Defusing the bully – DVD shows how to help someone recover from an eating disorder

Defusing the bully – DVD shows how to help someone recover from an eating disorder

Helping someone recover from an eating disorder can be hard work. Irrational and unpredictable responses from the person you love can have you feeling like you are afraid to speak in your own home.

If what you are doing works, keep doing it, if not perhaps a new DVD,

How to Care for Someone with an Eating Disorder, 

which draws on the research outcomes of Prof. Janet Treasure and her New Maudsley team, can offer new suggestions.

Do you feel bullied by the person you know with an eating disorder, like when and how you eat? Or about when you can use the bathroom? Or when and how meal times are arranged, and the type of food that is served for the meals? Perhaps you are covering up the negative consequences, like clearing up the mess when it is left on the plate or tossed onto the floor; or cooking a meal that you know is nutritionally inadequate, and buying expensive foods for the person with the eating disorder while others in the family go without.

Perhaps you are tired of thinking up ways to responding to the question: ‘Will I get fat by eating this?’ or ‘Do I look fat in this?’

Perhaps you are turning a blind eye to evidence of hoarding or stealing because you are afraid of confrontation.

Unfortunately, ignoring or covering up eating disorder behaviours prevents the sufferer from learning about the consequences and the chance is missed to help confront the illness. At the other end of the care spectrum, the carer who provides constant reassurance and obeys every request, no matter what the inconvenience or cost, prevents development of emotional regulation and provides the sufferer with a faulty shield against the world. In such an environment, the person with the eating disorder can come both dependent on the carer for support, and resentful of their loss of independence.

Behavioural traits influence outcome

Parents can sometimes be too emotional and have too little control, like a Jellyfish; these emotions cause tears, tempers and exhaustion. The Ostrich is about too little emotional control – and occurs when parents or partners put their head in the sand to avoid what seems too hard; the Kangaroo, whereby the parent or partner tries hard to make everything right, tends to keep the ill person in the pouch to avoid effects of stress; they think they are doing the right thing, but the ill person is left in limbo, in a childlike dependent state.

The Rhinoceros – who barges in with a don’t-dare-disobey-me attitude, commanding this food be eaten right now – is likely to cause eating disorder behaviours to become more embedded, the sufferer arguing back defensively with a strong ‘ED’ voice. Terrier-like behaviour, such as nagging persistence and criticism, also is negative, reaching the point where the sufferer tunes out or feels helpless, their morale sapped. The eating disorder itself is rather like the terrier – nipping at all sides, criticising and telling the sufferer that they need to listen to it and to try harder.

Dolphin-like behaviour, on the other hand, exhibits just enough caring and control to gently nudge and nurture the sufferer through the turbulence of the eating disorder to safety; behaviour like that of a St Bernard dog is also very effective – such behaviour being reliable and dependable, exuding calmness, warmth, love and gentleness, instilling hope and a future full of possibility.

Learning new skills

Parents and partners are in no way to blame for the eating disorder’s development, but their instinctive responses, unintentionally, can be unhelpful. Responses like the behaviours of the Rhino, Kangaroo, Ostrich, Jellyfish or Terrier, may be part of your natural default traits. If you recognise such traits in your self, and can proceed to acknowledge that these may be unsupportive for your loved one’s recovery, the good news is that you can try implementing new skills which will help to both confront the eating disorder and promote healing.

The learning of new skills involves much self-awareness; it takes time and plenty of practice before they become spontaneous. Therefore, be patient and you will be on the way to being an effective mentor in facilitating change for your loved one.

The skills involve motivational interviewing techniques, and come from working with, rather than against, the patient.

Eating disorder hot spots

Through re-enactment of life-like situations, the DVD explains how parents, partners and siblings can support change. First, you see the effect of unhelpful carer responses on the sufferer and their illness and then, the effect of helpful communication. Expect to take a while to become a master with your new skills. Be kind to yourself, remember these skills can be like gold in helping your loved one move along the path of recovery. Persevere in mastering them and don’t berate yourself if you slip up. Learn from that experience and do better next time. Don’t expect too much too soon. An accompanying booklet explains how to get the most out of the video.

Restaurant meal

A family of five sits down to a meal in a restaurant. So far, so good, but when the menus are passed around and it comes time for teenager Jack to order his meal, he asks for a salad, and Dad morphs into a rhinoceros. Mum morphs into the kangaroo.

Dad then turns into a jellyfish, very critical. “Another perfectly ruined evening,” he says. And the eating disorder gets stronger.

The eating disorder sometimes is depicted as a voice to shows how what the carer says, can fuel the eating disorder thoughts.

Jack was overtaken with anxiety when he sat down in the restaurant, and time was need for this anxiety to subside. Much warmth and support is required.

