Do' s and Donts
What you cannot (should not) do...
Just as there are many positive things you can do to help somebody with an eating disorder, there are also many negative things, which should be avoided.
Weight isn't the issue-
Don't concentrate on your friend or loved one's weight - it isn't the issue, even if they insist that it is. Food and weight are really coping mechanisms that your friend is using to deal with and help take control of their life. Remember, your friend's health IS your concern but is NOT your responsibility. By focusing on their weight, you are reinforcing the idea that it's central to the problem, which of course it isn't.
If you are a parent with an eating disordered child, then you DO have a responsibility to intervene, particularly if you feel your child's weight is dangerously low. You should always consult a doctor and, if necessary, go to the emergency room if you fear your child's health has reached a critical point. Tell me more about recognizing emergency situations.
Your friend or loved one will already have low self-esteem and this can be made worse if you try to make them feel guilty about their behavior(s). Don't try to make them choose between their eating disorder and your wishes - the chances are that they will choose the former. Comments that should be avoided include:
"Why are you doing this to me?"
Your friend or loved one is not deliberately doing anything to hurt you. Their actions are not intended to cause pain to anybody else and accusing them of hurting you is likely to make them feel even more guilty than they already do.
"Why won't you just eat?"
Food is a coping mechanism for somebody with an eating disorder. It is used (and abused) to help cope with a variety of negative feelings. Statements like the one above are likely to have the opposite effect of the one you desire because you are threatening their control.
"If you don't eat, I will..."
Again, this is threatening your friend's control over their life. You need to be a supportive influence, not a negative, domineering one. Cheap threats are never a good idea - even if you are prepared to carry out your threat, there is nothing positive or supportive about your actions and you are trying to take their control away.
"Why are you doing this to yourself? Can't you see what you are doing?"
Somebody with an eating disorder does not usually choose to live a life of starvation, binging or purging. Because it is not a conscious choice, they are not to blame for resorting to such a coping mechanism, albeit one which is physically damaging. Also, it should be remembered that the initial "aim" of an eating disorder is not normally ill health. Many eating disorders start off as just a "fad" or a "diet" which quickly spirals out of control.
You cannot force somebody to eat
One of the main points of an eating disorder is that it is your friend or loved one's "friend"; it is THEIR control and not yours. Trying to force somebody to eat by pleading with them or using emotional blackmail is never a good idea. It goes without saying that any attempt at physical force-feeding is cruel and extremely unproductive and may also be illegal in many countries. By pleading with your friend to eat (or not binge or purge) you are piling on extra shame and humiliation, something they already have enough of. Once again, by concentrating on their diet, you are avoiding the main issue(s) and reinforcing the notion that using and abusing food is the best way to cope with life's problems.
Methods of control
There are a number of methods, which those with an eating disorder (particularly anorexia and bulimia) may employ to try to affect their weight. The most common of these methods are laxative and diuretic abuse and over-exercise. Whilst it may be tempting to take away your friend's laxatives, they are only likely to go out and buy some more behind your back and your actions may cause more harm than good. However, it must be remembered that laxative and diuretic abuse can have extremely harmful side effects and you should encourage your friend to see a doctor, especially if they have been taking large quantities or have been abusing pills for a long period of time. Again, if you have a child with an eating disorder, then your situation is different because you have a responsibility to your child. Specialist eating disorder centers and hospitals don't allow patients to take drugs whilst in their care and this might be a consideration if your child is heavily abusing laxatives, diuretics or ipecac syrup. Tell me more about typical methods and their dangers.
What you can do
As mentioned in the introduction, the most important thing you can do is to offer your friend or loved one complete and unconditional SUPPORT. Support is vital to all of us and even more important for someone with an eating disorder because they are likely to have low self-esteem and feelings of worthlessness. Remember, unconditional support means you are offering to be there for your loved one no matter what happens.
It is possible that you friend or loved one will, at times, try to push you away and reject your offers of support. Don't take this personally - an important aspect of an eating disorder is the "negative voice" inside the individual that will try to resist all assistance. In a way, the "negative voice" is testing the resolve of all who come close and is looking for any excuse to be able to say, "See, I told you so, you're not worth anybody's time".
One typical feature of an eating disorder is mood swings in the person concerned. This can be for both physical and psychological reasons. Physically, an eating disorder can lead to vitamin and mineral deficiencies and this can have an effect on the brain. Deal with it. Don't turn it around on them and stress them out more. Just ahndle it, eventually, as the recovery sets in, it will pass.
Psychologically, the mindset of an eating disordered individual is usually negative, particularly if they have had an eating disorder for a long period of time. More than anything, they will have a negative opinion of themselves and may often put themselves down. They may take anything you say and try to use it against themselves. Accept that mood swings are likely, that it's not your friend's fault and that what is said during a period of depression doesn't reflect how they really feel.
"If only I wasn't so fat..."
Don't be drawn into an argument about how "fat" or "thin" your friend or loved one is. In reality, this is completely irrelevant because an eating disorder is not about weight. Your friend is likely to express her feelings through her weight, for example: "I feel so fat today". Of course, this is not really the problem, but their eating disorder has become a method of coping, therefore even basic emotions can be expressed in terms of weight or food. Think of an eating disorder as being a filter between the person's emotions and the outside world; all emotions must go through this filter before they are expressed.
Therapy and the recovery process
Whether your friend or loved one has confided in you about their eating disorder, or if you confronted them about it, it is always up to them to initiate the recovery process. Even if they are willing to talk about their eating disorder, it does not necessarily mean that they are prepared to "give it up" at this time. Things should be taken at their pace and, ultimately, the decision is always theirs.
Offer to help your friend or loved one seek help, but do not try to force them. There are many therapists who specialize in the treatment of eating disorders and finding one is often the first step towards the recovery process. In more serious instances, an eating disorders center may be appropriate, but that would be for a physician or therapist to decide. Again, it is up to your friend or loved one to want therapy; you should offer to support them in any way you can, including helping them to seek treatment. If they don't want to seek treatment, you must accept this and tell them you are always there for them and will continue to be there regardless of whether they are in therapy or not.