As an eating disorder specialist, two of the questions I get more than any other are: “How do I help a loved one who I suspect might be struggling with an eating disorder?” and “How do I encourage them to get the help they need?”
Those are great questions that deserve detailed answers.
When addressing this with your loved one, you may be met with defensiveness, resistance and even anger. They may feel unsafe or uncomfortable talking about their struggles. There’s a good chance the eating disorder has become part of their identity, and the idea of letting that go is often extremely overwhelming. Eating disorder behaviors are adaptive and functional for the person using them, and it’s important to be sensitive to that.
I reached out to some fellow eating disorder specialists who offered suggestions for how to navigate concerns you may have for a loved one. Here’s what they had to say:
Focus on their well-being, not their body size
If you suspect a loved one might have an eating disorder and want to help encourage them to seek help, focus on your heartfelt concerns for their well-being, not their body size, said Sumner Brooks, founder of EDRDpro.
“Although physical changes may sometimes be symptomatic of an eating disorder, a person’s lifestyle patterns and behaviors — such as avoiding social meals, isolation, personality changes, restricting, purging or over-exercising — may be the cause of any physical changes that need to be addressed in treatment,” Brooks said.
It’s important not to focus on the size of their body as the principal reason for seeking help, because a person with an eating disorder may not view their body the way you do and might be fearful of a change in their body with treatment, Brooks said. They might also feel shame when hearing your opinion on how they look.
“Eating disorder thoughts can become very loud and controlling, especially when faced with the possibility of getting help,” she said.
When approaching your loved one, Brooks says you should let them know you’re worried and that you’re committed to making sure they’re OK with the proper help from a health professional who can assess their situation.
Brooks suggests you be persistent, clear and kind. Let your loved one know you care about them and are willing to do whatever it takes to get well.
Validate their emotions
Approaching a loved one who may be struggling can be scary. You don’t know how they’ll respond, especially since one of the hallmarks of eating disorders is a belief that one isn’t sick enough to seek treatment, said registered dietitian Nikki Estep. She suggests you prepare for a range of responses — anything from denial, avoidance and criticism to rejection, blame, defensiveness, gratefulness, relief or sadness.
“If they respond with any of the first five emotions, keep in mind that what is underneath that response is likely a ton of fear, self-blame, hopelessness or helplessness,” Estep said. “If you keep that in mind, it makes it easier to manage your own emotions in the moment and respond thoughtfully.”
Estep suggests you validate whatever their emotional response is and offer to be there for them and support them in the ways they need to seek help from professionals.
“For example, a response of ‘I’m fine, I don’t want to talk about it’ can be responded to with ‘I wonder if you’re not wanting to talk about this because this is a really vulnerable topic and we don’t usually have hard conversations like this, and because the idea of seeking help might feel really scary and overwhelming. You don’t have to do this alone. I am here to support you. Maybe we can look up treatment providers together and come up with a plan so this doesn’t feel so overwhelming.'”
Use “I statements”
Know that it is OK if you feel nervous or anxious during these conversations; and, while you might be met with defense or denial, remember this may be the illness speaking, said registered dietitian Ashley Homrich of Fuel to Flourish.
She said one powerful tool is to lead with “I statements” rather than “you statements,” which may tend to feel like an attack. For instance: “I am concerned, because…” versus “you aren’t taking care of yourself, you have an eating disorder.”
Keep language neutral and non-judgmental
Whether your loved one is angry and denies there is a problem, or they’re relieved that someone else has noticed, expect that this might be an emotionally charged conversation, said Nina Mills, accredited dietitian of Feel Good Eating.
“Try really hard to keep your language neutral and non-judgmental,” Mills said. “You might prefer to stick to gently but firmly voicing your concerns you have about changes you have noticed in their mood and behavior rather than outright suggesting they have an eating disorder.”
She suggests choosing a neutral, calm and comfortable place and time to have the conversation. You might not want to approach the conversation over a meal or in an environment that is associated with food and eating. Also, make sure you have somewhere or someone to go for support either before and/or after having the conversation.
“Taking good care of yourself is really important too,” she said.
Be present without fixing
If you’re concerned that a loved one might be struggling with an eating disorder, remember to focus on the person and not their symptoms, said registered dietitian nutritionist Crystal Karges.
“So often, the symptoms of an eating disorder can be alarming and disturbing once you become aware of them. The tendency can be to want to ‘fix’ the symptoms in an attempt to help the person that you love,” Karges said.
Although you might have good intentions, this can sometimes make it more difficult for your loved one to reach out for help or to open up about any potential struggles.
“Express your concern but, more importantly, remind your friend or family member of your love and support that will be there no matter what — that this is something that doesn’t have to be endured alone,” Karges said. “Being present without having to ‘fix’ the problem can bring down walls for a person who is struggling with an eating disorder.”