EATING DISORDER - Helping Someone with an Eating Disorder

Advice for Parents, Family Members, and Friends

Are you worried that a friend or family member might have an eating disorder? It's not easy to watch someone you care about damage his or her health–especially when the solution appears, at least on the outside, to be simple. But eating disorders aren't really about food or weight. They are attempts to deal with emotional and stress-related issues. You can't force a person with an eating disorder to change, but you can offer your support and encourage treatment. And that can make a huge difference.

Understanding eating disorders

Eating disorders involve extreme disturbances in eating behaviors—following rigid diets, bingeing on food in secret, throwing up after meals, obsessively counting calories. But eating disorders are more complicated than just unhealthy dietary habits. At their core, eating disorders involve distorted, self-critical attitudes about weight, food, and body image. It’s these negative thoughts and feelings that fuel the damaging behaviors.

People with eating disorders use food to deal with uncomfortable or painful emotions. Restricting food is used to feel in control. Overeating temporarily soothes sadness, anger, or loneliness. Purging is used to combat feelings of helplessness and self-loathing. Over time, people with eating disorders lose the ability to see themselves objectively and obsessions over food and weight come to dominate everything else in life.

Myths about Eating Disorders

Myth #1: You have to be underweight to have an eating disorder.
People with eating disorders come in all shapes and sizes. Many individuals with eating disorders are of average weight or are overweight.

Myth #2: Only teenage girls and young women are affected by eating disorders.
While eating disorders are most common in young women in their teens and early twenties, they are found in men and women of all ages.

Myth #3: People with eating disorders are vain.
It’s not vanity that drives people with eating disorders to follow extreme diets and obsess over their bodies, but rather an attempt to deal with feelings of shame, anxiety, and powerlessness.

Myth #4: Eating disorders aren’t really that dangerous.
All eating disorders can lead to irreversible and even life-threatening health problems, such as heart disease, bone loss, stunted growth, infertility, and kidney damage.

Types of eating disorders

The most common eating disorders are anorexia, bulimia, and binge eating disorder.

• Anorexia – People with anorexia starve themselves out of an intense fear of becoming fat. Despite being underweight or even emaciated, they never believe they’re thin enough. In addition to restricting calories, people with anorexia may also control their weight with exercise, diet pills, or purging.
• Bulimia – Bulimia involves a destructive cycle of bingeing and purging. Following an episode of out-of-control binge eating, people with bulimia take drastic steps to purge themselves of the extra calories. In order to avoid weight gain they vomit, exercise, fast, or take laxatives.
• Binge Eating Disorder – People with binge eating disorder compulsively overeat, rapidly consuming thousands of calories in a short period of time. Despite feelings of guilt and shame over these secret binges, they feel unable to control their behavior or stop eating even when uncomfortably full.

Warning signs of eating disorders

In the early stages, it can be challenging to tell the difference between an eating disorder and normal self-consciousness, weight concerns, or dieting. As eating disorders progress, the red flags become easier to spot. But a person with an eating disorder will often go to great lengths to hide the problem, so it’s important to know the warning signs.

Restricting food or dieting

The most obvious warning signs of eating disorders involve restrictive eating behaviors. A friend or family member with an eating disorder may frequently skip meals or make excuses to avoid eating—he or she had a big meal earlier, isn’t hungry, or has an upset stomach. The person may also claim to be disgusted by foods that used to be favorites.

When your loved one does eat, he or she may take tiny servings, eat only specific low-calorie foods, or obsessively count calories, read food labels, and weigh portions. In an effort to curb appetite, your friend or family member may also take diet pills, prescription stimulants like Adderall or Ritalin, or even illegal drugs such as speed.

Bingeing

Some people with eating disorders eat normally around others, only to binge in secret—usually late at night or in a private spot where they won’t be discovered or disturbed. Warning signs of bingeing include piles of empty food packages and wrappers, cupboards and refrigerators that have been cleaned out, and hidden stashes of high-calorie foods such as desserts and junk food.

Purging

People with eating disorders may purge by throwing up, fasting, exercising vigorously, or using diuretics and laxatives.

Common warning signs of purging include disappearing right after a meal or making frequent trips to the bathroom. If your friend or family member is vomiting, he or she may run the water to muffle the sound and use mouthwash, breath mints, or perfume to disguise the smell.

Distorted body image and altered appearance

A loved one’s appearance can also offer clues to an underlying problem. Significant weight loss, rapid weight gain, and constantly fluctuating weight are all possible warning signs. A person with an eating disorder may also wear baggy clothes or multiple layers in an attempt to hide dramatic weight loss.

