Kate Bennett:

Kate: this is Kate Bennett speaking

E: Hi this is Emily Stokes

K: Hi Emily, how are you?

E: good how are you?

K: im good, feel free to call me Kate. I know you probably feel awkward and dont know what to call me
so just call me kate

E: ok thank you

K: no problem

E: so before we get started can I have you say your name and that its ok to be recorded

K: ya, absolutely my name is Kate Bennett and I am ok being recorded during this call

E: alright, and I just want to thank you for giving me this opportunity, it really means a lot

K: absolutely, Im happy to help

E: so my first question is can you walk me through the process of treatment you provide for a patient
with anorexia

K: so when I work with a patient with anorexia I always start with a clinical evaluation and so that is kinda
the question and answer period in regards to learning more about their history of anorexia, how it
developed, kinda both from a physical standpoint as well as psychological and emotional standpoints.
Looking for a possible trauma that may have triggered it, looking for relationships in their lives that may
support or encourage it but I also look medically, to make sure that the person is appropriate for an
outpatient level of care and so I ask them whether they had a physical recently and if so whether they
have had any abnormalities in regards to their blood draws in regards to electrolytes and and liver
function. We look at heart function whether they have done EKG I ask them to get a bone scan to
explore if they have osteopenia or osteoporosis and we also look at weight and if they are medically
unstable I actually will refer them to a higher level of care so at outpatient level I only work with people
who are medically stable

E: ok and so if you do see someone starting to relapse do you, what like the signs you look for? What do
you usually see first? Or what are like the definite signs that they need to be readmitted to inpatient or a
higher level of care?

K: so the biggest indicator is that they are medically unstable so if I have somebody who is working with
me but drops so weight then all of a sudden when they stand up they start to have dizziness upon
standing up called hypotension or they are having heart arrhythmias or electrolyte imbalances that are
measured by a physician and automatically they are sent strait to a higher level of care the medical
instability is instant referral to a higher level of care so that that person is physically safe but behaviorally
maybe somebody drops some weight and they arent that unstable but they are having a hard time in
their, um sorry, in their interrupting the eating disorder then that when we start to have conversations of
maybe outpatient level of care isnt enough so for example if I treating somebody and they have a
traumatic event in their life happen and they lose some weight and they were strong in recovery and
then they start to have trouble again Ill give them some time as long as they are medically stable but if
they cant behaviorally interrupt the restricting or over exercising or the purging then I will refer them
and so its a case by case basis I dont say ill give you 1 month and if your not there your gonna go to a
higher level of care but im constantly deciding if this is the work someone can do on their own with
some support or do they need to be in a program where someone is actively helping them interrupt
their day to day behaviors some people can restore on their own and some people cant

E: Ok and do you work with, are you, do you run your own practice or do you work with a hospital

K: I run my own practice so I work independently outside of an office but I have worked in eating
disorder treatment facilities so Ive worked in the hospital settings as well

E: ok do you find common behaviors with patients who need to be readmitted?

K: Ask me that question again

E: Do you find common behaviors in patients who need to be readmitted? Like do they all like show
similar signs or is it different case by case

K: Uh I mean the 2 behaviors that are the most concerning are restricting so people just cant simply cant
gain weight on their own that that is a very common behavior when I admit people to a higher level of
care um purging so people who are purging either through self-induced vomiting or laxative abuse or the
one that people dont actually think a lot about is exercise so if people are using exercise to purge and
they cant interrupt or alleviate the intensity the volume the frequency of their exercise sometimes they
have to go to a different treatment center where they literally dont have the option to exercise

E: ok and is it more common to be admitted usually once to into an inpatient facility or is it more
common to be admitted more than once?

K: I would say unfortunately it is more common to have multiple admissions and thats because anorexia
is very difficult to treat and so I Ive actually worked with people who have only had one admission and
they are successful in recovery and I dont see them having to be in a treatment program again but more
frequently I see people who have to go to treatment a couple of times to really not only interrupt the
behaviors but figure out their motivations why do I actually want to get better because often times
people go to treatment because their parents tell them to or someone else makes them and so their
investment isnt really that high and its different to tell a person like hey I dont wanna be sick anymore
that the treatment actually usually works for them.

