I'm so sorry she didn't stick with the program at Renfrew.
Did she have some specific objection to the way they ran THEIR program, or was it just the typical not wanting to really give up the ED (or being afraid to)? Not all inpatient programs are equivalent, you might find something better suited to her (mind you, I don't know anything about Renfrew itself - the little I've heard has been good).
It sure sounds like she needs a LOT more intervention than she's getting now, though. For comparison, with my anorexic/bulimic daughter, it took 6 months of 24/7 supervision at home (she didn't shower alone, she wasn't allowed to flush and I stood outside the door when she used the bathroom, etc.), weekly psychologist visits, monthly psychiatrist visits, and a whopping 70 mg of Prozac to break the behaviors and get her back to a normal weight.
Your sitch is additionally complicated by the likelihood that she is "punishing" herself for the affair, too.
I believe it's a lot harder for spouses than for parents to deal with EDs, but if you can, here's what I would recommend:
- do what it takes to get her on meds now. Prozac has been studied in bulimia, and is the drug of choice for OCD (which I believe most EDs are a variant of OCD or a close relative). Additionally, it is a good antidepressant and your W has components of depression too (as did my D).
- try some bibliotherapy. Maybe read The secret Language of Eating Disorders with her? (Read it yourself to see if it fits - my D said it described her mental state pretty well). Share with her some of the research articles on the biological causes of EDs (it seemed to help my D when I could explain to her the biology of WHY she was having these persistent thoughts - helped her to better fight them when she could understand them as "brain hiccupos" in the basal ganglia. Two books on OCD - Brainlock by Schwartz and The Boy who wouldn't stop washing by Rappaport - do a good job of describing.)
- personalize the disease as "Ed", someone you will HELP her fight. (It gets too easy to slip into being mad at the person for what they're doing to themselves - easier for you to unite WITH them against "Ed", who is doing this TO them. My D was terrified and needed to know that I would help her fight Ed, and that I believed we could win).
- one thing that helped my D, I made her a shake every morning and she drank it like medicine, whether she wanted to or not. Because it was blended, she could think of it as medicine. She didn't watch me prepare it, so she didn't know everything that went into it - a can of Ensure Plus, a scoop of the highest-fat ice cream I could find, and a calorie supplement called Benecal (order from Walgreens online). With all that, I could manage to get almost 1,000 calories into a single glass. Of course, she was only 13 and less calorie-savvy than your W, but something like this might work for you.
- it might not hurt to get a light box, like they use for treating seasonal affective disorder, and have her use it in the morning. There are some interesting studies on using them in ordinary depression. I commend you for sticking in there - you know, at 67% of her normal weight, that her brain cells aren't firing properly, she's really sick and needs you to be her rock just as if she had schizophrenia or cancer.
Good luck to you. I know it's a terrible thing to fight against. The more you can educate yourself, the better your chance of saving her. The good news is, she came out of it once before, so hopefully she can do it again. Three years later, my D is doing well. Be strong.
