Eating disorders are not a choice.
No more than the person with schizophrenia chooses to have delusions about alien invasions does someone choose to have an eating disorder. Going on a diet is a choice, trying to lose weight is a choice, developing an eating disorder is not a choice.
If you don’t have an eating disorder, it can be difficult to imagine that someone could be that fearful of food or that petrified of weight gain. In such a case, it might help to imagine a phobia that you have (i.e., spiders, heights, confined spaces) and imagine being asked to do the thing you’re most terrified of (i.e., hold a spider, bungee jump, etc).
If you still can’t imagine how challenging it is for the other person, ask them to help you to understand and listen with openness, curiosity, and non-judgment. Often, people are too afraid to ask because they don’t know how to respond to what the other person might disclose. The truth is, however, someone taking an interest and then simply listening can do wonders.
Eating disorders are not a phase or a lifestyle choice that someone will simply outgrow. They require evidence-based interventions. Early intervention is important. In fact, left untreated, eating disorders have an average duration of seven years.
If you notice changes to someone’s body weight or shape such as weight loss, weight fluctuations and/or eating behaviour like not eating with others, avoiding certain foods then raise your concerns in a sensitive and compassionate manner.
For example, “Sarah, I notice you have lost weight. Are you ok?” Although the person might not respond positively at that very moment, they will know you care about them and, should they decide to seek help/support, they will know they can turn to you. Too often eating disorder practitioners hear stories of those who suffered in silence for too long because no one raised concerns about the person, leaving the person to suffer alone in silence.
Eating disorders are serious and life-threatening, biologically based psychiatric illnesses. They are accompanied by an increased risk of serious medical complications. In fact, they have a mortality rate 12 times higher than any other psychiatric illness.
It can be difficult to remember how serious an eating disorder is when, unlike other life-threatening illnesses such as cancer, you can’t physically see the negative impact it is having on someone’s physical and mental health. This “invisibility” is further exacerbated by one of the most complex components of the illness; the sufferers’ inability to recognise they have a problem.
If you know someone with an eating disorder, try not to downplay it seriousness or buy into their attempts to invalidate it with remarks like “I’m fine”. Although it is counterintuitive, maintaining a level of concern and anxiety can be helpful: “Jo, you are suffering from a life-threatening eating disorder. I really want to support you to get well”.
We have a very marginalised view of what eating disorders are and who gets them. We tend to think of eating disorders as a condition only thin, white, high socio-economic adolescent girls develop. Eating disorders do not discriminate. People of all ages, races, genders, sexualities, and body sizes can and do develop eating disorders.
If someone describes concerns or behaviours that would be concerning in a young, thin girl, their admission is concerning and should be taken seriously irrespective of their demographic. It can be helpful to express your concern and offer to support the person in getting help by saying something along the lines of: “What you have told me makes me feel very concerned for you. We need to get you some professional support to turn this around before it gets any worse. Is there a professional you trust to talk to about this in more detail?”
Families are not to blame. No one is powerful enough to give someone an eating disorder. People can, however, be powerful enough to support someone achieve full recovery. There are organisations that offer free or low-cost support and training for those who care for someone with an eating disorder.
Sometimes, however, you may not be able to help. This is especially the case if you have experienced or are experiencing your own struggle with an eating disorder.
In this case, directing your loved one to seek support from someone without an eating disorder and/or agreeing to not talk to one another about your struggles might be the best form of support you can offer. While no one can give anyone an eating disorder, their duration and severity can be exacerbated by exposure to others with an eating disorder.
Finally, full recovery from an eating disorder is possible. The misconception that “it’s always something she’s going to have to deal with” is not helpful. It can leave the person feeling discouraged, unhopeful, and stuck in their eating disorder longer than necessary.
Instead, try to encourage your loved one towards recovery through reminding them that you believe in them, that recovery is worth it, and that you will support them along the way.