Other warning signs include a distorted self-image or an obsessive preoccupation with weight. A relative complains about being fat despite a dramatically shrinking frame, for example, or a friend spends hours in front of the mirror, inspecting and criticizing her body. 

Common eating disorder warning signs

• Preoccupation with body or weight
• Obsession with calories, food, or nutrition
• Constant dieting, even when thin
• Rapid, unexplained weight loss or weight gain
• Taking laxatives or diet pills
• Compulsive exercising
• Making excuses to get out of eating
• Avoiding social situations that involve food
• Going to the bathroom right after meals
• Eating alone, at night, or in secret
• Hoarding high-calorie food

Helping a loved one with an eating disorder

If you notice the warning signs of an eating disorder in a friend or family member, you may be hesitant to say anything out of fear that you’re mistaken, or that you’ll say the wrong thing, or you might alienate the person. Although it’s undeniably difficult to bring up such a delicate subject, don’t let these worries keep you from voicing valid concerns.

People with eating disorders are often afraid to ask for help. Some are struggling just as much as you are to find a way to start a conversation about their problem, while others have such low self-esteem they simply don’t feel that they deserve any help. Eating disorders will only get worse without treatment, and the physical and emotional damage can be severe. The sooner you start to help a loved one, the better their chances of recovery.

Talking to a friend or family member about their eating disorder

When approaching a loved one about an eating disorder, it’s important to communicate your concerns in a loving and non-confrontational way. Pick a time when you can speak to the person in private, then explain why you’re concerned. Try to remain positive, calm, focused, and respectful during conversations.

Your loved one may deny having an eating disorder or may become angry and defensive. However, it’s important you don’t give up. It may take some time before your loved one is willing to open up and admit to having a problem. Still, as difficult as it is to know that someone you love has an eating disorder, you cannot force someone to change. Unless it’s a young child, the decision to seek recovery has to come from them. But you can help by making it clear that you’ll continue to be there for him or her, with your compassion and support, whenever they’re ready to tackle the problem.

How to talk to someone about their eating disorder

Be careful to avoid critical or accusatory statements, as this will only make your friend or family member defensive. Instead, focus on the specific behaviors that worry you.

• Focus on feelings and relationships, not on weight and food. Share your memories of specific times when you felt concerned about the person’s eating behavior. Explain that you think these things may indicate that there could be a problem that needs professional help.
• Tell them you are concerned about their health, but respect their privacy. Eating disorders are often a cry for help, and the individual will appreciate knowing that you are concerned.
• Do not comment on how they look. The person is already too aware of their body. Even if you are trying to compliment them, comments about weight or appearance only reinforce their obsession with body image and weight.
• Make sure you do not convey any fat prejudice, or reinforce their desire to be thin. If they say they feel fat or want to lose weight, don't say "You're not fat." Instead, suggest they explore their fears about being fat, and what they think they can achieve by being thin.
• Avoid power struggles about eating. Do not demand that they change. Do not criticize their eating habits. People with eating disorders are trying to be in control. They don't feel in control of their life. Trying to trick or force them to eat can make things worse.
  Avoid placing shame, blame, or guilt on the person regarding their actions or attitudes. Do not use accusatory “you” statements like, “You just need to eat.” Or, “You are acting irresponsibly.” Instead, use “I” statements. For example: “I’m concerned about you because you refuse to eat breakfast or lunch.” Or, “It makes me afraid to hear you vomiting.”
• Avoid giving simple solutions. For example, "If you'd just stop, then everything would be fine!"

Adapted from: National Eating Disorder Information Center and National Eating Disorders Association

Helping your child with an eating disorder

Many kids with an eating disorder will react defensively and angrily when confronted for the first time. In addition to the health problems, kids who have an eating disorder are probably not having much fun. They tend to pull away from friends and keep to themselves, avoiding going out for pizza with their friends, for example, or enjoying a birthday party.

If you suspect your child has an eating disorder but he or she denies anything is wrong, book an appointment with their pediatrician or family doctor, or ask a school counselor, religious leader, or trusted friend to help. Often kids find it easier to admit that they have a problem to someone outside of their immediate family. A doctor will also be able to determine if there are any signs of the serious health problems associated with an eating disorder. Also, eating disorder specialists are used to dealing with children who refuse to admit they have a problem. They are experienced dealing with denial and making a child feel comfortable talking about the problem.

