15 ways to support a loved one with an eating disorder
Up to a staggering 200,000 people in Ireland are affected by eating disorders. To mark Eating Disorder Awareness Week, Áilín Quinlan talks to Harriet Parsons, psychotherapist with BodyWhys, and with clinical psychologist Dr Malie Coyne, a lecturer at NUI Galway to address some of the common myths surrounding the issue.
The first thing to do if you suspect a loved one has an eating disorder, is to read up on the topic and learn what an eating disorder really is - because despite what you may initially assume, it's not just about food and weight, warns Harriet Parsons. "It's important to inform yourself before you broach the subject with the person in question," adds Dr Malie Coyne.
"You need to find out what eating disorders are and what supports are out there," she explains.
What are Eating Disorders?
Eating disorders are extremely complex and potentially life-threatening conditions, characterised by severe disturbances in eating behaviour such as self-starvation - by fasting and/or food restriction, purging through self-induced vomiting, over-exercising, or laxative abuse or bingeing, which involves consuming quantities of food beyond what the body needs to satisfy hunger.
Prepare for the long haul
While recovery is possible, progress may be slow, warns Harriet Parson: "Progress in recovery from an eating disorder is not always a linear process. Generally there can be a 'two steps forward one back' feel to it, and relapse is always part of the recovery process, so it is important not to fall into 'all or nothing' thinking about recovery," she explains.
These disorders are very complicated because they affect every aspect of a person, she explains:
"His or her behaviour changes, their thinking becomes distorted and they are also physically affected.
"It's all tied in with how they experience their emotions and express what they are feeling."
While a person may take a step forward in terms of eating something new for example, she says, their thinking may not be totally in line with this, and they may feel very conflicted about it so it's important to be careful about how we 'praise' a person during recovery, because praising a step taken might be counterproductive if a person feels ambivalent about taking that step.
Understand that this is a mental health issue
On the surface, an eating disorders may appear to be about a person changing how they feed themselves - but that's really just symptom of what is going on internally in terms of what they' thinking or feeling about the world, Parsons explains. "It's a mental health issue and a psychological disorder and that shapes how you approach the person and the way you tackle the problem."
Don't take it from a food perspective: "The core message is that it is important to understand that essentially an eating disorder is a coping mechanism used by a person in order to feel they can cope with day to day issues."
If you try to pressure a person with an eating disorder to change, explains Dr Coyne, you're effectively taking away something they depend on - the coping mechanism they use to manage daily life.
Don't allow common myths to colour your thinking
Such myths include claims that an eating disorder is a lifestyle choice or diet, that it only affects women, that it is a teenage issue, just a phase, and that it is a problem which will last forever.
The truth, says Harriet Parsons, is that an eating disorder is not a lifestyle choice - it's a compulsion. It's not a phase but a very serious mental health condition which affects both men and women of all ages. However, recovery is possible.
Talk to the person when and where you both feel comfortable
Think about how you have this conversation. Pick your time carefully, advises Dr Coyne: "Pick a time when you can speak to the person in private and without interruption - and a time when you are both calm."
Also give consideration to choosing a place which is conducive to a discussion of this kind, suggests Parsons.
Be honest about your concerns
"Tell the person why you're concerned and describe what you have observed that is making you concerned," explains Dr Coyne.
In other words, talk sensitively about what you see - for example that the person may be losing weight or is off-form, and explain that you are really concerned, because you have noticed that the person has been skipping meals or may, for example, no longer be meeting friends, explains Harriet Parsons.
Don't put all your focus on specific food behaviours
If you approach a conversation about a suspected eating disorder by putting all the focus on what the person is doing with food, you will only put him or her on the defensive, Parsons explains.
"If you simply focus on food behaviours you risk getting into a power struggle and denial on their part." Don't just focus on what they are doing but also on how they are feeling and how they are in themselves, she emphasises.
Try to communicate that you're worried not just about what the person is doing but also how he or she is feeling and how they are focusing on life.
Avoid judgement, criticism or ultimatums
Being non-judgemental during a conversation about an eating disorder is crucial, believes Harriet Parsons. "Often when we're really worried about someone, we can jump to conclusions and think that the other person is thinking the same way as we do, which is often not the case. This is because of the way an eating disorder can distort a person's thinking."
It's very important to avoid issuing ultimatums, advises Dr Coyne: "They merely serve to break down communication," she explains.
"Let the person know how concerned you are, and that you value them and will be there for them." However don't allow the conversation to deteriorate into an either/or situation, she counsels.
Be prepared for denial
It cannot be overstated: An eating disorder is a coping mechanism to help somebody feel better and more in control - and a person will not willingly discard what is to them, a crucial form of support.
"They will resist any attempt to take it away from them or make them change it in any way," explains Parsons. "Resistance and denial are very real," she warns, adding that once you decide to approach someone, understand that you are doing so in the knowledge that this conversation will merely be the first of many.
Change will not occur overnight
Because an eating disorder is essentially a coping mechanism, it really will take time for a person to feel they can let go of their compulsion and find a different way of managing their lives, explains Parsons.
"There is no set time period for recovery. It is different for everybody, but it is always gradual. Relapse is part of recovery and is to be expected."
Acknowledge that you can't change someone's thoughts
The hard part about supporting someone through recovery from an eating disorder is knowing that they have to make the changes themselves, Parsons explains.
"A helpful idea is to separate out the person from the eating disorder."
Try to get across the message that you understand that there are two sides in their head, she explains - the eating disorder and the person themselves.
"The work of recovery is trying to build up the side of the head which is not the eating disorder so that the person will become strong enough to let go of the eating disorder side of their head.
Ask the person what he or she feels might be helpful
"This is a really important part of supporting someone with an eating disorder," Parsons explains."The support required for someone with an eating disorder is collaborative because it is all about the role that control plays in an eating disorder." What that means, she says, is that you need to bring the person along with you - and you do that asking what he or she believes could be helpful for them - in other words, your approach should be "how can I support you or what can I do for you," rather than "I want you to do X, Y or Z."
Accept that an eating disorder is not anyone's fault
"It is very normal for parents to think that it's their fault," says Parsons. Parents can feel guilty about what is happening to their loved one, but it's very important, she emphasises, to understand that there is never any one cause of an eating disorder.
"There is always an accumulation of different risk factors which can include everything from a genetic predisposition to low self-esteem to personality traits such as being very sensitive or perfectionistic, to life events such as bullying, dieting, over evaluation of shape and weight in terms of self-worth."
This is really important - early intervention is the best chance of recovery for your loved one.
"The earlier a person with an eating disorder gets help," explains Dr Coyne, "the better for their physical and emotional health."
There are different treatment options, says Harriet Parsons, adding that the family GP is often the first port of call, while the Bodywhys website provides information on the different treatment pathways. "It is very important to say that different treatment approaches work for different people, so inform yourself."
* For more information on this topic visit www.bodywhys.ie