The Silent Suffering
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How to Help
Offer support.
Be there -available to listen if your loved one needs to vent.
Avoid food/weight discussions. This isn't the real issue anyway. It could also result in the sufferer feeling attacked, or being triggered.
Never ever force food on them.
Don't make meal times a war zone. This won't help anyone.
Do not blame them, or argue with them. Eating disorders are complex illnesses, not something that they want to do to make your life difficult or complicated. And, a power struggle is inevitable if you argue, which will only worsen the situation.
Be PATIENT! The recovery process is an ongoing event. There will be struggles, setbacks, and triumphs. Not all of the "victories" are visible to the eye - aka progress is not synonymous with weight gain/maintenance. While that may be apart of it, the true battle is in the mind.
LISTEN. Don't try to fix it. Don't give advice or tell them what to do. It is not your responsibility to fix or change them. A listening ear can work wonders when someone is struggling.
Encourage your loved one to seek treatment. However, it must be realized that you cannot force someone into treatment and recovery, especially when the individual is an adult. Recovery must be done by the individual.
Support
Most people wonder what support looks like.
IT IS:
Listening.
Comforting.
Caring.
Encouraging.
Educating yourself.
Unconditional love.
Concern.
Treating them like a person, not a disease.
IT ISN'T:
Shown through anger and frustration.
Giving up.
Avoiding them, or the issue.
Complimenting their body/appearance. [i.e. "You look so much better", "I'm glad you've gained some weight", "You look healthy", and so on.]
Making meal times uncomfortable or a battleground.
An interrogation.
Establishing "boundaries" - 'you have to gain X-amount of weight'
Invading privacy. Be alert and aware, but don't pry.
Food policing. Don't suggest foods that they should eat, tell them what is healthy and what isn't. Many people with eating disorders have an extensive knowledge of nutrition and don't need to be told these things.
Nagging, Criticizing, or threatening.
What to Say/Do, What Not to Say/Do
Do NOT comment on appearance. If you say, "Oh, you look so much healthier!", "Wow, you look great!," "You've finally got some meat on your bones!", or any other similar statement - the distorted thoughts that are a part of the eating disorder will only hear one word. FAT. Even if you have the best of intentions, and even if someone comes from a low/dangerous weight, you should not say these things. Think about how insensitive it is to point out someones bodily changes, especially weight gain. It can make even a seemingly confident person feel down. Why then, should it be said to someone who is sick!
Do NOT blame the your loved one. Many people believe that eating disorders are entirely under the control of the sufferer, and that is not the case. Eating disorders are ILLNESSES, not lifestyles or choices. They are real disorders with real diagnostic criteria and real complications. Also, by placing blame on the sufferer, feelings of worthlessness will be added unto them. Additionally, DO talk with the person in a kind way when you are calm
and NOT angry, frustrated, or upset.
Do NOT try to force feed someone. It has been said that recovery is a process, not an event. Trying to push food at someone with an eating disorder will either make them push harder away, or in an attempt to please you, they could develop purging behaviors. Recovery is a decision and practice that can ONLY be made by the sufferer.
DO listen to them, and DON'T be quick to advise. Some believe the worst kind of vice is advice. Everyone wants to be heard, and people with eating disorders have a lot that needs to be said. You don't understand what they are experiencing, and that is okay. No one can truly understand an eating disorder unless they have experienced it. DON'T take on the responsibilities of a counselor!
DO educate yourself. The more you know, the better you are able to interact with them, and the easier it will be for you to figure out what you should/shouldn't say or do.
DO remind them that they are not alone. Millions of people struggle with eating disorders. And, help and support is available.
Do NOT take on the role a medical or psychiatric care provider should have.
DO have compassion when the person brings up painful issues about underlying problems.
DO Encourage social activities that dont involve food. DO NOT invite the person out for social occasions where the main focus is food.
Do NOT ask questions about behaviors or intake, like What did you eat today?, Did you really eat that?, Did you throw that up? Food policing makes everyone uncomfortable, it doesn't help the sufferer, and it places stress on you. These types of questions should be handled by medical/psychiatric care.
Do NOT say you wish you had an eating disorder so you could be thin. Eating disorders are NOT diets. THEY'RE NOT DIETS! They are psychiatric disorders, and they are deadly. They are not something to be desired. They are not glamorous.
DO understand that the person with an eating disorder is not out for attention or pity. We didn't ask for this disorder to happen, nor did we want it to happen.