The helpful restaurant video clip shows how, with care, the meal can result in entirely different scenario – instead of Jack walking out, he eats a nutritious meal. Dad morphs into a St Bernard, reminding Jack of goals, for example, of getting a new dog, and going to a ball game next Saturday; Mum suggests one way to off-set the anxiety of eating the meal will be to walk home with Jack and his siblings, and let Dad drive the car. Together the parents, by remaining calm and expressing compassion, alleviate their son’s anxiety and his urge to purge.

Eating at home

In another scenario a mother, fearing her young adult daughter, Rachel, is showing signs of a relapse, turns into a Rhino at the meal table at home. When charging in and ordering her daughter to eat, fails to work, the mother stings and criticises like a Jellyfish, yaps and nags like a Terrier and then reverts back to bossy Rhino behaviour. The daughter tries to defend herself but eventually walks out.

The next scenario illustrates a successful approach in which the mother sidesteps conflict and yet remains authorative about the need to eat. Instead of ranting on about why her daughter should eat the chicken submerged in a rich sauce, the mother discusses the latest novel she has read, asks about her daughter’s college plans and encourages dreams of travel. This Dolphin-like behaviour affirms Rachel and she refuses to respond the Eating Disorder.

Over-exercising

Over-exercising is a problem for many sufferers of Anorexia Nervosa. It becomes a serious symptom when the consumed energy is not replaced by food. The DVD portrays a young lawyer couple, with the woman feeling compelled to run every night after a demanding day’s work in the office. In the first scenario, interactions from the male partner, who is often alone in providing care and is often over-ruled by the Anorexia Nervosa, make it obvious that very soon the eating disorder will destroy the young couple’s loving relationship and dreams.

In the positive outcome, the relationship is strengthened when the young man responds with co-operation and care. Initially, his loved one retaliates and asks: ‘What page in the book is this all from?’

He says he does not know what page it comes from but he does know he loves her and wants a happy life with her. It is Friday evening and he does not want to lose what should be a relaxing time with the woman he loves, to the eating disorder. He hands responsibility back to her and asks what options other than running 8km does she have for relieving her stress. Soon she agrees that a long run every night before dinner is not in her best interests and agreement is reached that the young couple will eat dinner at home and later go for a leisurely walk.

Family celebration – a buffet

Buffets of celebratory foods are a challenge if you are suffering an eating disorder and this segment – where a family is celebrating Gran’s 80^th birthday – focuses on a girl with Bulimia Nervosa. In the first scenario, Dad is a Rhino and Mum a Kangaroo-cum-Jellyfish. Processed party food in buffet style can be triggering for eating disorder thoughts and encourage binge-eating, especially when visiting family members can unwittingly say the wrong thing. Low self-esteem encourages binge-eating. Sometimes, as the second scenario shows, one parent may need to coach the other parent.

Diversion is a helpful de-fuser of eating disorder thoughts – such as taking a walk. It is important to take time out to reflect on what sets a trigger off, what works and what doesn’t work, so that a better outcome can be achieved next time.

Parental teamwork

It helps when parents work together, rolling with resistance and re-affirming boundaries and limitations. In one segment with a young adult daughter, the mother practises the skill of externalising the eating disorder from her daughter. Dad recognises he is a classic ‘Ostrich’, and offers to help more at meal time, and reminds his wife they need a little normality – they need to look after their own mental and emotional well-being, and so he organises a dinner for just the two of them. Collaborative care does not work every time, and sometimes it is not possible, but it is important to persist. Fathers and mothers are not always at the same stage of change – it is important to be on the same page as much as possible and apply the same skills as each other.

Siblings – brother and sister

Siblings can often feel ‘left out’ when a brother or sister has an eating disorder. Their brother or sister can appear ‘lost’ in the illness and no longer there, plus their care can require the bulk of the parents’ time. To make things worse, people with eating disorders can have difficulty empathising with others. Holidays can be a big challenge, and often disastrous. The DVD takes us on a family holiday and it is no fun for the child without the eating disorder. She complains about walking at a fast pace for hours instead of leisurely enjoying the sights. ‘It is so all about him’, Mandy says about her brother Tom who has Anorexia Nervosa. She wanted fish and chips for dinner but Tom wanted soup only, so all family is eating soup. Sibling rivalry can cause rifts but parents can learn empathy and problem-solving skills to achieve a positive outcome. They can reflect openly and calmly, acknowledging they didn’t get it quite right, but will learn from today and do better tomorrow. Not eating, however, is not an option for anyone. Anticipating obstacles and planning it advance how to cope with them, can help avoid them being a pain. Tomorrow’s a new day.

