The Role of a Support Person in Eating Disorder Treatment
The most important thing you can do when assisting someone with an eating disorder is to prepare by educating yourself as much as possible about eating disorders. You will need to constantly remind yourself that behind this illness is the person you are trying to reach and care for. The eating disorder can be very powerful, so be patient. The person you are caring for may be experiencing high levels of anxiety, shame, embarrassment, guilt, or denial. They may be unaware that some of their thoughts and behaviours are due to the illness.
Be prepared to respond calmly with the person if they respond with anger or denial in relation to your efforts to counter their eating disorder behaviours. When the person you are caring for is angry or is denying that there is something wrong this does not mean they are okay. It means that right now their problem is out of reach, buried under the layers of their illness. At times, such as at mealtimes, the eating disorder’s “voice” can be extra loud and dominant. Your role is to reassure the person you are caring for, help to calm their anxiety and fears, and confront the eating disorder on their behalf when they are unable to do so themselves.
Open and calm conversation is best.
Listen and remember there is a person in there
Avoid putting attention on food; instead, focus more how the person is feeling. Nobody chooses to have an eating disorder. Do not use language that implies blame or that the person is doing something wrong. For example, if they are refusing to eat, or to sit still at the meal table, avoid saying, “You are making me worried.” Instead, own your feeling and say, “I am worried about your behaviour; can you tell me how you are feeling right now?”
Don’t dominate the conversation. The aim is to help the person you are caring for to reconnect with their healthy self; make an effort to listen and create a space for the person with the eating disorder to talk. Remember and respect that the person is there; it is just that right now the eating disorder is suppressing their healthy self and is trying to prevent them from connecting not only with their true self but also with you. Be patient because the eating disorder will try to sabotage and silence the person’s efforts to reach and express thoughts and feelings that are of their healthy self.
Be supportive in the language you use
When talking about the situation, show that you have heard the concerns, fears or difficulties expressed by the person you are caring for, by repeating some of the words they have used and reflecting these back to them. This is important to do, to improve understanding and avoid misinterpretation. For instance, if they have shouted at you, “I will be fine if you back off. You just make things worse,” you might reply with, “What can I do so that I’m not making things worse?” This signals to the person that you have heard them and are listening. At the same time, while acknowledging that the person you are supporting is ill, there are boundaries. They don’t have the right to hurt other people, including you, even if they’re finding things difficult. When things are calm, be clear with them about what is, and isn’t, acceptable behaviour.
Avoid using threatening statements, for example, “If you don’t eat right now, I will leave.” This form of approach can be extremely harmful to the person’s emotions and can exacerbate their fear and their eating problem. Be patient, keep to the boundaries, and always remember that the person you are caring for is a person first and foremost; they are a person who happens to have developed and become entrapped in a very serious illness called an eating disorder.
Trust is essential in learning to diffuse the eating disorder triggers
The gradual building of trust between support worker and the person with the eating disorder is essential to assist the reintegration of healthy self. Trust with the treatment team, including the support worker, is the glue that will eventually give the person with the eating disorder the courage to ignore the loud and relentless demands of their illness. Trust creates a bridge on which the person can feel safe and secure enough to let go of their eating disorder behaviours. Trust gives the person courage to develop healthy coping thoughts and behaviours that promote reconnection with their healthy self.
The eating disorder can cause the person you are caring for 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 might innocently say, and what the eating disorder might cause the person with the eating disorder to hear instead.
Share these potential eating disorder triggers with other people likely to talk to the person you are caring for, to help them to also understand more about the eating disorder and why it is important to avoid upsetting conversations. Remember, the eating disorder is always on high alert, ready to grab innocent, well-meaning words and twist them into a damaging put-down for the person with the illness. A few misinterpreted words can abruptly disrupt recovery efforts and, worse, cause a regression.
Comments to avoid include:
Just eat normally.
What the person with the eating disorder may hear: You’re not trying hard enough, it’s not difficult to eat, it’s your fault, you need to get over this.
Positive alternative: Outsiders may think that people with eating disorders just need to eat, or just need to stop purging or binge eating. Like it is an easy thing to do. This is not the case when you have an eating disorder – 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 eating is difficult for them, and you are there to support them. To avoid focusing on the food, encourage distraction at mealtime by talking about a movie, a book, the favourite sports team, or do a puzzle together.
You look well.
What the person with the eating disorder may hear: You look fat, you have gained weight, you’re greedy, you’re healthy now so things are easy for you.
Positive alternative: Comments that the person you are caring for is looking “healthier” or “better” are often taken to mean they have gained weight. Just because a person “looks healthier” does not mean they are free of the eating disorder’s loud “voice”. They might look “healthier” physically but can have a long way to go to in recovering their healthy self, mentally and emotionally. Remember, the eating disorder resides in the brain. The brain needs time to recover healthy-self thoughts and feelings. How much time? As long as it takes. There is no quick fix, so be patient. Importantly, remember that recovery IS possible at EVERY age. Instead of commenting on the person’s physical appearance, ask how they are feeling (and be prepared to listen).