Do NOT make or place stipulations on them, like, "You have four months to stop this", You must gain x-amount of weight by a certain amount of time or youre going in the hospital. You cannot put a time limit on recovery and this will only panic the person with an eating disorder. Tell that to a person will only cause them to lie to you about their stages of recovery, not encourage them to "speed up" the recovery process.
Do NOT make meal times a war zone. This won't help anyone.
DO learn the differences between facts and myths about weight, nutrition, and exercise.
DO remember that recovery takes time and food may always be a difficult issue, and that the recovery work is up to the affected person.
Do NOT threaten (e.g., if you do this once more I'll...).
Do NOT put timetables on recovery.
Do NOT take the persons actions personally
Do NOT try to change the persons attitudes about eating or nag about food.
Do NOT try to control the persons life
Do NOT use scare tactics to get the person into treatment, but do call 911 if you believe the persons condition is life-threatening
DO try to be a good role model.
Do NOT accuse or cause feelings of guilt.
Do NOT invade privacy and contact the patients doctors or others to check up behind his/her back.
Do NOT demand weight changes (even if clinically necessary for health).
Do NOT insist the person eat every type of food at the table.
Do NOT make eating, food, clothes, or appearance the focus of conversation.
Sources
"How to Be Supportive." Nationaleatingdisorders.org. National Eating Disorders Association (NEDA), 2008. Web. 28 Nov. 2009
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The following is an article written by Jeni Shaefer, Co-Author of Life Without Ed. The article can also be read online here.
"Just eat, they said.
They were my well-meaning friends and family members. I was in recovery from an eating disorder.
Whenever I heard the words, just eat, I sarcastically thought to myself, Let me grab a pen and write that down. I have never heard such great advice!
The truth is that if I could have simply just eaten, I would not have been struggling with an eating disorder in the first place. I could not just eat. I could not just stop bingeing, and I could not just stop purging. For the longest time, it seemed like I could not just do anything. To most people I have met struggling with eating disorders, just combined with any other words does not feel supportive.
The problem is that the eating disorder acts as a filter for words. But the eating disorder filter does not purify; it contaminates. Words said with kindness are transformed into ideas with a completely different meaning. With the eating disorder filter, for instance, You look healthy directly translates to You are fat. When I was really struggling with my eating disorder, Your hair looks good, and You have a beautiful smile, also translated into, You are fat. If someone could not comment directly on my entire body, I just knew they thought my body was fat. There is that word again, just. I suppose I was good at just assuming things without asking for clarification.
I was sensitive to dinner table conversations. In recovery, I began eating more at mealtimes, and people excitingly asked, Are you going to eat all of that? To me, this combination of words meant --- you guessed it --- You are fat. People in my life began to say that they felt like they had to walk on eggshells around me. They were frustrated that I took what they said the wrong way, and they did not know what to do in order to support me.
What is supportive? My former therapist, Thom Rutledge, taught me that the best way to support someone in recovery from an eating disorder or any addiction is to simply ask, How can I support you? Different things benefit different people. Words that felt supportive to some of the women in my eating disorder therapy group did not always work well for me and vice versa.
What helped me was for friends and family members to avoid talking about food and weight. I did not find it helpful to be asked, Did you eat today? or Have you gained weight? I enjoyed talking about other things in my life, including my job and hopes for the future. As long as I was connected with health care professionals who monitored my food and weight, other people in my life did not need to take on that burden. My friends just had to be friends, and my family just had to be my family.
For other people in recovery, it does feel supportive to talk specifically about food and weight. And I have learned in my work today that parents are sometimes forced to confront behaviors with food, especially when the child suffering with the eating disorder still lives at home. In these cases, the parents can ask their child, What is the most supportive way for us to speak with you about your behaviors with food?"
An eating disorder is a complex illness with no black and white answers. Due to this complexity, it can be beneficial for an entire family to seek professional help. One of the most powerful components of my recovery was participating in therapy sessions with my family. I learned that I am not as good at reading my parents minds as I thought and that I needed to speak with them directly about my concerns. Keeping the lines of communication open was a key to my recovery.
My parents learned that they did not have to understand my eating disorder. They just had to believe me. When I said, I am fat, I did not need my mom to try to convince me that I was not fat. The truth is that I really believed that I was overweight. My mom did not understand how I could actually have this thought, but she believed me. My family and friends never understood my eating disorder. The good news is that they never needed to understand it. They just needed to stand by my side, listen intently, and believe me. And they did.
