the topic for now and see if she can stick to it.

I know it’s hard, but I think the more you make this an issue the more it becomes one. You focus on her eating, so she focuses on her eating, so you focus on her eating, and so on. Try pulling back a little. Maybe give a little more thought to areas of her life where she feels she has less control? What can you do to help her there?

I’ll check into a book with my kiddo’s counselor and let you know.

The more you make it clear that you are concerned about her eating, the more she’s going to realize that she has you by the tail with the issue.

The people who suggest that she may be trying to avoid mealtimes to avoid interacting with unpleasantness are probably right.

If she really is getting 2,200 calories a day, she is getting plenty of calories, but if she wants to be a vegetarian, she needs to eat protein in the right forms.

You might try forming your inquiries into what she is eating as instruction in how to be a vegetarian/pescatarian, or whatever she wants to be. Instead of letting her know that you are concerned about whether she is getting enough calories, frame your concerns as concerns about her protein intake because she wants to be a vegetarian/pescatarian and you have experience here. It is possible that she is snacking between meals, and is actually getting the calories she says she is, but still isn’t eating well because she isn’t getting enough protein.

FWIW, I went through a depression when I was in intermediate school, because my aunt, who’d taken care of me a lot when I was younger, had moved out of state, and my issues I’d always had with my mother had gone nuclear. My mother got a research grant, and lived in Prague for almost a year when I was 12, and a lot of people thought my funk had to do with my mother being got, but that was actually the best part of the whole time. I was still missing my aunt, but at least I wasn’t having blow-ups with my mother a couple of times a week.

I was really thin during this time, and I don’t remember my father being especially concerned about it. It was never an issue, and it’s probably a good thing. I walked a paper route every day for 2 & 1/2 years, and rode my bike to school every day, plus rode to the train, and went into the city on the weekends a lot, and many weekdays in the summer, and walked and walked when I was there. I was burning a lot of calories. My father didn’t bake, so there were never cookies or pastries in the house, unless I baked them, which wasn’t often, or my grandmother brought some over, which did happen, but we weren’t overflowing with them-- my mother made something every Friday for Shabbes. And I was the one who ended up doing a lot of the cooking-- on Shabbes we went to my grandmother’s. I made more pre-packaged stuff than my mother did, and there were fewer leftovers. There just wasn’t as much food in the house, and nobody really cared.

When my mother was there, I didn’t feel like eating family dinners, because so often, dinner ended up in an argument of some kind with my mother. I left a lot of dinners unfinished.

Now, this was in the late 1970s. There was little awareness of anorexia nervosa. It was several years before Karen Carpenter died, which really set off a lot of the awareness campaigns.

I don’t think I was ever headed toward anorexia, though. The problem was more a sort of anhedonia. Not in food, or anything else. There were some times when I was happy, but not like I had been before my aunt moved. My happiest times were when I was playing pinball or videogames in the city with my best friend, or when I was playing D&D, and those just weren’t snack times.

If your daughter is depressed, she might not be able to find pleasure in anything, and that includes food. When she’s hungry, she eats until she isn’t hungry, and that’s the end of it. But if you keep suggesting that she is anorexic, and it’s important to you to have an answer to the question, she may give you one just to settle the issue. That’s the last thing you want.

Now, IANAD, and I don’t know your daughter. A visit to her doctor, her PCP, that is, might be in order. A growing child should not be losing weight, and if she is, then you have real reason to be concerned; albeit, as people have pointed out, if she is on medication, she could not have an appetite for that reason-- a doctor can tell you what weight loss might be normal or acceptable in that special case. If this were my daughter, I would see the PCP.

But keep pursuing the therapy. It sounds like whatever is happening, something is happening that needs attention. Her mother may not want to think that her own problems have been visited on her daughter through genetics, or she may have been forced to endure a lot of talk therapy before she could see someone who would give her medication that helped her-- I can see a lot of reasons that someone with her history would be resistant to your treatment plan for your daughter. But the more salient fact is that right now daughter is cooperating with it. You need that. So stick with it.

That’s all I’ve got.

My daughter crashed and burned emotionally at that age. In my not-textbook experience, here are some things to look for:

  1. Ulcer, colitis, Crohn’s disease or something else that makes it uncomfortable to take food.

  2. Turmoil at home is the most obvious emotional cause, but could also be turmoil at school. Have you talked to her teachers? Has anything changed in her circle of friends?

  3. Some sort of sexual abuse or sexual issue. Not to be Freudian, but she’s going through puberty, which can be upsetting for anyone. And when my daughter went through her problems, sexual abuse was one of the first things her therapist looked for.

  4. Adolescent depression. That could call for a combination of therapy and medication.

  5. It could just be one of those things. My niece went through a phase like that. It went on for a couple of years and sometimes led to dinner-table fights between her and her mother. Then it just stopped and she developed a normal (huge) adolescent appetite.

I recommend you step things up before the problem gets worse. Have her physician examine her, try to get her into individual therapy, and have a talk with the school to see if her work habits or grades are changing.

Kunilou - thanks for sharing.

  1. I don’t think so but it is tested for as part of the Seattle Children’s adolescent clinic evaluation process
  2. Got plenty of that. Divorce starting, and some friends/classmates with serious issues such as cutting
  3. Find this highly unlikely. No opportunity. don’t think I’m indenial
  4. Probably. Anxiety for sure, and working that through the group counseling, which is really helpful. She gets counseling sessions at school as well.
  5. Could be a phase, but I’m concerned to prevent it from getting worse. Again, dialing down the anxiety levels should help. Also, got referred for evaluation as an eating disorder but sadly the waitlist is long.

Twin A food avoidance has slowly increased over the past 5-6 months. It’s not just dinner, but pretty much every meal for 9 days when it was just my three daughters and myself.

