If someone you love is suffering with an eating disorder, it can be difficult to know how to support them. As an eating disorder therapist, I have the privilege of getting the inside scoop on what kind of support is helpful (or not so much) for my clients on a daily basis. So I’ve written this post for carers and supporters based on a culmination of my clinical observations and my reflections on conversations that I’ve had with clients throughout the years.
**Please note that this post is for educational and informational purposes only and it is not a substitution for therapy or professional support. If your loved one is struggling with an eating disorder it’s important that they seek professional support.
Separating the eating disorder from the authentic self
When someone is struggling with an eating disorder (ED), it is helpful to imagine the eating disorder as a separate entity. For example, I often refer to it as an angry little troll and invite my clients to conjure up their own descriptions. This type of separation is important in eating disorder recovery because it allows sufferers to distinguish between the eating disorder voice and their authentic self.
The ED voice is typically critical, mean, judgemental, angry, and deceitful (especially around food and exercise). It’s often identified by its heavy emphasis on “should’s” and its distorted perception of reality.
The authentic voice is kinder, more grounded, compassionate and reasonable. It can feel and seem quieter in comparison to the ED voice, but everyone’s got one — a big part of recovery is finding that voice and strengthening it.
When I’m working with clients to seperate their ED voice, I try to encourage them to reflect on what’s happening rather than telling them what they might be experiencing.
“It sounds like the eating disorder is really loud right now, how do you feel?”
“I wonder which part of you is speaking right now: Is it your authentic voice or the eating disorder voice?”
“It seems that the eating disorder is taking over at the moment, I wonder what your authentic voice might say about this?”
“I wonder what the eating disorder is saying to you right now? What does it want you to do? What would your authentic self want you to do?”
Separating self from the eating disorder also, in time, allows for a strengthening of that authentic voice. It can also enable sufferers to direct their anger and blame away from themselves and on to the eating disorder, which is helpful in terms of dismantling shame.
Understanding distorted thinking and shame
Distorted thinking patterns are a trademark of eating disorders and it's important to understand that they are absolutely not a choice. They can feel scary and overwhelming, much like living with a bully or an internet troll inside of your head. The eating disorder twists and distorts reality for sufferers through destructive and painful thinking patterns, with the main goal of perpetuating shame, which drives most of the disordered behaviours with food and exercise.
For example, when someone has an eating disorder they might experience shame about eating in front of other people because the eating disorder has distorted reality and tells them that everyone is watching them and judging their food choices. So, to try and minimise this shame the sufferer might avoid eating in front of others. This offers short term relief from shame, but the eating disorder voice is never satisfied so in time, that person might start to become preoccupied with avoiding social situations where food will or might be involved, leaving them feeling isolated and lonely because so many of our social experiences surround food in some way. But the more they avoid those situations the more shame they feel when they inevitably land themselves in a social situation involving food. As such the original attempt at diminishing shame results in an even more overwhelming sense of shame, growing that sense that "I am bad".
Shame is a big reason why it's so difficult for sufferers to untangle their authentic thoughts from their ED thoughts. One way of understanding shame is to reflect on its possible evolutionary function: to ensure our survival through social connection and protect from social rejection. Because of this, when we experience shame it can be incredibly difficult to engage with rational thinking and to process our emotions. Instead we feel preoccupied with ensuring that we won't be 'found out', which can ultimately lead to further social transgressions as we try to keep ourselves safe from rejection or from others "discovering" our "badness". This is how shame constructs the perfect breeding ground for the eating disorder thoughts and behaviours and contributes to a feeling of stuckness: Nobody enjoys feeling shame.
We can also understand the pull of the ED's distorted thoughts by taking a step back and exploring it from a biological perspective:
It takes repetition to build neural pathways in our brain, and the favourite saying in neuroscience is “neurons that fire together stay together”. This is incredibly true for eating disorder thoughts. It’s helpful to understand that these ED thoughts are going through your loved one’s head ALL THE TIME and thus the neural connections associated with them are being reinforced and strengthened every day.
Our brains are plastic though, which means they can bend and recalibrate. This means that we can apply the same principle to building new neural pathways in our brains; the key is to get the same neurons firing together over and over again. This is why patience, practice, and compassion are KEY to supporting someone with an eating disorder.
Think of it this way…
Imagine standing at the bottom of a mountain and being offered a choice:
Option 1. Walk up the well lit, well worn, easy to follow path. OR
Option 2. Head in to the bush with a machete and hope to find your way safely.
Which would you choose?
A person with an eating disorder will know, on some level, that the eating disorder is hurting them (this is an authentic self), but even so the eating disorder thoughts and behaviours will feel like Option 1 and recovery can feel like Option 2. It’s important not to judge someone for the choices they are making, because a lot of the time choosing the eating disorder can feel like the safest option.
We also have to hold in mind that when someone is suffering with an eating disorder they generally aren’t getting the nutrients (from food or other areas of their lives) that they require to function optimally. For example, our brains require 20% of our energy in order to function, so when we are restricting our food intake we are also restricting our brain’s capacity to function.
