I’ve been promising to blog about this topic for a while now and I’m finally doing it! I think I’ve pushed it off for many reasons. But mainly, I’m not a therapist, recovery specialist, dietician or a doctor, so I feel a little under-qualified to be discussing this topic. I AM however, a woman who was anorexic for seven years, excessively exercised and was one run away from death before I entered treatment three years ago. So while I am not a professional of any kind when it comes to eating disorders, I can give you my perspective on what you should do if someone you love is anorexic.
I won’t be discussing other eating disorders, as I don’t have any personal experience with them. However, there are so many similarities on a deeper level when it comes to different eating disorders that you can probably apply these ideas to those relationships as well :)
The first thing that I want to start off by saying is....anorexia is VERY dangerous. Eating disorders have the highest mortality rate then ANY other mental illness and anorexia is number one. Anorexics either die from their body shutting down, malnutrition, heart attacks, suicide or other medical problems that come up due to the starvations of the body. Anorexia has an extensive effect on the body and it can cause heart attack, organ failure, osteoporosis...you name it. I’m not sharing this information to scare you, actually, maybe I am! If someone you love is anorexic, this is a life and death situation. It may not seem like it. They may seem fine. THEY ARE NOT. I speak from experience. I was thin, running, beautiful, had a job, seemed like all was well. It was not. It almost killed me and I know/know of many people who it did kill.
So now that you know how dangerous anorexia is and what you are actually dealing with here, lets get to how you can help the person you love turn away from anorexia and turn towards a life of freedom!
These are written in no particular order and this is very long. Honestly, I tried to talk about anything I could think of and I might come back throughout the week and keep adding or clarifying :)
1. EDUCATE YOURSELF! It is very important for you to actually educate yourself about what anorexia is and how to deal with it and what your loved one is going through. Also, by educate yourself, I do not mean watch ‘To The Bone’ on Netflix, I mean look at reputable sites such as Nationaleatingdisroders.org or ANAD.org or talking with a professional who has worked extensively with eating disorders or a person who has recovered from one. Eating disorders are VERY complicated, tricky and serious. What you think might help, in the end could hurt. Talk to professionals. Educate yourself. (I have a resource page on this blog full of books, articles and websites...check them out!) It is also important to understand what the recovery process looks like. If they choose treatment, your loved one will go through probably one of the hardest periods of their life. It is helpful if you learn to understand the things they are going through. The re-feeding process, things that can happen during that, the weight gain, the nausea, the swelling and edema, the mental breakdowns, extreme anxiety and what triggers are and how to avoid them to prevent relapse. Familiarize yourself with what it looks like to recover so that you can be a big support to that person.
2. SPEAK UP! If you think something is wrong, don’t be silent. Yes, it’s hard. Yes, it might go badly. Also, you might save their life. Don’t stay silent on this one folks, but tread very carefully. Bullying will not work. Being passive or passive aggressive won't work. Being super emotional, will not work. Threatening, won’t work. (I’ll speak more on what to say when you speak up below!) Do you want that person to finally heal, have their recovery take X amount of years and look back and ask why you never said something? What would you do if they have organ failure and you just couldn’t overcome the anxiety of just trying to have a conversation?
3. UNDERSTAND THEY MIGHT NOT SEE IT. You need to understand that when a person is anorexic, they are being controlled by the eating disorder. I know this sounds crazy, it is true. A person who is anorexic probably does not see the extent of what is happening or how sick they are. I know for me I had some idea that I had a problem, but I did not know how consumed I was by my eating disorder. Honest to God, I still have days of denial about it now. Most anorexics will say they do not have a problem. They do! Most will not see how thin they are and most will deny having and issue.
4. SEPARATE THE PERSON FROM THE EATING DISORDER. REMEMBER! The eating disorder is in control of their thoughts and actions at this point. Your loved one does not have control over this. No matter how badly they may want to eat a burger, the eating disorder WILL. NOT. LET. THEM. Understand your loved one is in a very unhealthy mental state and they need help to see it and get out of it. It takes time and a lot of hard work to separate yourself from the eating disorder voice.
5. TALK TO THEM AT THE RIGHT TIME. It’s probably not a good idea when you are out to eat and they barely nibble on their salad to drop the bomb that you think they are anorexic and you are scared. This isn't a drunk convo and it should not be when you are angry. This is something that needs to be well thought out, prayed about, and handled very very carefully and with a HUGE amount of love, compassion and empathy. One time I talked with someone about my fear of what was going on I waited until we were had time to really talk and I approached it very carefully making sure the other person would be receptive to what I was saying.