E: ok and I know its really up to the person to find that motivation and drive to wanna recover but how
do you help them get to that point?

K: I do a lot of values work so the term values kinda prioritizes whats most important in your life and so I
actually have I start with a stack of cards like 160 or 170 cards and my clients sort through the cards and
they go from the 260 170 cards all the way down to one and that one card is the most important thing to
them in their lives and then we figure out how is the anorexia interfering with that value how does it
prevent them from connecting to it and when we determine that we start connecting with their values
and feeling a more personal driven life so we come back to that a lot so you identify these core values
and things that make you unique to yourself how is your eating disorder helping you today to connect to
those and how is your eating disorder interfering as you try to commit to those important things in your
life inevitably the eating disorder never supports core values

E: and kinda switching from admission but how do you approach like body distortion and dissatisfaction
with your patients?

K: so I always tell them that body image is the very last thing to improve so I never I never bring
someone in here and give them false hope that they are going to gain weight and all of a sudden love
their body so we talk a lot about normalizing body image that its normal to have day where youre
dissatisfied even healthy people who dont have eating disorders have body dissatisfied days but how
they feel in their body is not one a reflection of their emotions but two its not a reflection of their self
worth and so we start to take body image out of the emotions because people say I feel fat fat is not an
feeling you think your fat is a cognition so we start to separate feelings from thoughts we start to
separate self worth from how the precieve their bodies we talk a lot about neutrality I dont love my
body I dont hate my body it is what it is today so a very non judgmental approach and gratitude is really
important so I may not like how my body looks but I love that it allows me to go hiking up in the
mountains I may not like how my body looks but I love that it allows me to hug my mom every night
before I go to bed and so we start to find things that the body does that actually feel good and connect
with those ideas instead of focusing on what we dont like about our body

E: ok and so when you meet a patient for the first time what is the first thing that you work with them on
the like how do you address a patient for the first time

K: so I mean if im working with somebody who is anorexic that implies that they are under weight and
our very first goal is weight restoration so we are looking behaviorally of how do we get weight
restoration moving they always have to work with a dietician I dont do I am not a dietician so I am not
prescribing meal plans or following those so one we will set them up with a dietician but then two I
figure out ok so how do we reframe thoughts that are interfering with weight restoration or completing a
meal plan how do we find other ways to manage anxiety other than restricting not only restricts calorie
intake but restricting anxiety suppressants anxiety so we start talking about the ways to cope with
anxiety so it really becomes how do we restore weight so how do we challenge the thoughts that
interfere with weight restoration behaviors that interfere with weight restoration but how do we start to
develop new coping skills that the eating disorders actually work managing at an earlier point

E: ok and I saw when I read your profile on the internet that you do CBT and DBT work can you explain
the difference to me?

K: well DBT is a little bit of a modification of CBT so they are similar and different but CBT stands for
Cognitive behavioral therapy so it really looks at thoughts that go through our brain and behaviors we
know that we have feelings and thought that lead to feelings and feelings lead to behaviors or outcomes
so CBT is usually lets figure out what the thoughts are and how they are mauled after how they interfere
ultimately with your goals and your values and shift them and rephrase them so that they dont
negatively affect your emotions and the outcome likewise how do we change behaviors to suppor the
thoughts that you actually want to be having in your life DBT does similar work but it adds a component
of mindfulness and mindfulness is alittle bit more you know it kinda came from Buddhism well it does
come from buddhism but its not rooted in religion philosophy when its practiced in DBT but its this core
belief of when youre mindful nothing is good or bad or right or wrong nothing is perfect we dont focus
on comparisons so DBT really kinda focuses on this idea of when we are mindfully engaged then we can
respond to ways that are more neutral and it also its great kinda more of a relationship dynamic DBT has
4 components it has mindfulness distress tolerance emotional regulation and interpersonal interactions
and so it helps people kind of use CBT in specific situations that also builds mindfulness into that
curriculum

E: ok and how do you incorporate those in Anorexia how do you put them into the treatment?

