What is the most effective way to help someone who has an eating disorder? How do you talk about it? What should you say? What should parents be aware of? How about partners? In this post, we look at what it means to provide help effectively to someone who is struggling.
Eating disorder recovery means much more than replacing restricting, binge eating, and/or purging with healthy eating. It also means identifying the dynamics, emotions, thoughts, and behaviors associated with disordered behaviors and working to resolve them. The process often requires a level of skill, sensitivity, and experience that only trained medical and mental health professionals can provide.
So, where does that leave loved ones like parents, caregivers, family, and friends? What should you do?
Eating Disorders: Who Can Help?
It is very important to know that if you are reading this blog, then YOU can be a helper. Whether you are a parent, sibling, loved one, partner, friend, teacher, or coach, your voice matters and means something to the individual you are concerned about. You can also be a helper by being mindful of your own words and behaviors. It is important to take the focus away from body size, food, and weight. You can also help by respecting and embracing body diversity and critically evaluating media messages that uphold toxic diet culture and the thin ideal.
Defining What ‘Help’ Means
For teens and adolescents, it is essential for parents to play an active role in normalizing eating patterns and modeling a healthy relationship with food. However, a parent is not a trained eating disorder professional. A parent may need to encourage and remind their loved one to openly and honestly discuss their struggles in sessions with their physician, dietitian, psychiatrist, and/or therapist. If ongoing treatment is advised, you can also support the person by helping them research their treatment options, accompanying them to an assessment, actively listening to them without judgment, validating their emotions, and encouraging them to follow through with the experts’ recommendations.
Recognizing The Signs of an Eating Disorder
An eating disorder is a psychiatric condition in which there is a persistent disturbance of eating or eating related behaviors that often results in medical, psychological, and social impairment. The most common eating disorders are binge-eating disorder, bulimia, anorexia, and other specified feeding or eating disorder (OSFED). Early warning signs for any eating disorder can include: dieting, eliminating food groups, adopting strict food rules; following unhelpful social media accounts; frequently comparing self to others, experiencing distress when talking about relationship with food and/or body image; avoiding eating with others; behaving impulsively; ; changing eating behaviors (e.g., eating slowly, cutting food into small bites, eating very quickly); and becoming preoccupied with recipes or ingredients (i.e., taking an excessive time to prepare meals, obsession with calories and nutrition information) among others.
Binge-Eating Disorder
People with Binge-eating disorder engage in binge-eating episodes. They eat large amounts of food in a discrete period of time; they report feeling out of control and often eat past feeling full. Those struggling with binge-eating disorder typically experience a great deal of shame with their behaviors and unlike bulimia, they do not compensate for the food intake. As the binging continues, the shame grows, and we may begin to see heightened avoidance and isolation from others. Food containers and wrappers may be hidden in various places and an altered state of mood (usually a more depressive mood) may be seen.
Bulimia
Individuals with Bulimia Nervosa engage in cycles of binge eating and purging behaviors to compensate for binge eating episodes. The purging associated with bulimia may take many forms including self-induced vomiting, excessive use of laxatives or diuretics, or compulsive exercising. Folks with bulimia may suffer with symptoms for years prior to receiving help because the shame can feel so high. Bulimia occurs in all shapes and sizes, however those who are considered to be within a “normal” weight range can be easily overlooked during annual doctor visits, perpetuating the stereotype that only people of certain body sizes struggle with eating disorders.
Anorexia
Those with Anorexia Nervosa or Atypical Anorexia Nervosa purposefully restrict their intake, which leads to significant weight loss and/or a significantly low body weight in the context of age, developmental trajectory, and physical health. These individuals have an intense fear of gaining weight and high levels of body dissatisfaction regardless of weight, shape, or body size. Those with AN binge/purge type also engage in binge eating episodes and/or purging. It is important to note that body size does NOT determine whether someone has a restrictive eating disorder or not. Additionally, medical complications such as blood pressure issues, heightened or lowered heart rate, abnormal labs, fainting and dizziness can occur to folks in any body.
ARFID
People with Avoidant Restrictive Food Intake Disorder or ARFID may have restrictive eating and feeding disturbances characterized by the following: avoidance based on the sensory characteristics of food, a general disinterest in eating, or a concern about aversive consequences of eating. This restrictive eating leads to nutritional deficiencies or weight loss. Undue influences of weight and shape may be present; however body dissatisfaction and body disturbance are not the driving factors of the restriction. Folks with ARFID may be viewed as “extreme picky eaters,” and/or may also have a dependance on enteral feeding or oral supplements to receive adequate nutrition. Lastly, while ARFID can affect anyone, it is often diagnosed in children and adolescent males.
