Eating Disorders: A Guide for Parents and Loved Ones

In the course of speaking publicly about anorexia, I have heard the anguish in hundreds of voices as they've said, "She is 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 --- if she would 'just eat' everything would be 'just fine.' Unfortunately, it is not that simple at all. Whenever you find yourself tempted to believe that the solution is for her to "just eat," it may be helpful for you to remember that people develop anorexia for many different reasons. Remind yourself often that anorexia recovery is a complicated process that requires more than simply facing fears related to food and weight and learning to cope with them. It is a process that demands a deep introspective look at one's life and at one's own self. It is a process which necessitates exploring one's wants, needs, and desires for the individual herself as well as for her life in general. Recovery compels the individual to examine the underlying issues that led to the development of her anorexia in the first place. Dealing with and reconciling all of the thoughts and feelings attached to each of these areas takes time and patience from everyone involved. You may already understand that recovery requires a good deal of motivation and effort from the individual herself, and your knowing this may cause you to wonder if there is anything you can you do that will positively impact her recovery process. And there are in fact many things that you can do throughout her recovery process that can make a world of difference --- for both of you.

Because there is no one way or right way to recover, and because what works for some people does not work for or even remotely help others, it is crucial to develop a line of communication that flows openly and honestly in both directions: from you to her and from her to you. 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 communication will eliminate your fear of inadvertently saying 'the wrong thing' and being in some way detrimental to her recovery. We are all human 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 lines of communication are solid, she will be able to tell you that what you said was not helpful, and she may be able to suggest other things that you could say or do that would be more helpful to her. You in turn will be able to hear her feedback and respond to it compassionately. For example, if you say "Wow, you look really great! Have you finally put on some weight?" 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 still think that you really mean that I look fat. When you ask if I've put on weight it really 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." You might then offer, " I didn't realize it had that effect on you. I will try to watch out for that in the future, but please know that even though I mean well I may make a mistake and say something that isn't helpful. But if you will keep letting me know how what I say affects you, I know we can get through this together." With sound communication the process is reciprocal, meaning that it also works in the opposite direction. You will be able to let her know when she unintentionally hurts your feelings or needs more from you than you are able to give. And she in turn will be able to absorb that information and respond to you in a tender manner. If you are both communicating effectively, there will be no problem too great for you to work out and overcome together.

Practice your communication skills often by encouraging her to talk about how she feels and be an empathic listener. I cannot overemphasize the fundamental importance of empathy, it is so vital in the recovery process. What exactly 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 and that you are making a genuine effort to understand by offering her words such as, "It sounds like an aching that grows inside you with each passing day," or "That sounds so frustrating; I can only imagine how angry you must be. That would make me really angry, too." Offering her compassion opens the door for both of you to talk in more detail about how she experiences the world around her. Your acceptance and willingness to see things as she does will enable her to say freely, "It's really more like..." and further clarify her situation and feelings for both of you, thus taking the conversation to a much more intimate level. It is so helpful for every individual to be able to share her point of view, her thoughts, and her feelings without being judged. It will certainly help her feel less alone in the world, and she will undoubtedly take comfort in the fact that you understand and appreciate her on a much deeper level.

If she is in emotional pain, be there 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 and make her feel better. You may feel compelled to give her all sorts of advice or to cheer her up. But think about a time in your own life when you felt intense grief. Perhaps you lost someone you loved, or perhaps there were some tragic circumstances 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, and 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 give someone the sense that you really understand where she is 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 just 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 heal from it. Many people worry that their loved one will be trapped in that pain forever. Others find that witnessing their loved one's pain causes them great discomfort, and they try to 'talk them out of their pain' for that reason. But keep in mind that all pain is legitimate and has a purpose. Trust that pain needs to be recognized and experienced in order 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," then she will remain trapped in it and unable to grow from the experience. You will undoubtedly find if you walk with her through her pain that you will both learn and grow. While it may be true that time heals all wounds, it is love, comfort, and caring that makes the healing process more bearable and complete.

It is also important to remember that she is an individual separate from her eating disorder. 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 often so healing. It can be so hard for an anorexic to like herself and be gentle with herself. But 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 may be difficult for her to accept or even hear your compassion for her --- but don't give up! Continue to be gentle and compassionate, for this one day will help her to hear the loving voice of her own heart. Her critical inner voices may be muffling and overriding that loving voice now, but one day it will be 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 go a little smoother. Encourage her from a kind, caring place, as opposed to a harsh or rigid one. Convey your caring and concern through your eyes, your touch, your tone of voice, and your mannerisms. The concerned, compassionate look in your eye and your 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 her will ever be. Think of parents who set gentle but firm boundaries for their small children. They tend to receive the results they desire much faster and with far less stress than the red-faced parents we sometimes see repeatedly screaming at their children in grocery stores. It feels so 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. In the course of 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 cannot force her to use them.