K: So CBT I do a lot of self talk journaling so ill have people write down what they are speaking and saying
to themselves and then the bring their journal to me and we talk about rephrasing them so when I say
rephrase its not I hate my body I love my body, because thats not true but I we go from I hate my body
to facts what do I know to be true about my body based on these truths how do I want to move forward
in this situation what are my goals for the day and we bring somebody to a more neutral place you know
and if we look more at traditional DBT a lot of emotional regulation and coping skills how do I manage
myself if im feeling emotionally dysregulated, if I feel sad or scared or angry what are things I can do to
manage the intensity of that emotion whether its distract get away from it a little bit and come back
when I feel a little more comfortable with it or self soothing how do I calm myself down in the moment
we create lists of coping ideas so that people go from all of a sudden I dont know how to manage this
other than restrict or throw up or exercise to ok I have this whole list of 25 things I can do if im feeling
emotionally dysregulated in the moment

E: ok alright well thats all the questions I have actually

K: ok awesome

E: Thank you so much for your time

K: youre welcome and I hope your project goes well and I wish you the very best of luck with it

E: Thank you very much

K: youre welcome you take care

E: you too have a good day

K: thanks you too bye

E: bye

Katrina Schroeder

Katrina: hello this is Katrina

Emily: Hi this is Emily Stokes

K: Hi Emily how are you?

E: good how are you?

K: good

E: ok so would you mind if I record this phone call

K: nope thats fine

E: Can I have you state your name and that its ok to be recorded

K: yep my name is Katrina Schroeder and it is ok to be recorded

E: ok so Im gonna start of by asking what your role in the treatment for Anorexia is

K: ok just generally speaking?

E: ya

K: ok I am an outpatient dietician both, do you want specific locations?

E: sure

K: so I work with adolescents at the outpatient department at Boston childrens hospital and I run a
private practice as well I work with adolescents and adults

E: ok and can you explain the meal plan you suggest for your patients

K: there is not a one specific that I suggest I basically work with them on what they are currently eating
we compare that to what they need to be eating based on weight goals that usually either the medical
provider has dictated or the whole team of the medical provider and the dietician have decided that
they need to reach and then I work with them on what they are currently eating and what changes they
can make to their eating in order to reach the weight everyone has deemed healthy and or get back to
sort of a normal eating pattern as well as eating in a way that is responding appropriately to their bodies
hunger cues

E: Ok alright

K: Sorry if thats rather complicated

E: no no no

K: I can clarify any of that if you want

E: no it all makes sense to me thank you. And why do you think this is better than a regular meal plan
that other hospitals suggest

K: you mean like an exchange based meal plan?

E: ya exchange or the set items you have at every meal that kind of thing

K: ya so I work with a lot of people who are on those meal plans who come to me from treatment
centers so I certainly do work with those meal plans but I dont ever put someone on one if that makes
sense

E: ya
K: so my role is to sort of work with people who are on meal plans, help them follow them as needed so
if thats sort of what theyve been following then Ill help them to continue following that until they are
weight restored however following an exchange based meal plan is not its great for during the process of
recovery but its not the way that most people eat normally or intuitively if you will which is another way
to sort of say like following eating ques so a lot of what my job is is to sort of help them follow the meal
plan but also to progress in their treatment sort of beyond the meal plan

E: ok alright and how do you usually help transition a patient from not eating a sufficient amount to
eating a healthy meal plan

K: well its definitely a team based approach you know as an outpatient dietician I require that they are
working with also with a therapist to sort of help sorry not help but they work with a therapist in order
to ensure that they are working on sort of the reasons behind why they are unable to eat and sort of to
work on the whole fear of gaining weight piece of it so you know were all sort of doing what we can a
lot of what I do is help them identify motivators and sort of help them understand with doing some
nutrition education to help them understand like why their body needs certain nutrients why their body
needs certain types of foods why these foods are not scary even if they sound terrifying for the person at
the time sometimes you know challenge them to sort of think about how they used to eat and a lot of
times people you know want to get back to that point where they werent thinking about food all the
time and they were just able to you know go out to eat with friends for example does that answer your
question?

