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eating disorders
Are you worried that someone you know has anorexia, bulimia, or another eating disorder? These tips can help you support your child, family member, or friend.

Understanding your loved one's eating disorder

Eating disorders involve extreme disturbances in eating behaviors-following rigid diets, bingeing on food in secret, throwing up after meals, obsessively counting calories. It's not easy to watch someone you care about damage their health-especially when the solution appears, at least on the outside, to be simple. But eating disorders are more complicated than just unhealthy dietary habits. At their core, they're attempts to deal with emotional issues and involve distorted, self-critical attitudes about weight, food, and body image. It's these negative thoughts and feelings that fuel the damaging behaviors.

People with eating disorders use food to deal with uncomfortable or painful emotions. Restricting food is used to feel in control. Overeating temporarily soothes sadness, anger, or loneliness. Purging is used to combat feelings of helplessness and self-loathing. Over time, people with an eating disorder lose the ability to see themselves objectively and obsessions over food and weight come to dominate everything else in their lives. Their road to recovery begins by identifying the underlying issues that drive their eating disorder and finding healthier ways to cope with emotional pain.

While you can't force a person with an eating disorder to change, you can offer your support and encourage treatment. And that can make a huge difference to your loved one's recovery.

Types of eating disorders

The most common eating disorders are:

Anorexia. People with anorexia starve themselves out of an intense fear of becoming fat. Despite being underweight or even emaciated, they never believe they're thin enough. In addition to restricting calories, people with anorexia may also control their weight with exercise, diet pills, or purging.

Bulimia. Bulimia involves a destructive cycle of bingeing and purging. Following an episode of out-of-control binge eating, people with bulimia take drastic steps to purge themselves of the extra calories. In order to avoid weight gain they vomit, exercise to excess, fast, or take laxatives.

Binge Eating Disorder. People with binge eating disorder compulsively overeat, rapidly consuming thousands of calories in a short period of time. Despite feelings of guilt and shame over these secret binges, they feel unable to control their behavior or stop eating even when uncomfortably full.

Myths and Facts about Eating Disorders

Warning signs of an eating disorder

Many people worry about their weight, what they eat, and how they look. This is especially true for teenagers and young adults, who face extra pressure to fit in and look attractive at a time when their bodies are changing. As a result, it can be challenging to tell the difference between an eating disorder and normal self-consciousness, weight concerns, or dieting. Further complicating matters, people with an eating disorder will often go to great lengths to hide the problem. However, there are warning signs you can watch for. And as eating disorders progress, the red flags become easier to spot.

Restricting food or dieting

Making excuses to avoid meals or situations involving food (e.g. they had a big meal earlier, aren't hungry, or have an upset stomach)

Eating only tiny portions or specific low-calorie foods, and often banning entire categories of food such as carbs and dietary fat

Obsessively counting calories, reading food labels, and weighing portions

Developing restrictive food rituals such as eating foods in certain orders, rearranging food on a plate, excessive cutting or chewing.

Taking diet pills, prescription stimulants like Adderall or Ritalin, or even illegal drugs such as amphetamines (speed, crystal, etc.)

Bingeing

Unexplained disappearance of large amounts of food in short periods of time

Lots of empty food packages and wrappers, often hidden at the bottom of the trash

Hoarding and hiding stashes of high-calorie foods such as junk food and sweets

Secrecy and isolation; may eat normally around others, only to binge late at night or in a private spot where they won't be discovered or disturbed

Purging

Disappearing right after a meal or making frequent trips to the bathroom

Showering, bathing, or running water after eating to hide the sound of purging

Using excessive amounts of mouthwash, breath mints, or perfume to disguise the smell of vomiting

Taking laxatives, diuretics, or enemas

Periods of fasting or compulsive, intense exercising, especially after eating

Frequent complaints of sore throat, upset stomach, diarrhea, or constipation

Discolored teeth

Distorted body image and altered appearance

Extreme preoccupation with body or weight (e.g. constant weigh-ins, spending lots of time in front of the mirror inspecting and criticizing their body)

Significant weight loss, rapid weight gain, or constantly fluctuating weight

Frequent comments about feeling fat or overweight, or about a fear of gaining weight

Wearing baggy clothes or multiple layers in an attempt to hide weight

Worried about someone? Speak out!

If you notice the warning signs of an eating disorder in a friend or family member, it's important to speak up. You may be afraid that you're mistaken, or that you'll say the wrong thing, or you might alienate the person. However, it's important that you don't let these worries stop you from voicing your concerns.

