A Family's Guide to Tackling Eating Disorders
by Karen Asp
Women with eating disorders aren't the only ones who suffer. The struggle becomes a family affair, one that's even more difficult when the woman is on her own. While there are things families shouldn't do and say, there are just as many things they can do to help not only their loved one, but also themselves.
The Long Road to Recovery
Learning that someone you love is suffering from an eating disorder is never easy. The initial diagnosis may come as a shock, but for some people and their loved ones what comes after the diagnosis can be even harder. Successful treatment of eating disorders is a long and often difficult process. Progress is irregular and setbacks may be many.
"Progress in an eating disorder is measured in years," says Carolyn Costin, MA, MEd, MFCC, director of the Monte Nido Treatment Center in Malibu, California. "Recovery will take a long time, and you have to prepare yourself for that."
It is important for affected women and their families not give up hope. Bulimics and anorexics who want to get better can recover. "Recovery is attainable, but it's a matter of being patient and allowing that recovery process to happen," says Julie Clark-Sly, PhD, co-clinical director at the Center for Change in Orem, Utah.
Understandably, though, there will be times when your patience is tested. When you watch your loved one engaging in destructive behaviors. When everything you say or do triggers a defensive response. So what can you do?
Perhaps the first step in helping your loved one recover is educating yourself about eating disorders. People often assume that eating disorders are about food and weight, but that's not true. "Eating disorders are about underlying issues," says Julie DeLettre Holland, MS, an Atlanta-based certified eating disorder specialist and director of outpatient professional development with the Renfrew Center.
To deal with those issues, hopefully you've encouraged your loved one to seek professional counseling. If her health is in jeopardy, you may have forced her into counseling. Consider asking her therapist to set up educational sessions for your family. The therapist may also suggest family counseling. In almost all cases a medical consultant, either a generalist physician or a psychiatrist, will also need to be involved.
As you read books or attend educational meetings or family support groups, don't let the eating disorder consume you. "You have to take a break from the problem, especially if your loved one lives at home," Clark-Sly says.
Guilt may eventually catch up with you, as it does for many families. How could you have let her suffer with this eating disorder for so long? How could you have prevented it? What did you do to contribute to it?
Experts say you shouldn't blame yourself. "There's no single cause for an eating disorder," Clark-Sly says. "You have not created the disorder." Every family makes mistakes, she adds. And certainly, if you're doing things that are contributing to the problem, such as being abusive, then you need to correct those things.
But you can't blame yourself for what you have—or haven't—done. "If you're focusing on that," Holland says, "then you won't be able to move forward and learn how to help."
Costin encourages families to stay solution-oriented. "You can have all the insight about why someone needs to control her food intake," she says, "but that won't change anything."
The Do's and Dont's of Helping Her Recover
The best thing that you can do is provide support. "She needs the family to be a steady, stable force of love and support," Clark-Sly says.
Yet there are actions you can take to make things easier for you and your loved one:
1. Don't let your relationship with her have a one-sided focus on her. You’re an important person too. When you're talking about her day, for instance, share information about your day, Holland says.
2. Keep the focus off of food. Whether you're at a family reunion or the dinner table, "focusing on food creates disaster," Clark-Sly says. Talk about the day's events, go for a walk, or play board games.
3. Legalize all foods. "It's not healthy to cater to the belief that foods are good or bad," Holland says. Costin, a recovered anorexic, also suggests offering to serve something she'll eat if you're hosting the event. At holiday meals, her mother used to serve vegetables and salad so that it was less conspicuous that she wasn't eating gravy and stuffing.
4. Be a good role model. Don't criticize your own eating habits or weight. Don’t encourage anyone to pursue slenderness, and don’t admire weight loss or excessive exercise. Don’t start dieting or keep a scale around the house. "You have no idea how much this affects her," Costin says.
5. Don't change the family's eating patterns. Her eating disorder should not control how other members of the family eat and live, especially if any change comes from you deciding what will help her. If she feels that specific family changes would support her recovery, then as family members you can decide if and how those changes might be made.
6. Ask her how she wants you to support her, Clark-Sly says. You don't have mind-reading abilities. Talking about how you can help is the healthiest way of dealing with things.
7. Don't try to take a certain behavior away from her. "You can't take a behavior away until there's a healthier one to put in its place," Holland says.
8. Avoid responding to "I feel fat" comments. Hopefully she is in cognitive behavioral therapy, and both you and she will have a specific plan to deal with these kinds of “intrusive thoughts”. If there is no plan, then an honest way to address an “I feel fat” comment might be as follows: “I can understand you might feel that way, and that feeling fat might be very uncomfortable for you. However, those feelings are part of the illness of an eating disorder; they may feel real to you but they are not real, and to recover you will have to give them up. It would help me if you could tell me about a real feeling you have, for example it would help if you could say, “I feel sad” or “I feel angry.” We could talk about feelings of sadness, or fear, or anger, especially if you were able to say “I feel angry when you …”
9. Don't ignore destructive behaviors. Doing this empowers the eating disorder, Holland says. When you see her engaging in odd destructive behaviors like binging, purging, or not eating at all, show that you care. Ask if anything is going on or if she wants to talk.
10. Make her accountable for her actions. If she eats all your food or vomits in the toilet, ask that she replace the food and clean up her mess, Costin says.
11. Don't be afraid to approach her therapist with your concerns. Therapists won't reveal confidential information but they can discuss your concerns, Costin says.
12. Remember that there's no right or wrong reaction. "If you're always worried about how to relate, then you'll be fake and rigid," Clark-Sly says. "Be yourself and follow your heart."
American Anorexia/Bulimia Association
Laureate Psychiatric Clinic and Hospital
National Eating Disorders Association
The Renfrew Center