An eating disorder is a serious mental health illness. As a relative, carer or friend of someone with an eating disorder it can be very hard see someone you care about in distress and it can be difficult to know how to help. It is normal to want to have all the solutions, or to want to ‘fix’ the problem for the person. This is not possible, but there are ways in which you can help.
This section of the website will outline some of the ways in which you can better understand and support someone with an eating disorder, and also highlight where you can go for further advice and support.
The following information is intended for people who wish to support an adult (over age 18) with an eating disorder. If you would like help to support a child or adolescent with an eating disorder, please seek further support from your local child and adolescent mental health services (CAMHS).
Understanding an Eating Disorder
It will be helpful to first read the section of the website titled ‘Recognising an Eating Disorder’ to find out more information about what an eating disorder is, why it might develop, and some of the common types of eating disorders and their symptoms. Being informed about eating disorders and understanding that they are not all about food and eating, but about deeper, underlying emotional distress, is a good first step.
Nobody chooses to have an eating disorder. In times of distress we all look for a way to cope. An eating disorder can be viewed as a coping mechanism, something a person turns to or uses to try and deal with the distress they are feeling, however in time, this coping mechanism can become damaging to the person.
Each person will experience an eating disorder differently and the function an eating disorder has for each person will be unique to them. An eating disorder may help someone to deal with or to avoid very difficult or painful feelings. It may temporarily soothe anger, sadness or self-loathing. It may make a person feel safe or in control. It may even give the person a sense of achievement, make them feel better about themselves in some way, give them an identity or make them feel unique.
Recognising that an eating disorder serves a function to the person you care about can make it easier to understand why they continue to engage in behaviours that you may find upsetting or that are detrimental to their physical and mental health. It can sometimes be difficult for someone to imagine a life without their eating disorder, in the same way that it would be difficult for you to imagine life without a friend who comforts you in times of distress.
A person with an eating disorder may also be very embarrassed or ashamed of their behaviour or may feel guilty about the worry and anguish they will cause loved ones. Together with a perceived inability to change this behaviour, it is very likely that a person will attempt to keep their eating disorder a secret from family and friends or repeatedly deny that there they have a problem. A lack of insight or inability to recognise that there is a problem can also be common.
What you can do
Recovery from an eating disorder is possible, but it may take some time, and a lot of patience, understanding, and empathy on your part. Some ways in which you can be supportive are:
- Learn as much as you can about eating disorders. If the person with the eating disorder feels that you understand what they are going through to some degree, it may help them feel able to talk to you about their problems. Being misinformed on the other hand is more likely to drive someone away. See our ‘Resources’ section for some good information leaflets and websites on eating disorders.
- Seek help and advice from professionals. Eating disorders are a mental illness and it is difficult for you to tackle them alone. It is important to get help from professionals who can assess the needs of someone with an eating disorder and provide appropriate treatment. Encourage someone who has an eating disorder to make an appointment with their GP as a starting point. You may want to offer to go with them for support.
- Think of the eating disorder as separate from the person you care about. It can be helpful, for example, to think of the eating disorder as a gremlin on the shoulder of the person you care about, telling them what to do, and saying negative or critical things to them. Remind yourself that their behaviour is a symptom of the illness. This can help to reduce any feelings of resentment or blame towards the person for their actions.
- Remember that nobody is to blame for the eating disorder. Try to refrain from reacting angrily or placing blame on people or circumstances. It can be helpful to understand why the eating disorder might have developed, but the main focus should be on moving forward and helping the person with the eating disorder to find new ways of coping with their feelings.
- Communicate openly and honestly with the person, and encourage them to do the same. Try to be honest about how you feel and express any feelings or concerns at an appropriate time. Avoid bringing up issues at meal times, for example, as these are already likely to be a distressing time. Also try not to get drawn into conversation about food, appearance, weight or shape as this is likely to lead to disagreements. Focus instead on what the person is feeling, and how you can help with that.
- Give your time, and listen. It is unhelpful to second guess what a person is feeling, so make sure you explicitly ask how they are. Listen to their response with an open mind, and try not to interrupt, give advice or tell the person what they should or should not do. You may not always agree with what the person is saying, but arguing your point can make it appear like you are not listening to them or that you do not feel their viewpoint is valid.
- Do things you would usually do. Try to retain a sense of normality. Act normally around food and don’t feel pressured to change your own eating habits or routines. Encourage conversation about everyday, non-eating disorder parts of life. Constantly focusing on the eating disorder can create a stressful environment for everybody and may lead to the person you are trying to support withdrawing from contact with you.
- Involve the person in social activities and outings. Mental illness can lead to social withdrawal and isolation. Invite the person you care about to join in with any social activities and outings. If they say no, respect their decision, but ask again next time you are doing something. Encourage the person to continue seeing their friends or family regularly, and help them to maintain their social network and stay connected to other people.
- Be encouraging and positive. When the person with the eating disorder is tired of the struggle to recover, be a voice of encouragement. Remind the person of all the positive things they have to look forward to, or things in their life that they will be able to do once they are a bit better. Their inner voice and thinking style will be largely self-defeating and negative, so help them to overcome this with positive messages and praise.
