[rdgthree]

In my experience, I've found most deeply embedded self-destructive ideas to be rooted in fear.

The brain and body are effectively locked in a paranoid "fight" state - "I know this behavior is unhealthy, but if I don't behave this way, then [insert irrational fear] will happen."

If you can figure out what she is afraid of, you might be able to help her walk back the behaviors from there. But trying to correct the behaviors on their own is very hard. Since the fear is usually irrational, the behaviors may be a relatively rational response to said fear. They may hold the fear itself as table stakes - not understanding that they are afraid of something that isn't real (i.e. I will never find love if I'm not as skinny as the other girls on Instagram).

Again IME - the feeling from inside the self-destructive brain is "I shouldn't be doing this self-destructive behavior, but I don't know another way to achieve X goal, and I absolutely need to achieve X goal." Asking the question "Why do you need so badly to achieve X goal?" is usually a good start to defanging the fear.

[BLKNSLVR]

Thank you, I will work on getting an answer to that question today!

Not the underlying fear that you mention, but seeing her reaction to being asked (forced) to eat is reminiscent of being asked (forced) to pat a spider.

I'm not sure if visceral, immediate fear maps to an underlying fear or not, but fear seems to play some part at least.

[therealpygon]

No disrespect, but maybe you should instead be working on getting her into therapy instead of trying to be her therapist. If she is not inclined to be honest with you or herself in the first place, you don’t have the tools and are too close to the situation, especially if you are the one who is the “cause” (regardless of whether YOU think you do something to be the “cause”).

A therapist is an independent person who is completely outside that persons life and their situation and is more likely to have the appropriate tools, or at least more so than a parent will (no matter how many TikTok’s they might see or blogs they might read).

And if she is resistant, explain that “this is someone who you can talk to; I don’t expect anything, I’m only asking that you just go talk with them about whatever you want. It’s not my business what you discuss, and I won’t ever ask you to tell me what you discuss. You can talk about your homework or the sky, it doesn’t matter, I’m only asking that you go talk to them. If you talk to them a few times and don’t like them, we can find someone else. Again, I have no expectations from this and I’m not trying to “fix” you, it’s just someone you can talk with and who might be able to make good suggestions about whatever you discuss…no more, no less”. And then, more importantly, you have to both believe and respect it.

[BLKNSLVR]

I'm bang up for any suggestions, all good. Under no delusion that I know the right thing to say in this situation. I've actually found it difficult to find the right time to say, almost literally, anything; which may actually be a good thing (in minimising my opportunity to make things worse).

She has been seeing a psych for a month or two (regarding her 'minor' self harm, the eating disorder hadn't "presented" at that time). She's generally pretty closed about her emotions, but she did start opening up after a few sessions. Not that it was able to prevent the decline towards the current situation.

We've asked her "team" at the hospital whether there's a psych involved in her program. They said no, for two reasons:

1. They're currently understaffed in that area

2. They need to get her weight / nutrition back to a baseline level because 'starvation brain' is, essentially, not worth working on - it's not functioning correctly.

Despite that, they said they'd still see what they can organise.

We've also started the process to getting an eating-disorder-specific psych booked for when she's discharged from hospital.

[noahjk]

Dr. Becky on Andrew Huberman this year said something like:

The first thing you should do when your kid is feeling something is to just say, "I believe you."

Don't tell her that she really is skinny, or that she really is beautiful, or that she's not thinking right. Don't tell her those things because what you're really saying is, "I know you better than you know yourself." That, unintuitively maybe, damages self confidence - where self confidence is really just "believing oneself."

If you plant a seed of doubt that she doesn't know herself and that others know more about her than she does...

(Obviously this is about validating her feelings and not validating self harm, which is nuanced and could probably use some professional direction or deep thought about how to approach this in a way which doesn't encourage deeper affirmation of the self image)

Anyway, I wish you luck. That sounds gut-wrenching and terrible. I hope you and your family can safely pull through on the other side.

[rdgthree]

Interesting. Yeah, fear being a component of these things makes sense to me from an evolutionary perspective. Self-harm makes sense if your arm is pinned under a boulder. I think the psychology of these conditions is closer to that than anything else.