The first people we think about when we hear that it is National Eating Disorder Awareness Week are, naturally, those among us who have or are, suffering from an eating disorder. However, that is not what this week is about. This week is about raising awareness of eating disorders, their nature, their effect, the process by which they act on their victims and how to notice and recognise their signs and symptoms in those around us. Only after this, comes the knowledge, education, and power with which to act to help those who are in the grips of their disorder.
knowledge that something exists, or understanding of a situation or subject at the present time based on information or experience.
understanding of or information about a subject that you get by experience or study, either known by one person or by people generally
The common denominator here is understanding. Between both awareness and knowledge, understanding is the link. The practical, clinical or academic grasp on eating disorders and their action is not enough; what we seek is understanding. With understanding comes empathy, with empathy comes acceptance, with acceptance comes the power to change or be a support to someone in need of that change.
I'd like to talk to the people outside of the grip of an eating disorder, about;
1. Recognising the symptoms of an eating disorder
2. How to approach someone you think may be suffering from an eating disorder
3. How best to support someone when they are in recovery
Eating Disorders: Early Warning Signs
In the case of eating disorders, much like any other mental illness, the warning signs are not always black and white. There are behavioural changes as well as psychological and physical ones that may set off alarm bells.
⦁ Sudden or rapid weight loss
⦁ Frequent changes in weight
⦁ Sensitivity to the cold (feeling cold most of the time, even in warm environments)
⦁ Loss or disturbance of menstrual periods (females)
⦁ Signs of frequent vomiting - swollen cheeks/ jawline, calluses on knuckles, or damage to teeth (particularly if somone is suffering from bulimia)
⦁ Fainting, dizziness
⦁ Fatigue - always feeling tired, unable to perform normal activities
⦁ Constant or repetitive dieting (e.g. counting calories, skipping meals, fasting, avoidance of certain food groups or types such as meat or dairy, replacing meals with fluids)
⦁ Evidence of binge eating (e.g. disappearance of large amounts of food from the cupboard or fridge, wrappers appearing in bin, hoarding of food in preparation for bingeing - especially amongst bulimia sufferers)
⦁ Evidence of vomiting or laxative abuse (e.g. frequent trips to the bathroom during or shortly after meals - again, more common amongst sufferers of bulimia)
⦁ Excessive or compulsive exercise patterns (e.g. exercising even when injured, or in bad weather, refusal to interrupt exercise for any reason; insistence on performing a certain number of repetitions of exercises, exhibiting distress if unable to exercise - most common in sufferers of orthorexia)
⦁ Making lists of ‘good’ and ‘bad’ foods
⦁ Changes in food preferences (eg. refusing to eat certain foods, claiming to dislike foods previously enjoyed, sudden interest in ‘healthy eating’)
⦁ Development of patterns or obsessive rituals around food preparation and eating (e.g. insisting meals must always be at a certain time; only using a certain knife; only drinking out of a certain cup)
⦁ Avoidance of all social situations involving food
⦁ Frequent avoidance of eating meals by giving excuses (e.g. claiming they have already eaten or have an intolerance/allergy to particular foods)
⦁ Behaviours focused around food preparation and planning (e.g. shopping for food, planning, preparing and cooking meals for others but not consuming meals themselves; taking control of the family meals; reading cookbooks, recipes, nutritional guides)
⦁ Strong focus on body shape and weight (e.g. interest in weight-loss websites, dieting tips in books and magazines, images of thin people)
⦁ Development of repetitive or obsessive body checking behaviours (e.g. pinching waist or wrists, repeated weighing of self, excessive time spent looking in mirrors)
⦁ Social withdrawal or isolation from friends, including avoidance of previously enjoyed activities
⦁ Change in clothing style, such as wearing baggy clothes
⦁ Deceptive behaviour around food, such as secretly throwing food out, eating in secret (often only noticed due to many wrappers or food containers found in the bin) or lying about amount or type of food consumed
⦁ Eating very slowly (e.g. eating with teaspoons, cutting food into small pieces and eating one at a time, rearranging food on plate)
⦁ Continual denial of hunger
⦁ Increased preoccupation with body shape, weight and appearance
⦁ Intense fear of gaining weight
⦁ Constant preoccupation with food or with activities relating to food
⦁ Extreme body dissatisfaction/ negative body image
⦁ Distorted body image/ Body Dysmorphia (eg. complaining of being/feeling/looking fat when actually a healthy weight or underweight)
⦁ Heightened sensitivity to comments or criticism about body shape or weight, eating or exercise habits
⦁ Heightened anxiety around meal times
⦁ Depression or anxiety
⦁ Moodiness or irritability
⦁ Low self-esteem (eg. feeling worthless, feelings of shame, guilt or self-loathing)
⦁ Rigid ‘black and white’ thinking (viewing everything as either ‘good’ or ‘bad’)
⦁ Feelings of life being ‘out of control’
⦁ Feelings of being unable to control behaviours around food
It is important to remember that an eating disorder is not a diet- it is an illness. Someone who hates themselves, hates the way they look, feels unfit to show themselves in public, feels disgust and shame at the natural cravings of their human body, no longer has the perspective to see what they really look like, place little to no value on things outside of their weight and food, and live in constant pain, suffering from chronic cold, poor circulation, dizziness, fatigue and mental sluggishness, did not choose this life. It starts with a diet, but no one imagines looking a year down the line and seeing someone they don't even recognise. An eating disorder is not a choice- it is a leech. It sticks to you, sucking everything from you, mind and body until you have nothing left. Someone suffering from an eating disorder will be deeply attached to their disorder because it's insidious nature means it will have taken over every aspect of their lives. Most eating disorder sufferers when first confronted will deny, and even be shocked, affronted or offended by the insinuation that there is anything unusual in their behaviour. They will then become defensive, seeking to protect the only thing that they feel they have control over in their lives when in fact the disease has all of the control.
