Family and friends

For Family

As with many other physical and mental illnesses, eating disorders often affect family members more than they realize. As a parent, spouse, sibling, or child of someone with an ED, you might feel like you’re “walking on eggshells” around your loved one. You might feel like you can never say the “right thing.” Communication might be nonexistent except for arguments about the illness, food and weight. Some family members have difficulty finding the support they need from other family and friends, who may not understand this complex illness. In addition, some family members even feel guilty and wonder if the illness is somehow their “fault.” As a family member you might feel that there is little you can do to help in the recovery process. The good news is that this couldn’t be further from the truth!

I believe that families can be an important part of a patient’s healing. Through family therapy, family members and patients can work together to discuss concerns about treatment, areas of conflict, and what to expect during recovery. My goal is to help increase communication, understanding and support – both for the patient and the family members. Figuring out what “caused” the eating disorder, or whose “fault” it is are NOT the goals of treatment. Remember, no one knows what causes an ED – the best we can do is figure out what things are happening currently that keep the ED going, and look at ways to make changes. You should know that effective therapy does focus on the whole family – not one person as the “sick one” who needs to be “fixed.” This means that as a family member you might need to make some changes yourself. Again, this is not because you have done something “wrong,” but because there are alternatives that will be more helpful to the person struggling with the eating disorder – and maybe even more helpful to you and the rest of the family.

Some patients and families may feel that family therapy is unnecessary, or that “it’s all been done before.” Unfortunately, there are even some less informed healthcare professionals who think that family therapy isn’t necessary. But my experience shows that virtually every family could benefit from learning more about the illness, treatment and recovery, and that patients who include their family in treatment make more progress towards recovery. Still, your loved one with an eating disorder may be reluctant, for any number of reasons, to include you in treatment. Reassuring her/him that you want to help and be involved could go a long way towards reducing the resistance.

Even if your loved one won’t agree to family counseling, though, you and other family members can still seek treatment and support for yourself. Living with someone who is ill may make you feel scared, guilty and even angry. This is normal and counseling can help you deal with these feelings. Living with someone who has an eating disorder can be disruptive to the rest of the family, and it is not uncommon for other family members to develop struggles of their own (not necessarily with food). Again, family counseling can be very helpful to the entire family during this difficult time.

If you are interested in learning more about support groups for family members, click here for a list of resources.

For a list of ways you can help your child develop health body image, click here.

To arrange a consultation or counseling with me, please click here.

For friends

Sometimes friends are the first to realize that something is wrong with a person who is beginning to develop an eating disorder. Particularly among adolescents and young adults, friends might have the inside scoop on behaviors other people wouldn’t notice: behaviors like skipping meals, losing weight, excessive exercising, preoccupation with dieting, and abuse of diet pills or laxatives. If you’re in this situation you likely face a dilemma: on one hand, you might be getting worried and want to help your friend; on the other hand, you want to be loyal and not “tell” on your friend. What a difficult decision!

If you find yourself in this situation it might help to know a couple things. First, it is probably a good idea to tell your friend that you’re worried, even if she gets mad or denies she has a problem (and in most cases, this is exactly what happens!). If you decide to talk to him or her about the problem (yes, even guys can have problems with ED’s) remember a couple things: First, it’s important not to blame the person or accuse them of anything – you’d get further if you express CONCERN and let the person know you are not judging them. Second, you can help yourself by being informed about ED’s before you approach your friend – there are a number of really good websites (like this one, I hope!) that have great advice about how to approach someone AND take care of yourself in the process (click here, or the Resources button at the top, at any time, to see more sites and books).

The important thing to know is that ED’s are a really, really serious illness and can be very difficult and time-consuming to treat. So, if you are worried about someone, the sooner you do something about it, the more likely they can get the help they need. Much as you might want to, you CAN NOT “fix” someone with an ED all by yourself – no matter how close your friendship is!! Don’t let your friend convince you she can fix it herself, or with just your help. It is crucial that a caring adult know what’s going on. Ideally, this would be your friend’s parents, but if you can’t talk to them for some reason, a teacher, guidance counselor, nurse, doctor, sports coach, or any adult you trust will do. If you really aren’t sure who to go to think about your own parents – perhaps they might be able to help you with this difficult situation. In any event, someone has to know! Generally, the longer a person is ill with an eating disorder, the longer and more difficult treatment may be.

A couple quick things that WON’T help: ignoring the problem, hoping it will go away by itself; blaming the person who is sick (remember ED’s are an illness); and trying to fix it yourself.

There are also a couple things you can do to help prevent ED’s in yourself and your friends: don’t focus so much on appearance; don’t give in to pressure to diet or be thin – remember that people come in a variety of shapes and sizes and all of them are OK; and learn to feel good about yourself – and appreciate in others – qualities that have nothing to do with appearance… things like a sense of humor, compassion, and special interests and talents. For more ideas, click here.

For family and friends

There are a number of general guidelines that may prove useful when interacting with someone who has an eating disorder:

1. Educate yourself about ED’s as much as possible. There are many myths and hurtful misconceptions that can make this painful illness an even more difficult struggle for all of you!

2. Don’t get sucked into talking about the way your family member or friends looks – whether or not she could stand to lose a few pounds – or even complimenting her appearance. Conversations about appearance just reinforce the mistaken belief that appearance is important, and distracts both of you from the underlying problems.

3. Do ask if your loved one feels worried herself, or if anyone else (besides you) has expressed concern. If the answer is yes, have a discussion about why people might be getting so worried.

4. Seek support for yourself, preferably from a knowledgeable professional or from other friends or family members of a person with an ED, who might be able to help you develop strategies to cope.

5. Don’t focus all your attention on the person who is struggling. Try to keep life as normal as possible, especially for siblings of someone struggling with an ED. It’s hard, but try not to let the ED take over your life.

6. Don’t try to force someone to eat, or engage in struggles around food. Often, the harder you push, the harder he/she will push back.

7. Do remember it’s okay to have rules even with a person who is sick. For example, you might set a rule that someone who is vomiting has to clean the bathroom; or that someone who is bingeing has to replace foods she consumed if they belonged to the family. It can be extremely difficult setting reasonable limits with someone who is ill, and again, the help of a professional trained in eating disorders can be really beneficial.

8. Examine your own beliefs about treatment. Are you reluctant to get help because you think it is a sign of weakness, or because you don’t want to acknowledge that someone you care about has a mental illness? If so, then your loved one may also resist treatment – even if she knows she needs it!

9. Examine your own beliefs about weight, food and size. We all want the best for our family and friends, but if you mistakenly buy into the false belief that thin people are happier and healthier, you may inadvertently reinforce your loved one’s preoccupation with weight and food. If they think you’ll like or love them less if they gain weight, or that you are embarrassed by their size, they are less likely to work successfully towards true self-acceptance.

There are also many things you can do before some develops an ED to help prevent them, and increase a person’s self-esteem in general. To see my top 10 ideas, click here.