EDT Network - www.edtnetwork.com - Eating Disorder Treatment Network

Friends and Family Section

If you suspect a loved one is suffering with an Eating Disorder, early detection and intervention is key in the success of treatment. Use the following checklist to gather information and substantiate your concerns.

_______ Noticeable weight loss or extreme thinness
_______ Finding excuses to skip meals
_______ Unusual eating behaviors, ritualistic eating
_______ Unusual concern about school performance; earned grades are never “good enough”
_______ Oversensitivity to criticism
_______ Unusual concern over change in routine; not flexible or adaptable
_______ Tendency to be a perfectionist
_______ Closed communication; usually very proper, polite; may appear tense or too animated
_______ Unusual concern about appearance; very neat, “not a hair out of place”
_______ Hides food in odd places such as closets, suitcases, under the bed, etc. to be eaten later in private
_______ Withdrawal from friends and activities; an unusual immersion in an activity to the exclusion of other activities
_______ Amenorrhea (absence of menstruation)
_______ Unusual, compulsive behaviors, particularly having to do with food
_______ Mood swings
_______ Very controlled behavior, able to hide feelings
_______ Conversation largely about food and weight
_______ Intolerance of others
_______ Low self esteem
_______ Exercises excessively
_______ Frequently weighs herself
_______ Reluctant to eat in front of others
_______ Wrappers from laxatives, diuretics, or diet pills are found
_______ Eats in response to emotional stressors
_______ Seeks to avoid risks; looks for safety and predictability
_______ Fears not measuring up
_______ Distrusts self and others
_______ Hates big family dinners and finds excuses not to attend
_______ Prepares elaborate meals for other people but does not eat any of the food
_______ Avoids deep connections to others
_______ Believes her life would be better if she were thinner
_______ Is obsessed with clothing size and weight
_______ Increasingly avoids different food groups
_______ Eats only non-fat or diet foods
_______ Becomes a vegetarian to restrict eating
_______ Displays rigid control around food; including type, quantity, and time of food eaten (food may be missing later)
_______ Complains about specific body parts and asks for constant reassurance regarding appearance
_______ Spends time trying on clothing to make sure they don’t fit too tight.
_______ Terrified about gaining weight or being overweight
_______ Counts calories for all food eaten
_______ Disappears into the bathroom after eating
_______ Vomits up food and tries to hide the sound by running water or the shower. Smell of vomit may be present on her breath after bathroom visits

If you checked 5 or more of the above items, your loved one may be suffering with an Eating Disorder. Contact her PCP to discuss your concerns or contact EDT Network for more information

Friends and family members are often the forgotten victims and heroes of Eating Disorders. If you love someone with an Eating Disorder, it is difficult to know what to do for that individual. The first step is to understand and accept that you cannot control another person’s behavior no matter what your effort. The power you hold lies in what you choose to do about the situation. Your choice to educate yourself on Eating Disorders, including the signs, standard behaviors, and the adaptive functions they serve, as well as how to approach and support the individual, will increase your chance for success in dealing with your loved one’s Eating Disorder.

Approaching the Individual about a suspected Eating Disorder

First and foremost, approaching an Eating Disorder is not about assigning blame, feeling shame or responsibility, or carrying a burden of guilt. These feelings have no place in the therapeutic environment that is needed for your loved one. Once these feelings have been released, you are freed to help the individual as your responses are not clouded by what “could” or “should” have been done.
EDT Network understands relationships can be strained or severed due to the feelings of anger, fear, sadness, shame, guilt and abandonment that affect the friends and family of the individual with the Eating Disorder. These strained and severed relationships can make it even more difficult to approach the individual. What you must understand and accept is the individual’s actions and behaviors are not personally directed at you. They are a symptom of the Eating Disorder that has taken over her life. If there is any productive anger to be held onto, it should be directed at the Eating Disorder itself. Eating Disorders become a best friend/worst enemy to the individual sufferer. Direct your anger towards that best friend/worst enemy and channel that anger to resolve to “get your loved one back” from the grip of the Eating Disorder.

There are a few things to remember when approaching your loved one about their Eating Disorder:

Asking for help is typically one of the hardest things for individuals with Eating Disorders to do. Help is viewed as a weakness and the individual “should” be strong enough to handle everything on her own. The individual needs to learn (which usually requires therapy) that she can reach out to people to help deal with her pain instead of her Eating Disorder.
YOU ARE AN OUTSIDER meaning you don’t suffer with an Eating Disorder. You will never fully understand the depth or importance of the Eating Disorder but what you must understand is that it is not about food. All forms of Eating Disorders are emotionally based and the actions and behaviors are only a symptom of underlying emotional issues. The individual cannot cure herself through self control and you cannot cure her through “police-ing” her every move. Her issues need to be professionally addressed with a therapist trained in working with Eating Disorders.