I would not have found freedom from my eating disorder without the people in my life who walked beside me along recovery road --- picking me up every time I hit the ground. I fell down many times, so they probably became very tired along the journey. I am grateful for their persistence.
If you are struggling with an eating disorder, teach people how to best support you. Talk with your therapist about it. If you love someone who is struggling with an eating disorder, listen and be compassionate. Clarify how you can be the most supportive. Find support for yourself. Do not worry about being perfect.
Just do it!"
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The following was taken from Mirror-Mirror, and it can be read here:
It is important to remember that when you first approach the person you suspect has an eating disorder, they may react with anger or they may deny that anything is wrong. Do not push the issue, just let them know that you will always be there for them if they need to talk. In cases where the person is extremely underweight or is bingeing/purging several times a day, you may need to step in and take control. I would only recommend doing that if the individuals health is in extreme danger. If that is the case, you may need to speak to a doctor about a forced hospitalization.
Watching someone you love slowly kill themselves can be frightening. You will probably experience feelings of distress, anger, guilt and confusion. No matter how much you want to help them, you must remember that only they can make the decision to get help. You ca not force them to do this.
You must also be careful with the remarks you make to the person suffering. Below is a list of a few remarks that should never be made because they will usually only drive the person away or cause them more inner pain and guilt.
"Just sit down and eat like a normal person." If it were that easy, we would. Remind yourself that there are deeper emotional issues that may be preventing them from eating properly.
"Why are you doing this to me?" We aren't doing this to you, we are doing this to ourselves. A comment like that would only cause us more guilt and make us feel worse about ourselves.
"You've put on weight, you look great." We do not hear "you look great", we only hear "you've put on weight" leading us to believe that we are fat.
"Are you making any progress?" If in therapy, a comment like that could lead us to believe that we are not making progress and that we are in fact failing.
"I'll help to fatten you up." The words "fatten you up" is very terrifying to a person with an eating disorder. Comments like this can be very damaging.
"Are you keeping anything down?"or "When was the last time you puked?" The act of purging can leave the person with feelings of guilt and shame. Having someone ask this question can cause them to re-experience those feelings and leave them feeling ashamed for having a problem.
"You look terrible." Avoid commenting on the persons appearance. The person is already obsessed with their body, they do not need to hear any negative comments.
"Your ruining our family." Comments like this only causes the person more guilt. It will not motivate them to eat, instead, it may drive them deeper into their eating disorder.
"What have you eaten today?" This puts us in a bad position because we either have to lie to make you happy (which causes us to feel worse for doing so), or tell the truth and hear a lecture (which would lead us to feel like we are failing).
"If you think you are fat, you must think that I'm obese." Even though we are underweight, we still feel fat and see ourselves in the mirror as fat. We do not see others as being overweight. The only distorted image we have, is of ourselves. Any ways, it is best not to mention size and weights around anyone with an eating disorder.
"Go ahead and have a drink or eat that. You'll just go and throw it up any ways, so what does it matter." A comment like this is very insensitive and cruel. Unfortunately, there are actually people who would say this. We already put ourselves down enough as it is and the last thing we need is someone else making us feel guilty or ashamed for having an eating disorder. If you have nothing positive to say to us, do not say anything!
"I wish I had that problem." or "I wish I could be anorexic for a day." No you don't! Everyday we struggle with this problem and we go through tremendous pain in trying to overcome it. We would not wish this problem on anyone, not even our worst enemies. It is hard for us to hear a comment like that because we know how terrible it is to live with an eating disorder.
"For someone with an eating disorder - you're sure pigging out today." Believe it or not, some people would actually make a comment like that. This comment is very insensitive and it could cause the person to panic about what they have eaten and end up purging.
"You look so healthy, you were always so thin before." If you make a comment like that, you are basically telling us that we are getting fat! We may in fact be looking better and looking much healthier, but when we hear comments like that, we will be made to feel that we are in fact getting fat. It really is best not to comment on a person's appearance.
"I wish I could have your strength. I've tried to starve myself and I just can't. What's your secret?" I guess my response to that remark would be "Why would you want to starve yourself? Eating disorder sufferers do not starve themselves because they want to, they feel they have to. Most of wish we could eat normally so that we did not have to suffer the daily physical and emotional pain that goes along with having an eating disorder.