Being mindful of shame
Eating disorders also thrive off of shame and we need to be mindful of this when we are supporting someone in recovery. Shame emerges every time someone rebels against their eating disorder, and it can also shroud certain eating disorder behaviours (ie: bingeing or compulsive exercise). As you can imagine, the more someone gets sucked in to an eating disorder the more shame they will experience.
This is important to understand because research shows that when we experience prolonged shame this changes the way our brains function. Similar to a trauma, shame triggers ‘fight or flight’ responses which release cortisol and adrenaline that contribute to shutting down our prefrontal cortex. If our prefrontal cortex isn’t fully functioning we struggle to connect with empathy, process our emotions, and engage in the higher level rational thinking that is required to fight the eating disorder.
All we can do is try and support them to reflect on how their choices are hurting or helping them, walk alongside them without judgement, and offer them unconditional love.
For example: If your loved one restricted, binged, or exercised when they are trying to stop, it’s important not to pass judgement or express disappointment. After all, they’re trying to build a new pathway in their brain. Instead, you could try validating their experience, inviting them to be curious, reminding them of their coping tools, or simply reminding them that you love them unconditionally.
“It sounds like the eating disorder is loud, I wonder what tools you could use to look after yourself?”
“What did you do differently this time? And what can you learn from this experience?”
“I’m here for you no matter what”
Praise v. Affirmation
When we are supporting someone in recovery, it’s critical to celebrate the little ‘wins’ against the eating disorder because this helps to build a sense of authentic pride — which ultimately helps to break down shame. However, there’s a fundamental difference between praising someone and affirming someone.
Praise is ultimately a judgement and it often ties outcomes with the person’s self-esteem.
“Well done!”
“Good job!”
“You’re doing so well!”
Through praise we risk moralising certain outcomes: Labelling some as good and others as bad. This is problematic because we aren’t always going to achieve the outcome that we want, especially in eating disorder recovery. If we put too much emphasis on certain outcomes in recovery, we risk facilitating shame which, as we know, only feeds the eating disorder.
This is why in therapy we focus more on affirmations.
An affirmation is an observation about someone’s ability, attitude, intention, or behaviour. When we affirm someone, we are inviting them to reflect on something inside of themselves which ultimately cannot be taken away from them. In time, this helps to build confidence and motivation.
“I notice that you used your new coping skills to help you get through lunch”
"You seemed really determined to push back against the eating disorder today"
“I can see that you are tapping in to your motivation and determination!”
The biggest difference between praise and affirmation is that we can affirm someone even when they haven’t achieved their desired outcome.
“It sounds like you were able to be kind to yourself and practice self care even though the eating disorder was really loud”
Recovery Affirmations: Do’s and Don’ts
As I’ve mentioned, it’s important to cultivate authentic pride in recovery and that’s something that carers and supporters can help with through offering affirmations and separating the eating disorder. Working with folks with eating disorders has taught me that before we consider affirming someone it’s important to hold a few things in mind.
DO affirm someone for their:
Grit
Intentions
Determination
Motivation
Self Care
Courage
Honesty
Initiative
Capacity to reflect
Compassion
Kindness
Resilience
Recovery behaviours
Strength
Bravery
Perseverance
Energy
Learning
Coping tools
AVOID affirming or praising someone for their:
Appearance
This includes making comments about looking “healthier” or “well”. Remember: that ED voice and its distorted thoughts can easily twist that in to something that creates shame.
Weight & Shape
No matter what is said, or the intention behind it, it will likely increase shame. Furthermore, most of what happens in recovery isn’t appearance based - it happens within the person. Keeping affirmations based on internal resources is helpful.
Food choices
Commenting on specific food choices, however affirming or well intentioned, can increase stress and shame around mealtimes. It can also be perceived as an attack and thus can provoke defensiveness. If your loved one is working with a nutritionist or dietitian their food choices will be monitored. If you are worried about someone’s food choices, you can bring it up with them gently and non-judgementally at a neutral time when food isn’t present.
On this note, it's also helpful to avoid talking about your own food choices in great detail. Diet-culture is a contributing factor to eating disorders and it also makes recovery even more challenging. Removing diet and body chat from meal times (well..ideally ALL times...) is helpful for everyone to build healthier relationships with food.
Note: If in doubt, ask! It’s always nice to know we’ve got an ally - especially one that is curious and non-judgemental. If it feels ok to do so, invite collaboration and communication. We’re all on the same team!
Look after yourself
Looking after yourself is crucial if you’re caring for or supporting someone with an eating disorder. Eating disorders try to isolate and push others away, and this can be upsetting to experience. Therapy can be a great way to navigate and express how you’re feeling, and family therapy is an effective and important component of eating disorder treatment.
B-eat has some information on support groups and online courses for carers and family members that you can check out here:
And please try and remember that the compassion piece extends to you as well — there’s no perfect way of supporting someone with an eating disorder. The most important thing is that we remain committed to learn and grow alongside those we are trying to support xx