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Incorporating the above information, here are some tips on approaching your loved one about her Eating Disorder:

DO:

Speak to the person in private and allow the person enough time to respond. Do not be afraid of silence, as she may be formulating a response to your statements. Remember, individuals suffering with an Eating Disorder have difficulty expressing emotion and this will be a very difficult and emotional response (if they choose to admit their Eating Disorder). Listen carefully and non-judgmentally. Make sure you have enough time without interruptions to say everything that needs to be said.
Tell the person you are concerned about her. Do not specifically mention weight. Instead, focus on the behaviors and actions (for example, instead of saying, “You are way too thin”, say “I am scared you are not eating enough). Calmly tell the individual the specific observations that aroused your concern.
State all of your statements in an “I” format. Instead of saying, “You aren’t eating” say, “I’m afraid you are not eating in a healthy manner and it scares me.” Placing the focus on you rather than her will make her less defensive and express your concern.
Understand that the Eating Disorder is not about weight. Although it is difficult not to solely focus on the dangerous eating behaviors and the medical complications that result, remember the Eating Disorder is an adaptive function for her. Focusing solely on the Eating Disorder may lead your loved one to feel misunderstood and ignored regarding her emotional pain. Make sure you relate to her emotional needs also. Once you have cited your observations and why you are approaching her regarding her Eating Disorder, try to speak to her regarding her emotional well being (remember to keep it in an “I” format). For example, “I don’t understand this Eating Disorder but I would like to help you work through this. I’ve read that Eating Disorders help deal with emotional pain and I sense you are hurting. I love you and I am here for you, whatever you may need.” Make yourself available for intimate and in-depth talks. Opening a line of communication with your loved one is a victory in the battle of the Eating Disorder.
Expect a strong response from your loved one. Embarrassment, anger, withdrawal, betrayal are all emotions that the individual may use to mask her sense of terror of losing her perceived sense of control through the Eating Disorder. DO NOT GIVE UP. It may seem that the individual is angry, upset, embarrassed, etc. and she may even withdraw from you. Stay calm but firm on what needs to happen. Be prepared to “force” her to go to the doctor but tell her why. “I know you are upset with me but I am concerned that this Eating Disorder is causing physical problems that need to be assessed. I’m sorry you are mad at me but I’m scared you are hurting yourself".
Express your own emotion to your loved one in a non-threatening way. Dealing with an Eating Disorder in a loved one is a very emotionally trying situation. It is normal to feel anger, frustration, helplessness, fear and a host of other emotions. Don’t deny your feelings but share them with your loved one in a constructive way. “I get so angry and frustrated that this Eating Disorder has taken over your life. I feel helpless when I see you slowly kill yourself because I don’t know what to do to help you. I love you and I can’t stand to see this Eating Disorder slowly take you away from me.”
Be prepared with a list of resources for treatment in case your loved one is open to treatment. Do not wait to pursue treatment if she is open to the idea. Many times, her feelings may change if the appointment isn’t made immediately. If she does change her mind before the appointment is made or when the appointment time is nearing, remind her of her choice to seek help and the reasons she made that decision.
Get support for yourself. It doesn’t make the process any easier or lessen the pain but it helps to talk to someone else who is going through or has gone through the same situations. It also helps to realize that the responses of your loved one are not unique or personally directed at you. Behaviors, actions and responses are typically very characteristic of Eating Disorders. (For a list of resources and support, please go to the “On-line Support” section or the “Additional Resources”.

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DON’T:

DON’T argue or get into a power struggle. Expect that your loved one is going to reject your help at first and will probably be angry, deny the problem or lash out at you. Although it may be difficult, remember the Eating Disorder is responding, not your loved one. Stay as calm as you can, reiterate your concerns and the need for professional help. It may eventually come down to forcing your loved one to seek help. If it resorts to that, “negotiate” the need for at least one appointment and offer to go with her. Let the therapist negotiate any further power struggle for future sessions.
DON’T give your loved one compliments or admire her appearance. Although these compliments are well intentioned and made out of love, they will be taken as patronizing and she won’t believe a word of it. You may see your loved one as a beautiful, strong, confident girl/woman but her perception of herself is very different and will not change based on your compliments. In fact, telling her she is strong and can “beat” this Eating Disorder may actually place more stress on her and further the emotional turmoil she is already experiencing. Compliments should be directed towards positive behaviors such as, “I know it was really hard for you to eat that banana at lunch today. I am proud of you.”
DON’T tell your loved one that she is “crazy, stupid, sick or being ridiculous”. This Eating Disorder may be crazy, stupid, sick or ridiculous to you, but to your loved one, it is a way of life, a best friend, or insulation from emotions. Any negative comments like the ones above will likely be followed with anger, embarrassment and further withdrawal. She will also personalize those statements and interpret them as, “they think I’m crazy, stupid, sick and ridiculous”.
DON’T confront your loved one with her Eating Disorder in front of a group of unconcerned people. This will be a very private conversation and needs to be conducted in a place the individual feels safe (typically the home environment). If an intervention is conducted, be sure all attendees are those that have an emotional tie with your loved one. Ideally it would just be family and those that are important to your loved one. ONE person should take the lead and express the concerns while the remaining attendees are silent and present to show their support. An intervention should be carefully planned and involve a professional experienced in Eating Disorders.
DON’T give advice on appearance, weight loss or exercising as the Eating Disorder does not stem from any of these areas.
DON’T police your loved ones every move. Doing so will exhaust you and threaten the trust and alliance that need to be built with your loved one.