People with eating disorders are often afraid to ask for help. Some are struggling just as much as you are to find a way to start a conversation about their problem, while others have such low self-esteem they simply don't feel that they deserve any help. Whatever the case, eating disorders will only get worse without treatment, and the physical and emotional damage can be severe. The sooner you start to help, the better their chances of recovery. While you can't force someone with an eating disorder to get better, having supportive relationships is vital to their recovery. Your love and encouragement can make all the difference.

How to talk to someone about their eating disorder

The decision to make a change is rarely an easy one for someone with an eating disorder. If the eating disorder has left them malnourished, it can distort the way they think-about their body, the world around them, even your motivations for trying to help. Bombarding them with dire warnings about the health consequences of their eating disorder or trying to bully them into eating normally probably won't work. Eating disorders often fill an important role in the person's life-a way to cope with unpleasant emotions-so the allure can be strong. Since you may be met with defensiveness or denial, you'll need to tread carefully when broaching the subject.

Pick a good time. Choose a time when you can speak to the person in private without distractions or constraints. You don't want to have to stop in the middle of the conversation because of other obligations! It's also important to have the conversation at a time of emotional calm. Don't try to have this conversation right after a blow up.

Explain why you're concerned. Be careful to avoid lecturing or criticizing, as this will only make your loved one defensive. Instead, refer to specific situations and behaviors you've noticed, and why they worry you. Your goal at this point is not to offer solutions, but to express your concerns about the person's health, how you much you love them, and your desire to help.

Be prepared for denial and resistance. There's a good chance your loved one may deny having an eating disorder or become angry and defensive. If this happens, try to remain calm, focused, and respectful. Remember that this conversation likely feels very threatening to someone with an eating disorder. Don't take it personally.

Ask if the person has reasons for wanting to change. Even if your loved one lacks the desire to change for themselves, they may want to change for other reasons: to please someone they love, to return to school or work, for example. All that really matters is that they are willing to seek help.

Be patient and supportive. Don't give up if the person shuts you down at first. It may take some time before they're willing to open up and admit to having a problem. The important thing is opening up the lines of communication. If they are willing to talk, listen without judgment, no matter how out of touch they may sound. Make it clear that you care, that you believe in them, and that you'll be there in whatever way they need, whenever they're ready.

What not to do

Avoid ultimatums. Unless you're dealing with an underage child, you can't force someone into treatment. The decision to change must come from them. Ultimatums merely add pressure and promote more secrecy and denial.

Avoid commenting on appearance or weight. People with eating disorders are already overly focused on their bodies. Even assurances that they're not fat play into their preoccupation with being thin. Instead, steer the conversation to their feelings. Why are they afraid of being fat? What do they think they'll achieve by being thin?

Avoid shaming and blaming. Steer clear of accusatory "you" statements like, "You just need to eat!" Or, "You're hurting yourself for no reason." Use "I" statements instead. For example: "I find it hard to watch you wasting away." Or, "I'm scared when I hear you throwing up."

Avoid giving simple solutions. For example, "All you have to do is accept yourself." Eating disorders are complex problems. If it were that easy, your loved one wouldn't be suffering.

Encouraging a person to get help

Aside from offering support, the most important thing you can do for a person with an eating disorder is to encourage treatment. The longer an eating disorder remains undiagnosed and untreated, the harder it is on the body and the more difficult it is to overcome, so urge your loved one to see a doctor right away.

A doctor can assess your loved one's symptoms, provide an accurate diagnosis, and screen for any medical problems that might be involved. The doctor can also determine whether there are any co-existing conditions that require treatment, such as depression, substance abuse, or an anxiety disorder.

If your friend or family member is hesitant to see a doctor, ask them to get a physical just to put your worries to rest. It may help if you offer to make the appointment or go along on the first visit.

Treatments for eating disorders

The right treatment approach for each person depends on their specific symptoms, issues, and strengths, as well as the severity of the disorder. To be most effective, treatment for an eating disorder must address both the physical and psychological aspects of the problem. The goal is to treat any medical or nutritional needs, promote a healthy relationship with food, and teach constructive ways to cope with unpleasant emotions and life's challenges.

A team approach is often best. Those who may be involved in treatment include medical doctors, mental health professionals, and nutritionists. The participation and support of family members also makes a big difference in the success of eating disorder treatment.

Medical treatment. The first priority is to address and stabilize any serious health issues. Hospitalization or residential treatment may be necessary if your loved one is dangerously malnourished, suffering from medical complications, severely depressed or suicidal, or resistant to treatment. Outpatient treatment is an option when the patient is not in immediate medical danger.

Nutritional counseling. Dietitians or nutritionists can help your loved one design balanced meal plans, set dietary goals, and reach or maintain a healthy weight. Counseling may also involve education about proper nutrition.