"Why bother eating, you're just going to dig it out any ways." A comment like this is very insensitive and it really hurts to have someone say this to us, especially if that person is a close family member or friend. A comment like that will not do anything but cause us to feel worse about ourselves and more ashamed.
"She's too thin now, but she'll gain it all back." If your main purpose in making a comment like that is to scare us, you have probably succeeded. Telling someone that they will gain the weight back is not a good approach. Just hearing that could cause us to panic more and try to lose even more weight.
"I can't continue to live this way. When do I get time off from this disease?" It is very difficult to watch someone you love slowly destroy themselves, but a comment like this can do more damage. It would be best for you to seek outside support for yourself to help you cope, instead of lashing out at the person. A comment like this will only make us believe even more that we cause too many problems and we don't deserve to eat.
"I will give you 6 months to get over this."You cannot set a time limit on recovery. Telling someone that will add even more pressure to them and if they do not recover in the time limit you set, they will believe they have failed. Everyone is different and we all do not recover in the same amount of time. Recovery does take a long time, so everyone involved needs to be patient.
"Quit feeling sorry for yourself."We are not doing this because we feel sorry for ourselves. There are deeper emotional problems causing us to do this. A comment like this will only help to make us feel worse.
"You just need to exercise."If someone is bulimic, this comment could lead them to believe they are indeed fat and in need of exercise. You are dismissing all the important reasons why someone is doing this.
"You need to get your act together."Recovering from an eating disorder is not just a matter of getting our act together. Before you make a comment like that, educate yourself and find out how you can help us to overcome our eating disorder.
"You look like you have AIDS" Once again a comment like this is focusing on the person's appearance and will only make them feel worse. Avoid commenting on their appearance, especially if you are going to say something negative.
"What are your friends going to think." Many of us have had comments like this made to us. It only causes us to feel guilty and more ashamed of our eating disorders, which could lead to being more secretive and not seeking out help.
"You're just doing this for attention." We do not do this for attention. Most people with eating disorders would be happy to just keep it a secret from everyone. People with eating disorders are in a lot of emotional pain and this is their way of dealing with it. They need to be encourage to seek help, they do not need to be told they are only doing it for attention.
"I tried reading that book on eating disorders that you got for me, but it just wasn't really a page turner." Eating disorder books are meant to educate you so that you will have a better understanding. They are not meant to keep you on edge like a science fiction novel!
"If you are so scared of throwing up, then just don't eat." That is a ridiculous comment. It is like telling someone who is afraid of pollution not to breathe.
"I wish I could throw up all the food I eat, it would make things so much easier." This is yet another very insensitive comment. Having an eating disorder does not make things easier, it makes life a living hell.
"I barely ate once for a week, so I know what you are going through." Eating not so greatly for one week is nothing compared to having an eating disorder for years. You cannot compare stubbing your toe, to having your leg ripped off.
"You are never going to get better." A comment like this could be very damaging, causing the person to feel like they are failing. You need to remember that recovering from an eating disorder is a process and it takes a long time.
"You obviously are not trying to get better if you are just getting worse." Recovery is a long process and the person is going to have slips and relapses. You cannot expect the person to recover overnight and relapses are normal part of recovery and they should be expected to happen. During the rough times, that is when you need to be positive and support the person, not make them feel worse.
"I never thought I would have a friend stupid enough to have an eating disorder." I am sure the person with the eating disorder never thought they would have a friend stupid enough to make a cruel comment like that!
"Nobody is going to like the way you look." A comment like this only causes more damage. It is best to avoid comments on appearances, especially ones like this.
"If you loved me, than you would eat this food." A comment like this would do more damage, cause the person to feel more guilt and they will more than likely feel the need to punish themselves more. If you love the person, than try to help them in a positive and supportive way.
"All you need is a good man to sort you out." Whoever made this comment definitely knew nothing about eating disorders. I'm still trying to figure out how having a man is going to cure someone from their eating disorder!!!
"I can't take you out in public because you look like a skeleton." A comment like that can devastate a person. People with eating disorders already have a low self esteem. Making them feel like you are embarassed to be seen with them will only cause them to feel worse about themselves.
"If you would just sit down and eat, you wouldn't have this problem." Basically you are right. If we could sit down and eat normally, we wouldn't have an eating disorder. However, we do have an eating disorder and no matter how much we wish we could sit down and eat normally, we cannot do that just because you want us to. A comment like this will only lead to more guilt and the person may end up feeling the need to punish themselves even more.