The above tips will not make the experience of approaching your loved one about an Eating Disorder any easier but it will give you a sense of guidance from the professionals experienced at working with Eating Disorders at Eating Disorder Treatment Network.

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Assisting in the Recovery

Once your loved one has entered into treatment, it may seem like the battle is over; however, it is actually just beginning. Eating Disorders are relentless and are not easily cured. Research indicates that recovery from an Eating Disorder may take 4 to 7 years and while clients are typically not practicing the Eating Disorder behaviors the entire time, it takes years to deal with the emotional side of the disorder. It is important to not look for a “quick fix” or a magic pill to cure your loved one from an Eating Disorder. In most cases, long term therapy, support and understanding will be needed. In addition to this, family therapy should be incorporated into the client’s treatment. While the individual has been suffering with the Eating Disorder, the whole family has been affected. Strained or severed relationships, issues of abandonment, resentment, anger, guilt, etc are all feelings that the entire family may have experienced. This should be brought out in therapy so no unresolved issues are left to surface later and lead to a possible relapse for the individual suffering with the Eating Disorder.

While family therapy is important to the process of recovering from an Eating Disorder, it may not be available for a variety of reasons.

The following list will help you help your loved one through this difficult process.

As stated above, be patient. Recovery is typically a long term endeavor with no “magic pills” or “quick fixes”.
Don’t ask your loved one what you can do to help, ask her therapist. Too often the individual suffering with the Eating Disorder will ask you to do things that are detrimental to her treatment. Be sure to consult with her therapist as to how you can help the most throughout the treatment process. If your loved one does ask you to help in a specific way, check with her therapist to ensure it is not going to interfere with her therapy or enable her to regress.
Don’t make mealtimes a battle of wills. Don’t use meals to police her intake or offer advice on what she “should” be eating. Leave this to her therapist and dietician. Use mealtimes as a time to discuss the day’s events, school events, interesting situations from the day, etc. Open the lines of communication in the family. While the mealtimes are important, don’t go to extremes on serving something that only the individual suffering with the Eating Disorder will eat. If she is a vegetarian, don’t skip meat at meal times. While you want to be there for her and support her, she cannot dominate and change the family’s eating patterns. If she makes a statement such as, “I won’t eat unless…”, calmly address her alone and inform her that while her desires are very important to you, the needs of the rest of the family need to be considered also. If there are siblings, explain that their needs are also important.
Do not allow your loved one to rule your life. While an Eating Disorder is overwhelming and can seem to overtake your life, you need to do things for yourself and other people in the household. Skipping a sibling’s sporting event to monitor the individual with the Eating Disorder is an example of the Eating Disorder ruling your life. It is also important not to get into bribing, rewarding or coaxing the individual to do things. This will ultimately fail because your loved one is not dealing with her emotions, she is simply fulfilling a duty in order to get a reward. While celebrating therapeutic breakthroughs and milestones is important, make sure it does not turn into a bribery situation.
Offer unconditional love. This is very important and at times, very difficult. Eating Disorders can be very frustrating and infuriating but offering unconditional love to someone who feels unlovable is a vital part of therapy. Offering this unconditional love can be as simple as a hug, a shoulder to lean on, or even just a smile. Try to spend special time with her outside of the house and void of any mention of her Eating Disorder. Go to an art fair, take a drive, go shopping, do something to spend time with her. It will show her you value her and eventually help her to value herself. You can also send her text messages, emails or send little notes to express encouragement, concern or support without putting her on the spot or needing a response or reaction.
Get help for yourself. Educate yourself on the causes of Eating Disorders as well as what to expect in treatment. Understand you feel a wide range of emotions and that it may be an emotional “rollercoaster” for a while. If you are able, line up as many people to talk to as you can. Friends and family are very important because you can vent to them and release any emotions freely. (Make sure to do this somewhere your loved one is sure not to hear you.) Prepare your friends and family from the beginning that you are not looking for answers, you just need to vent, cry, get angry, scream, or whatever you need to do to release your emotions so you can maintain a calm presence with your loved one suffering with the Eating Disorder. While these good friends and family are important, if available a therapist or support group would be ideal. These groups may be difficult to find but may be found through a thorough search of community resources such as hospital support groups, support groups through the Community Mental Health or even support groups through outpatient counseling facilities. You may also find on-line support chat rooms or message boards like the one through EDT Network. Whatever resources you utilize, it is important that you get support.

This is not an easy process but it can be done. DO NOT GIVE UP!!!!

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