A Guide for Parents and Loved Ones

I have heard the anguish in hundreds of voices as they’ve implored, “She’s such a beautiful girl, she doesn’t need to diet… if she would just eat!”   It seems so obvious: she’s underweight and needs to gain weight; she’s beautiful and just needs to stop throwing up; if she would only ‘just eat’ everything would be ‘just fine.’ Unfortunately, it’s just not that simple. Whenever you find yourself tempted to believe that the solution is for her to “just eat,” it will be important for you to remember that people develop eating disorders for many different reasons rooted in the complex interplay of genetics and environmental factors. Recovery is more than simply facing fears about food and weight. It is a complex process that demands a deep look at one’s beliefs, perspectives, thoughts, actions, life and self. Recovery compels the individual to examine the underlying issues that led to the development of her eating disorder in the first place. Dealing with and reconciling all the thoughts and feelings attached to those issues takes time and patience from everyone involved. You may already understand that recovery requires a good deal of motivation and effort from your loved one. But you probably also wonder if there is anything that you can you to support the recovery process. In fact, the answer is YES! There are many things you can do that can make a world of difference for both of you.

Because there is no one right way to recover, and because what works for one person does not work for or even remotely help others, it important to develop open, honest, reciprocal communication. You need to be able to give each other gentle feedback about the helpful and sometimes not-so-helpful things that you both do and say to each other. An open line of direct communication means that you can stop worrying about saying ‘the wrong thing’ and inadvertently jeopardizing her recovery. We are all human, after all, and although we mean well, we sometimes do say ‘the wrong thing.’ But that does not mean that you have single-handedly annihilated her recovery! If your communication is effective, she can tell you that what you said wasn’t helpful, and maybe even suggest things that you could say or do next time that will be more helpful to her. In turn, you can hear her feedback and respectfully respond to it. For example, if you say “Wow, you look GREAT! Have you finally put on some weight? That is awesome!” She could respond with, “I know you mean well, but it’s really hard for me to hear you say things like ‘you look great’ because I think that you really mean that I look fat. When you ask if I’ve put on weight it just confirms for me that my fear is a reality. I’m trying really hard to concentrate on what’s inside of me instead of how I look. Could you not comment on my appearance from now on?”  You might then offer, “I’m sorry, I didn’t realize it had that effect on you. I will definitely try to watch out for that in the future! Please know that even though I mean well and love you, I may slip and say something that isn’t super helpful. If you can keep letting me know how what I say affects you, I can accommodate that and I know we can work through it.”  This dynamic also works in the opposite direction. You can let her know when she unintentionally hurts your feelings or needs more than you are able to give. She can then absorb that information and respond to you in the same respectful way.  If you’re both communicating effectively, there will be no problem too great for you to work through together!

Practice your communication skills often by encouraging her to talk about how she feels and be an empathic listener. Empathy is so vital in the recovery process! What is empathy anyway?  Empathy essentially means that you are trying to understand something exactly the way she understands it, as opposed to the way you think she should understand it.  Empathy is putting yourself in her shoes and being in her experience with her. Try to imagine how she feels by listening attentively and with compassion. Accept her point of view and how she feels without trying to change it with statements like, “Oh, don’t let that bother you, it’s not that important” or “Just let it go. You’re a great person, look at all you have going for you.”  Show her that you care by making a genuine effort to understand. Offer her words such as, “That sounds so frustrating; I can only imagine how angry you must be!”  Connecting through empathy opens the door for both of you to talk in more detail about how she experiences the world around her. Everyone appreciates being able to share unique points of view, thoughts, and feelings without being judged. Certainly it will help her feel less alone in the world, and she’ll take comfort in the fact that you understand and appreciate her on a much deeper level.

Bear in mind that empathy is not the same thing as enabling. You can hear a point of view and empathize with someone and still

If she is in emotional pain, be with her in it.  Give her the space to both experience it and move through it.  It can be difficult to see someone we care about in pain, and you may find yourself immediately wanting to ‘fix’ it to make her feel better. You may even feel compelled to give her all sorts of advice solve the problem or cheer her up. But think about a time in your own life when you felt intense grief.  Perhaps you lost someone you loved, or maybe there was some tragic circumstance in your life. What did you really want to hear? That it wasn’t that bad?  That you are blessed with a fabulous life? That you should get over it? Or did you really want and need compassion, a warm embrace, or a soft voice offering you comfort as you shared your inner most pain? Sometimes just being there provides the most healing kind of comfort there is. To really connect and give someone the sense that you understand where she’s coming from, and to do that with gentleness and compassion is one of the most precious gifts we as human beings can give to one another.

