The prospect of assisting a loved one fighting an eating disorder can seem daunting. There are practical strategies to consider when navigating treatment and recovery whether for a child, spouse, or someone else that you have decided to help during. The most important thing to consider is that you do not have to do it alone as there are many resources available.
How Will I Know When to Help Someone With an Eating Disorder?
If there is someone in your life that you suspect of needing help, the first step is to determine whether they have an eating disorder. This can be difficult to notice if the individual has not shared that they are struggling with an eating disorder or related condition. As a family member or friend, you may see the signs even before the person with the condition is acknowledging it to themselves. Many individuals with eating disorders do not feel that they deserve to seek out treatment or that they are yet sick enough to need help. It is not uncommon to be met with resistance in some cases.
It is helpful to understand some of the warning signs prior to approaching your loved one. Often when approached, the individual will attempt to persuade you that they are “fine” or that you are over-reacting. Being armed with information about your concerns is a helpful and neutral way to approach the subject. You can let the person know that it is not their fault and that you realize it is not their choice to have an eating disorder. Eating disorders are serious conditions that are often accompanied by other mental health issues such as depression and anxiety.
The following are some common warning signs of eating disorders:
- The individual follows pro-anorexia or pro-bulimia social media sites
- The individual has become more and more rigid with their eating or dieting behaviors
- The individual refuses to eat in front of other people
- The individual eats non-food objects
- The individual excuses themselves promptly after meals to use the restroom
- The individual becomes unusually distraught when they miss a work-out/run
- The individual refuses to engage in activities that require eating or revealing clothing such as shorts or swim wear
- Noticeable changes in weight in a short period of time (increase or decrease)
- Social isolation
What Can I Do to Help A Loved One With An Eating Disorder?
It is critical that those dealing with an eating disorder receive emotional support from family and in many cases professional intervention as it is unlikely the individual will be able to get back to a routine way of eating without some level of assistance. Left untreated, eating disorders have the potential to be life threatening.
If someone is interested in seeking out care for themselves or a loved one, an initial assessment with either an eating disorder therapist or registered dietitian is a good place to start. These individuals are trained to recognize and diagnose eating disorders. They will then make appropriate recommendations for additional providers if necessary. In the most severe cases, professionals may refer to treatment facilities or hospitals specializing in the care of those with eating disorders including intensive outpatient programs, partial hospitalization programs, or inpatient facilities.
What Emotional Support Can I Offer?
Those dealing with an eating disorder will need emotional support from family and friends. There are many ways that you can provide that support to a loved one. One important thing to remember is that every individual is unique and so is their eating disorder. They are the expert regarding their condition, and what they find to be supportive.
While various books and websites can provide a starting place, each person will need to verbalize which things they find to be helpful and not. The process is one of trial and error that you and your loved one will experience together during the recovery journey.
Here are examples of ways to support a loved one dealing with an eating disorder:
- Seek out professional care for your family member as soon as it becomes evident that the condition cannot be managed without intervention.
- Ask your loved one what they need from you.
- Spend time with your loved one outside of therapeutic activities.
- Make yourself available to talk, spend time with, and listen to your loved one when they need a person to lean on for support.
- Research eating disorders and related conditions so that you are informed and can adjust your behaviors and attitude as needed.
- Listen to them and validate their feelings when they share with you.
- Be honest and open with them about your experiences, observations, and concerns in a loving way.
- Role-model healthy attitudes and behaviors regarding food, exercise, and body image.
- Avoid food, body, weight, and diet talk around your loved one. Ask family and friends to do the same.
- When offering praise, focus on character traits rather than appearance and performance-based compliments.
What Practical Support Can I Offer?
In addition to emotional support, your loved one will also benefit from some practical support as well. While going through treatment and the recovery process, your loved one is likely to be exhausted, extremely busy, and overwhelmed at times. Offering them assistance with daily tasks and activities of recovery can be incredibly beneficial.
Here are practical ways to offer support:
- Monitor or sit with your loved one during and after meals.
- Assist your loved one in meal planning, preparation of meals, and grocery shopping if needed.
- Attend family or individual therapy sessions as needed yourself to address any issues that may be contributing to the maintenance of the eating disorder.
- Assist your loved one with getting to and from appointments if needed.
- Attend appointments with your loved one if needed.
- Schedule or plan activities to assist your loved one in staying distracted and engaging in self-care between meals and snacks such as movie nights, game nights, outings, and spa days.
- Encourage your loved one to stick with treatment when you notice that it is getting tough for them or they become ambivalent.
- Ask your loved one what they need assistance with and let them know that you would like to help (chores, errands, appointments, etc.)
- Avoid discussing the cost associated with treatment in front of your family member, especially minors, as this increases shame and guilt around being ill.
How to Talk About an Eating Disorder With a Friend
If you suspect that a friend has an eating disorder, you have probably given some thought as to how to approach them about it. It is difficult to know what to say and how to say it without making matters worse. The level of intimacy between friends will inform this decision to some degree. Your friend will likely appreciate that you are concerned whether he/she lets you know immediately.
Health issues can be sensitive, and eating disorders are especially so. They are difficult to talk about for both the person who has an eating disorder and the person who is concerned.
Here are some suggestions for approaching a friend with an eating disorder:
DO:
- Ask them how you can help: It is important to let your friend know that you are there to assist them in their pursuit of treatment and recovery.
- Ask questions: Asking helpful questions about what they need, and their disorder will signal that you are genuinely interested in them.
- Assist in finding resources for treatment providers or facilities: Ask your friend if they would like you to assist them in searching for a therapist or treatment center.
- Be understanding and patient while discussing their feelings: Listen patiently without interruption or interjection of opinion while your friend describes their eating disorder.
