If you have a friend or family member that you want to help suspect struggles with disordered eating or disordered exercise, and want to speak to them about seeking treatment, here are some ways of doing so:
Know that your talk with them may not seem to have an impact at the time of your talk…
Since many eating disorder behaviors are considered positive signs of discipline by individuals with them, they may disregard concern about them as threats to their hard earned efforts (to lose weight, omit food groups, over exercise, etc)
Other behaviors are highly secretive and shameful to individuals and require great sensitivity if brought up. It may be they deny having a problem, but another’s kindly spoken observations are helpful to break down denial and encourage seeking help.
Speak the truth ~ Then let go of the results
It takes courage to speak up, and an act of deep kindness. It is also important to let go of attachment to the results. We only grow when we become open to growing and no one else can decide when that will be. Your communication may add to the factors leading to someone’s decision to get help, but that is all.
A Nutritionist (Registered Dietitian) or Therapist ~ Who to Refer to? How Do I Find One?
If the fear in getting treatment is related to a fear of gaining weight, the person may be more willing to see a dietitian specializing in eating disorders first. It may seem less threatening to have their diet or metabolism analyzed for nutrition or exercise physiology advice rather than consider going to a therapist.
Psychologically trained dietitians (they must have extensive experience with eating disorders – check EDreferrals.com) know how to work with restrictive eating, bulimia and emotional overeating and will refer that patient to a psychotherapist soon after getting a safe attachment with the client. Many dietitians refer to therapists they work well with in a team. A dietitian may be the place to start in people that don’t want to admit to a disorder.
How to Approach the Talk
Organize your thoughts and your plan before you speak with them
It helps to have an opening statement about wanting to talk, and being honest that you may be nervous or this talk might be difficult…
Have in mind sharing any similar struggles in your past, using a bit of self disclosure as a way of normalizing and de-shaming their potential struggles. Any type of emotional issue or addiction of your own may be worth acknowledging….
Some “Do’s” and “Don’ts”:
- Speak with compassion. Keep in mind we all find maladaptive coping strategies that do seem to work initially. Most of us will find ourselves suffering from some form of emotional problem at some point in our lives, so come at it as a fellow human on a learning journey…
- Know that our culture has ‘disordered eating’. In other words, everywhere we turn, weight, eating advice, exercise advice and body image are topics of conversation. It is no wonder both genders and people of all ages get drawn into what is a disproportionate emphasis on body image and “healthism”. As a result, many young people feel that their obsessive relationship to body image or eating is quite normal these days!
- Eating disorders start out well intentioned, and like addictions, then get out of control. Do speak with respect for that individuals’ attempt at self- improvement, which may have gotten out of hand. Appreciating their initial effort to try to get healthy, or lose weight can help lessen defensiveness now that their behaviors may be out of control.
- Don’t come across in an accusatory manner. It just backfires.
- Don’t list the health risks of suspected eating disorder. People with EDs don’t respond to health risks as concerning and more than telling an addict that their addiction isn’t healthy. It just creates more anxiety, which can drive the disorder deeper.
- Don’t compare that person to anyone else, ever, at all.
- Don’t bring up other people and their concerns, like “your sister is worried about you too.” Keep the feedback from you and about your concerns.
- Don’t refer the patient to nutritionists that are not dietitian specialists. Do not refer this person to health practitioners likely to make nutrition recommendations, as ANY nutrition advice at this point only furthers the disorder. Well- intentioned practitioners that make diet or exercise recommendations (be it a personal exercise coach, a holistic practitioner) adds more fuel to the growing list of “good” versus “bad” foods.
- Don’t use patronizing statements like, “You are smarter than this”, “You know better” or anything implying shame in having a disorder.
- Don’t talk too much or too long. Keep your statements short and to the point. Otherwise you lose that person’s attention and interest in what you are saying.
SOME SPECIFIC STEPS that are helpful to do in series:
I. Open the conversation by asking if they have a moment to talk
Example: A) I have something I’d like to say which may be touchy to bring up. I’m a little nervous about saying this in a way that comes out right…
Example B) I’ve been thinking about you lately and I’d like to share some thoughts about some things I’m seeing…
II. Then kindly speak about 2-3 observations you have made re: their behavior.
Be specific and objective. In other words don’t go directly to your interpretation of their behavior. Don’t say “I think you have an eating disorder..” Rather:
Example A) I noticed you picking at your food the other night, and leaving most of it on your plate.
Example B) I noticed you got up from the table the last few night right after we ate and went into the bathroom. I began to wonder what might be going on…
Example C) Lately you’ve been getting up before dawn to go running. This is new for you, and then I noticed you going back to the gym in the evenings…
Example D) I noticed that there has been food missing from the cupboards, and it made me wonder what might be happening.
Important, in the above statements they are direct observations, but they are framed as what was noticed directly versus what you imagine or heard.
III. Third, after stating the observations with concern, and kindness, frame your observations as evoking curiosity in you about what might be signs of a larger problem.
Name the disorder or problem as best you can and state that your intention in this sharing is to ask the person to consider getting treatment.
Example A) What I saw made me curious to consider that perhaps you are struggling with bulimia and if so, I want to support you to get help.
Example B) I know personally what it is like being so afraid of gaining weight that I became obsessive about portions and over exercise. I know now that I should have sought help because there is excellent treatment available.
IV. Find a way of joining with the person through statements that offers understanding that well-intentioned health habits can become problematic or use personal self disclosure to normalize having a potential emotional disorder.
V. Check in as to what it is like hearing the observations and concerns you stated.
This invites them to share, and a chance for you to reflect back what it is they are saying. This “active listening” technique will help them feel understood by you, and whether or not they take action right away or not, it contributes to a positive experience toward being honest in the long run.
The individual may get defensive here, and this is an outlet for them to do so. Most people will react, and try to justify their behavior, saying they are fine and you don’t need to worry. If you are prepared for that very likely outcome, it helps! If they insist they are fine and there is nothing wrong… The goal is to leave the door open so if/when they are ready to talk about having a problem, you might be someone they could come to.
Responses can be something like:
Example A) Affirm their view, repeating what they said to you… “I get that you are happy to be going running this much and I know people are applauding you. I also know it can get out of hand, and at some point people feel controlled by their new diet thinking or their exercise efforts. If that happens, I get it and I’m happy to help.
Example B) Again affirm what they said so they know you heard them, “I hear you (say) that the missing food has nothing to do with you. I just know what its like to rebound after being so strict with eating, and I found myself (or knew someone who) couldn’t stop once they let themselves have more food. After awhile it gets annoying having everyone think so highly of someone for getting in shape or losing weight. In my experience its not that simple and I am someone you can talk to, or I found such and such a person really helpful.
If they admit to having a problem then you can move on to ideas about helping get treatment. Offer a few ideas of people/facilities to call, perhaps to go with them or help make that first appointment.
VI. Be specific about treatment options you have researched or have in mind.
Example A) I brought this up so that you know I care and that I’d be happy to help you consider treatment options. One option is just to see a dietitian that works with people who have focused weight concerns. She could see if you are fundamentally healthy and she knows how to keep weight off in very specific ways, once it has been lost. (Again many eating disorders start with a fear of gaining weight.)
Example B) I found a therapist (or program) right here in town that evaluates people for disordered eating. It is free and I heard they are friendly yet experienced in more subtle forms of eating/body image problems.
(Implying you don’t have to have a full blown eating disorder to go there…)