Eating Disorders: How to Help
This week is National Eating Disorder Awareness week and so we wanted to spend some time looking at some pitfalls and practical steps for family and friends of those who are struggling with disordered eating.
What's the context?
The major eating disorders, such as anorexia nervosa and bulimia nervosa, often result from complex circumstances that encompass much more than one’s relationship with food. They can affect up to 3% of the population and whilst currently they are much more prevalent in women compared to men, they are being increasingly diagnosed in young men. The nature of eating disorders also seems to be changing, with new terms coined to describe conditions, such as ‘orthorexia’ which is a preoccupation with ‘pure’ or ‘clean’ eating.
More than many other psychiatric conditions, eating disorders can often bring to light scenarios in which well-intentioned, rational reasoning from carers and friends may not deliver the intended results. The term ‘high expressed emotion’ describes situations in which such actions are viewed by the person struggling with disordered eating as over-involvement and criticism.
Expressed emotion (EE) is a concept established in the psychiatric literature to understand the impact of a relative’s interaction with the patient. It is defined as: critical comments, hostility, emotional over-involvement, positive remarks, and warmth.
Expressed emotion impacts treatment outcomes for patients with a variety of psychiatric and physical illnesses. In anorexia, 'high EE’ i.e. families making critical comments, expressing more hostility and displaying perceived emotional over-involvement, is associated with poorer treatment outcomes.
Disordered eating is often a manifestation of a need by the affected individual to regain control where a sense of agency is thought to have been lost, so interference from others can be received as a threat to this and is thus firmly resisted.
Such resistance can itself foster a range of emotions in those who are trying to care for someone struggling. These emotions can range from frustration to resentment and within the general public, the reaction to disordered eating can be very emotive. The term anorexia may conjure up very unhelpful ideas of a “middle class disease”, “attention seeking” or a “lifestyle choice”.
How can we support those we love who are struggling?
Supporting people with disordered eating is a truly holistic endeavour. There is plenty that suitably qualified healthcare professionals can provide, but the personal support network people have can also be utilised to good effect. There are many different ways to support someone with a suspected eating disorder, but here are a few overarching principles that may help:
A consistent, caring and non-judgemental approach. Recognising that it is a marathon not a sprint, can often lay the foundation for a supportive approach that is more likely to be sustainable
Resistance is to be expected – eating disorders are extremely controlling and rigid in nature – and should be addressed with compassion and empathy: having two angry, stressed or frustrated people in the room does not help matters
Early intervention has been shown to improve long-term outcomes and so professional support should be sought quickly, the spiritual support need not be in conflict with this
Guiding the affected person to disconnect from things that trigger their insecurities can be helpful e.g. unfollowing people and avoiding images/websites etc. that make them feel inadequate, or are otherwise invalidating by being unkind or critical. Instead, fostering a sense of gratitude and affirmation can have a positive impact.
Practical support can also come by way of encouraging them to keep a food and feelings diary. This will help them to see a pattern of when they are triggered to binge, as well as certain times or emotions that may contribute, and can be very useful for any health care professionals involved in their care. Another practical step is to help them create structure in their life so they have less room to focus on calorie counting.
On one hand, one should not underestimate how serious eating disorders can become if left untreated. On the other, the fact that people do recover from these conditions is often understated. In my clinical experience, there is usually no consistent factor in those who have a successful outcome; something just clicks in place at some point.
"Don’t you know that your body is a temple that belongs to the Holy Spirit? The Holy Spirit, whom you received from God, lives in you. You don’t belong to yourselves. You were bought for a price. So bring glory to God in the way you use your body." 1 Corinthians 6:19-20
So, this Bible verse – just one of a number that speak to this issue – can be used positively or negatively by a family member or friend who has good intentions. Those words can be adopted from differing perspectives and I would encourage them to be considered in light of some of the principles outlined here.
If used as a stick to ‘guilt trip’ someone suffering from an eating disorder into behavioural change, it is less likely to be effective and is likely to cause disillusionment, invalidation and resistance.
However, the same words can be used to positively affirm a loved one and whilst there may or may not have an immediate effect, could sow a seed that in time bears fruit.
If you are concerned that you or a loved one might be exhibiting symptoms of an eating disorder, you should consider contacting your GP as the first port of call. If you do seek therapy, dietetic or psychiatric input directly, please ensure that the clinician has experience of supporting people with eating disorders.
For more information about eating disorders, please see here:
Dr Chi-Chi Obuaya is a Consultant Psychiatrist working in the NHS and in independent practice, as well as a Mind & Soul Foundation Director
Dr Chi-Chi Obuaya, 28/02/2022