Supporting someone with an eating disorder

Mealtimes can be really difficult for both those suffering with an eating disorder and those supporting them. But there are things that you can do to help things go more smoothly and feel more comfortable for your loved one.

• Ensure you have everything you need for the planned meal to avoid last-minute changes that could increase anxiety.
• If you are eating together, plan with your loved one what you will be eating, at what time, who else will be there, and think about portion sizes.
• If your loved one is struggling to food shop due to anxiety about things such as nutritional labels, either offer to do the shopping for them or go together to help support them.
  
• Some people who binge eat may have difficulty with the abundance of food in supermarkets; therefore writing a list and shopping together for this can be helpful. Food shopping via the internet can also be helpful for some people.
• Often during treatment, avoided foods will need to be reintroduced. Planning the day and time that this will be along with the treatment team, and shopping for it together, can help this process feel more in your loved one’s control.
• When shopping, multipacks of avoided or fear foods can seem overwhelming, particularly if it is a food that the person tends to restrict or binge on. Buying the food as a single item rather than part of a multipack could be more manageable for your loved one.
• Ask your loved one what would be most helpful during the mealtime. Some examples of things that have helped other people are having the television or radio on, colouring tablecloths, doing a puzzle or being involved in conversation. Come up with a list of distraction techniques with them for them to use when they are struggling – this could be helpful outside mealtimes too.
• Keep conversation neutral at mealtimes, so avoid discussing topics such as diets, exercise or how treatment is going.
• In people with restrictive eating disorders, eating regularly again can bring about physical discomfort such as stomach pain and feeling full very quickly – it is important to follow the advice of your loved one’s treatment team in response to this. This may require supporting your loved one with pushing through this discomfort and continuing to eat regularly.
• Evening times are often the most vulnerable time for people who binge eat – ask your loved one what you can do to help with this, or at other times that they may find difficult.

People with eating disorders may become withdrawn, and you may need to go to more effort than usual to make them feel included and stop them from isolating themselves.

• Even if their eating disorder causes them to withdraw, keep inviting them to join in with group and family activities.
• Think of social events that don’t revolve around food or exercise, such as trying out different crafts, or playing board games.
• Take time to discuss topics outside of the illness and treatment – this can feel very tricky but your loved one is still there despite the eating disorder.
• Help your loved one try out new hobbies or return to hobbies that they used to enjoy. If your loved one enjoyed sports or exercise prior to developing the eating disorder and this became a problem, ensure that you consult with their medical professional about the best way to manage this.

Eating disorders can make people behave in ways that seem out of character. While early treatment is always the best option and will give the sufferer the best chance of getting completely better, this can be upsetting and frightening, and they may try to resist it. Emotional or aggressive outbursts and hurtful comments or responses to your attempts to help aren’t uncommon, especially when the person feels challenged – remember this is not them but the eating disorder speaking. There are some things that you can keep in mind to make these times more manageable and avoid escalating the situation.

• It might be best to walk away and talk once everyone involved has calmed down. Think about how best to ensure that you, your loved one and anyone else present are safe, and put into place the necessary actions.
• Try to resist any urge to respond to anger by getting angry yourself. It’s reasonable to feel frustrated, but try to avoid expressing that in front of your loved one.
• Try not to feel too guilty if you do find yourself getting angry at them. Make time when things have calmed down to explain your emotions to your loved one, and try to encourage them to do the same. Each of you clearly communicating your views and feelings might make it easier to avoid the situation in the future.
• After the situation has calmed down, take time to look after your own needs. You can explain to your loved one that you love them and don’t blame them for how they reacted, but that you are going to take some time to go to another room to call a friend, or to go for a walk to look after your own wellbeing. Here you are letting them know that you love them, but also recognising the importance of self-compassion and modelling this to them.
• When talking about the situation, show that you have heard your loved one’s concerns or difficulties by repeating some of the words they have used and reflecting these back to them. For instance, if they have shouted at you: “I would be fine if you backed off. You just make things worse,” you could reply with “What can I do so that I’m not making things worse?” This signals to your loved one that you have heard them and are listening. Remember that, much as the person you’re supporting is ill, there are still boundaries. They don’t have the right to hurt other people, even if they’re finding things difficult. When things are calm, be clear with them about what is and isn’t acceptable.
• Talk to other people involved about how to handle situations where emotions are running high. It’s best to come up with a plan where you work together, as conflicting approaches to defusing a situation may make things worse. You will probably find it useful to discuss this with your loved one’s clinician as well.

The eating disorder can cause your loved one to misinterpret what is being said to them, which can leave you unsure of what to say and concerned about upsetting them. Below are some examples of things that you may innocently say, and what the eating disorder may cause your loved one to hear instead. It could be helpful to share these with other people likely to talk to your loved one, to help them to understand more about the eating disorder and avoid upsetting conversations.

Just eat normally.

What may be heard: You’re not trying hard enough, it’s not difficult to eat, it’s your fault, you need to get over this.

Positive alternative: To outsiders it may seem like people with eating disorders just need to eat, or just need to stop purging or binge eating. This is not the case – eating disorders are not a choice but are severe mental illnesses that the person needs supporting through. It is therefore important to acknowledge to the person that you know it’s difficult for them, and you are there to support them.

You look well.

What may be heard: You look fat, you have gained weight, you’re greedy, you’re healthy now so things are easy for you.

Positive alternative: Any comments to do with your loved one looking “healthier” or “better” are often taken to mean they have put on weight. Instead of commenting on their physical appearance, try to ask the person how they are, or compliment something about your loved one that is unrelated to their body such as an item of clothing or an accessory.

I wish I had your control. 

What may be heard: You are lucky to have an eating disorder, you are in control of the illness, it’s a good thing to be obsessive with food, weight and shape.

Positive alternative: Often eating disorders are used as a coping mechanism and a way to feel in control. However, when someone is suffering from an eating disorder the illness controls them and fighting against the thoughts and behaviours is extremely difficult. Avoid commenting on the eating disorder as if it is the person’s choice.

You just need to stop eating so much.

What may be heard: You are fat, you are greedy, binge eating isn’t a problem, you are making this up, it is easy to stop binge eating.

Positive alternative: Acknowledge how difficult things are for your loved one, and how distressing the eating disorder must be. Let them know that you are there to support them.

Get well soon.

What is heard: It’s easy to get over this, you aren’t trying hard enough, you are being a burden, hurry up and get better.

Positive alternative: Reassure your loved one that although you recognise how difficult things are for them, you are there for them and will continue to be throughout. Let them know how proud you are of them for challenging the illness.

I wish I had your body.

What is heard: You are lucky to have an eating disorder, you are just doing this to look a certain way, you need to keep doing the disordered behaviours.

Positive alternative: Try to avoid discussing your own weight and shape in front of your loved one as it can be unhelpful for them to hear. Instead focus on topics away from body image, food or exercise.

I can easily finish a packet of biscuits so know exactly how you feel.

What is heard: Everyone eats that way, you don’t have a problem, it is normal to binge eat, you don’t deserve support.

Positive alternative: While many people will overeat on occasion, and this may be triggered by difficult emotions, this is not the same as having binge eating disorder. Binge eating disorder is extremely distressing for the person and involves the person feeling a loss of control while eating a much larger amount of food than most people would eat in similar circumstances. It is good to be understanding, but important to avoid trivialising what the person is going through.