It's not always easy to talk to someone you love who has an eating disorder. Here are tips for understanding the mindset and knowing what to say.
A person suffering with anorexia, bulimia, binge eating disorder or EDNOS is dealing with a mental illness that can cause a lot of potential physical and emotional damage. They are often in denial about being sick, and find it difficult to come to terms with the reality of their situation. They are also up against the pervasive misunderstandings and stereotypes about what an eating disorder is, and how to approach someone who has one. Three decades ago, the majority of the U.S. and other countries had only the story of famous singer Karen Carpenter's unexpected death from anorexia to count as an experience of hearing about an eating disorder. These days, many celebrities have stepped forward with their own stories about having dealt with an eating disorder, as well as it is more common to know someone in your personal life who has or had one themselves.
There are many stereotypes about eating disorders that still need to be shattered. They are not just about food. In fact, the food behaviors are actually the symptoms, and not the problem itself. Telling someone "just eat" or "use some willpower and go on a diet" is not only unhelpful, but demonstrates a lack of understanding of what eating disorders are really about. They are mental illnesses that usually take years to recover from, and almost always require professional help from a therapist, as well as utilizing any other source that can offer help, such as a doctor, nutritionist/dietician, support group, outpatient groups, or inpatient/residential care. At its most basic level, an eating disorder is an attempt to control, hide, banish, soothe or otherwise deal with difficult and painful emotions, situations and issues. These things must be dealt with in order to lessen the need for the behaviors and the emotional fix they provide, which in turn leads to a person no longer needing them at all.
Suggestions for Conversations
Supporting someone you care about who has an eating disorder is usually mystifying at first. The answers seem so easy: 'stop making yourself throw up' or 'stop eating too much' or 'stop starving yourself'. But these are surface level directions, and do not address the deep emotions and damage occurring beneath the surface; damage that is often built up over years or decades of time. Unhealthy family dynamics or child abuse (either current or in the past) may be part of the root of the problem. Ongoing issues with depression or anxiety can be present. The inability to use healthy coping skills or develop good boundaries is often a problem. Low self-esteem is present in every individual with an eating disorder. These are just some examples of reasons why recovery takes digging into a person's mindset, emotions, life experiences, and ability to deal with their past and present lives (and fear of the future). Doing so with trained professionals is essential to entering, staying in, and achieving true recovery.
When approaching a loved one with an eating disorder, remember that attempting to guilt or bribe them into giving up behaviors will not work. They need love, sympathy and support. Helping the person takes a great deal of patience and time, and will also require you to get educated on the options for offering help specific to their needs, including offering to assist them in finding the help they need. There are support groups, books, organizations and other resources to help the parent, child, other family member, partner, or friend offer assistance to the person they care about. These resources can also help the family member or friend cope with their own fears and questions related to caring about and being scared for someone who is dealing with an eating disorder.
One of the biggest complaints someone with an eating disorder has about the way others treat them is that they hate feeling as if they are being watched by "the food police". The instinct to monitor what someone is or is not eating is natural, but it's not always helpful. Sometimes it's necessary, depending on what is best for the sufferer (this often depends on their age and level of care needed), but sometimes it only worsens the situation. Take steps to understand what is best for the situation, and make adjustments as needed, such as if you used to have to monitor food intake a lot but now the person has made progress and earned a higher level of trust, you might be able to back off some.
When all the people involved are in a calm place, start a conversation about how the sufferer envisions you best helping them. Ask if they want you to check in with them regularly or just from time to time. Ask them when they feel the need to vent, to let you know if they want you to offer suggestions or just listen and validate their feelings. Ask them if it would be helpful to offer to do thinks like shop for food or prepare meals for them or would they prefer to take the responsibility for that. Discuss if there is someone in their lives they need to change or limit their contact with, such as a verbally abusive family member or a friend who might trigger their low self-esteem or behaviors. Offer to get rid of or hold onto potentially triggering items, such as a bathroom scale or workout DVDs. Let the person know you love and care about them, and your door is open whenever they want to talk. Acknowledge that you don't have experience with what they are going through, but you do understand that it must sometimes make them feel scared and alone, and you want to help ease those feelings when you can.
Comments About Weight
Something to be aware of is comments related to weight. While the average person considers "You've lost weight!" to be a compliment, it can come across quite differently to someone with an eating disorder. Even someone who needs to lose weight for health reasons (i.e. being overweight or obese due to an eating disorder) is learning to separate weight loss from being a "good" person. Too often a person who has constantly dieted sees both certain foods and themselves as either "good" or "bad", and learning to take the labels off everything is an essential skill. It's important that a loved one understands that acknowledging weight loss should be about being happy the person is making progress taking care of themselves, rather than how great they look or are now that they're thinner. Conversely, it is important to be mindful of comments said to someone who is anorexic and regaining weight. It's easy to say, "You look so much better now that you don't look like a skeleton" or "The weight you gained makes you look healthier" and mean it in the best way possible, but often healthy=fat in the mind of someone with anorexia. Try using more neutral phrases, such as, "I'm happy that you're taking better care of yourself." Be mindful of the reactions you get to any acknowledgement of physical changes in a sufferer's weight, as it's normal for them to be sensitive about it.
In addition, be aware of how you talk about weight and size yourself. Many people with an eating disorder grew up in homes or around people for whom weight was a huge topic and judgments about a person's size were common. This is not to lay blame on any one person's shoulders, but to point out that anyone who is trying to help someone who suffers from an eating disorder should be aware of their own dialogue about things like body shape, weight gained or lost, and views on people based on any of that. See The Media Influence for more thoughts on this.
Responsibility for Progress and Treatment
In addition to considering how to be gentle when dealing with your loved one, it's important to realize that eventually everyone with an eating disorder must learn to be willing to be accountable to themselves and those around them, and translate the desire to recover into changing their thought patterns and actions. It can be difficult to know when to push and when to pull back, especially if the sick person is not particularly open about what they are thinking or feeling.
While there are many times when a person, particularly a parent or partner, may need to be quite patient and assist when able to help with progress, there are also times when the sufferer may have to step up and take more responsibility for their progress in recovery. There are times a person with an eating disorder will feel anger at their loved ones for not accommodating their illness - such as preparing a separate meal with a 'safe food' or planning a day trip around their particular fears - but there are also situations in which it's not fair to ask the loved ones to rearrange things or tiptoe around situations. There is nothing wrong with accommodations initially made and used over time, but in some situations it can go on past the point of being helpful and all the way to simply being enabling. Learning the difference between the two is not necessarily an easy art form to learn, but it can become necessary when the person is particularly scared to move forward and may be playing the "But I'm sick" card as an excuse to stay stuck, rather than a legitimate request to help them.
If you are the parent of an underage child, or related/married to someone who is clearly a danger to themselves and not capable of making sound decisions, it may be necessary to attempt to push the person into intensive help that they may not want, such as inpatient or residential treatment. Talk to a doctor, therapist, or other medical professional about your options and what the laws are in your area.
Check out the Helpful Books page for suggestions for good reading for both yourself and the person you love.