As much as we may educate ourselves about an eating disorder to help out a family member or friend in their recovery, it’s often difficult to know how to really be there for them. Eating disorders are difficult for lots of people to understand, because, although they manifest physically in the body, it’s actually a psychological problem, which makes it more difficult to pinpoint and unravel.
If you’re worried about someone then it’s important to encourage them to seek treatment as quickly as possible to ensure the best chance of recovery. But treatment is only one aspect of the recovery journey, and there are ways outside of your loved one’s treatment programme that you can play a vital role in helping them get better, regardless of your relationship to them.
Because of this difficulty in understanding, it can be hard to know how to support the person, how to say the right things, avoid the wrong ones and show them you’re there without overwhelming them. Seeing someone close to you going through this can make us feel guilt, confusion, worry and frustration, but it’s important to remember that many people are unaware that someone close to them has developed an eating disorder – they are often developed slowly and very secretively.
We should think of an eating disorder as a coping mechanism for dealing with some psychological upset to make it easier to understand why the person affected may not feel like opening up and resistant to changing their habit. Communication around this can be stressful and it’s not a change that will happen overnight, nor is it a linear journey. Fear and anxiety can make the affected person lash out and everyone’s experience of them is unique. But there are ways to appropriately support and help them along this road to recovery.
There are six key things to remember when trying to support someone with an eating disorder.
It’s not about food
It’s a coping mechanism. By focusing on food, there is little to be gained except a power struggle that pushes the ‘all or nothing’ mindset that the affected person is already in. By pushing, it can actually drive someone in the opposite direction. Try compromising, by talking about something else and meeting in the middle, working out how you can work together on this, not as opposing teams.
Take small steps
Change can be frightening, and particularly for someone who is trying to control things through their relationship with food. Break down changes into small, manageable steps that are realistic, achievable and slow. Be patient and take it one step at a time.
The food shopping can be a major source of anxiety for your loved one. Nutritional labels can be another avenue of control, so offer to do the shopping for them or go with them so you can do it together and support them.
The sheer abundance of food in supermarkets can be overwhelming. Writing out a list before you go can add an element of clarity to the situation. Avoid buying multipacks of feared or avoided foods as that can be triggering, especially if it’s something that they usually restrict or binge. Buy it instead as a single item so it appears more manageable.
During treatment, these kinds of restricted and avoided foods will be reintroduced. Planning when where and how they will be reintroduced, with the help of the treatment team can make the process easier for you loved one.
Keep the channels of communication open, no matter how awkward you may feel. Ask your loved one what would be most helpful during the mealtime. Some examples of things that have helped other people are having the television or radio on, colouring tablecloths, doing a puzzle or being involved in conversation. These distraction techniques, with their input can help them when they are struggling – and could also help outside of mealtimes. Avoid topics like how treatment is going or exercise and try to keep topics neutral when eating.
In people with restrictive eating disorders, eating regularly again can bring about physical discomfort such as stomach pain and feeling full very quickly – it is important to follow the advice of your loved one’s treatment team in response to this. This may require supporting your loved one with pushing through this discomfort and continuing to eat regularly.
Ensure you have everything you need for the planned meal to avoid last-minute changes that could increase anxiety. If you are eating together, plan with your loved one what you will be eating, at what time, who else will be there, and think about portion sizes.
Keep engaging them
Evening times are often the most vulnerable time for people who binge eat – ask your loved one what you can do to help with this, or at other times that they may find difficult. They may become withdrawn, and you may need to go to more effort than usual to make them feel included and stop them from isolating themselves. Even if their eating disorder causes them to withdraw, keep inviting them to join in with group and family activities. Think of social events that don’t revolve around food or exercise, such as trying out different crafts, or playing board games.
Take time to discuss topics outside of the illness and treatment – this can feel very tricky but your loved one is still there despite the eating disorder. Help your loved one try out new hobbies or return to hobbies that they used to enjoy. If your loved one enjoyed sports or exercise prior to developing the eating disorder and this became a problem, ensure that you consult with their medical professional about the best way to manage this.
Keep cool during confrontation
Try not to feel too guilty if you do find yourself getting angry at them. Make time when things have calmed down to explain your emotions to your loved one, and try to encourage them to do the same. Each of you clearly communicating your views and feelings might make it easier to avoid the situation in the future.
After the situation has calmed down, take time to look after your own needs. You can explain to your loved one that you love them and don’t blame them for how they reacted, but that you are going to take some time to go to another room to call a friend, or to go for a walk to look after your own wellbeing. Here you are letting them know that you love them, but also recognising the importance of self-compassion and modelling this to them.
When talking about the situation, show that you have heard your loved one’s concerns or difficulties by repeating some of the words they have used and reflecting these back to them. For instance, if they have shouted at you: “I would be fine if you backed off. You just make things worse,” you could reply with “What can I do so that I’m not making things worse?” This signals to your loved one that you have heard them and are listening. Remember that, much as the person you’re supporting is ill, there are still boundaries. They don’t have the right to hurt other people, even if they’re finding things difficult. When things are calm, be clear with them about what is and isn’t acceptable.