How to help someone you suspect might suffer from an eating disorder

According to The Butterfly Foundation, there are over one million Australians living with an eating disorder. The concerning fact about this statistic is many people who are suffering – from any one of a number of types of eating disorders – are suffering in silence.

Eating disorders are about much more than food; they are complex mental illnesses characterised by dysfunctional and disturbed eating behaviours as well as relentless thoughts about food and body image. If you are worried that someone you love might be dealing with unwanted eating behaviours and/or exercise behaviours, your awareness and support can go a long way in their recovery process.

Knowing how to help can be very difficult but it’s important to raise your concerns. Often, the person struggling may be resistant to change so coming from a place of love and non-judgement can go a long way. Veronica Engel, the principal psychologist of The Engel Clinic, says that before approaching this complex issue, trying to understand these five functional aspects of eating disorders is a good place to start.

• Psychological function: A desire for a sense of control over one or more aspects of your life.
• Emotional function: Searching for security, safety, routine; a way to cope with troubling emotions.
• Social function: A need for more attention, a way to connect with others.
• Physiological function: Increased endorphin release leading to a temporary feeling of wellbeing.
• Avoidance of change: Puberty for instance, or other developmental stages in life.

Eating disorders can thrive in environments that are not overly conducive to change, isolation being one of them. “How much your friend or family member wants to fix the issue and how motivated they are to change are two different things and must be considered before trying to approach them,” Veronica tells me.

In fact, it can be helpful to think of their journey to recovery along five stages of change: pre-contemplation, contemplation, preparation and determination, action and maintenance.

For instance, in the pre-contemplation stage, a person with an eating disorder will likely be in denial that there is a problem, and their low level of want and motivation to change will reflect this. As they move through the stages, both want and motivation will begin to increase and how you approach the person will differ somewhat.

Due to fear and stigma, starting a conversation about an eating disorder can be scary but you can make a big difference by listening with an open mind and assuring your loved one they don’t have to avoid the subject. Veronica shared some tips that may help to start the discussion depending on their stage of change.

The pre-contemplation stage

Choose a time when you can be undistracted, one-on-one and when stress levels are low. Use a setting that is not around the dinner table or around food such as driving through nature or walking through the park. Don’t blame or shame.

If you are committed to their wellbeing you will want to stay calm and see things from their perspective. Take the focus off their disordered eating; instead talk about their interests, goals and things they may be missing out on because of the eating disorder. In other words, inspire them.

The contemplation stage

A person in the contemplation stage has an awareness of their problem but their attitude may fluctuate between wanting to change and keeping their disordered eating. This has been a coping tool for them for a while so letting it go can be difficult. You can manage this stage by encouraging them to voice their thoughts, feelings and concerns. You don’t need to go in and fix things here by trying to convince them to go to see a professional.

In fact, it can be more helpful to simply allow them to realise you can understand and empathise with their challenges by saying things like, “That must be really hard”. Don’t discredit them or minimise their struggle. Instead, normalise their struggle and validate them. This will help them realise they are not alone. Try saying things like, “It can be so hard to go through challenges like this. I know a lot of people struggle with this” and “I am here for you”.

Demonstrate you are listening. You can even repeat back to them what they are saying to show you’re actively listening by saying something along the lines of, “I hear you saying part of you feels like you want to change, while another part of you feels apprehensive”.

The preparation stage

A person in this stage has decided they want to change and is preparing to change. As a carer, you can help by being informed of the research. Learn as much as possible about what they need and what you can do. Help them identify SMART goals and work with them to put them into action.

The action stage

A person in the action stage will be taking their first steps to recovery! Supporting them can mean:

• Validating and acknowledging how hard the change is.
• Focusing on the benefits of change rather than the challenges.
• Letting them know you are standing by them every step of the way.
• If relapse occurs, let them know flare-ups are normal and gently help them get back on track with encouragement.

The maintenance stage

In this stage, they will be learning to live without the eating disorder and letting go of this once trusted coping tool. It’s important to realise relapse is possible but so too is full recovery. To assist in this phase you need to help them notice their triggers.

Use non-judgemental unconditional support and love – you don’t know how deep their suffering is so judgement really doesn’t work. And remember to avoid comments about food, eating and appearance.

If you’re struggling with body image issues or eating disorders, you can call the Butterfly National Helpline at 1800 33 4673 for free and confidential support, or email or chat to them online here.