Therapy. Therapy plays a crucial role in eating disorder treatment. Its goals are to identify the negative thoughts and feelings that are behind the disordered eating behaviors, and to replace them with healthier and less distorted attitudes. Another important goal is to teach the person how to deal with difficult emotions, relationship problems, and stress in a productive, rather than a self-destructive way.

Common types of Therapy for Eating Disorder Treatment

Individual therapy. Explores both the eating disorder symptoms and the underlying emotional and interpersonal issues that fuel them. The focus is on increasing self-awareness, challenging dysfunctional beliefs, and improving self-esteem and sense of control.

Family therapy. Examines the family dynamics that may contribute to an eating disorder or interfere with recovery. Often includes some therapy sessions without the patient-a particularly important element when the person with the eating disorder denies having a problem.

Group therapy. Allows people with eating disorders to talk with each other in a supervised setting. Helps to reduce the isolation many people with eating disorders feel. Group members support each other through recovery and share their experiences and advice.

Dealing with eating disorders in the home

As a parent, there are many things you can do to support your child's eating disorder recovery-even if they are still resisting treatment.

Set a positive example. You have more influence than you think. Instead of dieting, eat nutritious, balanced meals. Be mindful about how you talk about your body and your eating. Avoid self-critical remarks or negative comments about others' appearance. Instead, focus on the qualities on the inside that really make a person attractive.

Make mealtimes fun. Try to eat together as a family as often as possible. Even if your child isn't willing to eat the food you've prepared, encourage them to join you at the table. Use this time together to enjoy each other's company, rather than talking about problems. Meals are also a good opportunity to show your child that food is something to be enjoyed rather than feared.

Avoid power struggles over food. Attempts to force your child to eat will only cause conflict and bad feelings and likely lead to more secrecy and lying. That doesn't mean you can't set limits or hold your child accountable for their behavior. But don't act like the food police, constantly monitoring your child's behavior.

Encourage eating with natural consequences. While you can't force healthy eating behaviors, you can encourage them by making the natural consequences of not eating unappealing. For example, if your child won't eat, they can't go to dance class or drive the car because, in their weakened state, it wouldn't be safe. Emphasize that this isn't a punishment, but simply a natural medical consequence.

Do whatever you can to promote self-esteem. in your child in intellectual, athletic, and social endeavors. Give boys and girls the same opportunities and encouragement. A well-rounded sense of self and solid self-esteem are perhaps the best antidotes to disordered eating.

Don't blame yourself. Parents often feel they must take on responsibility for the eating disorder, which is something they truly have no control over. Once you can accept that the eating disorder is not anyone's fault, you can be freed to take action that is honest and not clouded by what you "should" or "could" have done.

Supporting a loved one's recovery

Recovering from an eating disorder takes time. There are no quick fixes or miracle cures, so it's important to have patience and compassion. Don't put unnecessary pressure on your loved one by setting unrealistic goals or demanding progress on your own timetable. Provide hope and encouragement, praise each small step forward, and stay positive through struggles and setbacks.

Learn about eating disorders. The more you know, the better equipped you'll be to help your loved one, avoid pitfalls, and cope with challenges.

Listen without judgment. Show that you care by asking about your loved one's feelings and concerns-and then truly listening. Resist the urge to advise or criticize. Simply let your friend or family member know that they're being heard. Even if you don't understand what they're going through, it's important to validate your loved one's feelings.

Be mindful of triggers. Avoid discussions about food, weight, eating or making negative statements about your own body. But don't be afraid to eat normally in front of someone with an eating disorder. It can help set an example of a healthy relationship with food.

Take care of yourself. Don't become so preoccupied with your loved one's eating disorder that you neglect your own needs. Make sure you have your own support, so you can provide it in turn. Whether that support comes from a trusted friend, a support group, or your own therapist, it's important to have an outlet to talk about your feelings and emotionally recharge. It's also important to schedule time into your day for relaxing and doing things you enjoy.

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Helping Someone with an Eating Disorder - HelpGuide.org

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eating disorders Eating disorders involve extreme disturbances in eating behaviors-following rigid diets, bingeing on food in secret, throwing up after meals, obsessively counting calories. It's not easy to watch someone you care about damage their health-especially when the solution appears, at least on the outside, to be simple.

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Stuck & not eating! Anorexia/ eating disorders: parents’ meal support tips

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Family-Based Therapy

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Family-based therapy highly effective for most anorexia patients

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Feb. 10, 2015 Anorexia nervosa, which affects about 2 percent of young women and 1 percent of adolescent males, has challenged clinicians for decades. The disorder profoundly alters the lives of patients, interfering with growth, development and fertility and commonly co-occurs with substance use and mood and anxiety disorders.

