@Householdceo here is type of inpatient care, along with family care. Just fyi. Your care provider can best advise.
http://www.nightingalehospital.co.uk/inpatient-services/
I was in group parent therapy with one kid for a very short time. Teens, mostly young women, were participating for all sorts of reasons. Mood disorders, depression, angry outbursts, drugs & alcohol abuse, self-harm, eating disorders – it was group DBT therapy with the focus on learning how the mind works and how to manage one’s overwhelming emotions.
I really think a family (or the decision maker in the family) needs a LOT of support when they are about to make a decision that could result in the young person harming herself further, or running away, ==fill in your own nightmare scenario==. A good therapist will help you make an informed decision and help support your emotions and steel your back.
It can be immensely helpful to talk to other people who have walked in your shoes, if a parent support group is your thing. Fair warning, I found it extremely difficult to listen to other parents’ pain & found myself sobbing in the car afterwards on more than one occasion.
And, I agree with @MaineLonghorn who said, way upthread, that it affects the entire family and even the kids who seem to be handling everything alright, might not be.
My oldest child is a mental health counselor who works in an eating disorder facility. As others have said, eating disorders are life threatening. It is a mental illness which manifests through physical illness. You must treat the mental illness. This cannot be done in 1-2 psychiatry sessions a week and antidepressants.
There are many levels of care, and it sounds like she needs to be in a much more acute level. Treatment levels include hospitalization, partial hospitalization (basically full-day care but the patient sleeps somewhere else, either at home or a supervised housing facility); intensive outpatient (again full-day care but not quite as intense as partial hospitalization) and outpatient. At the beginning of treatment, generally hospitalization or partial hospitalization are required. Many have feeding tubes. All are supervised during meals and afterwards (to make sure they are not purging).
Eating disorders are often comorbid with other problems–self-harm, trauma, etc. Patients are often in denial about the seriousness of their illness.
Please get your child the help she needs. Her life may depend upon it.
Hugs to you, OP!
“I’m afraid she will kill herself because of me. Let me repeat…I am AFRAID she will kill herself because I won’t let her go back and won’t let her live with her friend. I’m so daunted, sad and depressed myself. AND EXAUSTED…and burdened by all of the other family duties.”
She will not kill herself because of YOU. YOU are not responsible for anything she has done or will do to her body. The mental illness is 100% responsible. She will say ugly things because she can’t see reality right now.
" NOW how to force her into this choice? As @privatebanker mentioned…how do we get a 19 (nearly 20-year-old) to WILLINGLY get help?!"
If your checkbook is your most powerful weapon right now, use it. Make it clear that negotiations won’t begin until she is cleared by a doctor, has gained 30 pounds, and finds safe, parentally-approved housing.
Sending hugs, thoughts and prayers… You are indeed describing a nightmare!
I am, (and I think you are too) in complete agreement with everyone here that the eating disorder needs to be treated first and foremost. Your description of her study/eating habits show she is not remotely in remission of anorexia and the fact she hasn’t gained any substantial weight at home is further proof. This isn’t just about 30 lbs. …she is 94lbs 5’7" which as someone pointed out is dying territory. That is severely emaciated and severe anorexia. This needs to be tackled first and foremost!!!
Anti depressant use w young adults can have suicide as a side-effect so I would recommend she be closely monitored. If she has threatened suicide then you can involuntarily sign her in. Anti-depressants can also cause weight loss. she needs to be monitored closely while on them!!
I am wondering if there are any eating disorder programs inpatient/out patient in London that you could get her into. It may be way less $$ costly than American medical treatment. Can you get her a London psychiatrist/therapist?
Is there anyone/ family that could possibly be with her or take time off to be with her in London? (Just throwing out suggestions probably completely impractical) but if you cant find a way out bc she wont comply w taking a semester off or coming home then you or someone needs to be there to make sure she is getting the psychological treatment she dearly needs at the very least. .
I agree to use your checkbook power as that will save her life. I would stage an intervention like meeting w professionals. I agree get more professional input and not just from the psychiatrist, from other mental health specialists too.
Also as a side note look into zinc as a supplement, it can be helpful w anorexia https://www.ncbi.nlm.nih.gov/pubmed/17272939
“CONCLUSIONS:
Oral administration of 14 mg of elemental zinc daily for 2 months in all patients with AN should be routine.”
Where is home?
@Householdceo I thought of a friend after reading your post. I knew they could be of help to you. I can personally vouch for them. 