Tips for parents of a child with an eating disorder

It can be deeply distressing for a parent to know that their child is struggling with an eating disorder. As well as ensuring your child receives the professional help he or she needs, here are some other tips:

• Examine your own attitudes about food, weight, body image and body size. Think about the way you personally are affected by body-image pressures, and share these with your child.
• Avoid threats, scare tactics, angry outbursts, and put-downs. Bear in mind that an eating disorder is often a symptom to extreme emotional and stress, an attempt to manage emotional pain, stress, and/or self-hate. Negative communication will only make it worse.
• Set caring and consistent limits for your child. For example, know how you will respond when your child wants to skip meals or eat alone, or when they get angry if someone eats their "special" food.
• Remain firm. Regardless of pleas to "not make me," and promises that the behavior will stop, you have to stay very attuned to what is happening with your child and may have to force them to go to the doctor or the hospital. Keep in mind how serious eating disorders are.
• Do whatever you can to promote self-esteem in your child in intellectual, athletic, and social endeavors. Give boys and girls the same opportunities and encouragement. A well-rounded sense of self and solid self-esteem are perhaps the best antidotes to disordered eating.
• Encourage your child to find healthy ways to manage unpleasant feelings such as stress, anxiety, depression, loneliness, or self-hatred.
• Remember it's not your fault. Parents often feel they must take on responsibility for the eating disorder, which is something they truly have no control over. Once you can accept that the eating disorder is not anyone's fault, you can be freed to take action that is honest and not clouded by what you "should" or "could" have done.

Adapted from: National Eating Disorders Association

Seeking professional help

Aside from offering support, the most important thing you can do for a person with an eating disorder is to encourage treatment. The longer an eating disorder remains undiagnosed and untreated, the harder it is on the body and the more difficult to overcome, so urge your loved one to see a doctor right away.

A doctor can assess your loved one’s symptoms, provide an accurate diagnosis, and screen for medical problems that might be involved. The doctor can also determine whether there are any co-existing conditions that require treatment, such as depression, substance abuse, or an anxiety disorder.

If your friend or family member is hesitant to see a doctor, ask him or her to get a physical just to put your worries to rest. It may help if you offer to make the appointment or go along on the first visit.

Treatments for eating disorders

There are many treatment options for eating disorders. The right approach for each individual depends on his or her specific symptoms, issues, and strengths, as well as the severity of the disorder. To be most effective, treatment for an eating disorder must address both the physical and psychological aspects of the problem. The goal is to treat any medical or nutritional needs, promote a healthy relationship with food, and teach constructive ways to cope with life and its challenges.

Often, a combination of therapy, nutritional counseling, and group support works best. In some cases, residential treatment or hospitalization may be necessary.

• Therapy – Individual and group therapy can help your loved one explore the issues underlying the eating disorder, improve self-esteem, and learn healthy ways of responding to stress and emotional pain. Family therapy is also effective for dealing with the impact the eating disorder has on the entire family unit.
• Nutritional counseling – Dieticians or nutritionists are often involved in the treatment of eating disorders. They can help your loved one design meal plans, set dietary goals, and achieve a healthy weight. Nutritional counseling may also involve education about basic nutrition and the health consequences of eating disorders.
• Support groups – Attending an eating disorder support group can help your loved one feel less alone and ashamed. Run by peers rather than professionals, support groups provide a safe environment to share experiences, advice, encouragement, and coping strategies.
• Residential treatment – Residential or hospital-based care may be required when there are severe physical or behavioral problems, such as a resistance to treatment, medical issues that require a doctor’s supervision, or continuing weight loss.

Hospitalization for an eating disorder may be necessary if your loved one is:

• Dangerously malnourished
• Severely depressed or suicidal
• Suffering from medical complications
• Getting worse despite treatment

Take care of yourself and have patience

Don’t become so preoccupied with your loved one’s eating disorder that you neglect your own needs. Make sure you have your own support, so you can provide it in turn. Whether that support comes from a trusted friend, a support group, or your own therapy sessions, what matters is that you have an outlet to talk about your feelings and to emotionally recharge. It’s also important to schedule time into your day for distressing, relaxing, and doing things you enjoy.

Recovering from an eating disorder takes time. There are no quick fixes or miracle cures, so it’s important to have patience and compassion. Don’t put unnecessary pressure on your loved one by setting unrealistic goals or demanding progress on your own timetable. Provide hope and encouragement, praise each small step forward, and stay positive through struggles and setbacks.