Watching someone you love self-destruct is a heartbreaking experience. When someone we care about has an eating disorder — whether it's anorexia, bulimia, or binge-eating disorder — we regularly feel frustration, fear, confusion, hurt, and powerlessness.
As a registered dietitian for more than 12 years, and the founder and executive director of BALANCE Eating Disorder Treatment Center, I've had the privilege of learning how eating disorders affect individuals and their loved ones. Ultimately, their illness is largely out of your control.
But there are some important things you can do — and some you shouldn't do — to support them and move them toward recovery:
What You Should Do to Support a Loved One
1. Frame your concern in terms of their behavior — not their appearance.
When someone we love has lost or gained a significant amount of weight, we tend to open our intervention with "You're alarmingly thin" or "You've put on a lot of weight."
However, this only reinforces a focus on appearance, and, in the case of weight loss, being "alarmingly thin" might actually be received positively.
So instead of focusing on weight, say something like, "I've noticed you haven't been attending social events lately," or "You seem distracted and don't _____ anymore. What's up? Is everything okay?"
2. Offer them resources.
Fortunately, there are numerous resources available, both online and offline. Because there's a great deal of shame around having an eating disorder, online resources that allow a person to remain anonymous can sometimes be a good gateway into more effective interventions.
The act of researching a few options and sending them to your loved one in an email can be an act of caring in itself, even if they don't actually check out any of them. Some of my favorites include the National Eating Disorders Association (NEDA), Eating Disorder Hope, and Recovery Warriors.
3. Acknowledge destructive behavior in a supportive way.
Often, we react to disordered eating behavior by either a) accusing or interrogating (i.e., "I know you just made yourself throw up!"), or b) turning a blind eye to behavior.
A more constructive reaction to destructive behavior is saying something like, "I know you're dealing with stuff right now, as we all do at times. I know when I'm going through a tough time, it helps to know there's someone nonjudgmental around to talk to. I just want you to know I'm here as a confidential sounding board when you're ready to make a change."
4. Recognize the severity of the illness.
Eating disorders have the highest mortality rate of any mental illness. Yep, higher than depression, schizophrenia, and so on.
The earlier the intervention, the higher the rate of recovery — so don't wait for it to get worse before offering resources.
5. Tell them you love them.
If you keep reinforcing that you love them unconditionally, they'll feel safe coming to you when they're ready to seek help.
However, depending on your relationship to the person, you want to be mindful that you set boundaries around behaviors rather than enabling them. For example, if your partner has been struggling with an eating disorder and has replaced your evening meal together with the gym, it's okay to say, "I miss you. I miss having dinner together after work. I know the eating disorder might be telling you the gym is more important than me, but I want you to know that's just the eating disorder trying to come between us. It leaves me feeling neglected."
Because eating disorders can be so manipulative and all-consuming, it can sometimes be helpful to remind your loved one how it's affecting you — just be sure to do it in a very compassionate way that puts the blame on the disorder rather than the person.
What Not to Do
1. Don't take it personally.
We sometimes take it personally that our loved one is struggling with an eating disorder. We feel guilty, angry, offended, frustrated, neglected, hurt, and confused.
Know that all these feelings are normal and okay to experience, but remember that eating disorders are complex illnesses that almost never come from a place of ill intent. They have a way of manipulating people into making the eating disorder the priority. It's not about you.
2. Don't assume you can heal them on your own.
Eating disorders can be one of the most challenging mental illnesses to treat — for a professional. So don't assume that because you are close to the person you can heal them. You'll end up overwhelmed, lost, and frustrated.
Plus, in assuming responsibility, you might be preventing your friend or loved one from getting professional help. Finally, many cases require a team of individuals, such as a therapist, nutritionist, and psychiatrist. It usually involves education, helping patients improve their relationship to themselves and others, and finding purpose. A treatment center is often your best resource for covering all these bases.
3. Don't tell them they're "not fat."
An eating disorder tells a person that they're never thin enough. When a person with an eating disorder looks in the mirror, they are repulsed by the image before them. So telling them they're "not fat" can just reinforce their belief that they need to be thin to be loved, and keeps the attention on their body.
Instead, try something like, "I love when you're present with me and the eating disorder isn't coming between us. I love when we can share a meal together or sleep in on a Sunday morning."
4. Don't shame or monitor them.
I had a client whose mother told her "You're smarter than this. You're being childish and ignorant keeping yourself at this sickly weight." But shaming someone for their struggle is an avenue toward disconnection.
And because an eating disorder is often a way of dealing with difficult feelings (shame being a very common one), shaming a person is just likely to reinforce the illness. Similarly, "watching" someone during or following meals breeds distrust, judgment, resentment, and control in your relationship — all things that might inhibit recovery.
5. Don't forget about yourself.
When someone we love is struggling, it's a heartbreaking and exhausting place to be. So it's very important to set boundaries, practice your own self-care, and seek help yourself.
Consider seeing a therapist, or joining a support group for people with a family member with mental illness. If putting yourself first is hard for you to do, think of it this way: you will be a better support to your loved one if your own mental health is in balance.