<<I’ve asked MaineLonghorn to post this as my identity on CC is public – e.g. people in my community know who I am on CC. Thank you in advance ML.
So my daughter had an eating disorder, anorexia, that started in the spring of her senior year. She was, and is, a high achieving student who had gotten into her dream college Early Action and was all set for the fall. We went to therapy and seemingly had things under control when we dropped her off at school that fall.
Well, nothing could have been further from the truth. It came back with a vengeance and she ended up taking a leave of absence after one semester to stay home and try to beat this disease. Well, she spent one year at home, working part time and seeing a therapist weekly along with a nutritionist. Treatment at first kept things at bay but things then went downhill in a hurry and she ended up with a couple of 20+ day hospitalizations by the end of that first year. The second stay was enough to get her medically stable and healthy enough to go to inpatient care.
She then flew to LA to go to a care facility called Monte Nido. https://www.montenido.com. They are simply a world class organization who I believe saved her life. She spent several months in inpatient care and finally was able to kill off her ED and has now made a full recovery. Some will tell you that a full recovery isn’t possible – I’m here to say it is – but it is really hard work.
She ended up graduating Summa Cum Laude from a different college (her choice – original school wanted her to come back), got her Masters in Marriage and Family Therapy, and is in a PhD program doing research into Eating Disorder treatments.
I started this way to say – I’ve walked in your shoes. Reading your posts, I’ve resonated with every word and can empathize completely. I also cannot emphasize enough that everything you have written and thought about London, apartments and attending the university is a red herring.
The focus now needs to be completely on beating the eating disorder.
She needs a treatment team now. A doctor who is the core of the team and will see her a couple of times a month. A therapist who specializes in Eating Disorders who will see her at least once a week and perhaps more. Some of those sessions are likely to be individual and some will be family therapy. And thirdly, a nutritionist who will see her weekly. From there, the team can make coordinated decisions around the need for more intensive treatment – either inpatient or outpatient care.
Your family may need to have their own therapist sessions as well. My wife and I decided to get a therapist separate from our daughter’s therapist. Our other child was away at school and got help through the university.
A few other suggestions.
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Throw away the scales. Eating Disorders are in many ways about control and a scale simply is another tool for control. No one in the family should actually know what she weighs. That’s for her team to know.
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A couple of book suggestions - 8 Keys to Recovery from an Eating Disorder by Carolyn Costin. And Goodbye Ed, Hello Me: Recover from Your Eating Disorder and Fall in Love with Life by Jenni Schaefer
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I’d suggest checking out the resources on the Monte Nido site above along with NEDA https://www.nationaleatingdisorders.org and a group called Project Heal https://www.theprojectheal.org
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Lastly, it is important to understand that when your daughter says hurtful things, makes threats, etc. it is really not her talking. Her Eating Disorder is the one talking – and your young woman is still in there somewhere – just getting crowded out by this disease. Fight hard to get her back and to kill off her ED. I’ll be cheering you on….>>
https://www.mcleanhospital.org/programs/klarman-eating-disorders-center
The problem with outpatient treatment is that eating disorder behaviors are the equivalent of alcoholics hiding bottles. They really need to be in an environment where they CAN’T starve, purge, use laxatives, or induce vomiting. And eating disorders can be like air in a balloon: solve the starving part and you will get some of the others.
Eating disorders also become very entrenched, and the person no longer processes feelings or experiences normally. This can become chronic.
Aside from the immediate danger, I am saying, that this can extend over a decade or more if not addressed properly.
If she mentions suicide -ONCE- call an ambulance. Record it if you have to. It doesn’t matter if she hates you right now. In fact, anyone getting in the way of her eating patterns will be hated. She can thank you when well.
Yes. This escalation may require you to involve a legal remedy to be granted temporary guardianship or other form of hospitalization. Consent or not this is beyond serious.
Really hope you can find the strength to look past the harsh words and fear. It’s hard but you can do it.
Yes, this can involve a desperate need for discipline, a sense of control. Obviously, misplaced. Yes, you have to watch what you say, because next to everything can seem to be an attempt to wrest control from them or to unduly influence them. Our urge to apply normal rationale doesn’t work. Nor normal motherly talking.
Read up (google) on what ED kids don’t want to hear. In many cases, they already subject themselves to intense scrutiny (of course) and we need to be cautious not to add.
