How Do I Help a Loved One With An Eating Disorder?

If you’ve spotted the warning signs of an eating disorder in someone you care about, it’s hard to know what you should do about it. You don’t want to hurt their feelings, falsely accuse them, or say the wrong thing.

Do it anyway.

People who suffer eating disorders can be very afraid to ask for help, and eating disorders get worse over time. Say something to them when you first suspect there is a problem.

How to Talk to Someone About an Eating Disorder:

  • Avoid accusatory, critical or harsh statements as it may make your loved one defensive. Instead, talk about what worries you.
  • Focus upon feelings and relationships rather than weight or food. Use specific examples of times that you noticed a particular behavior.
  • Don’t mention their looks – the person with the eating disorder is already too aware of their body. Comments about weight and/or appearance will reinforce their obsession.
  • Avoid power struggles over food.
  • Don’t demand that they change.
  • Don’t criticize their eating habits.
  • Respect their privacy but tell them you’re concerned about their health. Knowing that you’re concerned will help the person with the eating disorder feel more comfortable.
  • Avoid casting blame, shame, or guilt-trips. Don’t accuse them. Instead of saying, “You just need to eat,” say, “I’m concerned because you didn’t eat breakfast.”
  • Avoid simple solutions. They’re notoriously unhelpful and may minimize the problem.

Help! My Child Has An Eating Disorder!

Having a child with an eating disorder is one of the hardest things a parent may have to handle. Alongside professional treatment, here are some tips:

  • Avoid threats, scare-tactics, angry outbursts, and insults. Negative communication will only make it worse.
  • Look at your OWN attitudes about food, weight, body image, and body size. Discuss the way you’re affected by body image pressures with your child.
  • Set caring, consistent limits.
  • Stay firm. Eating disorders are very serious and require constant supervision.
  • Promote their self-esteem in any way possible.
  • Encourage your child to find better, healthier ways to manage unpleasant feelings like stress, depression, loneliness and self-hatred.
  • Remember, above all else, IT IS NOT YOUR FAULT.

My Best Friend Is Starving Herself. What Do I Do?

If you know that your friend is not eating or is eating and purging, tell someone.

Tell his or her parents, a teacher, or even your parents. Your friend may listen to an adult before she listens to you.

If you are an adult, gently express your concern to them. Perhaps you can talk to their spouse or partner. Be supportive, especially if inpatient treatment or long-term outpatient treatment is needed. Recovery isn’t instantaneous.

Treatment for Eating Disorders:

There are many different treatment options for eating disorders, but an individualized care plan will be developed for the individual suffering an eating disorder. Effective treatment must address both psychological and physical aspects of the disorder, with the end goal of treating medical and nutritional needs, promoting a positive relationship with food, and teaching constructive ways to deal with food.

Eating disorder treatment can be delivered in a variety of settings. Understanding the different levels of care and methodologies can be helpful when selecting a provider.  It’s also good to understand types of treatment as insurance benefits are tied both to diagnosis and the type of treatment setting.

Levels of Care:

Inpatient Hospitalization

Patient is medically unstable as determined by:

  • Unstable or weak vital signs
  • Laboratory findings presenting acute health risk
  • Complications due to coexisting medical problems such as diabetes

Patient is psychiatrically unstable as determined by:

  • Rapidly worsening symptoms
  • Suicidal and unable to contract for safety

Residential Treatment Program:

  • Person is medically stable and requires no major medical intervention
  • Person is psychiatrically impaired and unable to respond to partial hospital or outpatient treatment

Partial Hospitalization Program (PHP)

Person is medically stable but:

  • Eating disorder does impair functioning without immediate risk
  • Needs daily assessment of physiologic and mental status

Person is psychiatrically stable but:

    • Unable to function in normal social, educational, or vocational situations
    • Engages in daily binge eating, purging, fasting or very limited food intake, or other pathogenic weight control techniques

Intensive Outpatient Program (IOP)

  • Person is medically stable and does not need daily medical monitoring
  • Person is psychiatrically stable and has symptoms under enough control to be able to function in normal social, educational, or vocational situations while continuing to make progress in recovery

Types of Psychological Therapy:

One of the most important considerations when selecting a psychotherapist is the type of therapy they provide. Different therapies work differently for different people, and some may be more helpful than others, depending on the person and their stage of recovery, while others may not be as helpful. It’s important to remember that if you don’t click with one therapist, there are many others available. Reducing eating disorder behaviors is generally considered the first goal of treatment, and the following therapies currently have the most evidence for effectiveness.

Psychodynamic Psychotherapy 

The psychodynamic approach to treatment of eating disorders focuses upon trying to understand the root cause of the disorder. Psychodynamic psychotherapists see eating disorder behaviors as the result of internal conflicts, motives, and unconscious forces; if these behaviors are discontinued without addressing the underlying motives that are driving them, then relapse will occur. Symptoms are viewed as expressions of the person’s underlying needs and issues, and are believed to be resolved by working through these issues.

Cognitive Behavioral Therapy (CBT) 

A relatively short-term, symptom-oriented therapy focusing on the beliefs, values, and cognitive processes that maintain the eating disorder behavior. CHT modifies distorted beliefs and attitudes about weight, shape, and appearance; these are heavily related to the development and maintenance of an eating disorder(s).

