Tuesday, March 5, 2013

What can I do to help someone who has an eating disorder?

At the end of the workbook I've been using there's a list of "dos and don'ts" for family and friends to help support someone with an eating disorder (in this case specifically bulimia, but I'm sure similar guidelines apply to other eating disorders as well).
1. Educate yourself about eating disorders. It's not your loved one's job to teach you about eating disorders. She can share her experiences, if she wants to, but if you want to learn data and facts, you're better off finding them out on your own. When other people expect us to teach them about our illnesses, it feels less like you're asking out of love and more like we're a curiosity. Additionally, once you've learned that eating disorders are caused by a number of factors (and that "symptoms can serve as a very effective coping mechanism"), you'll be able to act with more compassion rather than asking your loved one to "snap out of it".
2. Discuss aspects of your loved one that you enjoy that aren't related to weight or shape. At first, you want to reinforce characteristics about your loved one that are not physical at all. Don't say "you're so pretty" when someone first tells you they have an eating disorder, it might backfire and reinforce their behavior if they're still acting on urges for symptoms. However, as your loved one progresses through their recovery, it is nice to hear that we are pretty but that it doesn't envelop the whole of who we are.
3. Share activities that don't raise concerns about weight or shape. For a while the idea of exercising seemed kind of terrifying. One of my symptoms was to over-exercise, so it took a while for me to be comfortable with trying to find forms of exercise that I enjoy. This is also good for helping your loved one avoid thinking about or acting on urges for symptoms.
4. Express your concerns and communicate directly and openly. Words are very important things, and how you use them can be helpful or harmful, and when you're talking to your loved one about their eating disorder don't make it about you. If you have concerns, express them honestly, without threats, ultimatums, insults, or incriminations.
5. Offer your support by being available and listening. This journey feels like you're gradually going insane, and you feel completely alone. Part of why eating disorders are so difficult to recover from is because of that alienation. Knowing that the Emperor, and a number of other people, were on my team during this helped me get through it, because just about everywhere I went, if I suddenly needed to vent or talk about it I could and I felt less alone because of that.
6. Allow your loved one to be independent and in charge of his or her own recovery. Confidence is part of self-esteem, just like being comfortable in your body. I know the desire to rush in and save your loved one is strong, and that sometimes you want to monitor how much, how often, and/or whether your loved one is or isn't engaging in symptoms. You love them, and want to make sure they're getting enough nutrition, and aren't continuing to engage in behaviors that you both know are harmful. But, if you're too aggressive about your loved one's recovery they might be less likely to recover. It's not your fault, you just want to help, but sometimes the best help you can give is to just say "I love you" give them a hug or a kiss and shut up about everything else.
7. Allow your loved one to make their own choices and go at their own pace for recovery.  Don't rush them. Don't offer unsolicited advice. If you want to say something, but aren't sure if it will help, just say tell your loved one that you love them and are proud of them.
8. Examine your own beliefs about food, weight, and shape. This means don't talk shit about your own body. That's going to make your loved one feel badly about their body. Don't talk about dieting or weight loss. Don't talk about other people's bodies either. No gossiping. It's harmful in general, but in this specific case, you could alienate your loved one, which means the recovery process is less likely to hold. Be aware, again, that words are powerful, and that what you say really matters because your loved one is extremely vulnerable right now.

9. Treat your loved one normally. Aside from watching what you say, please avoid giving your loved one special status because of their eating disorder. This is a form of objectification, and it's hurtful.

10. Be aware of your own needs. This whole process is emotionally costly. If you are taking care of yourself, you'll be able to help your loved one. If you're not taking care of yourself, you run the risk of dumping your emotional garbage on your loved one who is already wading through a swamp of it.

11. Be patient. This journey takes time. Like any kind of success, successfully recovering from an eating disorder looks a lot more like your headphones do when you pull them out of your pocket than a straight line from A to B. "Having symptom slips after a symptom-free period is not unusual and does not mean your loved one is giving up or is back to square one."

And, if you've learned nothing else from me here, when you are helping a loved one recover from an eating disorder:
  •  Don't make comments on weight, shape or appearance. "Any comments you make about weight, shape, or appearance will probably be interpreted negatively." Even when you're talking about someone else. When in doubt, shut up.
  • Don't ignore the problem. Eating disorders won't go away on their own, and most people who have eating disorders aren't going to just change everything about themselves over night with no support.
  • Don't blame yourself or your loved one for the eating disorder. Not helpful.
  • Don't make demands. Confrontation is likely to cause symptoms to become worse. Also, making demands on someone who is sick is totally a dick move.
  • Don't get involved in a power struggle. "If you find yourself in a situation where your loved one is arguing in favor of the eating disorder and you are arguing the other side, disengage and reevaluate."
  • Don't take control or police eating or symptoms. Again, dick move.
  • Don't rescue your loved one. (See above)
  • Don't take on the role of therapist. If your loved one needs therapy, you are not qualified or objective enough to provide it. Help them get professional help, go along with them if they ask (but keep your mouth shut), and make sure they are seeing someone who has a background helping people with eating disorders. That last bit is really important.
The workbook I used is the 2003 edition of The Overcoming Bulimia Workbook by Randi E McCabe, PhD, Traci L McFarlane PhD, and Marion P Olmsted PhD; published by New Harbinger Publications, Inc

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