What can carers do?
We hope that this guide will give you the confidence to give support to somebody who is experiencing an eating disorder. You may not know what you can do to help at the moment but you can play a hugely important role - even though you may not get any thanks. Many people do make a full recovery from eating disorders and they say that the people closest to them helped in a way that cannot be put into words. Just being there for them can be extremely important. Nobody recovers from an eating disorder on their own, but carers can form part of the team which will help them.
Your son/daughter/partner may have already told you that they are having difficulties with eating. If they haven't been able to talk about it yet, there are some approaches that can help:
- If you haven't done so, try to discuss your worries in a calm way, rehearsing what you want to say beforehand. Confrontation is not going to achieve anything.
- If two or more of you are worried about the person, make sure that you agree on your approach beforehand. If they sense that you don't agree about how serious the problem is, they will try hard to split you.
- Choose a time when you are all as relaxed as possible. (Mealtimes are the worst time to talk about it)
- Be firm but be gentle. They may feel that you are 'ganging up' on them.
- Give them a chance to respond to what you say so that they feel they are not being lectured.
- Summarise what they say: 'I think you said that.. Have I got this right? This can help keep things clear for everybody.
- Do not be surprised if they deny everything you say.
- However persuasive you are, do not expect that they will start eating normally again.
When you first raise the issue, you may not get anywhere, and this may leave you feeling very frustrated. It may take several attempts, but don't give up. If they are an adult who no longer lives with you, it can be harder to have this kind of discussion or follow it up later. Somebody will feel even more determined to hide the problem if they feel their privacy is being invaded. There are no hard and fast rules but in general, try to respect their rights whilst explaining your concerns.
Comments by eating disorder patient: The worst thing my parents did was to make comments about my eating in front of other people. It really didn't help when they kept offering me food, saying 'Go on, just have a little bit!'
Logically, I knew that eating would resolve the whole situation, but it was the one thing I couldn't do.
Why can't they just eat something?
Somebody who has been starving themselves may very firmly believe one or all of the following:
- I don't deserve to eat
- Not eating is the only thing I'm good at
- I will get fat after only a mouthful
- If I start eating, I won't be able to stop
- If I put on any weight I am a failure
- If I put on weight nobody will love me
Eating disorders are particularly hard to understand because the 'medicine' seems so obvious. The whole issue of eating has become tangled up with a lot of difficult emotions. Food is not simply food any longer. This is why filling the fridge with treats, or cooking somebody their favourite meal is not going to help; they will feel bullied and will probably angrily reject it. They will feel very scared of eating because they are extremely scared of getting fat. They may feel fat if they put on even a few ounces. Somebody with anorexia or bulimia may strongly dislike having any food inside them because it makes them feel 'dirty' or 'bloated'. Most of the time they will prefer to feel 'clean' and 'empty'. They may feel that even the smallest amounts of food will lead to huge weight gain. If somebody is very thin, the smallest weight gain will be noticeable.
- Try to see food through their eyes - they are phobic about it and it frightens them. Remembering this can take some of your tension away.
- Refuse to pay for fizzy drinks and chewing gum. They bloat the stomach and give a false feeling of fullness.
- Try not to buy laxatives, diuretics or any kind of slimming pills because this presents unfair temptation to somebody who is desperate. (Eating disorders do cause constipation and indigestion, which is very uncomfortable. It will seem unkind to resist these requests, but a person who suffers from anorexia or bulimia is not going to be able to use such medication safely, however much they insist otherwise.)
- You might be relieved if they ask to join Weight Watchers because this is a safe way of controlling weight, but this is a bad idea. Slimming clubs are not designed to cope with people with a much distorted relationship to food.
- If they suggest that other people join them on their 'diet', resist, as there is a strong possibility it may develop into a competition.
It is dangerous for somebody at a low weight to do strenuous exercise. Younger people may bully you into helping them to over-exercise. They may beg you to let them stay on the school athletics team, or cry if you refuse to take them to the swimming pool. Exercise is probably one of the few things that will make them feel a bit happier, and you may feel cruel discouraging them from doing this. However, you are within your rights not to help them, as long as you clearly explain that this is because you don't want to help them to put their long-term health at risk.
The best approach is to let them know that you are aware that they are over-exercising, and that this is dangerous. Try not to be critical, because they will probably feel that they have no choice in the matter. It is unlikely that you will be able to stop someone from over-exercising.
Remember that they feel driven to do this because they are desperate not to feel or look fat. If you are able to discuss why they need to exercise so much, or how it makes them feel, this may help you to understand their perspective. It may also make them feel that you are on their side.
Why getting angry does not help
You might have feelings of disbelief, frustration and fear, all at the same time. They may lead you to lash out with angry or sarcastic comments. These are normal human responses, so try not to blame yourself for them. Talk to other people (a support group, for example) rather than bottling things up. Remember that no one decides to develop an eating disorder out of spite, but because it seems impossible to live in any other way. A small part of the person may be aware of the damage they are doing to themselves, and feel scared by this. They are going to feel unable to express their fears if they feel criticised or threatened
- Don't believe that if you work and worry yourself every minute of the day you will be able to cure her/him.
- Don't try to take over and cope for them.
- Don't suffer the pain with her/him - it makes it harder for them to cope.
- Constantly try for different approaches to try and 'get through' to the sufferer i.e. write a letter rather than blowing your top. This allows a cooling down period. Remember the encouragement that you give now is not wasted but may be stored up by the sufferer and used at a late date to fight the illness.
Total involvement increases the sufferer's anxiety but 'I'm with you and here for you whenever you need me' works better.
Challenge the eating disorder. If the person hates you for this, that's healthier then them hating themselves.
"SEE ME FOR WHAT I AM, NOT FOR WHAT I HAVE"
The symptoms of eating disorders are so alarming that it is easy to forget that there is still a person behind them. As much as you can, try to have normal conversations involving their interests and opinions, so that they feel that their eating disorder is not the most important thing about them. If somebody is severely ill, this will be very difficult, but it is worth trying. It can be helpful to separate the disorder from the person in an explicit way, so that is clear that the behaviour makes you angry, rather than the person. If you can say 'I love you very much but I don't like it when the bulimia makes you steal food' 'We all love you but we are worried because the anorexia makes you over-exercise', it is clear that you are fighting the same enemy, rather than each other.
Try to find a balance between the terribly ill and tormented child and the manipulative, power-grabbing, destructive force that is trying to take over everyone in the family.
We recognise and understand that is it extremely difficult trying to suport and encourage somebody with an eating disoder. Why not come along to our monthly carers support group whereby you can have the chance to talk about your difficulties in a supportive, understanding and non-judgemental environment amongst other parents/carers/partners who are also trying to support their loved one. Help is available. Reach out today.