E: ya and what is the most important aspect in recovery to prevent relapse in patients

K: the most can you say that one more time?

E: What is the most important aspect in recovery that is vital to prevent relapse?

K: I would say the most important aspect of recovery to prevent relapse would be really the patients
motivators so sort of having a clear reason that they know very clearly like why they want to recover and
their sort of ability to access those motivators on a regular basis so for example and also very important
early treatment so like the shorter the amount of time that someone has had one an eating disorder like
the earlier the treatment begins the better the outcome so they are less likely to relapse but I think its
also really important for people to know that recovery in eating disorders is sort of a fluid maybe lifelong
process so like eating isnt just going to become easy and be easy for the rest of their lives like there is
sorta gonna be ebbs and flows

E: ok and when a patient you are seeing does begin to relapse how do you usually go about helping them

K: so usually what happens is again the team the team is sort of saying between the doctor their
therapist and myself and if their weight starts to drop and they are restricting a lot for example if this is
anorexia we are talking about then we sort of all collaborate and like make a suggestion to the patient
that they need to step up to a higher level of care and depending on the age of the patient and they
their level of inhibition they will either go on their own or their parents will take them a lot of times to
be quiet honest they know they are like ya I need more help so

E: is there anything you do with the meals with the meals and food you are suggesting that kina helps
them transition from where they are back to a better place when they are relapsing
K: say that one more time

E: is if someone is beginning to relapse is there something you do with the meals and sorry the meal
plan to help them in

K: absolutely I mean I think there is a lot of people you know one of the things I work with people on is
sort of getting away from what I would refer to as safe foods so eating like the same thing everyday feels
comfortable because you know that is not normalized eating which is what we are try to get them back
to whatever their normal was prior to their eating disorder but if someone is slipping and they really
dont know what to do sometimes we will sort of review like ok what foods have felt safe in the past can
you go back to eating those until at least eating feels more comfortable again and your back to sort of
being able to be able to get back to a where you are more comfortable and then we can sort of
reintroduce some of the foods that are less comfortable

E: ok and so with goal setting does that tend to help patients in recovery like setting goals for like you
know this coming week about trying a fear for or you know something like that does that usually help

K: yes so a lot of what I do is motivational interviewing and so with that style its sort of up to the patient
to come up with the goals because studies have shown that they are more likely to meet the goals if they
are the ones to come up with them and the goals that we are setting I mean I think this is sort of much of
what eating disorder outpatient treatment is is just making sure that the goals are small and attenable
and making sure that the patient knows that it is ok if they are unable to meet the goals you know its not
like a failure on their part but thats just sort of more data for us to have like ok you had the goal of
having for example having 1 cookie this week and then when they come back next week they say they
were not able to do it ok so why so why do you think you were unable to this what happened when you
went to try to have the cookie did you even get that far you know or maybe its like one cookie was so
easy like that wasnt even challenging enough maybe but then you know like ok in the future we need to
make the challenge even harder but you know making them so that its like ok do we need to take a step
back and the goal even smaller to just something to eat 3 times a day you know I mean some goals are
so small but it seems like they should be you know more intuitive but its just not for a lot of people so

E: ya and with outpatient treatment how do you can you explain a little bit of how you specify your meal
plan to each specific patient can you talk about that a little bit

K: about how I specify the meal plan?

