What to do when you think someone has an eating disorder
What to do when you think someone has an eating disorder
It always helps to know the warning signs of an eating disorder.
- guilt and shame about eating
- low self-esteem
- need for perfection
- extreme concern about appearances, both physical and behavioural
- preoccupation with food and weight (counting calories, excessive dieting)
- significant reduction in eating coupled with a denial of hunger
- significant weight loss in the absence of related illness
- claims of “feeling fat” when weight is normal or low
- frequent weighing
- evidence of purging (vomiting, laxative/diuretic abuse, emetics, excessive exercise, frequent fasting)
Talk to the person about your concerns before deciding that they have an eating disorder (i.e. make sure that they haven’t just had a bout of the flu).
When you first discuss food issues don’t be surprised if they refuse to talk or deny that there is a problem. (It is frightening to admit you have a problem that is out of control and the thought of giving up the behaviour can be even more frightening). No matter how much you care and want to help there is very little you can do if the person does not recognise that they have a problem.
When discussing your concern be compassionate and open. Encourage the person to seek some professional help. For recovery most people benefit from a combination of education, counselling and support. If the person is loosing weight rapidly and/or you are aware that they are purging 3 or more times a week be insistent.
Listen without judging. For example, say “that must be heard to deal with” rather than “you’re overreacting”. Accept and validate the feelings they have, rather than tell them how they should feel.
Learn everything you can about eating disorders. Pass the material on to the person you are concerned about. We have a list of books that you might find useful.
You may be thinking……
What else can I do??
- Discuss your concerns with them and encourage them to get help – let them know that it is serious – don’t pretend it’s not happening
- If you are worried about them, tell someone else
- Encourage them to see their GP – this is perhaps the most important step
- Let them know that you are happy to listen if they want to talk
- Realise just how scary it is for them to talk about it and how real it is to them
- Know your limits – remember that you are not a counsellor
- Be patient – they may deny their problem at first so give them time
- Try not to blame either yourself or them
- If you feel angry try to aim it at the eating disorder rather than at the person
- Learn all you can about eating disorders
- If they are underweight – tell them, but don’t keep going on about it
- If they are not underweight avoid commenting on their weight or appearance at all
- Encourage non-food related activities
- Don’t monitor their food or scrutinize their eating but do try to keep an eye on their eating patterns
What to do next…
Whether you are a family member, friend, partner, flatmate or colleague we know how hard it can be watching someone you love cope with an eating disorder. While we have attempted to answer most common questions and give general advice please remember this is intended as a guide only. It will hopefully help you with how to behave around them and what to say to them. However everybody’s experience of an eating disorder is different and it is impossible to provide a blanket “Do this” guide for everyone. While it may feel like you often can’t do anything right, you are probably doing more than you realise and it is always better to do something, than nothing, even if it is just showing them how concerned you are. Ignoring the problem is the one thing we’d definitely NOT advise you to do. You will get to know which methods work for you and them. If you are unsure whether something is working, always check this by asking, “Is this helping the eating disorder stay or go?”
Eating disorders come in many types and forms. Without intervention, they tend to get worse. An eating disorder is a mental illness – this means that what is most important is the thoughts and feelings inside their head. However, unlike many other mental illnesses, it has a very strong physical component and the physical consequences of an eating disorder can be serious, even fatal.
Depending on the age of the person and whether or not they are living with you, some strategies may be more helpful than others. Having said all that there are eight golden rules we think are very important.
“8 Golden Rules”
- Learn as much as you can about eating disorders, especially the signs and symptoms, what these mean, and about how they feel inside, eg. understanding that they may be as terrified of food as someone else is of spiders (this can be very difficult).
- Do not ignore the problem
- Ask them what it is like for them
- Be direct – tell them why you are worried, be specific – but also try to be very gentle in your approach, try not to be critical (remember it will probably be felt more harshly than it is meant)
- Try to listen without judging – take their fears seriously. Eg., say “that must be heard to deal with” rather than “you’re overreacting”.
- Try to persuade them to get professional help – from the Eating Disorder Services, a GP or school counsellor
- Try not to blame them or yourself. It is not them behaving this way – it is the eating disorder.
- Seek support for yourself. This is absolutely essential.
Seek Support for yourself
An eating disorder is difficult to cope with – especially when it strikes someone you love. It is important to remember that you cannot solve it alone. You didn’t cause their eating disorder and you can’t make them better, but you can probably help. Friendships and families are all different and you will find your own unique way through this time. Dealing with an eating disorder is very exhausting. You may feel unwanted and out of line, you might even feel guilty. That’s okay – you’re doing your best. Remember that it is the disorder that you are both struggling with, not each other. It is very important to get support for yourself if you are supporting someone with an eating disorder, as it is easy to get overwhelmed. An eating disorder affects more than the person who is labelled with it.
- Don’t make promises you can’t keep.
- Accept and validate the feelings they have, rather than telling them how they should feel.
- Encourage discussions about feelings (if they won’t talk to you try to suggest someone else they might talk to).
- Try to accept them for who they are, not how you think they should be; let them be their own person, even if it means having different ideas from your own – often people with eating disorders have a very fragile sense of who they are.
- Encourage non-food or weight related activities and discussions – try not to have lots of discussions about food or weight.
- Look at your family’s/flat’s rules, behaviours, and beliefs around food.
- Try to be consistent in family/flat approaches (ie. ensure you are all saying the same thing to the person).
- Try not to talk about food being good or bad.
- Try not to talk about diets.
- Let them maintain control over their life/activities and take responsibility for their actions as much as possible, and try not to make decisions for them (this will depend on how worried you are about her physical and mental health).
If they cannot maintain a balanced physical state themselves, what should I do?
Ideally the person should be encouraged to make as many choices and decisions as possible (with guidance and encouragement), however depending on their physical state, their age, whether they are living with you and whether you are able, some suggestions are:
- Take them to a professional mental health clinician or GP or go yourself
- Be aware of the symptoms of the eating disorder and know when to seek professional help
- Take control of their eating and exercising routine, but leave them in charge of the rest of their life as much as possible
- Spend quality time with them away from food issues
- Talk with them about the things you can do that will help
- Limit activity according to the amount of food they are eating or keeping down
- Find a way for them to eat – this will be unique to your family/friendship, they may need you to sit with them, or to have specific food (that is less scary to them) at specific times etc
- Do not give them options about whether they eat, but they may have options about what, when and how much, within the limits of safety.
- Do not enter long negotiations about food
- If they are vomiting, make sure they are with someone for at least half an hour after eating; reduce the opportunities for them to vomit or binge
- If they are vomiting or using laxatives challenge this and encourage them to cut down their use of them, with a doctor’s advice.
- Make sure there is food in the house that they like to eat