When you want to help someone you care about

First, understand that eating disorders are serious medical and psychological problems. They are not just a fad, a phase, or a trivial eccentricity. If your friend or loved one had cancer, you would do everything you could to get her/him the finest professional care available. Eating disorders require that same level of treatment, and in fact we sometimes refer to them as “soul cancer” because they so effectively destroy a person’s body, mind, self-esteem, and relationships with friends and family. They deserve and require professional evaluation, diagnosis, and treatment.

Eating disorders cripple the mind and heart with growing tumors of body dissatisfaction, perfectionism, and an overarching need for control. You cannot fix those things. That is a job for physicians, psychologists, and other mental health therapists who have been trained to work with these desperately needy, yet stubborn and defiant, people who are doing the best they know how to take control of their lives in a world they find scary, lonely, and confusing.

Many factors contribute to the development of an eating disorder. For a discussion of the major problems, read our information on Causes. Recovery means much more than replacing dieting, binge eating, and purging with healthy eating. It means identifying the underlying dynamics that have brought the person to disordered eating in the first place and then resolving them. The process requires skill, sensitivity, and training; in other words, it’s a job for medical and mental health professionals.

Does that mean there is nothing you can do to help? No. There is much you can do. You can be a friend, a parent, a spouse, a partner, a sibling — someone who cares –and there is great value in the support and encouragement you can provide in that role. What you cannot be is a trained clinician, and trained clinicians are what is required for recovery from an eating disorder. Therefore, your primary focus should be to encourage the person to talk things over with a physician or counselor. If, after an evaluation, ongoing treatment is advised, encourage the person to begin it and continue until the problem is resolved.

Your biggest problem will be convincing the person to do this. Nothing will change until s/he admits she has a problem and accepts help. At first s/he will deny there is a problem. S/he will fear weight gain and resist it mightily. S/he will be ashamed and not want to admit what s/he is doing. S/he has used the eating disorder to protect, hide, comfort, and empower her/himself. In the beginning, at least, s/he will not want to give it up. S/he sees asking for help as some kind of shameful admission of inadequacy and entering treatment as loss of control. Arriving at a new and healthier perspective is her/his first challenge on the road to recovery

Here are some suggestions to help you talk to an unhappy, and defiant, person.

  • If your child is younger than 18

Get professional help immediately. You have a legal and moral responsibility to get your child the care s/he needs. Don’t let tears, tantrums, or promises to do better stop you. Begin with a physical exam and psychological evaluation.

If the physician recommends hospitalization, do it. People die from these disorders, and sometimes they need a structured time out to break entrenched patterns.

If the counselor asks you to participate in family sessions, do so. Children spend only a few hours a week with their counselors. The rest of the time they live with their families. You need as many tools as you can get to help your child learn new ways of coping with life.

  • If your friend is younger than 18

Tell a trusted adult — parent, teacher, coach, pastor, school nurse, school counselor, etc. — about your concern. If you don’t you may unwittingly help your friend avoid the treatment s/he needs to get better.

Even though it would be hard, consider telling your friend’s parents why you are concerned. S/he may be hiding unhealthy behaviors from them, and they deserve to know so they can arrange help and treatment. If you cannot bear to do this yourself, ask your parents or perhaps the school nurse for help.

  • If the person is older than 18

Legally the person is now an adult and can refuse treatment if s/he is not ready to change. Nevertheless, reach out. Tell her/him that you are concerned. Be gentle. Suggest that there has to be a better way to deal with life than starving and stuffing. Encourage professional help, but expect resistance and denial. You can lead a horse to water, but you can’t make it drink — even when it is thirsty — if it is determined to follow its own path.

  • A note for boyfriends and girlfriends

If you are in love with someone with an eating disorder, by all means provide all the support you can, but we suggest you postpone making a binding commitment until s/he is recovered. People with eating disorders can be physically and emotionally attractive. Their vulnerability and fragility can appeal to a partner’s instincts to protect and help. This can be a trap.

Some people never do recover from an eating disorder. Don’t link your life to a person with problems unless you are willing to put up with them for the rest of your life — or theirs. It might come to that. It is far wiser to wait until you can see that your life partner will be able to hold up her/his end of the commitment contract.

The kind of change required for recovery is extremely difficult. Kindness and love, as beautiful as they are, will not by themselves heal your beloved. S/he needs professional treatment too.