If you notice evidence of the presence of an eating disorder in someone you know, it is crucial to act, but you must remember that their brain functioning is impaired, they are under constant stress and are in constant fight or flight mode due to their body being in starvation. The way you broach the subject must be delicate, compassionate and carried out with extreme awareness- there's that word again. You need to know when to back off, perhaps try again another day, or try a different tactic.
Approaching someone about their eating disorder:
⦁ 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 confrontation.
⦁ 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. Don’t take it personally.
⦁ Be patient and supportive. Don’t give up if the person shuts you down at first. The important thing is opening up the lines of communication. 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.
⦁ Instead of asking about weight, inquire about how he or she is doing in general. Remember that eating disorders aren’t really about weight and food. They are expressing something else troubling happening in their life. The person you are concerned about may be much more willing to talk about the other things that are really bothering them—stress, grief, or anger etc. They may discuss the things triggering the eating disorder rather than the eating disorder itself
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”, "I am worried about you"
⦁ 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.
⦁ Avoid putting the focus on food; instead, try talking about how the person is feeling instead
⦁ Try not to take on the role of a therapist or dominate the conversation. You do not need to have all the answers; it is most important to listen and create a space for the person to talk
⦁ Avoid manipulative statements; e.g. ‘Think about what you are doing to me’ or ‘If you loved me you would eat properly.’ This can worsen the eating disorder and may make it more difficult for the person to admit to their problem
⦁ Do not use any threatening statements; e.g. ‘If you don’t eat right I will punish you.’ This can be extremely harmful to the person’s emotions and behaviour and can exacerbate the eating problem significantly
The most important thing to remember is that someone suffering from an eating disorder is lost and vulnerable. It can be helpful to think of them as a child when you're approaching them. (FYI, do not make it obvious you are doing this or take this advice literally- if anyone had spoken to me in a baby voice and broken English I would have broken their fingers.) What they need is encouragement and consistency- if you say you are going to be there, then be there, but know that you are not a therapist or a psychologist (and even if you are, you can't be in that role and the role of a friend/family member) and impress upon them that you will be there every step of the way, but you cannot 'fix' them. They need a serious medical, psychiatric and psychological intervention which, you are not able to provide. Their treatment may involve an inpatient programme, it may involve working out a treatment plan with their therapist or GP, but whatever the plan is, you do not judge. You are Switzerland. You hug and kiss and dry the tears, you listen and you comfort, but you are not on their side, you are not on the eating disorder's side and you are not on the doctors' side. You are on the side of recovery, if you are on any side at all.
Some days will be bad and some will be good. Some days, the person with the illness will have clarity and realise that they are a patient in need of help; the following day they may be in total denial. Some days I pinch my stomach or my thighs and I am disgusted; other days I feel the muscles in my legs and am thankful for recovery and the renewed strength in my body. Some days I feel like I lost- like I gave up on anorexia by eating, by wilfully gaining weight, by eating that extra biscuit and I feel like a failure. I feel embarrassed by my own weakness. Interestingly, the strongest thing I ever did was come back from anorexia for a second time. When I relapsed, I thought, this is it, this is me done. But here I am, almost back to a healthy BMI and 6 days out of 7 I am thankful for recovery and just a little proud of myself for making it.
Recovery is possible. It is hard, one of the hardest things a person will ever do, but man, is it worth it. I hope that any family members, friends, colleagues or loved ones reading this will have some sort of clearer insight into the mind of an ED sufferer. That being said, we prefer to be called Warriors. So, to all you ED Warriors reading this, stay strong, Let people help you. Let go of your pride a little for a while so that you might see more clearly. If people are clumsy and say the wrong thing, give them a break and try not to take it too personally; they are bumbling their way through this as best they can.
An eating disorder makes no sense. It is impossible to understand if you have not experienced it. Even while you are in the grips of it there is a part of your mind that knows it makes no sense. But it's a life-vest, a ring buoy- from what, well, that depends on the individual and you don't want to let that go. It's like holding a burning coal but being afraid to drop it because the fear of what might come if you drop it is worse than the fear that put that coal in your hand in the first place.
I hope this has been a help to someone, in some way. If there is a particular topic you would like me to write on, please do drop a comment or e-mail me and I'll make it happen. Likewise if you have any questions about this post, which, I realise is a lot to take in, leave a comment and I'll get back to you.
My Yogilateral Warrior, my ED Warriors and Soldiers, thank you as always. You inspire me.