One of mine also worked in a well known ED facility. Ironically, she’s just completing her own program at McLean/Klarman (in-patient and now partial. Atypical Anorexia, not thin.) What she knows from the education and work experience is that this is a long and cyclical problem, a struggle that exists.
Not a mistake that just goes away, not a temporary string of poor judgments to lose weight. Not a matter of forgetting to eat. Control (when one feels its absense) can play big.
In some ways, I think mine has a disconnect in the usual search for happiness, a normal sense of control, choices, and what will truly be effective and, in the long run, healthy. (See how I’m still being the rational parent?)
I’m trying to write this and not getting the right words. It’s hard to look at this from the outside (parent,) think you know what to say or do, what’s real progress. In many respects, we need to creep our way through this, one day at a time. Any psychiatrist needs to understand ED, not pooh-pooh it.
Yes, add to all this, the feelings of guilt. This is a whole new arena for most of us. I think we have a sense of what to do when they have a physcial illness. My D is 27.
Best to you. Hugs. Stay with us.
Just chiming in to give my support. My D is a dancer and we have dealt with our share of eating disorders. I know just how difficult it is and how good kids with ED are at hiding it. Somebody made that apt comparison to dealing with an alcoholic.
There is so much good advice here, so I don’t think that I need to add anything onto that, but I do want to add my voice to the support you deserve and truly need.
Hang in there, everybody is here to support you.
OP, will chime in and also give kudos to the CCer who shared a D’s battle.
An extended family member has a relative who’s been battling EDs since she was 17. She denies, says she’s eating, but at 5’4" she’s maybe 80 lbs. Her parents have tried everything. She’s now 34 and pregnant. We are all very concerned that she and the baby may not survive this pregnancy. She’s also a mental health professional. It is terrifying to watch this unfold.
Your D’s health must take priority over school. I was going to add that European universities don’t do the nurturing thing, but someone else beat me to it. You’ve gotten excellent advice here. The sooner your D gets help, the better. You’ll need to play the long game here. Job One is keeping her alive and healthy.
I hope you feel good about the psychiatrist and the medication management. Yes, not much will be solved in one session but hopefully it will be a good start. Keep in mind though that the vast majority of psychiatrists are not trained in doing therapy or family therapy and don’t have particular expertise with eating disorders. So, in addition to looking into inpatient programs with good reputations, I would suggest finding a good psychologist for therapy and some local people who have experience treating patients with ED. It sounds very stressful - so sorry you are going through this.
And you won’t be the first parent who declared a living situation a big NO.
My niece and her best friend went off to college in Hawaii. Friend’s mother came to visit and said NO to the apartment they’d found and were happy with. They had to find a new place (and I think it cost a good deal more) but the parent thought the original place was just too dangerous, both from being in a rough neighborhood to just being plain dirty. It was a big disruption for them, but the mother insisted and they complied. They are all still friends, including the mother.
You’ve found an alternative in the dorm room, but if your daughter won’t agree then you have the right, and IMO the obligation, to say no to that living situation.
Is the daughter currently in London or at home ?
Right, where IS home, mental health care in the UK is not the same as the USA and neither helps if you are in Serbia or Mongolia. If you are looking at getting her care in the UK that needs to be your focus, understand the mental health care system there. Ditto to your location.
You’re not quite at this point yet, but investigate the school’s policy for medical leave of absence so you can prop that door open and keep the option available for a time when she’s ready to consider school again. You all may come to a different decision once you’ve worked on this for a while, but if it’s such a dream for her then it’s worth taking a moment to keep it from being wrecked right away. Check with them to see if there are any specific things you need to do now to simplify re-engaging later. There’s no commitment to leave or return, but knowing the process can provide some peace of mind in moments of reflection down the road.
I said we creep through this, but you are allowed to set limits. Not just because you pay the bills, but out of love, concern, and presumably, a more mature view. This thread is no longer about the safety of her apt building or street, but the life of your daughter. Getting mad, her threats, etc, show she is not thinking rationally. We can’t get into a control battle with them, but we can set limits. Unfortunatley, that needs to be in the words, language, and attitude they can digest.
My heart goes out to you and others with these tough concerns.
OP, FEAST has some wonderful resources on evidence-based ED treatment, including an active parent support community: https://www.feast-ed.org/
There are a lot of outdated, non-evidence-based ED myths and treatments that are still unfortunately common among practitioners.
Dear EVERYONE!