  • Some things to do
    • Talk to the person when you are calm, not frustrated or emotional. Be kind. The person is probably ashamed and fears criticism and rejection.
    • Mention evidence you have heard or seen that suggests disordered eating. Don’t dwell on appearance or weight. Instead talk about health, relationships (withdrawal?), and mood.
    • Realize that the person will not change until s/he wants to.
    • Provide information. Show the person this Website.
    • Be supportive and caring. Be a good listener and don’t give advice unless you are asked to do so. Even then, be prepared to have it ignored.
    • Continue to suggest professional help. Don’t pester. Don’t give up either.
    • Ask: “Is doing what you are doing really working to get you what you want?”
    • Talk about the advantages of recovery and a normal life.
    • Agree that recovery is hard, but emphasize that many people have done it.
    • If s/he is frightened to see a counselor, offer to go with her the first time.
    • Realize that recovery is the person’s responsibility, not yours.
    • Resist guilt. Do the best you can and then be gentle with yourself.
  • Some things not to do
    • Never nag, plead, beg, bribe, threaten, or manipulate. These things don’t work.
    • Avoid power struggles. You will lose.
    • Never criticize or shame. These tactics are cruel, and the person will withdraw.
    • Don’t pry. Respect privacy.
    • Don’t be a food monitor. You will create resentment and distance in the relationship.
    • Don’t try to control. The person will withdraw and ultimately outwit you.
    • Don’t waste time trying to reassure your friend that s/he is not fat. S/he will not be convinced.
    • Don’t get involved in endless conversations about weight, food, and calories. They make matters worse.
    • Don’t give advice unless asked.
    • Don’t expect the person to follow your advice even if s/he asked for it.
    • Don’t say, “You are too thin.” S/he will secretly celebrate.
    • Don’t say, “It’s good you have gained weight.” S/he will lose it.
    • Don’t let the person always decide when, what and where you will eat. She should not control everything, every time.
    • Don’t ignore stolen food and evidence of purging. Insist on responsibility.
    • Don’t overestimate what you can accomplish.
  • Discussion

ANRED has received several e-mails in the past several weeks from friends and family members of people with eating disorders. These folks are concerned and want to help. They ask for information they can pass along to their loved ones so they will stop their unhealthy food and weight behaviors.

ANRED is happy to provide information, but information by itself is never enough to change behavior. Something else is needed.

So what is that magic something? Well, first of all, it isn’t magic. It is usually a long and difficult process that begins with the realization that starving and stuffing will never work to increase self-confidence, happiness, and satisfaction with oneself and one’s life.

People with eating disorders aren’t crazy, irrational, stupid, or dumb. Even if they can’t, or won’t, express themselves directly, they want to feel better about themselves. They also want to accomplish something, or get something, or avoid something, and because they don’t know how to do so in forthright ways, or because they are too frightened or inexperienced to know how to attack their problems directly, they resort to working symbolically via food, weight, and eating. In addition, even though they want us to think they are strong and can handle anything, folks who use food and diets to try to work out other problems are emotionally fragile and easily hurt.

Confrontation and nagging create power struggles. You want the person to do things your way. S/he does not want to be manipulated or controlled. Even when you are right, your approach invites the person to rebel and stubbornly resist taking your good advice. As one person put it, “Even though I’m healthier now, I feel like I’ve lost and you’ve won. I hate it!”

Making changes, even minor ones, is hard, and giving up entrenched habits like starving, binge eating, and purging is overwhelming. That’s why physicians and mental health therapists should be involved in the process. Friends and family members, as loving and filled with good intentions as they may be, don’t have the training and experience to shepherd a person through the usually lengthy and always hard journey from eating disorder to health.

Don’t forget to have fun with your friend or loved one. A movie, shopping trip, or a day at an amusement park can give the person a glimpse of some of the benefits of living and acting like normal people do. Don’t spoil the event with lots of talk about food.

And lastly, be aware of your limits, and keep your expectations reasonable. You can be a resource person who provides friendship, support, and encouragement, but you cannot control her or make him change before he is ready.

What about psychiatric commitment? Sometimes parents or spouses are so frightened that they want their loved one in treatment regardless of what has to happen to make that so. If your child is younger than 18, you do not need a legal commitment to place her/him into treatment. Just do it. If your child or spouse is older than 18, and if you are considering commitment, talk to your attorney, but be aware that the process is difficult and may make treatment even more difficult, or even impossible, because of the anger, defiance, and resistence triggered by such loss of control. In the U.S., also know that a commitment is difficult to obtain. Individual freedoms are protected fiercely, even the right to have an untreated mental illness.

A note to boyfriends, husbands, and other pragmatists: Sometimes people with eating disorders ask their friends and partners to “be there for me.” Most men and some women think that means finding an answer or solving the problem. Almost always, however, the person who asks really means “just listen and be supportive.” This is very hard to do when the person is in medical danger — but it is all that you can do– which underscores the necessity of professional treatment focused on resolving underlying issues and changing behavior.

A note to young friends: Don’t promise to keep secrets about your friend’s self-destructive behavior. If you have already promised not to tell her/his parents, break that promise, and do it now. Yes, your friend will be angry, but you just might prevent a tragedy, and in so doing spare yourself a lifetime of guilt.

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In the end each of us must be responsible for the choices we make. We can support one another, encourage mature thinking, provide information, and offer advice, but eventually each individual must decide what to do and how to do it. To live with honor and integrity takes courage. You cannot provide that for another person, just yourself.

To protect your own mental and physical health, you may find it necessary to take a break from the person you care about. Just say that it’s too frustrating and heartbreaking to watch the continuing self-abuse and rejection of your best advice and counsel. You might add that when s/he is ready to get help and make healthy changes, you will be back with support and encouragement.

Life is not a TV show where some compassionate parent / friend / lover / pastor / counselor / doctor says just the right thing so that the victim / sufferer sees the light and makes a 180 degree turn before the last commercial. Life is complicated and messy. We don’t have maps or scripts to follow, but we do have multiple opportunities to choose wisdom and integrity over blind adherence to destructive patterns. Best wishes as you continue your journey.

Note: See For Parents, Partners, and Other Family Members for more information about helping someone you love.