Well, you can’t trust them. That’s the first thing. They’ll lie to your face, tell you anything you want to hear, to protect their compulsion. It’s not that they’re bad people. It’s that they’re scared and the eating disorder is their coping mechanism. They already think they’re nothing. Without it, they’re worse than nothing. At least that’s what the voices tell them.
But don’t give up – they need you. Incidence of eating disorders are rising
among almost every group, with a surprising (or not, depending on your level of media consumption) surge in adult women. It has a 6% mortality rate. It has only a 50% cure rate.
Loving and Losing
After my post on Thin
, I got several e-mails and a couple of comments asking me about how to deal with eating disordered loved ones. I find this slightly humorous and more than a little frightening that you all trust me so much to give you such personal and sensitive information. But I can never resist a chance to share my opinion so please take the following advice as just that – my opinion. I base this solely on my own experiences, my reading and talking with many anorexics, bulimics, fence-sitters, recidivists & just plain ol’ disordered eaters. I sincerely hope that any of the rest of you that have something to add will jump in and help me answer these questions. If you think I’m wrong, please feel free to correct me – I know I’m not the possessor of all knowledge;)
“I remember in a previous post about eating disorders, you were told not to talk to a girl about how much weight she’d lost. Is that a general guideline? Not talking about weight or dieting?”
I wish we women, eating disordered or not, could just leave weight & dieting out of every discussion. We are so much more than a number on a scale or a pair of pants. And yet I’m as guilty of this as the next girl (probably more so!). Our female culture practically revolves around this discussion. It’s unaviodable even with healthy women. However, the thing with eating disordered people is that their disease can and will twist everything you say. If you tell them they look too skinny they will most likely not believe you or if they do, take some pleasure in the “compliment” and desire to be more thin. If you tell them they gained some weight (even if you mean it in a good way) it will inevitably send even the most recovered ED’ed into a diet spiral. Ask her about her hobbies. Compliment her on her singing voice. Tell a funny story. Laughter really is the best medicine.
“What if the person openly brings it up themselves–how should I respond?”
This is great. It means that a) they trust you and b) they are at least investigating looking for help. A lot of ED’ed will deny they are sick even when the feeding tube is shoved up their nose, so if they tell you about it, it is a really good sign they want help. Recovery from an ED can be a long process. Just be encouraging. Tell them they are beautiful inside and out and that if they need a hand to hold, they’ve got yours. I’ve seen this come out in two main ways: one, they burst out into hysterical tears and confess their dark secret or two, they bring it up in a joking manner. In the former, they are looking for support and love. They want to know that you accept them anyway. In the latter, they are testing you first – to see how you react before they tell you anything else. They may also be testing themselves – to see if they are ready to talk about it yet. Either way, listen (resist the urge to joke back with them about it) and then offer to help them find the appropriate help. In no way should you consider yourself their sole source of help. Unless you are a trained professional, you can’t do it. And even a trained professional doesn’t work alone.
“What should you do if someone isn’t open about it, but you suspect they have an eating disorder?”
Sadly, there is not much you can do. You can gently broach the subject with them. Perhaps, “I noticed you haven’t been eating much lately. Are you doing okay?” But they’ll probably tell you they are sick or dodge the question. Sometimes they’ll respond with one of the two responses listed above. But if they don’t then this is the hard part: there is nothing you can do to force someone to get help for an eating disorder. Until they are ready to recover, pushing them isn’t going to help. If you are the parent of an underage child, you can have them committed to an in-patient facility against their will (an option that sounds harsh but is certainly better than watching them die). But if they are an adult, all you can do is love them and encourage them to be healthy. Whatever you do, don’t try and trap or trick them into revealing their disorder. You’ll lose any trust between you. Don’t enable their behavior either by catering to their food whims.
“What is the typical treatment for an eating disorder?”
I suppose it depends on the severity. If the sufferer has declined to the point of medical emergency then their physical needs will be addressed in a hospital setting. Often they are rehydrated with an IV and can be fed through a nasogastric tube if they refuse food. After they are stabalized they are usually moved to a psych ward (or ED ward, if the hospital has one). They are usually only held for a few days there until it can be decided what their course of treatment is (and what their insurance will pay for). An option from the hospital is to go to an inpatient ED clinic (like Renfrew, the one featured in the Thin Documentary). Another option is an outpatient clinic where they can still attend classes and support groups and be monitored but live outside.
For most people though, treatment starts with a family practice doc. Often, if they aren’t an active danger to themselves, they will be referred to counseling with a psychologist specifically trained in eating disorders & a psychiatrist. Antidepressants and anxiolytics are often prescribed to help stabalize the patient. Therapy is usually continued on an ongoing basis.
ED’s have a very high rate of recidivism so often sufferers will go through various incarnations of the above treatments until they find a combination that works for them. Sadly, eating disorders have the highest death rate of any mental illness so treatment is imperative.
“So what can I do to be supportive of loved ones with eating disorders?”
Be loving. Be supportive. Be positive. Don’t enable their bad behavior. Don’t feel responsible for their problems. EDs are like a vortex that will try to suck everyone around them into their negativity. Don’t get caught up in “am I fat?” arguments. Offer them help finding resources. Give them a positive outlet for their frustrations. Don’t force food on them (not your job – unless you are their parent and then my heart goes out to you because you are in a supremely difficult situation). Don’t try to trick or shame them into eating (they might eat for you but they’re likely to throw it up later, even if they’re not typically bulimic). Let them talk about their feelings. Be gentle.
And lastly, get educated. ANAD, the National Association of Anorexia Nervosa and Associated Disorders
, is a great starting place to learn about the different eating disorders and to find qualified help in your area. It’s also a great place to find support for you.
Being the caregiver/friend/spouse/significant other of an ED’ed is not easy. It can feel overwhelming at times. Make sure to take care of yourself first. You can’t help them if you’re not healthy:)
Soooo… I hope this helps a little bit. Remember – just my opinion and I’m certainly not a mental health professional.