This article contains references to eating disorders and disordered eating.
If you think someone you know might have an eating disorder, it can be a very concerning time. Do you approach them about it? If so, how? What if you say the wrong thing and end up driving them away?
I know how hard eating disorders and disordered eating can be for those closest to you. As someone who's been open about my history of bulimia and purging disorder – both publicly, through my job as a journalist; and privately, because, well, something about thousands of strangers knowing your innermost battles makes talking to your mates about it comparatively straightforward – I've been approached about this topic numerous times. Concerned friends, family members or colleagues who fear that their loved one is developing – or has developed – an unhealthy relationship with food, exercise or body image. Perhaps they've lost a lot of weight in a short period of time, their eating habits have changed, or they've become socially withdrawn or agitated, particularly around food.
Whatever it is, knowing how to broach the subject can be intimidating. We live in a society that likes to proudly declare how far it's come in breaking the taboo around mental health. And for the most part, I like to think that this is true. When I was growing up in the ‘90s and 2000s, anxiety – or ‘nerves’ – was something you got before a job interview, and OCD just meant people who liked to clean a lot.
But eating disorders? We aren't there yet. They're still shrouded in stereotypes and misinformation. Those of us with ‘eating problems’ either lack control or are simply vain and obsessed with the way we look. Media portrayals of the rise in eating disorders often exclusively picture very young, thin, white women. But these illnesses, in all their psychological nuance, develop for a whole host of complex reasons and can affect anyone, regardless of their gender, race or socioeconomic background.
So it's no wonder approaching a loved one about it can be daunting. But as anyone with personal experience will tell you, to live with an eating disorder is an incredibly lonely thing. They thrive in secrecy and feed off feelings of isolation. If your loved one is going through this, they are going to need your support.
“It can be really challenging as you might worry that you’ve “got it wrong” or that they might react badly to you asking questions,” says Tom Quinn, Director of External Affairs at Beat, the UK's leading eating disorder charity. “However, it’s important to remember that you’re asking because you love them and are concerned about them.”
We don't need magic mushrooms, crystals, or zinc. We need a government that gives a damn about mental health.
What are the signs that someone has an eating disorder?
Before we go into how to approach your loved one, let's talk warning signs. “It’s important to remember that the first signs of an eating disorder are likely to be behavioural or psychological rather than physical,” says Tom. “There’s a stereotype that everyone with an eating disorder is underweight, but in the case of eating disorders such as bulimia and binge eating disorder, people affected wouldn’t usually lose weight rapidly.”
There are many different types of eating disorders which all have different warning signs. As well as the general signs – physical or psychological changes, isolation or secrecy, preoccupation with food, fear of gaining weight or pursuit of thinness, disordered perception of body shape/weight – I asked psychotherapist Kerrie Jones, CEO & Founder of specialist treatment eating disorder service Orri, to break down the signs by the most common eating disorders:
- Food and/or exercising has started to dictate life decisions
- Preparing meals, and meals themselves, have become a challenge
- Food ‘rituals’ in the preparation or eating of food
- Tightly regulated and restricted eating
- Social withdrawal and isolation
- Preoccupation with size and body image
- Insomnia or struggling to sleep/stay asleep
- Low self-esteem and insecurity
- Perfectionism, often at the expense of relationships
- Co-occurring conditions, such as depression and anxiety
- Eating uncontrollably (binging) and/or fear of eating uncontrollably
- Alcohol or drug abuse
- Petty theft to get hold of food to binge on
- Secretive eating and isolation
- Social erraticism —sometimes withdrawn, sometimes seeking approval
- Acts of self-disgust and self-harm
- Perfectionism
- Depression and other co-occurring conditions such as OCD
- Low self-esteem
- Preoccupation with body image and appearance
- Masking true feelings with promiscuity
Our bodies – with all their wobbles, cellulite, stretch marks, folds, curves, scars and hairy bits – tell a story.
- Eating uncontrollably (bingeing) and/or fear of eating uncontrollably
- Planning bingeing at particular time/with specific foods
- Secretive eating and isolation, perhaps concealing food or wrappers
- Feelings of shame or embarrassment after eating
- Acts of self-disgust and self-harm
- Petty theft to obtain food to binge on
- Perfectionism or ritualistic behaviour / rules
- Depression, and other co-occurring conditions such as OCD and anxiety
- Low self-esteem
- Preoccupation with body image and appearance
Avoidant Restrictive Food Intake Disorder (ARFID):
- Avoiding particular types of food
- Fear of phobia of choking or vomiting, or
- Only eating certain textures of food and maintaining a limited range of options, or
- Displaying a lack of interest in food or lack of appetite – sometimes missing meals altogether when distracted
- Not eating enough food to be nutritionally healthy and satisfied
- Avoiding eating in social scenarios
- Anxious around mealtimes
- Taking a long time over mealtimes
- Weight loss
- Stunted growth in children
- Developing nutritional deficiencies
Other Specified Feeding and Eating Disorder (OSFED):
- Represents a category of eating disorders that do not meet the strict criteria of disorders like anorexia or bulimia but still involve significant disordered eating behaviours that cause distress or physical impairment.
How do I approach a loved one about an eating disorder?
The first thing I always tell people is to approach the subject without judgement. Your friend's eating disorder is underpinned by a complex burden of emotions that can be unbearably heavy to carry. More often than not, this includes an immense amount of shame. Nothing breeds further shame like judgement.
One way to avoid your loved one feeling judged or attacked is to use the first-person narrative. So, instead of: ‘You're worrying me,’ try ‘I’m worried about you’. This also works for sentences such as ‘I’ve noticed that you're not eating much at mealtimes,’ instead of: ‘You’re not eating’. Similarly, open-ended questions like ‘I wondered if you’d like to talk about how you're feeling’ is better than ‘You need to get help’.
Tom and Kerrie also have this advice:
- Before you speak to them, you might like to read as much as you can about eating disorders so you feel informed (Beat’s website is a great place to start), and then speak to them as soon as you can.
- Pick a time when tensions aren’t running high and when the other person appears receptive.
- Choose a time/place where you both feel safe and won’t be disturbed. Avoid before/after meals as this will be a stressful time.
- Broach the topic gently, keeping in mind that despite how they appear, eating disorders are not about food. Rather, food is a symptom of much more complex, underlying causes, with emotional distress often at the root.
- Focusing on food behaviours in isolation may cause someone to become defensive or to deny their experience. Instead, focus on their emotional experience and your care for their emotional wellbeing.
- It is very important to keep lines of communication open, and know that you may need to return to the conversation multiple times depending upon how ready they are to talk.
- If they say that something is wrong, you can help them to make an urgent GP appointment. You can also speak to Beat 365 days a year by calling the helpline on 0808 801 0677.
But what if they deny it or get defensive? “If they tell you there’s nothing wrong, even if they seem convincing, keep an eye on them and keep in mind that they may be ill even if they don’t realise it,” says Tom. “Don’t wait too long before approaching them again.”
Also try to remember that their anger or frustration isn't personal. “Eating disorders exist to help someone cope during significant, often emotional, challenge,” explains Kerrie. “It makes sense that someone might get defensive – the eating disorder is serving a ‘purpose’ to help them cope, and they don’t want to let go of that just yet. We can recognise, with compassion, that they’re in emotional distress and we may need to return to the topic another time.”
Finally, remember to look after yourself. Caring for a loved one with an eating disorder can be extremely tough, and you shouldn't be afraid to seek support for your own mental health if you need it.
For more information and advice, call Beat's helpline on 0808 801 0677.