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#TomorrowsDiscoveries: Understanding Anorexia Nervosa – Angela Guarda, M.D.

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other specified feeding and eating disorders (osfed)

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and avoidant/restrictive food intake disorder (arfid)

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the foundation for research and education in eating disorders

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Types Of Eating Disorders Anorexia Nervosa A serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss.

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An Eating Disorder Specialist Explains How Trauma Creates Food Disorders

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Surviving an Eating Disorder provides a combination of information, insight, case examples, and practical strategies for families and friends to work on their relationship with someone who struggles with an eating disorder.
Author(s): Michele Siegel, Judith Brisman and Margot Weinshel

Buy

Yoga and Eating Disorders bridges the knowledge and practice gaps between mental health providers and yoga practitioners who work with clients suffering from disordered eating. Combining the wisdom of 20 experts in eating disorders treatment and yoga practice, editors Carolyn Costin and Joe Kelly show how and why yoga's mind-body connection facilitates treatment and recovery.

Buy

This fully updated second edition incorporates important advances in the understanding and treatment of eating disorders. It features expanded coverage of body image issues and enhanced strategies for achieving-and maintaining-a transformed relationship with food and your body.
Author: Christopher G. Fairburn

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The authors bravely share their unique stories of suffering from and eventually overcoming their own severe eating disorders. Interweaving personal narrative with the perspective of their own therapist-client relationship, their insights bring an unparalleled depth of awareness into just what it takes to successfully beat this challenging and seemingly intractable clinical issue.
Author(s): Carolyn Costin , Gwen Schubert Grabb, Babette Rothschild

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Sick Enough offers patients, their families, and clinicians a comprehensive, accessible review of the medical issues that arise from eating disorders by bringing relatable case presentations and a scientifically sound, engaging style to the topic.
Author: Jennifer L. Gaudiani

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Crave helps readers understand why they crave specific foods, recognize their individual triggers, and modify their responses to those triggers. Readers will develop a variety of strategies to use in conquering their cravings and establishing healthy eating habits.
Author: Cynthia M. Bulik

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Make peace with food.
Free yourself from chronic dieting forever.
Rediscover the pleasures of eating.
The go-to resource--now fully revised and updated--for building a healthy body image and making peace with food, once and for all.
Author: Evelyn Tribole and Elyse Resch

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Find The Emily Program's book recommendations about eating disorders. Learn more about topics such as anorexia nervosa (AN), binge eating disorder (BED), bulimia nervosa (BN), other specified feeding or eating disorders (OSFED), avoidant restrictive food intake disorder (ARFID), body image, intuitive eating, eating disorder recovery and supporting friends and family in recovery.

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Until recently, eating disorders have been rare in younger children. Unfortunately, this is no longer the case. Both the Westmead Hospital in Sydney and the Royal Children's Hospital in Melbourne have observed that eating disorder cases have increased substantially in the under-12 age group.

Often, an eating disorder develops as a way for an adolescent to feel in control about what is happening in their life. While people with eating disorders focus on food, weight and shape, there are nearly always underlying issues being masked by the eating disorder.

As well as addressing the behavioural aspects of the eating disorder, such as restrictive eating, binge eating, or excessive exercising, it is important that the underlying issues are also dealt with. For example, significant life events, such as a divorce or death in a family, might trigger an eating disorder. Adolescents may need counselling to help manage these difficulties, such as issues of loss or feelings of abandonment.

Early warning signs of eating disorders

Adolescents can become fussy about particular foods or lose weight for lots of reasons. It is important to get any concerns checked by a health professional.

Some signs that a young person might have an eating disorder and that should be investigated further include:

rapid weight loss or weight gain

changes in shape

feelings of unhappiness with body shape and size

an intense fear of gaining weight

denial of being hungry

deceptive behaviour around food -- for instance, throwing out or hiding school lunches

avoiding food and eating in social situations

excessive physical activity

compulsive exercising and a need to be active all the time

eating in secret

cutting out particular food groups, such as meat or dairy products

developing food rituals - such as always using the same bowl, cutting food up into tiny pieces or eating very slowly

behavioural changes - such as social withdrawal, irritability or depression

sleep disturbance.