Thank you all SOOOOOOO very much for all of the continued support. Our family has been travelling this week and we only arrived back Frida. We will turn around and fly out again tomorrow afternoon until Friday. VERY hectic times. I was so happy to log onto my computer to read and catch up on all of the continued wonderful advice and input today!! THANK YOU FROM THE BOTTOM OF MY HEART! <3 Again there have been SO many valuable opinions and input that I can’t even begin to thank each and every one of you. Everyone has such empathy and understanding…and on top of that, such useful and profound suggestions! I am SO touched.
This past week was a trip for my daughter’s 20th birthday (nearly a full week away from home). I tried to not “spoil” the birthday trip by talking about London or school or eating disorders just because perhaps I myself needed to focus on something positive. During this vacation, she was EATING (and don’t worry I was monitoring after for throwing up) and she seemed to be enjoying life! Maybe it was a “Honeymoon” effect from it being her birthday celebration, but it was SO WONDERFUL!! It was SO encouraging to see her happy and eating REAL food in restaurants…and BIG quantities. For the first time in weeks, I wasn’t afraid that she would die of malnutrition!!! Sadly though on more than one occasion, she explained to me how guilty she felt about eating so much…but that she knew it made me happy so she would just try to overcome the guilt. That was a big message to me that she UNDERSTANDS this very clearly. She was basically saying she didn’t have control over her feelings or the eating disorder acations, but for this trip, she was going to force herself for ME. Before leaving my husband and I had a good discussion on the importance of finding a SERIOUS PLAN. Our one week visits to the Psychiatrist and the Paxil are just not enough. WE ARE GOING TO GET HER BETTER and if we want to do that we have to be more pro-active.
We will be going to the USA in a few weeks and although the trip is only planned for one month, I am considering leaving her there in a treatment center. I have talked to my parents and everyone is supportive in helping get her the RIGHT help. We have discussed perhaps doing an intervention with the family members upon arrival so we can get her to commit to an assessment. We don’t really know WHICH center to contact or even what to say when we call. We live in France…and as I mentioned she is studying in the U.K.
Right now everything feels SOOOOOOOOOOO up in the air! I don’t know when the treatment will start or WHERE.I don’t even know IF she will agree?!?!?! It all feels so hard.
I was wondering if anyone who has been where I am could tell me how they decided upon their treatment center. DId they contact the center directly? I wanted to thank @MaineLonghorn for finding your friend to share his daughter’s journey!!! <3 The Monte Nido facility in California looks amazing!!! Also thanks to @Hippobirdy for posting about the Nightengale center in the UK. I think for our treatment it will either be here in France or with my parents in the United States. The Monte Nido looks amazing…especially seeing that it was THAT center that saved your daughter’s life!
Also about cost 
I am very scared about this. We have some limited private health insurance here in France but I have no idea if it will cover us outside of France. I also have no idea how much this usually costs? Or for how long the inpatient usually lasts?
My parents want to help. They are located in Indiana. They noticed there was a center called The Charis Center for Eating Disorders in Indianapolis, but we are really willing to try ANYWHERE. I just want it to work! I want her to get better. I also am SOOOOOOOOOOOOOOOOOOOOO worried that she is not going to agree. That she is going to say “I’m eating” and that “I’m FINE now” and that she is going to refuse treatment. Sure she IS eating now…and this week on the trip she did great. But for now she is still under the 45kg mark and that is really very very light for 170cm. Also it seems she does periods where she eats “normally” but it is followed by days of “catching up” with no calories.
She had her weekly Psychiatrist appointment on Friday and unfortunately, the therapist delayed the group session YET again. This time it was a bit due to my husband being away. We haven’t found a date yet for the family together since it requires a “double” session time for the doctor. I feel so DAUNTED by how far away we are from a recovery plan. I don’t even know in what country we will have her treated, or even IF we can afford treatment in the United States If we have her treated here in France I’m sure it will be covered but I’m afraid that it won’t be as good or comfortable for her. She is much more comfortable in the English language also.
Well, I need to pack for tomorrow’s trip but I just wanted to say THANK YOU!!! I will be back with computer access on Friday and if anyone has an idea of treatment cost or of any suggested facilities I would love to hear (either in France or in the US). The Monte Nido center looks amazing, but I’m fearful about the cost. I know we could find a solution for financing somehow…I hope! Thank you again, everyone! YOU ARE BEYOND WORDS AMAZING!