Living with, and caring for, a child, partner or other loved one with an eating disorder is never easy.
This article aims to give advice on how to cope and how to make sure you help, rather than hinder, the
sufferer's recovery. We recommend that you read "An Introduction to Eating Disorders" before this article.
It is vitally important to remember that eating disorders are not really about food. They are about intolerable emotional states, and food is just the vehicle through which the emotional pain is expressed. Therefore concentrating on the sufferer's food intake rather than their emotional feelings will not be helpful. Please try never to forget this when dealing with an eating-disorder sufferer.
Eating disorders, and most especially anorexia, are often about control. People turn to controlling their weight and food intake when they feel that other parts of their lives are out of control, or excessively controlled by someone else (such as a parent, very often). For this reason, taking a controlling or forceful attitude to the person's eating, or using threats, will simply make matters worse, and in countless cases, well-meaning but ignorant parents have made their child's anorexia much worse by doing this, sadly resulting in the child's death in many cases. Instead, it is necessary to be extremely gentle with the eating-disordered person, address their emotional pains, and encourage rather than force them to eat better.
It is all too easy to become angry or frustrated with the person's behaviour, but this must be avoided at all costs. People with eating-disorders already suffer from inappropriate and disproportionate feelings of guilt and poor self-esteem, and if they perceive that you are getting angry with them they will feel even worse -- which will obviously make the anorexia worse, completing a vicious circle of anger and anorexia which can be fatal. Remember that although the eating-disordered behaviour may seem irrational and stupid to you, the patient is suffering from a psychological illness that compels them to behave in this way and they do not mean to be difficult or hurtful.
For recovery to take place, it is important that the sufferer has someone to talk to who they can trust. However well-meaning family members are, they are usually "too close to the problem" for the sufferer to be able to confide in them effectively, and family members might well have been (unintentionally) part of the problem that has led to the eating-disorder in the first place. So it is necessary for the sufferer to have someone independent to talk to who will respect their confidences. Ideally this will be a counsellor or psychotherapist with special experience of eating disorders, but even a trusted friend is better than no-one. Family members must accept that the sufferer may not want to open up to them about the emotional underpinnings of the disorder, and must respect that wish and not pry, otherwise the sufferer will feel violated and the problem will likely get worse.
Very frequently, eating disorders especially in adolescents, are connected with issues of control and independence. Becoming more independent and having freedom and privacy from parental intervention is a normal part of growing up, and if this freedom is not provided, young people invariably develop emotional problems. If you are a parent of an eating-disordered youngster, it is important to examine your relationship with her or him in an open and honest way and try to see if you are doing anything that makes them feel too controlled or restricted. Even with the best intentions, parents sometimes do not give their teenage children the freedom that they need to develop into normal, well-adjusted adults, and eating disorders are a very common result. If such a problem underlies your child's eating disorder, then it is essential to rectify the situation otherwise it will never be possible to cure the eating disorder.
An attitude of respect, understanding and unconditional love is the key to success. People with eating disorders often feel that they do not match up to the standards that others expect of them, and that gives them a feeling of failure which reinforces the disorder. Make the sufferer feel accepted for who they really are, rather than letting them feel criticised for falling short of some ideal, and they will be much more likely to recover.
So, assuming that steps are being taken to address the underlying problems, what else needs to be done? Firstly, it will be necessary to ensure that the sufferer is getting the medical care that they need. This will depend on the extent to which the eating disorder has already developed, and the point of first contact will be via your family doctor. There is much medical information on this site and the ones to which it is linked.
Secondly, it is necessary to encourage and support the sufferer to eat a healthy diet (and, if the sufferer is bulimic, to avoid over-eating and purging). Many eating-disorder sufferers lose sight of what constitutes a normal healthy diet, and it is usually best to ask a professional to advise on this. A doctor or dietitian may be able to help; additionally some counsellors or psychotherapists may also have training in nutrition. It is usually helpful to have a professional prepare a "meal plan" which the sufferer should try to stick to. This can be calculated to provide a balanced diet taking into account the sufferer's preferences and personal nutritional needs. Having an agreed meal plan can help avoid arguments about what to eat or not eat.
With a meal plan established, the sufferer should be encouraged (but not forced) to eat the planned meals. It may help to sit with the sufferer and reassure them that the meal plan is only to make them healthy, not to make them "fat", and to provide emotional support mouthful-by-mouthful as they eat. Sometimes it can help to remind the sufferer of why they need to eat: the purpose of different nutrients in their diet and the risks that an inadequate diet can cause. If a professionally-designed meal plan is in use, it is important not to change it without the agreement of the patient (otherwise they will feel controlled). It is also wise to consult the professional before making any changes to the meal plan so that expert nutritional advice can be considered and a healthy, balanced diet can be maintained.
Often, a treatment professional will prescribe or recommend a liquid nutritional supplement to augment the sufferer's intake of solid food. Many anorexics find that liquid nutrition is less emotionally traumatic than solid food, and the possibility of a semi-liquid diet should always be considered for an anorexic who is struggling to take in enough nutrition. This can be a regular part of the meal plan, or may be offered as an alternative to a solid meal, for days when the sufferer feels emotionally unable to deal with the meal.
Remember never to show anger towards the sufferer or to use force on them, and that an approach of "unconditional love" and respect works best. Remember that the eating-disorder sufferer is experiencing a great deal of emotional pain, and be prepared to give them "their own space", in other words to let them be themselves, let them spend time alone when they wish, and to express their emotions when they wish. Eating-disorder sufferers are often very frightened to show their true feelings for fear of hurting or upsetting people, but they need to be given the freedom to express their true feelings that is a basic right of all human beings.
As a carer, you also need to look after your own emotional and physical health and avoid becoming "bogged down" in the day-to-day business of caring for your loved one. Be sure to make time for your own interests and recreation and do not let your life become totally centred around your loved one's eating disorder. Remember that there are both statutory (via Social Services) and voluntary Carers' Support services available to help you. You may need counselling or psychotherapy yourself -- this doesn't mean that you are inadequate or ill, but simply reflects the fact that trying to save a loved one from a potentially fatal eating disorder can be difficult and stressful, and you may need help yourself in order to be the most effective carer possible. And being the most effective carer that you can be is the best way to help your loved one break free of her or his eating disorder. Most eating disorder support groups welcome parents, spouses and other carers as well as the sufferers themselves, and joining one will give you the opportunity to share experiences and receive advice from other people in the same situation. Many groups have access to professional facilitators or counsellors who can help you. It is also well worth contacting the Eating Disorders Association for help, as well as many of the other organisations listed on the Links page.