The anxiety is impacting getting a good nights sleep, which negatively affects everything. Learning to cope with the anxiety, which the group therapy is very helpful with, will hopefully bring down the anxiety level. I have found that removing or reducing even one stressor (or whatever the magic number is say 3 or 5 stressors), gets the overall level down to something more manageable/less impactful, better sleep, less stress, virtuous cycle.

Yes, there is the divorce stress, my wife doing things like flipping me off behind my back in front of the kids/talking smack either in front of the kids or to the kids, teen drama at school, Twin A taking on the burden of acting as a “therapist” with her teen friends girl drama (she’s learning to respond I’m your friend and not your therapist, here’s the number of the teen crisis hotline), has a friend that is cutting and turning to Twin A for help (I have intervened with the parents in question once I found out about this), looking out for Twin B (who is on the autism spectrum), starting 8th grade next week, big sister going off to University in LA for the first time, etc. There’s a lot going including the anxiety around talking to a store clerk or an irrational fear of being kidnapped when she goes out of the house. Yes, and puberty. And figuring out sexual orientation.

School is very supportive. She has a 1:1 counseling session at school every week. Teachers have relatively small classrooms and are aware/or being made aware of her anxiety about asking questions in class.

We did a psychoeducation assessment earlier in the year at the University of Washington school psychology program. Pretty comprehensive where a master’s student under direction of a professor, did a whole study. Interviewed teachers, observed in class behavior, I filled out volumous surveys and was interviewed, Twin A filled out surveys and had 3 interview sessions. Findings were Twin A is very smart, but 90%+ percentile for anxiety.

Does she do any physical activities? I found swimming (went back to it as an adult, took some lessons and started going by myself) to be helpful in alleviating stress. Also learning how to “breathe properly” helped me (associated with going back to swimming, I would walk around holding my breath). Doing some family yoga? Tai Chi? Those things where you breathe, and you stretch can help get the breath-holding, and the muscle tension, and the stomach-in-knots things under better control.
Something associated, but “fun”? Singing lessons?

If your goal is to ensure she is well nourished, you could try letting her eat in private.

If your goal is to ensure she has a healthy relationship with food, insist she prepare the food and let her eat in private.

Familiar, though less extreme for us. Our 14YO was self-harming and (as I learned going through her tablet) posting depression memes on an anonymous Instagram account and googling the horrible things some teenagers think about themselves (why am I so fat? why does nobody like me?). She has also been step by step reducing the number of things she will eat, and trying to skip entire meals.

Therapy has helped, however (glad to hear your daughter has that). We also took her in for a physical and learned she’s had absurdly low iron and Vitamin D levels because of the reduced food intake, so we’ve been getting her to take supplements, and those also seem to be helping.

The other thing that has helped has been getting her more involved in physical activities, in this case horse riding. She’d already been taking lessons, but we upped the frequency of them and she’s started engaging in competitions…that part of her life seems to completely destroy any depression, at least while she’s doing them.

Good luck with this, I know it’s stressful.

My ex-borderline-eating-disorder-teen said: is she on Tumblr? Instagram could be another danger site. There are some online communities that reinforce this behaviour pretty strongly.

Can you clarify please as I am missing something here?

#1 message of the anxiety group is to NOT enable avoidance. In fact, the opposite is true, with the therapy very focused on how to recognize avoidance, how parents should absolutely not enable avoidance, how to self analyze anxiety causing situations, how to step by step expose your child to anxiety causing situations in a very planful way to address and mitigate anxiety. Eating in private is the opposite of what the professionals at Seattle Children’s Hospital are coaching my daughter and myself on how to deal with these issues. Maybe there is something nuanced about going down the bulimia path that you can enlighten?

FYI, she does physical activity. Runs 5+ miles per week in PE. I’m looking into martial arts class options again (I did martial arts for 5 years at a very family oriented dojo so very supportive). A year ago we were not able to find a good fit, but I’m revisiting this again as there are a ton of benefits (exercise, discipline, breathing control, and knowing how to break bones is a big confidence booster).

Not on Tumblr, Instagram and barely on Snapchat. Understands, at least intellectually, the potential toxicity of those sites.

This is interesting CG. I appreciate you flagging this. I mentioned the opposite in my earlier post because my daughter will eat away from the table, but will not eat at the table, so I have allowed it. I’ll be adding this to the list of things to discuss with the therapist.

Be interesting to hear what your therapist says. It may be eating disorders are different.

I meant to add on the non enablement post. This week in the parents coaching session, and I think this is anonymous enough to not be breaking the code of silence inside a support group, one parent raised that their child will vomit not once but twice at school as the school rule is two pukes and the parent MUST come pick up the child. The doctor leading our group said "very simple guideline, no get out of school free cards with the exception of running a fever. No avoidance. Nurse visits limited to 5 minutes and then back to class. Bathroom breaks 5 minutes and then back to class. You name it, and back to class. The child absolutely cannot be allowed to avoid class for any reason except running a fever (let’s be reasonable and not throw in what about a live shooting situation, asteroid strikes, the Cubs winning the Series again, etc). The parents are putting in a 504 plan (I think that’s the right one) to address this.

There are judgement calls for the parents to make, but be very clear about enabling avoidance. It’s painfully obvious how much avoidance I have enabled in retrospect. It’s a negative feedback loop. Looks like this in a scared of the dog example: child sees dog >> child feels anxious >> child avoids >> adult comforts/rescues/protects >> child’s anxiety temporarily decreases >> child reinforced for avoidance >> child sees dog >> and the enablement cycle starts all over again. Certainly I have played the part of parent rescuing from an uncomfortable situation, and if I could do over would act differently. That said, don’t have that luxury, and there is some baby step tough love actions that we will discuss in advance and then follow thru on in a very planful way based on professional guidance.