An eating disorder can be confusing for not only the person with the illness, but for their family and friends. If unaware, family members can get caught up in the eating disorder behaviours, and inadvertently support the eating disorder rather than their loved one. Knowledge is power, for often the person with the eating disorder may seem irrational, unreasonable, unpredictable and selfish. Remembering that the eating disorder symptoms are an expression of unhappiness and distress can be challenging.
This article has been written for National Eating Disorders Awareness Week and is published on Routledge Mental Health site; for full article click here.
Families may ask ‘Where did we go wrong?’ But asking this question will not help at all because parents don’t cause eating disorders. A more helpful approach is to focus on how best to access and support treatment and to contribute to your loved one’s recovery.
An eating disorder is definitely not:
* An indication that parents have failed in raising their child;
* A phase of rebelliousness or attention-seeking;
* Something that sufferers can ‘snap out of ’.
* Biological and environmental factors are known to affect the likelihood of developing an eating disorder. No one factor is responsible; instead, combinations of smaller factors, which alone may not seem harmful, appear to precipitate the problem.
A prison in the mind
Having an eating disorder becomes a lonely experience, because this illness in the brain is like living in a prison of one’s own mind.
Acknowledging there is an illness is a major first step towards recovery but in itself can be an enormous challenge. For instance, the tragedy of the death-rate due to anorexia nervosa, 16 times that of the normal population rate, is compounded by the fact that the sufferer may be unable to understand that they are putting their life at risk.
The eating disorder ‘bully’ works on convincing the sufferer that they can live according to its impossible-to-keep rules, but with help this bully can be overcome, and a full and purposeful life regained at every age. Giving up must never be an option.
One of the most difficult things about coping with an eating disorder is the feeling of fear, anxiety, isolation and confusion. You may experience peculiar behaviours and unpredictable moods when your brain does not receive adequate nutrition.
Factors affecting onset
The factors that contribute to the onset of an eating disorder are complex. No single cause of eating disorders has been identified; however, known contributing risk factors include:
The combination of genetic and environmental factors means it is not uncommon for two sisters to have an eating disorder. In one out of 14 families, another family member will be affected. This causes additional difficulties.
Importantly, when an increased genetic risk does exist, steps can be taken to help prevent the illness developing. The environment accounts for something like 50 per cent of the risk. In addition, the genetic vulnerability may need some sort of environmental, psychological or social stress before it expresses itself. By being aware and knowing how to respond, you can help ensure that the family environment is as supportive as possible and that you and your family modify some of the more harmful cultural influences outside the home.
Most eating disorders start in childhood and adolescence, but can manifest at any age. Challenges on the recovery path may include the addressing of problems that were encountered during childhood, before the eating disorder began. These may include:
Childhood problems such as school refusal and emotional issues.
Difficulty in making friends; experiencing severe shyness or alienation.
Difficulties within the family.
Listening to how other people have struggled and overcome their eating disorder can be useful in becoming aware of the illness. Importantly, there is no set pattern. The stories vary considerably.
Message to parents and partners
First, repeat ‘I am not to blame’ until you accept and believe it. You have not done anything to cause the problem. Hit the delete button on ‘blame’ and ‘guilt’ at all times. Guilt is harmful both for you and for your child, for it will ‘feed’ the eating disorder symptoms.
Remember, an eating disorder is not a choice – nobody can choose to develop this illness, which develops in the brain. When your loved one behaves in an unseemly, embarrassing, outrageous way, that is uncharacteristic of their authentic self, remember that this is their illness.
As a parent, partner or close friend, you can be an important part of the solution by learning as much as you can about the illness, and developing skills to manage the symptoms and behaviours.
Love is a powerful tonic. People with eating disorders say that one of the few things that can give them pleasure and reward is time with family. Keep this in mind when the going gets tough.
Be aware that social isolation easily develops, for the eating disorder thrives on ‘separating and conquering’, and is toxic for the person with the illness.
Time with family, engaging in pleasant diversionary pursuits that you know the sufferer enjoys, can help ward off this loneliness.
Do not try to be a perfect carer. Scheduling time out to relax and recharge is essential. Having support readily available is essential.
Often family members have the same strengths in analysis and persistence as the person with an eating disorder. These traits can be used in a positive way to help recovery.
High levels of anxiety run in the families of people with eating disorders and look after yourself is very important. Seek support and allow yourself time out to replenish your ability to nurture. ‘Care for carers first’ is a useful motto.
A consistent joint approach is very important for optimum results in the recovery process. Teamwork and collaboration by everyone involved is crucial to outsmart and overcome the eating disorder. This includes the patient, the family/carers and all members of the treatment team. Staying on the same page and keeping each other informed will help defuse the eating disorder’s power.
Message for the person with the eating disorder
Remember that recovery from an eating disorder does not occur overnight. It could take many months, and sometimes, years. The important thing is to hold on to hope and to continually persevere and be open to taking on board new information and skills in seeking solutions. To improve your chances, aim for:
The more people who are supporting your recovery process, the better. Compassionate care can help you maintain the effort to achieve recovery.
