Information Sheets
Eating disorders cause great distress for sufferers but it is often not acknowledged just how much families are left bewildered, heartbroken, challenged and torn apart by the stress of having to live with loved ones so seemingly bent on self destruction. There is confusion and anxiety about how best to cope and often very little advice about the best ways to respond.
Parents often comment on the deception practised by their daughter or son. Anorexia sufferers will usually deny having a problem and those with bulimia will go to great lengths to conceal the eating disorder.
It is devastating for parents to find evidence of vomiting, or empty boxes of laxatives, in a daughter’s room. Husbands are shocked to learn the reason their wife delays coming to bed each night is to engage in purging behaviours. Boyfriends are at a loss, trying to understand a girlfriend who responds negatively to every compliment or innocent comment. Brothers and sisters can become confused, hurt and angry at the change in a sibling’s behaviour. Very often the sufferer manages to conceal the eating disorder for a considerable length of time.
The strain of living with the eating disordered person can create huge divisions in the family. Each person involved will be affected in a different way, but everyone involved feels bewildered, helpless, anxious and even angry and frustrated. All concerned wonder how to approach the problem: What is the right thing to do? How can one best cope with the situation? Often family members have very different views on how to deal with the situation, and will react to the sufferer in ways that cause further stress on the rest of the family. This can also create disagreement and rifts amongst families, particularly if the sufferer does not seem to be getting better.
The first step is to bring the problem into the open, taking great care to be honest with your concerns and sensitive to their response. Don’t criticise, accuse or blame the sufferer. They already feel shame, guilt and distress and initially may feel threatened by the ‘intrusion’ into their privacy. Anger is a normal reaction - don’t be put off by this - just show your concern and offer the opportunity to talk.
Reassurance that friends and family members will not blame the sufferer and are willing to be patient greatly helps. Of course, sufferers need to be encouraged to seek professional help. In fact, if the person is truly endangering his or her life with their eating habits or behaviour, family and friends may need to insist that professional help is sought.
First Contact
If you suspect someone has an eating disorder - it is important to do something about it. Approaching someone with your concerns is not easy; you may feel talking about it will somehow make the problem worse, or that you’ll say the ‘wrong thing’ and make them angry or upset. However, delaying it will not make the problem go away, nor the approach any easier. You may be unwittingly sending out the wrong message -
No one cares about me … obviously I haven’t lost enough weight … I mustn’t have a problem if no one is saying anything
How you approach the subject will depend on the age of the person, your relationship with them, and the degree to which the problem has developed. It may be that you are concerned because your thirteen year old daughter has suddenly become very conscious of the fat content in the food she eats, or that she complains of being ‘too fat’ to wear certain clothes. You may be very worried about one of your colleagues at work who has lost a significant amount of weight and is taking an increasing number of days off work, yet refuses to talk about it. You may have just discovered that your 30 year old male flatmate is vomiting in the shower after ever meal. What is an appropriate course of action to take in one situation will differ significantly for another.
Some Tips
Timing
Pick a time when you are calm, and when you know you have time to talk without interruption. Avoid ‘ganging up’ on her - having the whole family, or all the flatmates, involved could be too overwhelming and she may feel judged and completely alone and isolated.
Focus on your concerns
Describe how you feel, and the changes or behaviour you have noticed. Saying ‘I have noticed that you have lost weight and I am concerned about you’ or ‘I have heard you throwing up in the bathroom and this really worries me’ is clearly stating your concerns, without judgement or blame. Try to avoid labeling or making statements, such as ‘You need help’, ‘I think you are anorexic’ or ‘You’re only doing this for attention’. This approach is more likely to lead to defensiveness or denial, as it could be perceived as judgemental and critical. At this stage your main aim is to offer her the opportunity to talk. Regardless of her response, do not be deflected from this straightforward goal.
Allow her to respond
Simply express your concerns and then give her time to respond. Try to anticipate what she might say. Don’t be at all surprised if your comments result in anger, tears or defensiveness. She might seek to reassure you - convince you that she is fine, or she might suggest that you have the problem, not her. She may completely ignore you, walk away and lock herself in her room. She may even admit she has a problem and be relieved that someone has finally spoken to her about it.
Avoid arguments
Trying to get her to see your point of view, or admit there is a problem, is not likely to meet with much success. If she does react with anger, or deny there is a problem, or be unable to talk about it, be aware that this negative reaction is unlikely to be about you personally. She may feel afraid, confused, distressed, ashamed, humiliated… and be therefore be unable to respond to you in a calm, logical, rational way. Arguing with her at this point could be perceived as rejection or just confirm that it is too difficult to talk to you. Let her know that you can see that she is upset or not able to talk, but that you are concerned for her and will be there to talk to whenever she is ready. This will allow you both time to think about the situation, without being too threatening.
Focus on feelings, rather than food or weight
Eating disorders are not about food and weight. Focusing on food and weight may just demonstrate that you ‘don’t understand’. Instead ask how she is feeling and acknowledge her response, even if it upsets you or you disagree with what she is saying. It is important that you support her and you and show her that you care about her, no matter how she feels about herself.
Be patient
Be aware that you are unlikely to resolve the problem in this first conversation (or even the second, third……). She may feel threatened or frightened by your discovery and your observations. She will need time to absorb what you have said and think about her response. Listen to what she has to say and be guided by her response, despite your own urgency to find a solution. If you are patient and understanding, she will be more likely to listen to you in future discussions.
Be persistent
Don’t back down or be put off by an initial denial or angry response, but be careful not to nag. Calmly let her know that your concerns are such that, although you can see she is not ready to talk about this, you will not let her struggle alone with this. Offer her the chance to talk whenever she is ready and that you will be there to support her the best you can.
Avoid tricks or deceptions
Trying to ‘catch her out’ with hidden cameras, listening at doors or snooping in her room for her diary, as a way of confronting the problem will only leave her feeling betrayed, humiliated, invaded and/or paranoid! She may also then rightfully feel that she can be equally dishonest and disrespectful in her response to you.
Focus on recovery and your willingness to help
Encourage her to seek help. Let her know that you will be there to support her, to help her find out about treatment options, but that getting professional help is an essential part of recovery. Recovery is possible and the earlier treatment is sought the better. The Eating Disorder Foundation can provide you with up-to-date information about treatment options available in NSW or can put you in touch with similar organizations in other states of Australia for local information.