How can loved ones support someone suffering from an eating disorder?

The first step in determining where to begin to with treatment options is with a medical exam by a physician that understands eating disorders. This is essential to determine if the individual is medically stable. If not, a medical hospitalization would be advisable before pursuing other options.

An unfortunate but undeniable fact is that most people must make treatment decisions with finances in mind. Most insurance companies are tightening the reigns on what they approve for residential or inpatient treatment of eating disorders. For this reason, it is recommended that outpatient treatment be examined as the next course to be pursued. This generally consists of the client working with a team of professionals that is made up of a physician, a nutrition therapist (registered dietitian), a psychologist or other mental health specialist, and, often, a psychiatrist. It is important that the team members are all experienced in the treatment of eating disorders and that they are willing and able to maintain effective communication with each other. Sometimes group therapy is also offered in this setting.

Inpatient treatment is often offered within the context of a psychiatric unit at a medical center or at a separate facility. These programs often treat other psychiatric and mental conditions. They may or may not specialize in eating disorders which may be advisable if there are other diagnoses present (i.e. substance abuse or sexual abuse issues).

Residential treatment centers offer intensive treatment in a non-hospital setting that allows for more freedom than inpatient. This type of treatment may last from as little as two weeks up to several months in duration. These facilities usually specialize in the treatment of eating disorders. Most often, the family of the patient becomes involved at some point during the treatment process. There is a complete team on staff and a variety of therapies are offered. This may include art therapy, body image work, and group therapy in addition to intensive individual therapy.

How can loved ones support someone suffering from an eating disorder?

If you suspect someone you care about is dealing with an eating disorder and has not acknowledged their problem, it is best to approach them with evidence and not conjecture. Someone who is in denial about their eating disorder is also more likely to listen to concerns if more than one person approaches them with those concerns at the same time. This is sometimes referred to as an “intervention”. This should occur in a calm, loving, non-judgmental setting.

You can enhance your ability to support your loved one by learning as much as possible about eating disorders. This may prevent you from unknowingly offering simplistic advice for a complicated mental disorder. Many a sufferer has been alienated from those trying to help them by hearing statements like “just eat” or “that behavior is so disgusting.” Suggested resources are listed below.

Helping ferret out treatment options, lending a listening ear or planning diversions to help make life less focused on the eating disorder can be caring ways to show support. Never take on the responsibility of the person’s eating disorder. You cannot become the food police or bathroom patrol. Practice patience and love, but don’t be manipulated. Lastly, don’t neglect your own emotional and physical health.

Binge Eating Disorder (BED) has only recently been recognized in the eating disorder field as a distinct disorder with its own set of characteristics. The criteria* for diagnosing BED are as follows:

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

1. Eating, in a discrete period of time (e.g. within any two hour period), an amount of food that is definitely larger than most people would eat during a similar period of time in similar circumstances.

2. a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

B. During most binge episodes, at least three of the following behavioral indicators of loss of control are present:

1. Eating much more rapidly than usual

2. Eating until feeling uncomfortably full

3. Eating large amounts of food when not feeling physically hungry

4. Eating alone because of being embarrassed by how much one is eating

5. Feeling disgusted with oneself, depressed, or feeling very guilty after overeating.

C. The binge eating caused marked distress

D. The binge eating occurs, on average, at least two days a week for a six-month period

E. Does not currently meet the criteria for anorexia nervosa or bulimia nervosa, purging or non-purging type.

F .Diagnostic & Statistical Manual of Mental Disorders, American Psychiatric Assn., Fourth edition.

BED is different than bulimia nervosa in that there is no purging component, such as vomiting, laxative abuse, or excessive exercise. Most people with BED are obese. It is estimated that between 20% and 50% of all obese people suffer from BED. People with BED are more likely to have been obese as children, experienced frequent bouts of weight loss and regain, have significant body shape distortion, and have other psychiatric problems such as anxiety or depression.

Compulsive Overeating (COE) is not formally recognized as an eating disorder diagnosis. However, the term “compulsive overeating” is often used by professionals and their clients to describe a disordered eating pattern that includes repeated bouts of over eating in response to emotional triggers and an obsession with food and weight. The overeating often occurs without conscious awareness. Binge-eating, as defined in the criteria for BED, may or may not be present. Overeating is usually described as eating when not hungry, eating beyond satiety, or eating based on emotional triggers.

People with COE are not necessarily obese. Dieting is often part of this disorder and can lead to subsequent overeating; causing a dieting/overeating cycle that is repeated over and over.