E: ya

K: ya so basically we so like I do a pretty detailed 24 hour recall so reviewing what they ate over the past
24 hours and then talking with them about you know was that typical was yesterday a typical day what
does each day sort of look like and then its sort of its sort of a pretty individualized thing but like for
example if someone is not eating breakfast and having a very small lunch and then having dinner right
that in that situation we would write out I would work with them to say ok can you have is there
anything that you could have at breakfast and then if they say well I guess I could manage a piece of fruit
you know and then its like ok can we put just a little bit of protein in there so can you have a piece of
fruit and some peanut butter and then so then we write it down on a sheet of paper and then we talk
about it and then thats their goal for the week is that meal plan for having that very small amount of
breakfast to addition their current lunch and current dinner and then if they are able to succeed with
that then next time the change in the meal plan would be ok so you know lunch doesnt have any
carbohydrates so you know is there based on something or not they are is important for them you know
is there something we can add in so its sort of basically I write it down on paper but its like working with
what they are currently doing and what changes we can make

E: and with this whole like health trend going around and you know big things about just this food dont
eat this food and this kind of stuff with people that are saying they are nutritionist and stuff how do you
reassure patients that thats not the case

K: That thats not what sorry

E: that not the case like you need a balanced diet

K: ya ya good question that happens all the time I guess in those situations I just sort of encourage them
to look at the data behind sort of fad diets as well as like the actual like nutrition science behind it and I
sort of tell them you know I have a degree you know I you know you are coming to me because clearly
whatever the diet was that you were following was harmful to your body and thats what the doctor is
saying and thats why they suggested that you come and talk to me you know just sort of explaining to
them that there is a lot of misinformation out there on the internet and on social media but to really
help them to sort of examine you know well who you know well who actually originated that article or
who wrote that diet and do they actually have a nutrition science background or are they just trying to
make money off of it or with a lot of education about why our body like physiologically what do our
bodies do with carbohydrates like why do we actually need them in our body things like that

E: ok alright well thats all the questions I have

K: ok

E: thank you very much for taking the time to let me interview you

K: ya no problem and if you have any other questions feel free to send me an email

E: alright thank you very much

K: ok yep youre welcome

E: bye

K: bye

Eleanor Herman

Hi Emilysee below for articles and some answers in blue. I hope this helps with your project!
These articles address refeeding syndrome, and the first three are by Dr. Mehler. I dont know if you only
want to send her those, as more specific to ERC.

For the questions about outcomes:

https://www.eatingrecoverycenter.com/ERC/media/global/PDFs/ERC-Treatment-Outcomes-Report-
2016-booklet_09-16_single-page-view.pdf

Sachs, K. V., Andersen, D. M., Sommer, J., Winkelman, A. B., & Mehler, P. S. (2015). Avoiding medical
complications during the refeeding of patients with anorexia nervosa. Eating Disorders, 23(5), 411-421.

Brown, C. A., Sabel, A. L., Gaudiani, J. L., & Mehler, P. S. (2015). Predictors of hypophosphatemia during
refeeding of patients with severe anorexia nervosa. International Journal of Eating Disorders, 48(7), 898-
904.

Arthur, B., Strauss, L., & Mehler, P. S. (2015). Refeeding the patient with anorexia nervosa: perspectives
of the dietitian, psychotherapist and medical physician. World Journal of Nutrition and Health, 3(2), 29-
34.

http://pubs.sciepub.com/jnh/3/2/1/

Garber, A. K., Sawyer, S. M., Golden, N. H., Guarda, A. S., Katzman, D. K., Kohn, M., . . . Redgrave, G. W.
(2016). A systematic review of approaches to refeeding in patients with anorexia nervosa. International
Journal of Eating Disorders, 49(3), 293-310.

Kohn M, Madden S, Clarke SD. 2011. Refeeding in anorexia nervosa: increased safety and efficiency
through understanding the pathophysiology of protein calorie malnutrition. Current Opinion in
Pediatrics, 23(4), pp.390-34.

