has an eating disorder and has been hospitalized twice, IOP twice but what really helped was she was sent to an apartment with a live in counselor and accountability to prepare and eat meals. Even though she has a ton of support with me and her family it was necessary to get away and break habits. She stayed a month then continued IOP. She’s been out for 5 months and is doing really good. 

Recovery is really hard when you have a ton of support but seems impossible if everything around you is a disaster. Also, no matter how much you care it’s ultimately up to them to put the work in.

I watched a show on Netflix, it was a few months ago, they probably still have it.  Don't Call Me Crazy.

It was about teens who were committed into inpatient treatment.  When outpatient fails, control will be taken away from the child and parents, and put into the hands of doctors.  Eating disorders are all about control. 

IMO, it is a manifestation of anger.  It sounds like your SD is angry with her mother.

In the documentary, one of the girls had anorexia, and when she refused to eat, they forced her.  They took control away from her, and that fixed her, at least for a while. 

Just make sure SD is being monitored by a doctor, and if she falls below a certain weight, the doctor will step in.

My sister has an eating disorder. At one point, I constantly worried that she would keel over and die. It was hard. She was so thin - like 75 lbs at 5'9. She would randomly black out and fall over quite often. My brother and I would have to pick her up/try to catch her and get her to sit down for a bit. It was stressful. I can't imagine dealing with this from my own child. It would be horrifying and saddening beyond belief. 

I know in my sisters case, and often, eating disorders are about being fragile and small enough that people will finally worry and pay attention to you. Now I'm not saying this is always the case. But I did watch a TON of documentaries and do a TON of research trying to understand EDs. My sister was ignored a lot by my dad when she really, really wanted his attention. I do think a huge part of her eating disorder was trying to become something people, and more specifically, my dad, wanted to take care of. 

From the sounds of it, BM is not paying attention to her daughter but instead, doing what she wants to do and having her own fun. I strongly recommend therapy for SD, because it's possible she is trying to gain control of her life (controlling the numbers is a great way to do this) OR get her mom to finally take care of her the way she wishes she would. This is subconscious - they often don't know WHY they're doing it. 

Either way, I once heard a line in a poem that really struck me. It was something like "if you have an eating disorder and you are NOT in recovery, you are dying." 

And it's true. 

Please look out for your SD. 

Check out this amazing poet: https://www.youtube.com/watch?v=58k-xfyZFfY she gives some great insight.  

Not purging/laxatives, but calorie counting and denying myself food.

It's about control and body image. You feel bad about yourself and/or things are out of control. What starts as something you think you can handle and will only do until X happens then escalates as you get compliments on your appearance. And you've found something you're "good at" and are getting praise. And you see bumps and bulges (that are supposed to be there) that need to go away and you know how to do it. So you do. Your whole body image is distorted. I remember the day I was ecstatic when I went to put on a skirt and it fell straight to my feet. And I wasn't heavy before it started, just wanted some of the extra to go away.

I didn't end up in a facility but my mom put the fear of her in me (not God, he's not as scary). She said some things, I don't remember what but one was to take me away from school and my friends and do a facility. For some reason I also remember looking at myself in the mirror against pictures and saw that I was way closer to a concentration camp victim than a model or a healthy looking person (athletes). It took years for my metabolism to even out.

I wanted to feel loved (my parents were really fighting and almost divorced, so losing weight to be more attractive would get me attention/love from others), to feel in control, and to feel good about myself. It's also during this time I first had sex, again looking for love in all the wrong places. I bet you any money, deep down, she doesn't feel loved or lovable.

What does "intensive outpatient" treatment consist of?  My sister had anorexia (not bulimia), and outpatient treatment didn't work.  She eventually did a "partial hospitalization" program where she was at the facility from 8 am to 4 or 5 pm.  She did school there - she was not going to her regular school.  She came home overnight.  She never needed to do a full hospitalization program.  It sounds like intensive outpatient isn't working and your SD needs to go another step up the treatment ladder.

There is enough stress with this disorder without an alcoholic (or heavily drinking - not sure what you're dealing with) mother at home.  Are SD's doctors aware of the home situation?  I'm sure you and your husband are aware that anorexia is the most deadly mental disorder.  Disengaged or not, I personally would push DH to discuss the situation and more intensive treatment with SD's health team, if only so I knew that I did what I could to help.  You don't want guilt or regrets.

Who’s going to take care of G kid?  Not BM

from anorexia. She is in her mid 30's. She isn't going to make it. She has tried anything and everything. Her heart is failing. She blames it on her brain and she blames it on her mother who was a real piece of work. She legally emancipated herself at 16 because of her mother. I think your biggest chance of success is if you get her full time away from her mother . It starts as control. It is something they can control when they feel helpless and adrift with no control of their own lives . That's how my friend explained it to me

It's been a while since this was posted so I'm wondering how she's doing. Any progress?

I don't have experience with anorexia but my master's degree is in counseling, so I'm interested and hope my thoughts can help.

What we know is it has a lot to do with lack of reasonable control in her world. As kids grow, they should feel they have somewhat control of their environment while having healthy relationships around them. She most likely doesn't feel loved, so it could also be a form of self punishment. Like part of keeping food away could be convincing herself she doesn't deserve it. 

You're in a really tough position being this powerless. It's a shame you feel you need to disengage because of BM because it sounds like you are a very caring, compassionate person who I'm sure she would benefit having a relationship with. 

Have you spoken to your DH about this? What are his thoughts, what is his course of action? You can always team up with him and have him lead. 

Ideally, you should be able to say "screw BM, this girl's life could be on the line." And proceed with a relationship with her anyway. Maybe just starting with approaching her and saying although you haven't been close, you see she is going through a lot and you care a lot about her. Ask her how she's feeling, how she feels about you. Let her be angry, let her get it out. As long as she isn't hurting anyone or breaking anything, she could be holding that inside and releasing it could help. Just stay calm and maintain a stance of listening, understanding. If she has this episode, or not, continue telling her it's okay she feels this way. Remind her you love her, and her dad loves her. 

I love the suggestions ITB2012 gave. Showing small gestures of love and care, and openness of being there for her. Let her know it's okay she's mad at you, you understand. I'm curious to know how things have unfolded since then.