Types of eating disorders

The main types of eating disorder include:

- characterised by restricted eating, loss of weight and a fear of putting on weight

- periods of binge eating (often in secret), followed by attempts to compensate by excessively exercising, vomiting, or periods of strict dieting. Binge eating is often accompanied by feelings of shame and being 'out of control'

- characterised by recurrent periods of binge eating (can include eating much more than normal, feeling uncomfortably full, eating large amounts when not physically hungry). Feelings of guilt, disgust and depression can follow binge eating episodes. Binge eating does not involve compensatory behaviours

- feeding or eating behaviours that cause the individual distress and impairment, but do not meet criteria for the first three eating disorders.

Risk factors for eating disorders

We don't know why some older children (aged eight years and over), particularly adolescents, develop an eating disorder and others don't. However, many factors might influence an adolescent to develop an unhealthy eating pattern or to become afraid of gaining weight. These factors may be psychological, social, environmental or biological.

Often, a combination of things may trigger an eating disorder in a vulnerable person.

Psychological risk factors

Personality factors that make a person more at risk of developing an eating disorder may include:

low self-esteem

perfectionism

difficulties expressing feelings like anger or anxiety

being a 'people pleaser'

difficulties being assertive with others

fear of adulthood.

Social or environmental risk factors

Social or environmental risk factors in the development of an eating disorder may include:

being teased or bullied

a belief that high expectations from family and others must be met

major life changes such as family break-up, or the accumulation of many minor stressors

peer pressure to behave in particular ways

a parent or other role model who consistently diets or who is unhappy with their body

media and advertising images of the ideal body size and shape as slim and fit

a cultural tendency to judge people by their appearance.

Biological factors

Contributing biological factors may include:

adolescence and its associated physical changes

genetic or familial factors - for example, families that are overly focused on food, weight, shape and appearance.

Dieting increases the risk of developing eating disorders

Dieting is common among adolescents and normalised by society, but it is not a healthy behaviour and should not be considered a normal part of being an adolescent. Eating disorders such as anorexia nervosa or bulimia nervosa can be triggered by dieting.

A person who crash diets (severely restricts calories for a period of time), substantially increases their risk of developing an eating disorder. Adolescents should not be encouraged to go on a diet.

Boys and girls experience eating disorders

Eating disorders are more likely to affect females than males. However, about 25 per cent of cases in adolescents occur with males.

Girls and boys can experience different social pressures about how they should look. Primary school-aged children are not immune to these pressures, and their attitudes and behaviours reflect adult concerns.

Like many adult females, some girls want to lose weight and be thin. Like many adult males, some boys want to lose body fat, but increase muscle mass. Some boys try to meet unrealistically thin ideal standards.

Parents and teachers can help prevent eating disorders

Children are great imitators, so parents, teachers and other adults can play an important role to help prevent eating disorders and promote positive body image in young children.

Foster a healthy relationship with food

You can encourage older children and adolescents to develop a healthy relationship with food if you:

Try not to label foods as 'good' or 'bad' - this sets up cravings and feelings of guilt when the 'bad' foods are eaten.

Avoid using food as a reward, or for bribes or punishment.

Accept that children are likely to have different eating habits from adults - for instance, adolescents may require more food more frequently during the day or may go through periods of liking or disliking particular foods.

Avoid going on diets and do not try to put your child on a diet.

Allow your child to eat when they are hungry and stop when they are full. Do not force your child to eat everything that is on their plate.

Encourage older children and adolescents to feel good about their bodies

There are lots of ways to help your children feel good about their bodies, including:

Show an acceptance of different body shapes and sizes, including your own.

Make a positive effort to portray your own body as functional and well-designed.

Demonstrate healthy eating and engage in physical activity for health and enjoyment.

Don't criticise or tease your children about their appearance.

Encourage your children to 'listen' to their bodies and to become familiar with different physical feelings and experiences.

Encourage sport and regular exercise to help maintain your child's health and fitness and foster their body confidence.

Encourage self-esteem

A strong sense of identity and self-worth is important to help older children and adolescents cope with life pressures. You can:

Help them to develop effective coping strategies.

Encourage them to express their needs and wants, to make decisions (and cope with the consequences) and to pursue things that they are good at.

Teach them that it is ok to say 'no'. Encourage them to be assertive if they feel they have been mistreated.

Help them develop a critical awareness of the images and messages they receive from television and social media.

Professional help for eating disorders

If your older child or adolescent is preoccupied and unhappy with their body, or seems to be developing behaviours like restricting their eating or binge eating, then professional advice may be helpful. See your GP for information and referral.

Where to get help

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Until recently, eating disorders have been rare in younger children. Unfortunately, this is no longer the case. Both the Westmead Hospital in Sydney and the Royal Children's Hospital in Melbourne have observed that eating disorder cases have increased substantially in the under-12 age group.