OSFED
Finally, Other Specified Feeding or Eating Disorder (OSFED) is a diagnosis given to those who do not meet the strict diagnostic criteria for AN, BN, BED, or ARFID, but report behaviors and symptoms severe enough to cause impairment across various domains. If eating disorder symptoms such as restricting, binging, and/or purging result in significant impairment professionally, mentally, emotionally, spiritually, or financially, it is recommended to seek support from an eating disorder specialist.
How to Help: Do’s, Don’ts & Tips for Overcoming Barriers
One of the greatest obstacles can be waiting for your loved one to admit they have a problem. At first, there may be denial. They may be ashamed or embarrassed of their symptoms. Patients often tell us that their eating disorder is controlling them and that they have lost the ability to stop. Their behaviors aren’t a choice, but rather symptoms of a complex psychiatric diagnosis impacting their mind and their body.
The following are some suggestions to help you talk to someone who is fortunate enough to access treatment resources, but has mixed feelings about accepting help for an eating disorder:
- Be kind. Talk to the person when you are calm rather than frustrated or emotional. Keep in mind that the person with an eating disorder may feel especially sensitive to real or perceived criticism, irritation, or rejection.
- Be non-judgmental. Don’t talk about appearance or weight. Instead, talk about mental health, relationships and mood.
- Be realistic. Realize that change will be difficult without motivation and support. You can help them identify the positive reasons for changing and some of the negative consequences of staying the same.
- Be helpful. Provide information.
- Be supportive and caring. Be a good listener and don’t give advice unless you are asked to do so. Be compassionate because they might not immediately want or appreciate your support.
- Be patient. Continue to encourage them to seek out professional help. Don’t pester, but don’t give up either. If you notice you’re becoming tense or uncomfortable, take a break and create a plan with them to continue the discussion at a later time.
- Talk about the many physical, emotional, and social advantages of life in recovery.
- Validate that recovery is hard work but emphasize that it’s possible and many people have achieved it.
What NOT to Do
Despite the best of intentions, there are actions and approaches that often hurt more than help. Here are a few things to avoid:
- Never nag, plead, beg, bribe, force, threaten, or manipulate. These approaches don’t work and can potentially damage your relationship.
- Avoid power struggles. Eating disorders are irrational disorders and will likely not improve by arguing or debating with logic. Express your own concerns and feelings without expecting them to agree with you.
- Never criticize or shame. Most people with eating disorders already feel ashamed and guilty. You may make it harder for them to open up to you about the eating disorder or other struggles in the future.
- Don’t ignore or minimize the problem and its warning signs.
- Don’t try to control. Your task is to help them come to their own realization that the eating disorder is interfering with the life they want to live.
- Don’t get involved in endless conversations about weight, food, and calories. These discussions are usually unproductive. Help them identify the ways the eating disorder impacts their mood, energy, and relationships. Focus on the benefits of recovery.
- Don’t let the eating disorder always decide when, what, and where you will eat. Eat together and try to keep to a normal meal schedule. Constantly adapting to the demands of the eating disorder may keep your loved one from recognizing that something is seriously wrong.
When to Call an Eating Disorder Professional
It is critical to understand that eating disorders are not just fads, phases, lifestyle choices, or trivial eccentricities. They are extremely serious disorders that have one of the highest mortality rates in the DSM-V. Patients with eating disorders deserve and require professional assessment, diagnosis, and treatment.
Resources for Educating Yourself
Before discussing your concerns with your loved one, take time to educate yourself on eating disorders. There is more information than ever before and not only will this knowledge empower you to better understand what your loved one is going through, but it will also demonstrate to them that you care about them and want them to get better.
Resources:
More resources can be found here: https://renfrewcenter.com/best-learning-resources-for-eating-disorders-and-recovery/
Conclusion
Eating disorders can be devastating to the mind, body and spirit. People with eating disorders typically struggle with intense emotional experiences, anxiety, depression, and poor body image. No matter how much you may care for a person, you cannot fix those things. Your support can help tremendously, but your loved one also deserves treatment by expert physicians, therapists, and dieticians, as well as the support found among a community of recovering peers.
