What To Do If You Suspect Your Loved One Has An Eating Disorder
By: Katherine Metzelaar, MSN, RDN, CD
Existing in a culture that normalizes disordered eating and disordered exercise behaviors makes it difficult to know with certainty if your loved one has an eating disorder.
This is especially true if your loved one tells you that everything is “fine,” that there’s nothing to worry about and that they are doing ok. And despite their insistence, you know that things aren’t and haven’t been ok for them in some time. You’ve noticed the ways they have eaten or not eaten. You’ve noticed them skipping meals, spending hours at the gym or getting really anxious after eating out. So what do you do when you want to address your concern with them, but don’t know where to start?
Let’s start with some compassion toward you, the reader
Having a loved one that has an eating disorder is scary, alarming, frustrating and can feel overwhelming at times. After all, you love them and therefore you want them to be well and get help. You might often feel totally outside of your lane and may even get in fights with your loved one especially if they are in denial of the eating disorder.
Starting from a place of deep compassion for yourself is going to be helpful and necessary as you support your loved one in moving forward in their own recovery and healing. You’re not always going to know what to say or what to do and you’re going to mess up, often. And that’s ok, you will be figuring out what to do as you go along and as you learn alongside your loved one. You are human. Remember that self-compassion is not a Pollyanna “I’m ok and everything is great” but rather acknowledging when things feels hard and allowing for uncomfortable feelings to exist without beating yourself up for having them or trying to turn away from them.
How do you know if your loved one ACTUALLY has an eating disorder?
Part of what prevents a lot of people from expressing concern and saying something to their loved one is not feeling a sense of certainty or expertise around eating disorders and worrying that they will get it wrong. This can show up for partners, parents, siblings or friends. But here’s the good news: You don’t have to be an eating disorder expert or know what you’re talking about to know what to do if you suspect that your loved one has an eating disorder. There is still a lot that you can say, do and offer to your loved one even when you feel totally outside your comfort zone. You don’t have to know about diagnosis codes or whether or not your loved one fits criteria for an eating disorder.
So what then do you do?
One of the most important things you need to know is that eating disorders are mental illnesses and they thrive in secrecy. They don’t want to be found out and they do an incredible job at convincing the person suffering from an eating disorder that they aren't “sick enough,” that they don’t deserve help, and that the way they are eating and exercising is “healthy” for them. This is especially true if your loved one is not in a very thin body and even more so if they are in a larger body. This is because they are getting comments and medical advice that either they “look fine” or that they need to “loose weight.” Either way it’s not helpful for someone suffering from an eating disorder.
The eating disorder will also communicate things to your loved one like, “you're not that thin so it can’t be that bad,” “you are fat so there is no way you have anorexia,” “you see, your lab work is fine which means you are fine,” “this is bad but gaining weight would be worse,” “you don’t deserve help,” “yes purging is not great for me but at least it controls your weight,” “other people just aren’t dedicated to eating healthy like you are” and many other sneaky statements that make your loved one that’s suffering with the eating disorder really doubt that they even have one in the first place.
So because the eating disorder doesn’t want your loved one to get help and is constantly telling your loved one that they aren't sick enough, it can be hard to confront them about the eating disorder. Defensiveness often comes up when those that are suffering from eating disorders are confronted with someone that tells them that they are concerned about them and that they suspect that they are experiencing disordered eating or may have an eating disorder.
How do you talk to your loved one about the eating disorder the first time?
Let’s set some realistic expectations: the first time you have a conversation with them you’re likely going to be very nervous and maybe even anxious. What will they say? Will they get mad at you? After all, you care about them and don’t want to hurt them. So here are a few suggestions for you:
Lead with an open heart. Tell them that you want to have a conversation with them and that you’re feeling really nervous about it (this is very different for parents with children with eating disorder as I would not recommend sharing your feelings in this way). Tell your loved one that you’re not quite sure how to go about having the conversation but that it feels important to you to have it because you love them and you feel concerned. It’s ok to feel vulnerable and to not have it all figured out.