Siblings – sisters

Sister relationships can suffer. The sister with the eating disorder can seem a total ‘pain in the arse’. Sometimes it is tempting to believe that she is deliberately refusing to eat, and deliberately disrupting the entire family. The healthy sister sits on her bed and says: ‘I want my sister back; I want to go to the movies, buy popcorn, play tennis.  We don’t laugh or talk any more, about guys or clothes, or go on our dog walks any more.’

The sister with the eating disorder sits on the end of the bed and responds:  ‘Dad thinks I am choosing not to eat, and I see the pain I cause our mother. Perhaps it will be better if I’m not here’

The healthy sister applies a helpful response: ‘Let’s think about when we both marry and have children. You will be the best possible aunt.’

By assuming a positive role, the healthy sister comes up with distracting topics of conversation.

Supermarket shopping

Shopping can be a pain. Supermarket visits can turn into an all-out brawl between mother and daughter. Mother can morph into a rhino, terrier and jellyfish all-in-one.

Several scenarios are shown, with the advice that no-one gets it right all the time so try a strategy and remember what works and what doesn’t.

Every mistake can be a treasure if you reflect and learn from it. Plan the shopping list ahead of the visit. Diversion conversation helps – like looking forward to university next year.

When the daughter selects a salad – a lettuce and a carrot – for her dinner, her mother reminds her: ‘This is not enough to reach your goals’. The mother separates the illness from the person, self-reflects and resets the supermarket visit goals.

Contemplating change is difficult. Adults need to get their own oxygen first, before helping their child. For example, the mother may have reset the goal on the shopping list a little to suit the daughter but maintains that due to work and other family commitments, she is making only one supermarket visit this week. And this is it.

Learning the care techniques

The How to care for someone with an Eating Disorder DVD, with 17 clips of daily life scenarios, demonstrates practical strategies and techniques to help build constructive support.

Parents and partners can feel great relief to discover that they are not the only person in the world having a problem in getting their child or partner to eat. And it can be a great help to see how others have handled the same situation. 

The DVD portrays different daily life situations relating to eating disorder behaviour. It illustrates how carer interactions are important and can influence whether behaviours are maintained or alternatively create an atmosphere in which change becomes possible.

‘Evidence of experience’ is invaluable in getting the upper hand on an eating disorder and this DVD shows how to build on it.

Parents who have been down the ‘recovery track’ demonstrate the benefits of understanding the Anorexia Nervosa mindset and how learning how to modify their own behaviour, and learn new skills, can defuse and outsmart the eating disorder thoughts.

Adapt the techniques to your situation

The best way to learn new skills is to actively learn and consider how you can adapt the techniques to your own situation. Remember that it takes time to learn new ways of speaking or interacting. Change won’t happen automatically – you need to develop self-awareness and apply the new techniques regularly. If you slip up, forgive yourself and get back on track straightaway.

The DVD illustrates the importance of focusing attention on behaviours and efforts that reflect the true person, and not the illness. It helps to reduce attention to eating disorder behaviours and talk that relates to food, weight and shape.

Calm is good

Finding support to remain calm and compassionate in the face of great emotional pressure is invaluable. Allow plenty of time to develop self-awareness sufficiently so that you can manage your default ‘animal’ – for instance, if you know you tend to be critical, like the jellyfish, or tend to be like a rhino and order people around like they are in an army regiment rather than a supportive family. Don’t berate yourself – outsmarting the eating disorder takes time.

It helps to remember, too, that the person with the eating disorder often does not see a problem – as far as they are concerned they are not sick, everything is fine and manageable. Disagreeing with them provides an opening for an argument, which invariably allows the eating disorder to embed itself more deeply. Therefore, arguments are a no-no. You can’t win.

Timing is important. This DVD will show you what a difference it makes when you take time to choose your time in confronting eating disorder behaviour.

Be a role model

Helping your loved one to improve their self-esteem and their confidence to take risks, by supporting change, requires you to be courageous. Learn from what doesn’t work and remember that it may work at a calmer time – keep trying, change focus and be flexible.

We learn from others and from a very young age, copy their behaviour. Role modelling that you are hopeful, wise, kind and compassionate in caring for yourself and others is important.

Remember that an eating disorder affects the brain’s capacity to learn new ideas, and new learning takes time and persistence.

To get your copy of the DVD, go to: http://www.succeedfoundation.org/work/order_dvd

The Succeed Foundation has created, coordinated, developed and funded this DVD, based on research outcomes of Prof. Treasure and her team, and the New Maudsley Approach. Check the website for further support and to provide feedback: www.succeed-foundation.org/skillsforcarers

Or go to: www.thenewmaudsley approach.co.uk