How to support a loved one with an eating disorder

Listen, ask questions and learn: psychotherapist Harriet Parsons offers some advice from the PiLaR support programme for Bodywhys

Eating disorders are serious psychological disorders that affect every aspect of how a person functions: how they think and feel; how they feed themselves; and their physical wellbeing. When a person develops an eating disorder (ED), they use disordered eating behaviours as a way to manage how they are feeling. An ED is not primarily about food or weight, rather it is a (destructive) coping mechanism; the person engages in the ED behaviours because it helps them feel better. It has a function, and that’s why it can be so hard to let go of. However, always remember full recovery is possible.

– When supporting someone with an ED, it helps to reframe their behaviours. So if you see a person restricting food or over-exercising or binging, try to understand the behaviour means your loved one is struggling with something, and needs support. Try to shift your focus from the behaviour to how they are feeling, and ask how you can help.

– Families often put themselves under pressure to learn everything they can about EDs generally, sometimes with the knock-on effect that they feel responsible for their loved one getting better or not. It’s more helpful instead to become an expert on your loved one’s ED. Listen, ask questions, and learn. This builds trust.

– Everyone’s ED is different. This is partly why EDs work as a coping mechanism, as they can help a person feel special. When supporting someone to let go of their ED, it is important not to assume their ED is like other people’s, or that you understand how their ED functions. Focusing on language can help. For example, when your loved one says something like “I feel fat”, instead of rushing to reassure or minimise, or negate, ask what they mean when they say that. This tells them that you are willing to listen, that you are not making assumptions. Helping your loved one to articulate the thoughts they have can be therapeutic for them, reducing their anxiety.

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– Thinking of the ED as a separate entity, as an “it”, helps in a number of ways; it helps the person to speak openly, without feeling blamed or guilty, and you can both talk about “it”. It also initiates the process of the person separating from their ED, and helps them to experience themselves without “it”.

– Things change when there’s an ED in the house. There’s a lot of anxiety, anger, frustration and fear. EDs thrive on this and often push families into “all or nothing”‘ positions, creating power struggles. Arguments happen. However, remember the ED will use an argument as a way of gaining a stronger hold. Although it is incredibly difficult, being able to stand back and take stock on what’s happening helps. If you find yourself getting really angry, can you pause and walk away? Because nothing gets solved in an argument. Can you demonstrate that it is ok not to be perfect, that you can row and make up? Recovery is about learning to tolerate uncomfortable feelings without using control of food to cope. So all of these situations can be opportunities to help your person learn how to cope with life.

– As a rule, don’t comment on anyone’s appearance, instead ask them how they are. EDs potentially distort any comment to keep the person trapped within it. This is also why it’s so important not to comment on what a person is eating, or have conversations about food and weight.

– Conversations can be tricky when supporting a person with an ED. The role that control plays in the disorder, means that even well-intentioned comments, like praise, can be viewed as controlling and judgmental. Deleting the word “should” from your vocabulary can help. And try to begin conversations by asking the person with the ED what they think or feel about something. After you have asked them, then there will a chance for you to offer your thoughts. This sets up a collaborative dynamic that builds trust.

– Every family is different, but it can be helpful to give siblings an age-appropriate explanation of what’s going on. Even a simple: “your sister’s not feeling good, and she’s finding it really hard to eat” can be enough. Make sure siblings know it’s not their fault, and that it is not their responsibility to fix things.

– No matter what type of ED a person has, a regular eating routine helps recovery, such as the rule of three: three meals, three snacks and not going longer than three hours without eating. This routine does a number of important things: it reduces the spikes in hunger; it regulates the digestive system; it helps to normalise weight; and it helps stabilise feelings and separate them from food.

– Christmas (and any family occasion) can be daunting for a person with an ED and their supporters. If the person has an eating routine, it’s important they can stick to it as much as possible. The most important bit of advice I can give about managing Christmas is to talk about it beforehand: what does each person want it to be like; where are you spending the day; who will be there; who is cooking; when are you eating; what foods are available and can there be options for the person with the ED; is there the option of eating where they feel most comfortable; can you develop a code word if the person with an ED gets into a panic; who will support them? Thinking through all these things in advance will help everyone.

– It is hard to avoid diet talk as we go into the new year. Reassure your person that they are ill and those messages do not apply to them. Be aware of your language around your own eating behaviours.

– Encourage being in the “here and now”. A helpful way of thinking is: if you look after yourself today, the future will look after itself!

- Harriet Parsons will host a webinar on Coping with Christmas on Friday, November 26th. Details at bodywhys.ie