The number of people living with one of the various eating disorders, including anorexia, bulimia and binge-eating disorder, is rising every year. Families all over this country are struggling to help someone who has an eating disorder, but Una Bennett, staff nurse at the Eating Disorder Unit at Saint John of God Hospital, Dublin, says there are multiple ways to support a loved one who is dealing with food issues.
1 Communicate Concern
If you're worried that a loved one may have an eating disorder, educate yourself on the tell-tale signs. These include skipping meals, going to the bathroom after meals, over-eating to the point of sickness or engaging in an increased level of exercise to burn off food.
Psychological changes can include mood fluctuations, relationship difficulties and social withdrawal. Physical changes may include weight loss, fatigue and loss of menstrual cycle.
2 If your research suggests that there may be a problem, use this knowledge to start a conversation
Gently let the person know you're concerned and describe specifically what you have observed that has caused your concern. This gives him or her the opportunity to acknowledge the problem.
It's important to accept that the person needs to acknowledge the problem and ultimately make the decision to move toward recovery, Bennett explains.
If the person doesn't accept that there's a problem, try not to be disheartened she says - be patient and let him or her know you're there for them to discuss the issue further, should they wish to do so.
It's also a good idea to leave relevant written information around for the person to read, she suggests.
3 Be a supporter - not a fixer
Try to demonstrate that you're not trying to 'fix' the person or make them stop what they're doing, she advises.
"Explain that you understand that whatever they're doing helps them feel safe. Encourage him or her to speak as openly as possible about their situation and ask what they would like to happen. Try to negotiate a way forward together and ask what the person what he or she needs to help reduce the stresses they are experiencing."
4 Inform yourself
Learn as much as you can about eating disorders - this not only increases your capacity for empathy, but also improves your understanding of the condition, explains Bennett.
While food, weight and body image are part of the picture, showing you understand that something else is troubling the person can be hugely reassuring for him or her, she says.
"A person with an eating disorder is often terrified of change and may not be able to imagine living without the eating disorder," she explains.
"Thinking of an eating disorder as a coping mechanism can help those around the person understand why it may be hard for them to let the eating disorder go."
If you can acknowledge that the eating disorder is serving a particular purpose, you may be better able understand why the person may want to maintain the eating disorder, as it makes them feel safe, she explains.
5 Seek professional help
Remember sorting this out is not your job; there's plenty of professional help available, says Bennett. Understand, she adds, that the level of your intervention depends on the person's age, the degree to which their health is compromised as a result of the disorder and their living and eating arrangements; for example, whether they're living at or outside home.
Support your loved one in seeking the help of a professional, she advises, adding that a good starting point can be suggesting that your loved one makes a visit to the GP.
"Different treatment options can be explored, such as a referral to a nutritionist, a counsellor or therapist who specialises in this area or to more intensive treatment options such as out or in-patient treatments. Again, encourage and be a champion in his or her recovery."
6 Create a meal plan
If you live with a person experiencing an eating disorder, offer to help them develop a meal plan - this is crucial in recovery. Discuss what is realistic. Emphasise the importance of eating breakfast, lunch, an afternoon snack, tea and an evening snack as a way of introducing a regular pattern of eating again, advises Bennett.
"Eating needs to become normalised again through regular meals and the reintroduction of certain food types."
7 Be mindful of the issues raised by eating out
Eating outside the home environment can raise all sorts of anxieties for a person with an eating disorder, Bennett explains. However the experience of doing this is important in order to continue normalising eating behaviours. It can be helpful to do some forward planning in advance with the person, for example, discussing the venue, timing and the menu.
"It's important to discuss what is manageable and realistic in terms of eating and what support they may need. A person can feel under scrutiny when eating out with families for occasions. Keeping the conversation varied and the focus on the social aspect of being out can help relieve this."
8 Offer to go food shopping together
"Supermarkets can be incredibly daunting places for someone with an eating disorder," says Bennett.
Not only can they be very busy places, she explains, but the choice of foods can be overwhelming and the brain can go into overload comparing calorie options.
"Offer to go with him/her. Make a list first, and help the person to navigate the aisles and stick to what is planned.
"If you've created the meal plan together, you can become a support in helping the individual stick to the list that supports the plan you made.
9 Separate the person from the disorder
Remind yourself that the person's behaviour is often a symptom of the disorder rather than a reflection of their character, says Bennett.
"No matter what disordered eating behaviour a person is engaging in, change will occur: in their body, in the way they think, in the way they behave and the way they relate to people.
"During this time, they are unwell and relating to them can be increasingly difficult.
"At times you may feel confused, angry, sad, exhausted, helpless. Accepting these feelings in yourself and trying not to blame the person with the disorder is one of the most helpful things you can do in your efforts to give support."
10 Take the bird's eye view
Don't use food and weight as your only criteria for measuring your loved one's progress in making a recovery from an eating disorder.
"Recovery will look different from person to person and the process of achieving recovery will be unique for each individual," says Bennett, adding that it includes both physical and psychological elements - everything from improved blood results, resumption of menstrual cycle for females and improvement in skin condition to increased energy and concentration levels, renewed interest in socialising and better self-esteem.
11 Shift the focus from food to feelings
Ask questions based on feelings, rather than diet. "'How are you feeling?' is more tactful than 'How is your diet going; are you eating more?'" says Bennett. Make a point of using 'I' statements when commenting on appearance or mood, she adds:
'I notice you have become quieter in yourself' or 'I see you are looking a bit tired' is better than 'you're very moody lately'.
12 Be the canary in the mine
Sometimes, one member of a family notices that something is wrong, while other family members fail to see it, or are in denial.
If you have a suspicion that a loved one has an eating disorder, seek support and information.
"Talk to your GP or to an organisation like Bodywhys, advises Bennett.
"There's no harm in running it by them," she says, adding, however, that it's important both to accept that there are limits in your responsibility and to understand that, while support and encouragement from families/friends is vital, it is the responsibility of the person with the eating disorder to make the changes required for recovery.
13 Be a source of hope
Nobody wants to be unwell, says Bennett, but sometimes a person can be so caught up in the disorder and in the low mood which accompanies it, that they feel they are undeserving of support.
"Communicate a belief that recovery is possible and a belief in your loved one's ability to recover.
"It's important that even if he/she suffers from a lack of self-belief, that you are a constant source of reassurance and belief.
"Holding hope for somebody until they are able to hold it for themselves can be extremely encouraging."
14 Slow and steady...
Accept that change will not happen overnight, says Bennett.
"Just as an eating disorder takes time to develop, similarly it takes time to overcome.
"While it may seem like a frustratingly slow pace, be mindful the person lacks the ability to overcome the disorder quickly and there is no specific time frame for recovery. Accept that progress will be gradual and will include setbacks. A lapse in recovery is extremely common. When this occurs, it can indicate additional support may be required or more effective coping mechanisms may need to be explored. This can prevent further relapse."
15 Support yourself
The experience of supporting someone through an eating disorder can take a significant toll on families, Bennett explains.
"It's important to acknowledge your own needs for support and to identify support mechanisms for yourself at this time.
"This involves not just identifying a need for information and practical know-how but also finding a supportive space for yourself."
■ The Eating Disorder Recovery Centre at St John of God Hospital offers treatment for eating disorders on an inpatient and outpatient basis. See stjohnofgodhospital.ie/treatment- programmes/eating-disorders
■ Bodywhys is a national voluntary organisation, see bodywhys.ie