Hofer, M., Pozzi, A., Joray, M., Ott, R., Hahni, F., Leuenberger, M., . . . Stanga, Z. (2014). Safe refeeding
management of anorexia nervosa inpatients: an evidence-based protocol. Nutrition, 30(5), 524-530.

https://www.researchgate.net/profile/Roland_Von_Kaenel/publication/261370529_Safe_refeeding_man
agement_of_anorexia_nervosa_inpatients_An_evidence-
based_protocol/links/02e7e53b10f843449f000000.pdf

My questions are as follows:

What methods do you use to prevent refeeding syndrome?

2. How do you monitor a patient to check for refeeding syndrome?

3. What are some signs that a patient is developing refeeding syndrome?

How common is the diagnosis of refeeding syndrome in your patients and throughout the treatment
facility? An answer from one of our physicians: Dr. Mehlers articles will give her the best info and will
have some stats too. Overall, worldwide, refeeding syndrome itself is very rare. But part of that is that
you monitor closely and there are signs and symptoms that will occur prior to actually going into full
refeeding syndrome. There is often much confusion on hypophosphatemia actually being refeeding
syndrome which is not accurate. It is an early and reversible risk factor, so really, any of the programs
doing research on refeeding wont actually find it in their own patients as they will correct the phos prior
to anything occurring. However, sometimes it is tertiary centers who get admits to their ER who are
actively in re-feeding from Outpatient attempts to refeed, often without supervision.

4. How common is readmission in your patients and throughout the treatment facility? Im not sure we
have research for thisbut we do see frequent readmissions for multiple reasons: often due to early
discharge the first time in treatment based on what the insurance company. (i.e. when someone restores
weight, they often are told by insurance that they must discharge. Although, from our treatment
perspective, weight restoration is just one piece of the puzzle. Other issues must be addressed: Mood
stabilization, implementation of coping mechanisms, therapy, etc.

5. Are these statistics higher or lower than the average rates of readmission and diagnosis of refeeding
syndrome of Anorexia patients?

6. Are there common trends that are associated with patients that are readmitted? (i.e. below healthy
weight, poor family life, no support team after treatment, ect.) I can speak to what we see, but not
official researchbut usually its lack of ability to cope without using the eating disorder.

Malia Dunn

Here are the answers to your questions!

What does the typical meal plan look like at the treatment facility you work at? See attached. We break
down meals into 3 meals and 3 snacks to be eaten every 3 hours. We call this the rule of 3's. We break
down meals and snacks into exchanges once we know the calorie level for the patient.

Why is this more effective than other meal plans (exchange, counting calories, ect)? Since our clientele
has a high rate of Obsessive Compulsive Disorder and anxiety, we tend to lean away from using numbers,
as our patient can fixate on these. In America, calories are synonymous with dieting and there are many
myths out there surrounding calories and how they work in the body. By using exchanges it allows the
patient to be flexible with their food choices, challenge calorie levels of different foods (some dense,
some light in calories), and ensure balance. If it was strictly calorie based, they could receive those
calories from foods of their choice which could mean a protein, or carb, or fat deficiency depending on
the preferences/fears of their eating disorder. We also use exchanges to ensure we meet protein needs,
carbohydrate needs, fat needs, and calcium needs to heal and maintain the body's health.

When a patient is first admitted for anorexia what is the typical protocol used when they begin eating?
Start meal plan either at a minimum of 1400 calories/day or where they are currently at. This will ensure
they're body exits survival mode (starvation) as soon as possible and begins to heal. By starting at 1400
calories it also allows us to shorten the window of refeeding syndrome. This protocol is primarliy used in
the in-patient setting where there are doctors and nurses availabile to monitor these clients if they do
enter refeeding. In out-patient we would start lower (minimum of 900 calories/day) since they are not
monitored by medical staff daily. We encourage a balance between the exchanges upon admission and
will continue it throughout their stay. Patients with either start with 3 meals and 3 snacks or 3 meals and
2 snacks depending on the calories they need. Increases are usually calculated as: each day they don't
receive an increase you give them 100 calories. So if it's been 4 days since their last increase, they would
get a 400 calorie increase, and so on - until they reach their target calorie level.