6. BE READY FOR DENIAL. If you approach your loved one about their anorexia, be prepared that they will most likely deny it. So many people told me I was too thin and looked like a skeleton. Even an ex boyfriend on facebook private messaged me about it. I didn’t see it. I denied there was a problem. I said I just love to run. I’m super healthy. I’m ok! It took me well over a month of therapy to admit I truly had a problem and to see how bad it was.
7. THEY CANNOT JUST EAT! I’m serious. If you look at an anorexic and you say, “just eat a burger,” you sound like an idiot. If the person could eat a burger without being murdered in their mind with high anxiety, depression, horrible nasty words, stress and pain, I think they would! When I entered treatment I literally could not eat a burger. It took me months! I had to take it very slow and overcome the very real fear I had of burgers. If fixing anorexia was as simple as just looking at them and telling them to eat, we wouldn’t really have this problem now would we? Just know, whenever they eat something they are scared of, they have a voice inside their head screaming at them to stop, telling them they will become huge and letting them know how disgusting they are. They cannot just eat, so don’t tell them to just eat. It just doesn’t work that way.
8. SEEK HELP! To overcome anorexia it takes therapy, dietitians, doctors, support groups, faith and sometimes inpatient treatment. It’s extremely difficult to overcome, but it can be done....with HELP! Don’t try to help your loved one on your own, get some help. There are a ton of resources online. I highly suggest reading them.
9. THEY ARE NOT JUST VAIN. Anorexia commonly gets the bad rap of being a vanity problem. 50-80% of anorexia comes from genetics. It is not a vanity issue. It is a coping issue. Although on the outside it seems your loved one just wants to be pretty and thin and perfect, they are struggling with a very serious disorder. They physically cannot just let go of it. They are not doing it just to be pretty, there is something else going on. When I was anorexic I was fit, thin, beautiful and could wear a bikini no problem. I was also about to have a heart attack and was so afraid of eating a chip without working it off that it caused anxiety attacks. That isn’t vanity, that is a mental disorder.
10. REALIZE THEY ARE COPING WITH SOMETHING MUCH DEEPER. Anorexia is all about control. I’ve blogged about some of the things that led to my eating disorder. While at the surface there is a desire to be thin and fit and beautiful, there is also major fear going on as well as coping from some pretty painful things. I’ve been in a couple of support groups and almost all of us have had traumatic experiences, insecurity, rape, abuse, hard relationships etc in our backgrounds. Eating disorders don’t just come out of nowhere.
11. STATE THE FACTS. It’s best when confronting the person you love about their eating disorder if you simply stick to the facts, and do it with love and gentleness. What do I mean by stick to the facts? Exactly that. Say what you see. Suzy, I noticed that since you broke up with Todd you have lost 30 pounds in a couple of weeks and you seem to be going to the gym and running every day as well. This is a huge change in lifestyle and I’m nervous for you. Losing weight that quickly is unhealthy. I notice that you are eating a lot less, it is recommended that a normal person at LEAST be eating three meals and snacks a day, I see you only eating a small breakfast. I’m very concerned, can we talk about it? How can I help you?” Don’t say things like, you’re too thin (they might take it as a compliment), You don’t eat enough (they literally have no metabolism anymore so they truly might not be hungry, Just eat a burger! (Again, THEY CAN’T!). I love you, this is what I see, how can I help you, here are some ideas of how to get help....
12. VALIDATE VALIDATE VALIDATE! If they choose to open up to you, validate how they are feeling. It IS very scary to eat. It IS really hard. They might truly fear gaining weight or losing a relationship or what might happen if they seek help. Validate it. What they are experiencing is very real, whether you understand it or not. Trying to dismiss it, or argue it away will get you nowhere. See what they say as real and help them through it. Sometimes people need a safe place to talk about what is really the problem and they need to learn healthy coping skills instead of anorexic behaviors. Give them a place to talk about the things they are dealing with.
13. BE PATIENT AND SUPPORTIVE. Entering treatment might take some time. Going through recovery definitely will take time. There are ups and downs. Relapses and milestones. Be patient with them. If they choose to recover and then the next week restrict again, or count calories, don’t roll your eyes. Remember what I said above, there is an eating disorder voice screaming in their head and anorexia IS a mental illness. It is strong enough to lead to death.
14. START TO COMPLIMENT THEM ON THINGS OTHER THEN THEIR LOOKS! Their job, their personality, their talents, ANYTHING! Help build them up about things that have nothing to do with their weight or how they look. I’m telling you it helps. When I had anorexia, over time I started to believe the only thing that gave me worth was how thin I was, how I looked and my ability to eat perfectly “clean” and as low calorie as possible. One of the hardest things about recovery is gaining the weight, and feeling like I lost what I thought was my worth while trying to find what it really was again. One of the things that helped me the most was the people who encouraged me to be myself, loved me for who I am and saw talent in me despite my appearance.