I’m not at all suggesting that anyone wallow in their misery. It’s more that sometimes we worry so much about saving someone from their pain, that we go to the opposite extreme and try to rush them out of it before they have even had the chance to process it and heal. Many people worry that their loved one will be trapped in that pain forever. Still others find that witnessing their loved one’s pain causes them discomfort, and they try to ‘talk them out of their pain’ to make themselves feel better.  Try to keep in mind that all pain is legitimate and has a purpose. Trust that pain needs to be recognized and experienced to be moved through, and that it is in moving through our pain that we eventually come to heal from it.  If your loved one is constantly being diverted from her pain by being told that she “shouldn’t feel that way” or that “it’s not that bad,” she will remain trapped in it and unable to grow from the experience. Adversity is one of the greatest teachers on the planet. Don’t deprive someone of her opportunity to learn and grow just because you’re feeling a little uncomfortable with it. You’ll find that if you walk with her through her pain you’ll both learn and grow.  It might be true that time heals all wounds, but it’s love, comfort, and caring that makes the healing process bearable and complete.

It’s also important to remember that she’s not her eating disorder. She is a separate, distinct individual. Sure, it can be hard to differentiate sometimes, but the fact remains that she is her own person, even when she’s hard to spot under the cloak of ED. Get to know who she is by paying attention to the things that make her smile. Notice what puts the twinkle in her eyes. Wonder with her about whatever it is that she wonders about. Show her that you appreciate who she is by letting her know when and how she touches your heart. Tell her how happy she makes you; let her know about the light she brings into your life.  Believe in her ability to heal, to grow, and to flourish. Most of all tell her that you believe in her. Express your concern with a warm embrace or hold her hand–a caring touch is so healing.  It can be so hard for someone with an eating disorder to like and be gentle with herself. Your treating her with gentleness, compassion, and respect will help her to be able to do that for herself somewhere down the road. She may feel so innately bad that it’s hard for her to accept or hear your compassion for her, but don’t give up! Continue to be gentle and compassionate, one day it will help her hear the loving voice of her own heart.  Her critical inner voice may muffle and override that loving voice now, but one day that loving voice that will finally prevail.

Encourage her to seek treatment. Getting help in the early stages of the eating disorder often makes treatment smoother. Encourage her from a kind, caring place, as opposed to a harsh, directive, rigid one. Convey your caring and concern through your eyes, touch, tone of voice, and mannerisms. The concerned, compassionate look in your eye and gentle hand on her shoulder will be a far more compelling and effective way to convince her to seek treatment than yelling, shaming, or threatening will ever be. Think of parents who set gentle but firm boundaries for their small children. They tend to receive the results they want much faster (and with less stress!) than the red-faced screaming parents we sometimes see in grocery stores. It feels much better to be on the receiving end of tender firmness than it does to be on the receiving end of out of control anger.  While encouraging her to seek treatment, you may offer to help her locate doctors, therapists, nutritionists, programs, and books. Keep in mind, however, that while you can offer to help her find these resources, you can’t force her to use them.

Recognize your own limits. We all have them. Pretending that you don’t have limits and forcing yourself to do more than you can will only make you feel resentful and angry. She is bound to sense that resentment and anger and is likely to feel guilty and shameful in response. Ignoring your own limits will only hurt both of you in the end. If you can be there for her and listen for a only certain period of time each day or week, be clear within yourself and with her about when and how long that time is. It’s far better to commit yourself for a shorter period of time and then really be present for her during that time, than it is to make yourself overly available and subsequently distracted while you’re together.  It’s no fun to be on the receiving end of someone who has offered to help and isn’t paying attention! Ask yourself what you are willing and able to do. Are you willing to keep certain problem foods out of the house for her? Are you willing to cook specific meals for her? Are you able to buy the specific foods that she may request? Are you able to listen to her vent about her day? Can you hear her fears around what she just ate? Can you non-judgmentally and factually challenge her food and body fears with her? Once you have thought about these things, sit down and have an open discussion with her about it.  This is also a good time to also set limits around what you can tolerate. For example, if she is purging, this is a good time to let her know that she is the one who needs to clean up the bathroom afterwards-not you. If she is bingeing, you might discuss how she will replace the food she has taken. This is one area where your effective communication will be extraordinarily beneficial to you both.