Acceptance and Commitment Therapy (ACT)

The goal of ACT is focusing on changing your behavior instead of focusing upon your thoughts and feelings. People in ACT are taught to identify core values and commit to creating goals to fulfill these values. ACT also encourages patients to detach themselves from emotions and learn that pain and anxiety are a normal part of life. The goal isn’t to feel good, but to live an authentic, good life. After people begin to live a good life, they often find they do start to feel better.

Dialectical Behavioral Therapy

DBT is behavioral treatment that has been proven to be effective for treatment of binge eating disorder, bulimia nervosa, and anorexia nervosa. DBT operates under the notion that the first course of treatment should focus upon changing one’s behaviors. DBT treatment focuses on learning skills to replace maladaptive eating disorder behaviors. These skills focus upon building mindfulness, learning how to better build interpersonal relationships, how to regulate emotions, and the tolerance for distress. While DBT was first developed to treat borderline personality disorder, it is currently being used to treat eating disorders as well as substance abuse.

Evidence-Based Treatment

While all of these therapies are frequently used to treat people with eating disorders, they have varying levels of efficacy and research supporting their use. Many therapists now recommend the use of evidence-based treatment, which is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual people.” In eating disorder therapies, evidence-based treatment usually means that the therapy has been used in a research study and found to be effective in reducing eating disorder symptoms, encouraging weight restoration in underweight patients, and decreasing eating disorder thoughts.

Calling a therapy “evidence-based” doesn’t mean that it works for everyone; just that it works for many people. Research and evaluate which types of treatments would best target your symptoms and psychological concerns. Also, not all therapists who say they utilize a type of treatment actually use it in all of their sessions. Some CBT therapists might have a primarily psychodynamic approach and only occasionally use CBT principles. Ask about how strictly the therapist adheres to treatment guidelines, what a typical session might consist of, how much training the therapist has received in this particular treatment modality, the rough percentage of patients who they treat using this form of psychotherapy, and how current their ED knowledge base is.

Interpersonal Psychotherapy Therapy

Interpersonal psychotherapy (IPT) is an evidence-based treatment for people who have bulimia nervosa and/or binge eating disorder. IPT contextualizes eating disorder symptoms as occurring and being maintained in a social and interpersonal context. IPT is associated with specific tasks and strategies linked to the resolution of a specified interpersonal problem area.

The four problem areas include grief, interpersonal role disputes, role transitions, and interpersonal issues. IPT helps clients improve relationships, communication, and resolve interpersonal issues in the identified problem area(s), which leads to a reduction of eating disorder symptoms. Just as interpersonal dysfunction is linked to the onset and maintenance of eating disorder behaviors, healthy relationships and improvements in interpersonal functioning are linked with symptom reduction.

Cognitive Remediation Therapy (CRT)

CRT works to develop the person’s ability to focus on more than one thing. CRT works to target rigid thinking processes that make up a core component of anorexia nervosa through simple exercises, reflection, and guided supervision. As of 2017, CRT is being studied to test effectiveness in improving treatment adherence in adults with anorexia. However, CRT has not been tested in other eating disorders.

Family-Based Treatment

Family-Based Treatment, also known as the Maudsley Method, is a home-based treatment approach that has been shown to be effective for some teens with anorexia and bulimia. FBT doesn’t focus on the cause of the eating disorder but does place focus upon eating and full weight restoration to promote recovery. All family members are considered an essential part of treatment, which consists of re-establishing healthy eating, restoring weight and interrupting compensatory behaviors; returning control of eating back to the adolescent; and focusing on remaining issues.

Eating Disorder Hotlines:

The ANAD (National Association of Anorexia Nervosa and Associated Disorders) Helpline – 630-577-1330

National Eating Disorders Association’s Toll-Free Information and Referral HelpLine at 1-800-931-2237

Additional Eating Disorders Resources:.

The National Association of Anorexia Nervosa and Associated Disorders (ANAD) has an international network of support groups, offers referrals to health care professionals, publishes a newsletter, and will mail information packets customized to individual needs upon request. They work to educate the public, promote research projects, and fight insurance discrimination and dangerous advertising. Their national hotline (847-831-3438) can give you a listing of support groups and referrals in your area.

Maudsley Parents is a site for parents of eating disordered children. The site offers information on eating disorders and family-based treatment, family stories of recovery, supportive parent-to-parent advice, and treatment information for families that opt for family-based Maudsley treatment.

The Something Fishy Website on Eating Disorders has lots of resources of all kinds, including information and online support. (Scales are for Fish!)

The Academy for Eating Disorders is a global organization for professionals from all fields who are committed to leadership in eating disorders research, education, treatment and prevention.  Phone (US) 703-556-9222.

Overeaters Anonymous is a twelve-step program offering support for recovering from compulsive overeating. Phone (US) 505-891-2664.

About-Face focuses on the impact mass media have on the physical, mental and emotional well being of women and girls. They challenge our culture’s overemphasis on physical appearance and encourage critical thinking about the media.  Phone (US) 1-415-436-0212.

The American Dietetic Association has information on good nutrition, sensible eating habits.

The Weight-control Information Network provides the general public, health professionals, the media, and Congress with up-to-date, science-based information on weight control, obesity, physical activity, and related nutritional issues. Phone (US): (202) 828-1025 or 1-877-946-4627.

The Council on Size and Weight Discrimination, Inc. provides information on eating disorders, “sizism,” the non-dieting movement, and size discrimination. Phone (US): (914) 679-1209.