15. LEARN ABOUT THINKING ERRORS AND HELP THEM TO SEE THEM. There are many thinking errors, and my blog next week will be about them. Things like thinking everyone is talking about you, exaggerating, all or nothing, mind reading. Most likely your loved one is struggling with most of them, help them to recognize them and help them work through them. In treatment they will learn positive coping strategies to deal with them. Learn them too. Memorize them and help them when needed.
16. BE A PERSON THAT EATS! When you are around them, EAT. Show them it’s ok to eat. Eat ALL foods. Eat to fullness and don't talk about working it off or say how "bad" you just were. Be a normal eater around them and if you can't, don't eat around them. But honestly, if you are worried about them you can make the small sacrifice to not talk about calories or your dumb keto diet or intermittent fasting for like an hour...
17. STOP ALL DIET TALK. I’m serious. This one is HUGE. In their presence, do not diet talk. Period. No calories, no compensation talk, no keto talk, no sugar talk, no carb talk, ZERO. It is VERY VERY VERY (you get the idea) triggering. How can they possibly recover from their eating disorder with you talking about how fat you are and how you should just stop eating an entire food group?! It doesn’t work! Even better, don’t do a diet yourself. That’s another topic for another day, but at the very least, do not do ANY diet talk around them.
18. STAY AWAY FROM WEIGHT RELATED TALK. “You look so good!” “You look too thin..” “You look healthier!” “Wow, she put on weight.” These things seem like compliments and are probably done with a pure heart, but they are not helpful. Concentrating on their appearance makes them concentrate on their appearance and it never goes will with an anorexic mind. So many people tell me I look healthier now. All I hear is that I look fat. When I was anorexic and people said I looked too thin, it was the greatest compliment there is. Just don’t talk about it.
19. OFFER TO HELP THEM FIND A DOCTOR/THERAPIST/TREATMENT CENTER ETC... Sometimes people just don’ t know what to do, so if you help them do it, they might seek treatment. Say things like, “Hey, maybe we can sit down together to find a therapist that might be able to help with this!?”
20. REMEMBER: NOT ALL ANOREXICS ARE 80 POUNDS. I repeat! NOT ALL ANOREXICS ARE EIGHTY POUNDS! Yes there is a definition of anorexia and if you aren't underweight they call you A-typical anorexic, it's dumb. Many people in bigger or normal bodies are suffering from this eating disorder. Starving is starving, whether you are 80lbs, 140lbs, 200lbs or 280lbs. Don’t assume they don’t have a problem if they have every other symptom just because they aren’t skeletal or skinny. Our bodies are AMAZING at keeping us alive. Metabolisms slow. Hormones adjust. You don’t have to be skinny for this to happen. If your friend is 250 lbs and not eating, they still are at risk and are suffering.
21. NOT EVERYONE GETS TERRIBLE TEST RESULTS. When I entered treatment I had severe malnutrition, osteopenia, heart problems, gut problems, organ problems, no period, you get the idea. This was after seven years of anorexia. When I had been anorexic for only two years all of my medical tests came back normal. So many woman in my support group never got help and never realized they had a problem and continue to relapse because they were not “sick enough.” Until you have health complications, the eating disorder will make you think you are just fine. Don’t let that person get to year seven of anorexia and have to deal with all the healing and health problems from that length of starvation. Check the facts. Are they eating? Are they counting calories? Are they obsessed with food? Are they obsessed with exercise? Do they try to burn off everything they eat? Do they seem to think they are big even though they are not? Have they cut out food groups? More then one food group? Do they try to eat perfect and SUPER healthy? Do they have a ton of food rules? Do they call most foods good or bad? Do they have a hard time eating out? Do they body check all the time with their phone or in mirrors or anywhere they can see their reflection? Do they never take a break from exercising? Do they skip meals or are their portion sizes extremely small? Do they have a lot of headaches? Do they seem foggy and out of it? Do they seem irritable? Are they missing their period? Are they losing weight? Were they losing weight and it stopped? These are just some things to consider to determine if someone has an eating disorder other then tests proving malnutrition.