Counting daily blessings, rather than thinking about ‘what could have been’, and envisaging the bigger, brighter picture, helps.
Encouraging more grey in what has been a black and white view of the world, helps in developing flexibility and the forging of a true identity, and confident personality. It can be fun, practising imperfection, such as arriving several minutes late, wearing an un-ironed shirt or a colourful, outrageous skirt, dancing along the street, wearing a ribbon in your hair, or borrowing a library book on a risqué topic and leaving it on the coffee table when friends arrive for a visit. Learning that little things don’t matter, and other little things do matter, is liberating.
Cherish small steps – there are times when the eating of a crumb may resemble the conquering of Everest.
Phases of recovery
Three nutritious meals and three nutritious snacks, regularly spaced through each day, are considered an essential element both in recovery and as a relapse-prevention measure.
Treatment of eating disorders usually has three parts, though not necessarily in this order:
The restoration of a healthy weight to prevent dangerous physical problems.
Helping the sufferer recognise and defuse eating disorder thoughts and impulses.
Understanding the personality features and environmental difficulties which may have increased the risk of developing an eating problem.
Everyone has their own path
The extent to which families can help with re-feeding a sufferer depends on the eating disorder’s development and level of risk.
The family of an adult sufferer can help by providing information, resources and feedback that facilitate the move into recovery. Family members can encourage and assist recovery by providing guidance, and creating an emotional buffer against the eating disorder bully.
However, younger sufferers may not be at the developmental stage to grapple with the reality of the illness, and parents therefore need to step in and confront the illness on their child’s behalf, guiding their child along the recovery path. For example, parents need to supervise meals and prevent compulsions taking control.
This hard but vital work may also apply to carers of adults if insight into the severity of the illness is lost. There are no strict chronological cut-off points – each set of parents, each partner, must assess their own situation with the treatment team. Also, every sufferer, no matter how sick, appreciates being treated as a person first, and illness second.
Early intervention is important because, once the illness sets in, many other problems emerge.
One advantage with early intervention is that links with friends, school and other areas of life are easier to maintain. An advantage of inpatient treatment is that in specialist units other sufferers can give help and support. Problems can be shared, reducing isolation and alienation.
Do people who are ‘recovered’ get over all their symptoms?
To shake off all abnormal attitudes to food and eating is unusual and after all, even ‘normal’ people have days when they eat too much or feel like a potato sack. Such feelings are not surprising as eating disorder attitudes to food and eating have merged into Western cultural attitudes about health, body image and attractiveness. However, for the person who has experienced an eating disorder, constant vigilance is necessary.
Even after a two to three-year period of recovery, relapse can and does occur. Early warning signs must be heeded promptly, and the best way to do this is to reach out and seek help.
Relapse particularly occurs after stressful events, such as losing a job, a relationship breakdown, or death. It can occur as a way of coping with a change in circumstances, such as the empty nest syndrome when children leave home. It can occur if weight loss has been triggered by any reason. For example, after childbirth, the increased stress of looking after a new child, combined with the weight changes after birth, can lead to a relapse. Or perhaps weight loss has occurred following an operation, and the illness behaviours sneak back and people comment that you look better minus ‘those few kilos’. Self-awareness is supreme.
At the earliest sign, seek help
By being aware of the danger signs and intervening swiftly, you can prevent the illness getting a severe grip. Seek help immediately, for instance, if you recognise the return of eating disorder thoughts (e.g., ‘I didn’t feel like eating breakfast yesterday, and got through the day okay, so I won’t eat it today either. Maybe I can skip lunch, too.’ Or ‘I’ve eaten too much, and now I’ve started I can’t stop. I’ll pig out today and won’t eat anything tomorrow.’).
Recovery from an eating disorder becomes more difficult with time because the illness thoughts become entrenched in thought processes and behaviours. Regaining authentic self is hard work. However, people have recovered after more than 30 years of illness. It is never too late. At all times hold on to hope.
Importantly, a supportive environment also can be created and strengthened in the home by joining a parent support organisation. Here are some international links that offer assistance and links to more to local support:
Academy for Eating Disorders (AED) www.aedweb.org
Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T.) www.feast-ed.org
Eating Disorders Mentoring (EDM) www.eatingdisordermentoring.org
International Association of Eating Disorder Professionals (IAEDP) www.iaedp.com
National Eating Disorders Association www.nationaleatingdisorders.org
Schmidt, U., Treasure, J., & Alexander, J. (In press). Getting better bite by bite. A survival kit for sufferers of bulimia nervosa and binge eating disorders (2nd ed.). UK: Routledge Taylor and Francis Group.
Treasure, J., & Alexander, J. (2013). Anorexia nervosa: A recovery guide for sufferers, families and friends: Routledge.
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