Forced into treatment -- HELP!!!

Mental health
1

Okay.  Where shall I begin.

I am a fifteen year old girl.  About two years ago, I got introduced to the raw vegan diet.  At first, I was innocently experimenting with it, but after a while I became more and more strict on this diet and created more and more rules.  I moved into fruitarianism, and though my weight was dropping, I was convinced that this was healthy weight loss.  My mom put me in touch with a raw food nutritionist to try to gain some weight back, but that didn’t work because I had no intention of doing so.  Finally, my school counselor recommended to my mom to take me to an eating disorder clinic for an evaluation.  With a resting heart rate of 44, I was hospitalized on the spot (sent to an eating disorder comprehensive care unit).  After I left that horrible hospital, I was supposed to continue “nutritional rehabilitation,” but I did no such thing and soon lost all the weight that I gained in the hospital.  

So I got sent to an eating disorder clinic, where I went for partial care treatment and then inpatient treatment for a month.  I was supposed to continue going there, but my mom and I had planned to move to Bali that summer, so my mom took me out of the program before I was “recovered” and hoped for me to continue gaining weight in Bali.

During the first few months in Bali, I was super motivated to gain weight.  Also, my school wasn’t allowing me to do sports until I did gain some, so that also motivated me.  I was having frequent hunger signals and was happy to respond to them.  

Then, at the beginning of 2015, seeing that I had gained some weight on my own, my school allowed me to do sports.  So I lost my motivation to gain weight, started exercising every day, and skipped meals.  So I lost weight.  

Now I’m back to the same weight that I was when I was hospitalized the first time.  I weigh 80 pounds and have a height of 5’2”.  Seeing that I lost weight, my school said that I can’t return to school until I get treatment.  So my mom got tickets to go back to America for me to go to the hospital and then do an intensive partial hospitalization program over the summer.  

But here’s the thing.  I don’t actually have an eating disorder.  I never did.  The reason I skipped meals and lost weight after I was allowed to do sports was because everyone convinced me into behaving like I have an eating disorder.  For the past year, my mom, doctors, and all sorts of people have been telling me that I have an eating disorder, and so finally they managed to convince me into behaving like I do have one.  

But now I have changed.  I have recognized that I have control over my thoughts and that I choose whether I have this “ED” or not.  And I am prepared to gain weight on my own.  I eat A LOT more than people think.  I get frequent hunger signals and eat whenever I’m hungry (about 2000 cals/day), but since I’ve been maintaining weight this way, I’m prepared to eat more to gain weight.

We were supposed to fly to America today, but I rode away on my bike and didn’t come home until I was sure we would miss the flight, which we did.  This is because I know I don’t need treatment.  I can do it on my own.  Even though I tried to gain weight and failed before.  This time it’s gonna work.  

But my mom doesn’t think so.  She doesn’t trust me.  And she wants to force me into treatment.  But I don’t have an eating disorder!  I can recover weight on my own!  Please help.

2

Hi - it's not what you want to hear, but you do need help.

I'm glad you have admitted you need to gain weight. Sometimes we need to trust the people who care for us too.

If you are not physically in danger, you can probably manage recovery with a therapist and dietician, but outpatient eating disorder recovery is very challenging.

Sometimes, it's easier to go inpatient, because you have the 24/7 support of caring nurses (when you just want to cry), others going through the same thing, extra group activities, 100% focus on recovery, and you have to eat your meal plan, no excuses.

I won't lecture you about your current food behaviours/restriction diets, but one thing they will get you to question is whether you vegan lifestyle is a part of the eating disorder. 

You have mentioned you are 15 years old, which is an integral age for physical development. Therefore, it's not the age to be experimenting with different diets, even though I know it's inevitable. You will experience stunted growth. I should be 2 inches taller, and have other issues which my e.d. has contributed to.

Do you know what caused you to have a difficult relationship with food? It's maybe worth having a think about why you became vegan, then what led you to cut out more. Were there particularly difficult events happening in your life at the time? Were you trying to fit in with others in your year group? Was school becoming overwhelming? There are all sorts of reasons.

I am not a consultant psychiatrist, and therefore not qualified to make a diagnosis. I've yet to come across anyone on here who is, but I have lived with at times a very serious eating disorder for 15 years. I have seen people much worse than me, and seen people make a full recovery. I have had peaks and troughs in my own battle and am beginning to do really well now. 

What I do know, is that early intervention saves lives. I also know that I'm far better now, emotionally having commited to treatment.

You might be right, you might have something else which is causing you to lose weight. Pancreatic cancer causes a deterioration in appetite and weight. So it's probably better you minimise all other physical conditions as well.

You only get one body - choose recovery

3

Hi, thanks for your response! I'm writing this from the hospital... You mentioned in your post that outpatient recovery is challenging... Why is that? I understand that for some it's challenging to eat more because of the ED getting in the way, but in my case I don't think that will be an issue because I have had a change in mindset. Is outpatient recovery also more challenging just physically, in terms of getting enough calories? Does the structuredness of a program such as partial hospitalization make the weight gain process more effective and manageable? Thanks!

4

No worries at all. Happy to help.

Managing recovery as an outpatient is a challenge, because you have to do everything yourself. You are allowed "bad days" or "off days" but when you have those struggles it is far easier to fall backwards.

If you are coming from an eating disorder mindset e.g. the eating disorder is doing all the talking, then that sounds great. You can cut corners from the regimented structure of the inpatient unit.

It's what I did. I couldn't understand why they wanted me to eat so much when I was in my final months of inpatient treatment. I was desperate to get out. I managed to manipulate my way out (turning 18 also helped), and as soon as I got home I started justifying why I didn't need various aspects of my meal plan. 

A year later I relapsed fully, and should have probably come back in again.

It's taken several years to get to this point.

I wouldn't say outpatient is completely alone, but I have had to do it mostly alone. That's why it is so hard. I've seen a therapist weekly, and a dietician fortnightly. But on the 6 days a week when I didn't see anyone, that's where it's tough.

And it's then you realise there's a reason for the rigidness of the inpatient unit. 

You're right, yes getting enough calories is an issue, but I would try and avoid thinking in numbers. That tends to fuel anxiety. Recovery is all about learning to be balanced and healthy in outlook.

Before you can start understanding the emotional issues, you need to recover physically, which means gaining weight, which means you also have to come to terms with your body changing shape. This sucks, but it is part of recovery. You can't recover and have an ill body. Likewise you can't recover and have detrimental behaviours. An alcoholic has to give up alcohol, and someone who self harms, has to give up harming themselves before they can understand the roots of the problem. Eating disorders are the same.

Why is it harder outside the safety of a unit? Because all this time when things are changing, you will be feeling a whole range of emotions, including a change in hormones (I recommend doing a food and mood diary btw).

The safety of the uni means that when you want to scream at someone or something, or you don't want to get better, or you think it's a waste of time, there are people around you, all the time to help you.

At home, you don't have people who are trained, and it's easy for the eating disorder to take over.

That said, people do manage in outpatient too, but it's so important to stick to the plan and have a good support network.

Trust your treatment team