I wish I had your control.
What the person with the eating disorder may hear: You are lucky to have an eating disorder, you are in control of the illness, this is something you can do well, it’s a good thing to be obsessive with food, weight and shape.
Positive alternative: Often eating disorders develop as a coping mechanism and a way to manage daily stresses. The person with the eating disorder thinks they are in control but the reality is that the illness is controlling them. Countering the thoughts and behaviours is extremely difficult. Avoid commenting on the eating disorder as if it is the person’s choice. It’s not. Avoid talking about control and body shape and size. Compliment their smile, the colour of their hair, or the colour coordination of their clothes. Better still, play it safe (because the eating disorder will try to outsmart you every time) and focus on other things – the leaves on the trees, the bird on the windowsill, the cat on the mat.
Externalising the illness
Externalising the eating disorder – viewing it as separate to the person you are caring for – can help you to distance the person from the illness and challenge the eating disorder behaviours. This challenge to the eating disorder may cause the person you are caring to behave in difficult ways, but this is often the illness reacting due to feeling threatened. By externalising the illness, you can also help the person you are caring for to recognise and become aware of the thoughts and behaviours that stem from their eating disorder and to gradually recognise and focus on developing the thoughts and behaviours that are of their own true, healthy self. To encourage this, aim to address the eating disorder as distinct from the person you are caring for.
- “What did the eating disorder say to make you feel unable to eat your snack?”
- “What did the eating disorder say to trick you into purging after your dinner?”
- “How does the eating disorder make you feel about yourself?”
Externalisation can also help the person with the eating disorder to feel less like they are being criticised or are to blame; you both recognise the thoughts and behaviours that belong to the eating disorder, and which belong with the healthy self.
Externalising the eating disorder will not be helpful for everyone. Some people may feel that the eating disorder is part of them, rather than separate, and they may struggle with assertions that the relationship they have formed with the illness is not of their healthy-self. They might not see the eating disorder as a negative in their life. They might like their eating disorder because it helps them feel like this is something they can “do well” and the thought of letting go of it is far too scary. At such times, explore reasons why with the person you are caring for and their treatment team, to find a dialogue that works for everyone. When a person has had an eating disorder for a long time, or even a short time, the thought of trying to cope without it can be frightening. What will they replace it with? How will they manage daily life? Great patience, reassurance, and cultivation of hope, faith and trust is required while the process of reconnection with healthy self, including the development of healthy-self thoughts and behaviours, takes place.
For more suggestions on how to understand and address the eating disorder, see my book, with Cate Sangster: Ed says U Said – The Eating Disorder Translator. https://thediaryhealer.com/books/ed-says-u-said-eating-disorder-translator/
Defusing negative emotions
Pleasant and distracting activities may help to diffuse negative emotions. Engaging in enjoyable activities is likely to improve the mood of the person you are caring for and can help them to tolerate negative emotions. When you notice that the person you are caring for is experiencing an urge to engage in a disordered behaviour, respond quickly to try to delay and defuse the urge. Distraction is a very important strategy because if the urge can be delayed long enough, it will decrease in intensity and then pass. As recovery proceeds, the person you are caring for will develop skills to help themselves recognise and manage the triggers, but right now, when their eating disorder is so powerful, they need you to do this for them.
Support for yourself
Supporting someone with an eating disorder can affect your own physical and mental health. Remember that you’re not alone, and it’s especially important to look after your wellbeing, too. For self-help guidance by parent and caregiver Bharati Lall, see: https://thediaryhealer.com/2020/06/29/writing-connects-caregivers-and-creates-a-channel-for-healing/ and https://www.amazon.com/Growth-Amidst-Darkness-caregivers-suffering-ebook/dp/B088YDX7LG
Recommendations for further reading and learning
Remember, knowledge is power when helping someone recover from an eating disorder:
Mealtimes can be challenging, for both the person you are supporting and yourself. The best way to prepare is to arm yourself with knowledge.
Providing a distraction
Talking with someone who has an eating disorder
Things to say and not to say to someone with an eating disorder
Supporting someone with an eating disorder during the pandemic
Strategies to provide structure and support before, during and after meals
This video provides strategies to help parents, caregivers and families provide structure and support to the person who has an eating disorder before, during and after meals.
See this video: https://www.youtube.com/watch?v=pPSLdUUlTWE
Supporting someone with an eating disorder – Beat Eating Disorders (UK) https://www.beateatingdisorders.org.uk/get-information-and-support/support-someone-else/tips-for-supporting-somebody-with-an-eating-disorder/