Get support for yourself.  It’s not easy to watch someone you care about wrestle with an eating disorder, and realistically there is only so much that you can do. Ultimately you have no control over her choices; you can only encourage her to make healthy ones. She is the one who must decide whether and how she will live. Accepting that you have no power over her choices is bound to evoke feelings of helplessness. It is a painful, frightening, frustrating, maddening, and sad experience indeed to feel helpless when someone we care so much about is in trouble. These feelings need a place to be expressed, and you need to express them for your own health and well-being. Be true to yourself-it will allow you to be a reliable, trusted source of support for your loved one. Holding in your anger, fear and frustration only increases your likelihood of blowing up- most likely at her. This will only further isolate her, and probably make you feel guilty to boot. A neutral party can offer you a safe place to vent your anger and air your concerns. It  also helps ensure that you don’t burn out. They can help you find constructive ways of talking with your loved one about how you feel and are affected, because that is important, too. Many people worry that they caused their loved one’s eating disorder. A good support person can help you explore these feelings while reassuring you that no one person causes an eating disorder.

Getting support may be particularly important if you are a parent. Most parents are faced with a host of unpleasant feelings stemming from their child’s eating disorder. You most likely experience feelings of guilt, shame, frustration, anger, sadness, doubt, and denial regarding your child’s problem. It can be tremendously difficult to come to terms with the fact that this is one time that your child is really hurting and you can’t fix it.  You deserve support around these painful feelings! While your child is engaged in a recover process, it’s often helpful to investigate aspects of yourself. For example, you may need to examine the ways you communicate and the roles you have played in the past as well as in the present. You may need to explore your own views around food, weight, dieting, and body image and how they may be influential to her. These issues are certain to arise if you are involved in family therapy. Family therapy is a great place to explore and resolve communication problems, improve strained relations, and work out hurt feelings. Family therapy is most helpful when all family members agree to look honestly and openly at any and all problem areas existing within the family’s dynamics.

12 Tips for Successfully Supporting Recovery

  • Make sure you take care of yourself… Be good to you!
  • Avoid commenting on her looks. If you say she is too thin that will only please her eating disorder, because that is its goal. If you tell her she looks ‘good’ she will invariably interpret that to mean that she looks fat and further fuel her attempts to lose weight.
  • Remember that she is not her eating disorder. It is possible to love her and hate her eating disorder at the same time. Love her unconditionally.
  • Remember to avoid simplistic solutions like “just eat.” It only invalidates her struggle and compounds her feeling misunderstood and isolated.
  • Avoid discussing what, how, or when she should eat. You’ll only up in a power struggle.
  • Avoid trying to control her food intake unless you are receiving guidance from a practitioner specializing in the Maudsley model. Also avoid making judgments about her choices and her behavior.
  • When communicating use “I” statements. “You” statements sound accusatory and judgmental. “I” statements show that you’re taking responsibility for how you feel and think. For example, you can say “I am worried about you. Why don’t we make an appointment with a doctor to just to make sure that you are medically safe?”  This sounds far less attacking and judgmental than: “You’re too thin! What are you trying to do to yourself!!?? Don’t you know how upsetting this is to see?”
  • Avoid labeling foods as good or bad. All foods are fine in moderation.
  • Don’t advocate the diet mentality! There’s a reason they’re called “die-t”s.
  • Focus on things that don’t relate to food, weight, and exercise. Be there for company. Remember that she needs people in her life who can respond to her on more than one level and about more than just her food intake and body weight.
  •  Even though I’m suggesting you avoid certain topics of conversation, try not worry about saying the ‘wrong’ thing. You won’t have an irreversible negative impact on her recovery. Worrying about that, however, can silence you which will in turn prevent you from being supportive. It’s better to say something with supportive intentions than to say nothing and have her interpret your silence as a lack of caring.
  • Encourage her to be human… not perfect.