One of the most common features of eating disorders is a lack of self-awareness that prevents people from recognizing that they are in trouble; indeed, many are openly protective of their disorder. Keep this in mind when you think about approaching someone with your concerns.
Recovery means much more than replacing dieting, binge eating, and purging with healthy eating. Restoring weight in women with anorexia and normalizing eating in women with any eating disorder are essential first steps in treatment. It also means identifying the dynamics, thoughts, and behaviors that underlie disordered eating and working to resolve them. The process requires a level of skill, sensitivity, and experience that only trained medical and mental health professionals can provide.
Does this mean there is nothing you can do to help? Not at all. There is much a patient’s parents, family, or friends can do in collaboration with a mental health professional. For teens and adolescents, it is essential for parents to play an active role in restoring healthy eating. What you cannot be is a trained clinician. That means your primary focus should be to encourage the person to talk things over with a physician or counselor. If ongoing treatment is advised, you can encourage the person to begin treatment and stay with it until the problem is resolved.
The greatest obstacle will be convincing the person to admit she has a problem. At first, there may be denial. She may be ashamed and not want to admit the behavior. She will be afraid of becoming “fat” and will likely resist any effort to convince her to gain weight or stop bingeing and purging. Patients often tell us that their eating disorder is controlling them and that they have lost the ability to make the decision to stop using eating disorder behaviors. The reluctance to both change behavior and to accept advice are part of the illness itself.
Following are some suggestions to help you talk to someone who has mixed feelings about accepting help for an eating disorder.
Things to do
- Be kind. Talk to the person when you are calm, not 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 positive. Mention evidence you have heard or seen in her behavior that suggests disordered eating. Don’t dwell on appearance or weight. Instead, talk about health, relationships and mood.
- Be realistic. Realize that she can’t change without motivation and support. You can help her identify the positive reasons for changing and some of the negative consequences of remaining unchanged.
- Be helpful. Provide information. Show her Renfrew’s website.
- Be supportive and caring. Be a good listener and don’t give advice unless you are asked to do so. Don’t be put off if she doesn’t immediately appreciate your advice.
- Be patient. Continue to suggest professional help. Don’t pester, but don’t give up either. If the discussion becomes too tense or uncomfortable, take a break and let her know that you will be coming back to her to continue the discussion.
- Ask “Is doing what you are doing really working to get you what you want?”
- Talk about the advantages of recovery and a normal life.
- Agree that recovery is hard, but emphasize that many people have achieved it.
- Offer to go with her the first time if she is frightened to see a counselor.
- Realize that recovery is her responsibility, not yours.
- Resist guilt. Do the best you can and then be gentle with yourself.
Things NOT to do
- Never nag, plead, beg, bribe, threaten, or manipulate. These approaches don’t work.
- Avoid power struggles. Express your own concerns and feelings without expecting her to agree with you.
- Never criticize or shame. Most people with eating disorders already feel ashamed and guilty. You may make it harder for her to open up about her eating disorder.
- Don’t ignore the problem and its warning signs. Take action.
- Don’t try to control. Your task is to help her come to her own realization that some things must change.
- Don’t waste time trying to reassure her that she is not fat.
- Feeling fat is rarely a rational assumption. It may be best to tell her you understand why she feels that way, while also reassuring her that you do not see her like that.
- Don’t get involved in endless conversations about weight, food, and calories. These discussions are usually unproductive. Help her identify the consequences of her choices and the positive benefits of change.
- Don’t give advice unless asked.
- Don’t be frustrated if she’s not ready to heed your advice.
- Don’t say, “You are too thin.” What you intend to be a warning she may see as a sign that she is achieving her goal.
- Don’t say, “It’s good you have gained weight.” Remember, weight gain may feel like a failure to her.
- Don’t let her always decide when, what, and where you will eat. Try to keep to your family’s normal meal schedule. Constantly adapting to the demands of her eating disorder may keep her from recognizing that something is seriously wrong.
- Don’t ignore stolen food and evidence of purging. Insist on responsibility and emphasize that the disorder is leading her to make choices that are not like her healthy self.
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 diseases that have the highest mortality rate of any psychiatric disorder. Patients with eating disorders deserve and require professional evaluation, diagnosis, and treatment. If someone close to you had cancer, you would do everything in your power to get them the finest professional care available. Eating disorders require that same level of treatment.
Eating disorders can cripple both body and mind. People with eating disorders typically struggle with intense self-criticism, often in the form of profound body dissatisfaction and anxiety. No matter how much you may care for a person, you cannot fix those things. That is a job for physicians, psychologists, and other mental health professionals trained to work with patients with eating disorders. Call 1-800-RENFREW (736-3739) and talk with a program information specialist.