- Express concern in a neutral but specific way: Let your friend know that you have observed certain changes or behaviors and how that makes you feel.
- Avoid accusatory statements: Focus on your perspective of the situation that you have observed. (“I” statements versus “You” statements).
- Remain calm and reassuring: Attentive listening will reassure your friend that you are supportive and care about what they have to share with you.
- Respect their privacy: Let your friend know that you can be trusted by keeping what they tell you to yourself unless they are in immediate danger. If they are suicidal, seek out professional assistance immediately via a suicide hotline or call 911.
DON’T:
- Blame: Blaming your friend for starting their eating disorder or waiting to seek out help will not help and may postpone them seeking out assistance or coming to you for support in the future
- Focus on food: Focus on feelings rather than food or weight. Eating disorders are not really about food and weight, those are the symptoms.
- Shame: Avoid making shaming statements that lead them to feeling as if they are “bad” or “gross” due to your level of surprise or shock at hearing about their behaviors.
- Scared straight: Telling your friend stories of people who have had serious complications or died is not the best strategy as it only increases anxiety rather than provides support.
- Pressure: Avoid pressuring your friend to discuss aspects of their disorder that they prefer not to reveal.
- Break their confidence: Keep what your friend has to say to you private unless they share that they are currently suicidal. Gossiping about their eating disorder will only increase their shame and damage your relationship.
- Play therapist: You are not their therapist, so encourage them to seek out professional treatment. It is not helpful to try to be your friend’s therapist no matter how much you think they want to hear your advice. Eating disorders are life threatening conditions that require specialized care.
- Threaten or manipulate: Threatening what you will do if they don’t get better or trying to guilt them into getting better is not effective. Be honest about how you think and feel.
What If My Friend Doesn’t Want My Help?
Being ambivalent about seeking help and getting better is a part of the recovery process. This can be a difficult aspect of an eating disorder for family and friends. It is important to recognize that this does not mean that the individual isn’t interested in recovery, but that they are struggling with what recovery may look like for them. Many individuals are also embarrassed about the fact that their eating behaviors have become so escalated as to have garnered the attention of family and friends. Accepting help is the equivalent to admitting that they are sick. Once this admission is made, it is harder to continue the eating disorder behaviors without negative consequences.
When a friend is not expressing a desire to accept your help, it is important to realize that you may not be the person that is able to reach them. Let them know that you care about them and want to see them address their heath. Let them know that you are available to assist them when/if they choose to take you up on your offer. Once you have offered, you can continue to check-in with them periodically to let them know that your offer still stands. In the meantime, spending time with them and offering emotional support as long as it remains healthy for you allows them an opportunity to stay close to you and reach out when/if they desire.
There may, unfortunately, come a time that you decide to set a boundary for your own health and wellness if they continue to engage in eating disorder behavior without seeking out professional assistance. There is a limit to the personal distress a friend can be expected to endure. Each person will have to determine what their limit is. The important thing to remember is that you need to take care of yourself to effectively offer anyone else support.
Once you have reached a point of saturation where watching someone you care about harm themselves through self-imposed starvation, bingeing and purging, clean eating, or over-exercising has transpired, it is time to limit or cease exposure to that person until such time as those circumstances have changed. It is important to allow your friend the ability to make choices for themselves regarding their own health and recovery. You also have the choice about how long you expose yourself to it if it causes you emotional damage.
What Should I Do in an Emergency or Crisis?
At times, those with eating disorders struggle with co-occurring disorders such as anxiety and depression. With that, comes instances of suicidal thoughts and actions. Additionally, eating disorders can and do lead to medical emergencies. If you witness or are aware of an emergency with a friend or loved one due to a mental health condition, calling 911 is an option to receive immediate medical attention in the case of a life-threatening emergency.
If your loved one is experiencing a medical issue due to their eating disorder, but it is of a less severe nature, they may simply need you to take them to an urgent care or a local emergency room (ER) to be evaluated.
How Do I Respond to Someone Who Is Suicidal?
If your friend or loved one has shared that they are currently suicidal, it is critical to obtain professional help. There are several options in this situation if you are not able to quickly de-escalate this situation on your own. It is important to remain calm and communicate in a composed manner with your loved one to assist them in remaining calm as well.
If you know their location or if you are with them, 911 can be contacted to assist your loved one in getting help to them quickly. You can let the 911 operator know that there is a psychiatric emergency taking place. They will know what services to dispatch.
There are also suicide hotlines that can be utilized with trained crisis counselors who can talk to you and/or your loved one in this situation. There is a National Suicide Prevention Lifeline that can be contacted at 1-800-273 TALK (8255). Another option is the Crisis Text Line. Text NAMI to 741 741. A trained crisis counselor will provide support via text message.
Make Sure You Are Caring for Yourself, Too
Setting boundaries is critical as the treatment and recovery process for an eating disorder is a lengthy one in most cases. You cannot assist someone else if you are not taking care of you. Eating disorders are overwhelming and difficult to deal with for everyone involved. It is natural to need a break at times. Remember that you cannot be everything for your loved one. The wonderful thing about locating a team of qualified professionals to assist your loved one, is that you can return to the role of wife, mother, husband, father, sibling, child, or friend. You do not have to be a therapist, dietitian, and loved one all rolled up in one person.
It may be that you find yourself in need of counseling while your loved one is completing their own treatment. Having your own professional support is a good way to gain valuable knowledge about the disorder and learn ways to manage your own stress and anxiety about your loved one’s condition. There are also support groups available for family members in many cities and treatment programs which offer peer support as well. This is invaluable to family members who often feel alone in dealing with the battle against an eating disorder and the havoc one can cause.