It is also important for you to be aware of and recognize your own limits. We all have them. Pretending that you do not have limits and forcing yourself to do more than you are able to do will only make you feel resentful and angry. She is bound to sense that resentment and anger which in turn may cause her to feel both guilty and ashamed. You can see how ignoring your own limits will only hurt both of you in the end. If you are able to be there for her and listen only for a certain period of time each day or each week, be clear both with her and within yourself about when and how long that time is. It is better to commit yourself for a shorter period of time and then really be there for her during that time, than it is to make yourself overly available to the extent that you are constantly distracted while you are together. Ask yourself what it is that 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? Once you have thought about these things, sit down and have an open discussion with her about these topics as well as any others that may arise for each of you. This may be a good time to also set certain limits around what you are able to tolerate. For example, if she is purging then she is the one who needs to clean up the bathroom afterwards, not you. This is one area where your open line of communication will be extraordinarily beneficial to you both.

Get support for yourself. It isn't easy to watch someone you care about wrestle with anorexia, and there is only so much that you can do. Remember that you have no control over her choices; you can only encourage her to make healthy ones. Ultimately she is the one who must decide whether and how she will live. Accepting that you have no power over her choices often evokes 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 where they can be expressed, and you need to express them for your own health and well-being. Everyone deserves to be true to his or her own self, and doing just that will also enable you to remain a reliable and trusted source of support for the person you care about. By constantly holding in your anger and frustration you are setting up a situation which will inevitably lead to your blowing up, and most likely at her. This will only further isolate her, and most likely make you feel guilty in turn. A neutral party can offer you a safe place to vent your anger and air your concerns, which will also help to ensure that you do not burn out. They can help you find constructive ways of talking with your loved one about how you feel and how you are affected, because that is important too. An impartial party can provide you with the opportunity to explore your own feelings. Many times people feel so guilty, worrying that perhaps they are the cause of their loved one's eating disorder. A good support person can help you explore these feelings while simultaneously reassuring you that no one causes an eating disorder alone.

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 in regard to 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 not fix it for her. You deserve to have support around these painful feelings. It may also be important somewhere in the course of your child's recovery for you to investigate certain 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 of food, weight, dieting, and body image and how these views may be influential to her. These issues are certain to arise if you are involved in family therapy. Family therapy can be extraordinarily beneficial for everyone involved. It is a good place to explore and resolve communication problems, improve strained relations, and work out hurt feelings. Family therapy tends to be most helpful when all family members agree to look honestly and openly at any and all problem areas existing within the family's dynamics.

There are also a few more general tips which will be helpful for you as you support you loved one through her journey:

• 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, because that is her goal. If you tell her she looks 'good' she will invariably interpret that to mean that she looks fat, therefore, this statement is likely to only further fuel her attempts to lose weight.
• Remember that she is not her anorexia. It is possible to love her and dislike her eating disorder at the same time. Love her unconditionally.
• Remember to avoid simplistic solutions such as "just eat." This will only add to her feeling misunderstood and isolated --- it overlooks the complexity and severity of the problem.
• Avoid discussing what, how, or when she should eat. You will inevitably wind up in a power struggle.
• Accept that there is nothing that you can do force her to eat, stop bingeing, or stop purging.
• Avoid trying to control her food intake and avoid making judgments about her choices and her behavior.
• When communicating use "I" statements, "You" statements tend to be judgmental. "I" statements show that you are 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!?"
• Avoid labeling foods as good or bad.
• Do not advocate the diet mentality that is so prevalent in our culture.
• Focus on things which do not relate to food, weight, and exercise. Be there just 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.
• Despite the fact that I am suggesting to avoid certain topics of conversation, try not worry about saying the 'wrong' thing. You will not have an irreversible negative impact on her recovery. But worrying about that can and probably will silence you which will in turn prevent you from being supportive. It is better to say something with the intention of being supportive than to say nothing at all and have her interpret your silence as a lack of caring on your part.
• Encourage her to be human --- not perfect.

by Monika Ostroff, co-author, Anorexia Nervosa: A Guide to Recovery

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