22. TRY AND REMEMBER THAT UNTIL THEY ARE READY, THEY WILL NOT RECOVER. If they are a minor, of course as their parent you can force them to go away and get treatment. Often this helps and with treatment they can see what is going on and heal. If this is an adult friend or a peer, you really can’t force them to do anything. They have to want to recover. You can help them to want to recover by eating freely around them, encouraging them to seek help, talking about what it could be like to eat freely, how much you miss the person they use to be etc. Recovery takes time and the person recovering will have to go at their own pace and allow their mind and body to heal within a time frame that is their own. I know for me going to recovery took a near death experience. Recovering from it has been a very very slow process both mentally and physically. The thing that helped the most was the people who stayed by my side and simply encouraged me every step as well as gave empathy freely as I went/go through it.
23. LEARN TO ACCEPT THEM AT ANY WEIGHT. The person you love may enter treatment. They will most likely gain weight, and possibly a lot of it. I overshot my normal weight range by a LOT while eating very normal. This is horrific for a person recovering for anorexia. Love them through it. Do not tell them to diet. Do not tell them to lose the weight. Do not get scared of the fat. Let their body heal and hang on to much needed fat after starvation. With proper rest, nutrition, and time their body will eventually find it’s way back again. Most likely not in the time frame you or they want. Believe health at every size and advocate for that for them.
24. LEARN THEIR TRIGGERS AND AVOID THEM AT ALL COSTS, OR AT LEAST BE AWARE OF THEM SO YOU CAN HELP YOUR LOVED ONE THROUGH THEM. Everyone has different triggers. Some are the same but some can be individual depending on why their ED came about in the first place. Being weighed triggered and still triggers me into relapse every. single. time. Therefore people should never suggest to me that I weigh myself or ask how much I weigh outside of a doctors office and blind weigh in. People talking about calories or diets is hugely triggering. Being called fat or talked to in a hurtful way is triggering. Being in a large group with lots of food around for me can be triggering. People letting me know how much weight they lost or are losing...very triggering. I mean honestly, there are so many other things to talk about then diet, weight, calories and food...find those topics.
25. REMEMBER, YOU ARE NOT A PROFESSIONAL. There are people out there that are highly educated and experienced in working with anorexics. Find them and help your loved one see them.You are most likely not a dietician. Find one who works with a doctor, that embraces health at every size and anti-diet culture and help your loved one see them. Help them get into a support group. There are professionals there and people who have recovered and gone through or are going through the same thing. Help them find these groups and encourage them to go. Heck, go with them! It is important to let professionals do their job, and you do yours. So many times in my recovery people gave me unsolicited advice that was literally the opposite of what the professional would tell me. It truly isn’t helpful. Anorexia is complicated. It takes people who really understand it to help.
26. EXTEND GRACE TO THEM AND YOURSELF. You will not be able to fix them and do everything for them. It is not your burden to carry. They have to choose to recover. They have to choose to eat. They have to choose to practice DBT and CBT skills. They have to do it. Be there for them the best you can and take care of yourself too. There are support groups for loved ones of those struggling with eating disorders. Find one and go to it! My husband went to a therapist on his own to talk about some things and he even came with me to my groups too. It helps.
27. DO NOT ENABLE THEM. Remember, this is a life or death situation, don’t enable it. Don’t work out with them, don’t say it’s ok when they don’t eat. If they don’t have a diagnosis from a doctor or have been told by a registered dietician to cut out food groups, don’t go along with it. Do not start a diet with them for fun, and do not talk about how amazing and thin they look. Just don’t do it.
I know this list is very long, and honestly, I don't even know if it was helpful or not! If you have specific questions, feel free to message them to me or comment them below and I'm happy to answer them.
Anorexia is very complicated and scary. It is hard to recover from but it is possible. People can go on to live very fulfilling and wonderful, healthy lives after anorexia. The most important thing is to remember that it is a mental illness and it has a high death rate. It is very serious and people will need medical, emotional, physical, financial and spiritual help to recover from it.
Above all else, LOVE this person. What they are going through is horrific. You may not be able to have all the answers, but if you speak to them from a place of love, you can't go wrong, even if in the moment it feels like it.
I am always here to talk so feel free to reach out to me or direct your loved one too me. Sometimes talking to someone who was anorexic can help. I've had many people contact me about their ED and we have created great friendships and support for one another as we navigate healing.
Know that I empathize with any of you who are reading this and have a loved one who is suffering. Yes, they are suffering from and eating disorder, but it is also very hard on you. Please practice self care!
Also, it wouldn't be a blog from me if I didn't add a little of my faith into it. God is good and prayer is powerful. If you are afraid to talk to them, pray for them. Pray for God to move in their lives and for Him to renew their minds, open doors for treatment, guidance on how to move forward in the situation and for the strength to help your loved one get through this!
I'm praying for all of you too :)