"I need to be eating soon, I'm getting hungry. You need to eat everything you can possibly get your hands on, you're too skinny!" Once again, it is important not to comment on the person's appearance. Your comments can be taken the wrong way causing the person to feel worse.
"No one is ever going to love you if you don't get some of that weight off." This comment would only cause pain to the person with the eating disorder and it is a very cruel comment. It is time people learned it is what's on the inside that counts. People need to love each other for who they are, not what they look like.
"Repent of your sins and things will get better for you." This comment could make a person feel as though their sins were the cause of their eating disorder and that they have done something terribly wrong. They could feel like they are horrible and deserve to have an eating disorder. No one deserves to have an eating disorder. If a person has a strong faith in God, remind them that God loves them just the way they are. He created them and God does not make mistakes. A comment like the above could push a person with a strong faith away from God, instead of bringing them closer to Him which is where they need to be.
"You are just trying to be the worst case anorexic." No one strives to be a worst case anorexic. No one wants to go through this pain each day. Comments like this hurt and the person does not deserve anymore pain.
"You shouldn't go to counseling anymore. It's not helping you anyways." Recovery does not happen overnight. It takes time and the person will experience periods of relapses. Also, the person may not be receiving proper treatment which makes therapy difficult. You need to encourage the person, not make them feel worse.
"Can't you see how this is affecting me." The person is not doing this to you, they are doing this to themselves. They do not develop an eating disorder to hurt you. They can see how it is affecting you, but can you see how it is affecting them? You are watching it happen, the person with the eating disorder is living it.
"You don't even try, all you have to do is eat." If it were just that easy, then no one would have an eating disorder. Remember that there are underlying issues that are causing the eating disorder. The person will need time to deal with those issues and time to learn new and healthier ways to cope.
"If it wasn't for you and your eating disorder, then we wouldn't have to waste all of our time running back and forth to these doctors." First, seeking treatment is not a waste of time. Also, a comment like this would only make the person feel worse about him/herself and cause them to feel guilty, which in turn could cause them to turn even more to their eating disorder as a way to cope.
"Don't expect me to baby you, remember I'm not the one who got this eating disorder." A person with an eating disorder does not want nor need to be babied. However, they do need love and support and a comment like this is not providing them with the support they need and deserve.
"Boy, you ate a lot today." or "You were certainly hungry today." After a comment like this, you can be sure that the person is going to spend the next few hours or days obsessed with the amount of food they ate and whether it's making them fat.
"You look good, but you'd look even better if you worked out." A comment like this would only confirm in the person's mind that their body does need to be altered. It is best not to comment on a person's appearance at all.
"The reason you feel fat in your bathing suit/shorts/other revealing clothes is that you haven't been toning your muscles." No, the reason the person feels fat is because they more than likely have an eating disorder voice in their head telling them that they look fat.
"Why can't you just...
-get on the scale once a week as a gauge;
-keep the scale in the house and not get on it;
-eat a little of this without freaking out;
-stop comparing your body to other people's?" If the person could do just that, they would have stopped a long time ago. A person in recovery from an eating disorder needs encouragement, they do not need to be made to feel worse. Recovery takes time and a person should not expect someone to just stop having one immediately. Recovery takes a long time and hard work.
If you have had comments made to you that you felt were inappropriate and should not be said to someone suffering from an eating disorder, please email colleen and I will include it on this list.
Someone with an eating disorder has the best chance for recovery when they are surrounded by people that are loving and supportive. Recovery takes a lot of time and hard work, but with the proper treatment, which should include individual, group and family therapy, support groups, medical and nutritional counseling, eating disorders can be overcome.
I would also recommend to the families to get support for themselves. Dealing with someone that has an eating disorder can be frustrating and emotionally exhausting. You may want to seek the help of a therapist or a support group to help you through this difficult time.
The National Eating Disorders Association has a wealth of information available on their website, including what is called a "toolkit" for parents. You may visit the links at the bottom of this page to view the PDF's and print them at your convenience. NOTE: The entire list of PDF's from the NEDA can be found HERE. I am NOT listing all of their resources. I have also chosen to post some of the material, so that you may get an idea of what they have available.
SOME NEDA PDF'S
Starting a Discussion with Your Loved One
Myths
Do's and Don'ts
Parent/School Difficulties
Online Resources
Signs, Symptoms, Behaviors
First Steps to Getting Help
Advice from Other Parents
Understanding Insurance Issues
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