- Focus on the person’s strengths, and help build their self-esteem. Remind them of their achievements and their value to you as a friend, sibling, parent, son or daughter. Praise them when they have done well and support them through any setbacks. People with eating disorders can be extremely self-critical and have very strong beliefs about being unworthy of help or attention from others so support them to overcome these beliefs.
- Respect a person’s right and need for independence. This will depend on a person’s age and degree to which their health is impacted by their eating disorder, but independence should always be considered a long-term goal in recovery. You can’t be there for someone all of the time so the key is getting the right balance between being supportive and allowing the person with the eating disorder to have control over, and be responsible for, their own recovery and well-being.
- Be patient. Although a person with an eating disorder doesn’t want to be unwell, they can not just decide one day to stop having their illness. Recovery takes time and overcoming an eating disorder does not happen over night. Progress can appear slow, but each small step towards recovery should be acknowledged. Setbacks will also always be part of the recovery journey and accepting this early on can help you both avoid feeling disheartened and frustrated by them.
- Accept that you can’t fix things for them. You can only offer support and encourage a person to seek or engage in treatment. The decision to change and to ‘give up’ the eating disorder must come from the person with the eating disorder. Giving simple solutions to what is a complex problem, such as “all you need to do is eat”, is very unlikely to help.
- Get help for yourself. Set boundaries if the person’s behaviour becomes too difficult or challenging to manage and impacts negatively on your own ability to cope. Confide in someone you trust about how you are feeling, and how you are coping. There is more information at the end of this section on support services for carers.
Where to go for help
If the person is willing to accept help, ensure they make an appointment with their GP as soon as possible. The earlier an eating disorder is diagnosed and treated, the better. You may offer to attend the appointment with them for support. Your GP may make a referral to your local community mental health team or to a specialist eating disorder service depending upon the severity of the problem and resources available locally to you. You cannot refer yourself to these types of services.
Eating disorders have an impact on a person’s physical health so whether or not someone is willing to accept help for their eating disorder, encourage them to allow their GP to monitor their physical health. This might include keeping track of a person’s weight over a period of time, monitoring their blood pressure or doing some blood tests.
Self-help materials for overcoming eating disorders are widely available and can be beneficial. Self-help materials are commonly available as computer-based programmes or as printed text or workbooks. They can help a person begin to address some of the underlying psychological issues or behaviours associated with the eating disorder.
There are also several voluntary organisations that have been set up specifically to help support people with an eating disorder. Many of these organisations have websites and run online support forums, local support groups, telephone help lines or text messaging services. You will find details of some useful self-help programmes and support services for people with an eating disorder in our ‘Resources’ section of the site.
Counselling is a further option and can provide a person with a safe space to talk in confidence about any issues affecting them, whether these directly relate to the eating disorder or not. Counsellors can provide support with a number of issues including eating disorders, anxiety, low mood, family or relationship problems, low self-esteem, or identity related issues.
Most people with an eating disorder receive treatment in the community on an outpatient basis. This means that they may attend appointments at a clinic or a day hospital or may be seen at home. If an eating disorder is more severe, such that the person is at a very low body weight, is losing weight very rapidly, or develops medical complications, they may need to be admitted to a hospital. This may just be for a brief period to stabilise a person’s physical condition or to make a further assessment. Longer hospital admissions are usually only considered when a person has a severe or enduring eating disorder which has not responded to other community-based treatments.
Eating disorders can be life-threatening if left untreated. If you suspect someone you care about is vomiting or abusing laxatives frequently, or is at a very low body weight, it is very important that they seek medical advice or see a doctor as soon as possible. The new NHS 24 free telephone line for health advice and support out of hours is 111, or in a medical emergency you should call 999.
What to do if the person is not ready to accept help
It can be extremely hard for someone with an eating disorder to admit that they have a problem, or to allow them self to accept help from others. It may be very difficult for the person to consider change or the prospect of life without their eating disorder. You cannot force an adult to get treatment. It must be the decision of the person with the eating disorder to get help. Continue to remind the person that they have your support and be there for them if and when they decide they are ready to get help.
In the event that someone is very unwell and refuses life-saving treatment or is unable to make an informed decision about treatment due to their illness, a compulsory admission to hospital may be considered under the Mental Health (Care and Treatment) (Scotland) Act 2003. The Mental Health Act is always a last resort and can only be used if deemed absolutely necessary, such as when a person is at significant risk to themselves or to others. Anyone detained under the Mental Health Act has the right to appeal the decision.
Recognising and caring for your own needs
Caring for someone with any kind of mental illness can be hard. It is important that you do not become so preoccupied looking after somebody else’s needs, that you neglect your own. You too will need support so that you are in the best position to provide that support in turn to others.
Support for carers is available from many different sources. You may be able to seek support in the form of a trusted friend or family member who you can talk to and confide in. There are also many organisations that support carers and which provide telephone help lines, online forums, or local support groups. You may also decide to seek help for yourself from a mental health professional such as a therapist or counsellor. Wherever the support comes from, it is important that you have an outlet to talk about your feelings and space to emotionally recharge. It is also vital to take time out from your caring duties and continue to do things that you enjoy or find relaxing.
Supporting someone with a severe and enduring Eating Disorder
For help and advice on supporting someone with an eating disorder that they have had for a long time, or have previously received treatment for, please refer to the Living with an Eating Disorder section of the site.