Does everyone eat the same meal plan, or is it individualized towards each person? Why is one more
effective than the other? Everyone has an individualized plan based on their body's needs. Patients are
given choices for snacks (from a certain list) so they may have different snacks than others. This allows
them to challenge their eating disorder by eating something different than someone else, or eating more
than someone else. Some patients have meal plans at 2000 cal/day, and others have 5000 cal/day - these
meal plans would be considerably different. At meals, there are two options for entrees, and they must
select one *unless there is a medically documented allergy*. So they are not able to eat "whatever they
want" but they do have flexibility.

Is there limitations on a patient on what they can and can not eat? Why or why not? They cannot mix or
add certain things to food which may be consistent with eating disorder behaviors. Examples: over-
salting foods to ruin the taste, same with pepper, over using hot sauce, mixing weird foods (mustard into
oatmeal) to ruin the taste. Patients are required to challenge their fear foods and eat what is on the
menu. There is no option to be "low carb" as this usually plays into their eating disorder. They are also
not allowed to ask kitchen staff to change their meal or cook it in a different way (without butter/not
frying/etc.). Patients are only allowed 16 oz water at each meal, no refills as this may make them overly
full and they may not eat their meal. Patients are not allowed to take foods apart (sandwiches, burgers)
they must eat them whole - like a normal person would. Also no eating finger foods with utensils, and
visa versa (no spaghetti with hands).
I hope these questions help you! Feel free to send back some follow up questions if you have any! These
answers are consistent with Eating Recovery Center in Denver and Essential Nutrition in Boulder, CO.

Anonymous patient with an eating disorder

Hi Emily, I would be happy to answer your question as long as its understood my name and personal
information is left out of everything pertaining to my answers to the following questions

1. Will asking any of these questions trigger any negative behaviors?

No, I have been in recovery for a couple of years right now

2. Have you been admitted in inpatient more than once? How many times? How much time
between each admission?
I have been admitted to inpatient, partial hospitalization, intensive outpatient, and currently in
outpatient treatment. I have only been to inpatient once for around 1 month.
3. Have you experienced refeeding syndrome? What did your treatment team do to treat it?
I have not, nor anyone treated the same time as me experienced it, there was fluctuations in my
potassium levels, however not to a point that I was medically in danger
4. How long did you have anorexia before you were admitted the first time?
I had anorexia for about 3 years before I was admitted, although it did get progressively worse
through out the years
5. Do you feel like your treatment team helped you recover and prepared you for recovery on your
own? Why or why not?
Yes, I had an especially excellent treatment team, they gave me full rounded treatment including
nutrition therapy, individual therapy, group therapy including CBT and DBT, family therapy as
well as an excellent doctor to monitor my physical health
6. Did or do you have a meal plan you follow(ed)? Can you explain it to me?
I was given a meal plan and I still follow it today at breakfast I have 5 items and a dairy, this could
be anything from 4 ounces of juice as an item, a small muffin, a small serving of cereal as an item
and I need 5 of those and only 2 can be fruit based
For lunch its a little different for a hot entre I need a protein 2starched, vegetable, additional
item (can be anything I want) and caloric beverage and a dessert, if I have a sandwich it is a
sandwich plus 3 items ( can be chips, fruit, etc.) a caloric beverage and a dessert
For dinner it is the same thing as lunch, but I can not have two cold sandwiches in one day.
7. Did/do you have support once you left inpatient treatment? Was your family supportive? Did
you have a psychologist? Do you believe this had anything to do with your readmission? Why?
Yes I gradually had less and less supervision during my day which definitely helped because there
was not a big shock from having supervision 24/7 to having no supervision which I think would
contribute to relapse. My family is always supportive, sometimes they are too supportive, they
sit with me every meal and make sure Im doing ok multiple times a day which I was so happy to
have people in my life to support me like that.