Be clear with your concern. This part you can practice or write down as it can sometimes be the hardest part of having this initial conversation with your loved one. This can sound like “I have been noticing that every night you purge after dinner and I am feeling so scared and afraid for your well being. I cannot diagnose you but I am concerned that you have an eating disorder” and then pause. It can also sound like, “I’ve noticed at night after everyone goes to bed you go down to the kitchen to eat and in the morning I notice that there are large amounts of food gone. They you say you’re not hungry. I am concerned that you have disordered eating that is happening or possibly a eating disorder” and then pause.
Take deep breaths in through the nose and out through the mouth. Let your loved one be in conversation with you, this is where the pause is important. This may feel hard in the moment because you are going to want to fill in the spaces especially if you’re nervous, but you want to allow your loved one to process what you are saying.
Keep coming back to your concern and love for them. People with eating disorders deserve to be loved and yet often don’t believe that all parts of them deserve love. Love and concern from others can often be a powerful motivation to seek out support for the eating disorder and can give them a greater sense of not feeling alone in the future when they decide to get help.
Remember that this will not be the only conversation you will have. The eating disorder has likely been around for some time. Expecting that your loved one changes over night and decides to seek out help based on only one conversation that you have with them is unrealistic. This is going to be an ongoing conversation that you may need to have with your loved one many times to help support them in seeking professional help.
What happens after you have that first conversation with your loved one about the eating disorder? How do you support them moving forward?
Expect that your loved one will have conflicting feelings about you talking openly about your concern about the disordered eating or exercise. It may be helpful, as your loved one is sorting out their resistance to getting support, for you to get your own support. Doing a quick search on google for eating disorder support groups for loved ones can often put you in contact with others that are going through and experiencing the same difficulties you are experiencing. This can help you feel less alone.
Secondly, you can offer your loved one support by helping to connect them to resources. This can look like making a list of eating disorder treatment center in the area or making a list for them of possible eating disorder specialist in the area they can reach out to. This way it makes it less overwhelming for your loved one to get started. You can also encourage them to reach out to a eating disorder treatment center to do an assessment. This is completely free and the treatment center will be able to let your loved one know what kind of help they recommend based on the assessment. This can be anything from inpatient treatment to partial hospitalization to residential treatment to outpatient support.
In addition to continuing to have conversations with your loved one about your concern for their well being and offering resources and ways to connect to eating disorder health professionals, another way you can help support your loved one is to start educating yourself about eating disorders. You can listen to podcasts, start reading blogs or books (this one is a great one for partners: “Loving someone with an eating disorder”) to learn more about what diet culture is, why eating disorders exist, what it’s like to have one and how to unpack any stigmatizing beliefs that you may hold about bodies and fat.
The journey may be long and professional help will be needed
It takes people on average 5-7 years from start to finish to heal from their eating disorder. This means that while there will be improvements over time, there are going to be a lot of ups and downs. If your loved one has an eating disorder, getting support from a nutrition therapist or a mental health therapist or both will be necessary for you if you want to support them fully. This is because you are going to need the time and space to process difficult things that come up, learn how to have compassion toward yourself, unlearn any dieting/disordered eating behaviors you may have, challenge your beliefs about bodies, learn how to accept that you cannot make your loved one change or stop the eating disorder even though you so desperately want to, and learn how to be an expert at boundary setting with your loved one. Additionally, it will be helpful over time to learn how to respond sensitively and with care to your loved one even when you feel frustrated and like giving up.
Don’t give up hope
Remember that eating disorders are not something that your loved one has chosen, but that they do make people very sick. Eating disorders are mental illnesses which is why the healing process is complex. People with eating disorders are strong, capable, lovable, successful, and smart humans. They are not their eating disorder and they will heal over time with a willingness to do so and with your support as their loved one. There will be healing that will take place for your loved one, but you will find that both you and your relationship will experience healing too.
And remember, you don’t have to do it alone.
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