Even if you’ve never personally experienced an eating disorder, there’s a chance that you’ve still been affected by one, either directly or indirectly. According to the National Association of Anorexia and Associated Disorders (ANAD), an estimated 30 million people in the U.S. are living with an eating disorder, and eating disorders can affect people of all ages, genders, and ethnicities. But what's not reflected in these stats are those who care for people living with eating disorders, who also may need mental health support.
My sister is a survivor of an eating disorder. We were in high school when she developed bulimia. It started slowly at first, something that no one in our family noticed except for me, but when she started looking at colleges, the stress exasperated the issue. As not just her older sister, but her best friend, I didn’t know how to handle my sister's eating disorder. When I confronted her, she denied it. When I brought it up to my parents, they also refused to see it.
Just as my sister's disorder is common — ANAD says 1.5 percent of U.S. women will develop bulimia at some point in their lives, and 0.9 percent of women will develop anorexia — my family's reaction to it is equally widespread.
“Being in complete denial is all too common,” clinical psychologist and therapist at Flourish Chapel Hill PLLC, Stephanie Zerwas, Ph.D, tells Bustle. It's this denial that, according to Mirror Mirror, an organization that offers eating disorder help, that makes definitive eating disorder stats and percentages tough to nail down.
But no matter how common the denial might be, turning away from an eating disorder isn't going to make it go away; it has to be addressed. And addressing it, experts say, needs to be done in a way that isn't accusatory or judgmental.
"I recommend approaching your loved one in a conversational matter to make sure that they understand you are there to help," Dr. Jennifer MacLeamy, PsyD, an executive director at Newport Academy, an adolescent treatment center, tells Bustle. "Let them know that you’re concerned about them, not judging or criticizing. Use 'I' phrases, such as, 'I care about you' or 'I’m worried about you,' so they won’t feel attacked." The point is to break through to those denying the disorder and help your loved one recognize that they have an illness. "The most important thing to do for a person with an eating disorder is to encourage them to seek help from a trained professional," Dr. MacLeamy says.
Even now, I can't forget what my sister went through, but I also wish that my 16-year-old self had known what to do.
"One piece of advice we always give people who want to support a friend or family member is to stick to the facts and express interest," Zerwas says. "If you describe and ask about the situation without judgment, guilt, blaming, and criticism, it will be so much easier for your loved one to hear you. Instead of saying, ‘Ugh, you are so selfish. Why do you always prioritize your stupid diet over going out to eat with your family? If you really cared about us, you’d change’, try sticking to the facts.” Facts can be anything from pointing out that your loved one isn't quite their usual self, then giving examples of what you've noticed.
A softer approach, according to Zerwas, would be: “I’ve noticed that you don’t go out to dinner with us these days and I’m wondering if your eating pattern has something to do with it. I really miss seeing you there.” This type of approach might even open up a productive dialogue. But, Zerwas points out, eating disorders are so steeped in stigma that trying to break through that wall isn't easy.
“Help them understand that you’re always going to be there for them without judgment, and just want what’s best for them,” Dr. MacLeamy says. “Showing empathy, compassion, and understanding will help break down any barriers that your loved one may have erected. Learning more about eating disorders is also a way that caregivers can join in the process of healing and recovery.”
But while doing all that you can to help your loved one with the eating disorder and being there for them is helpful, it’s important to not forget about yourself and your health.
“Making room to take care of yourself is critical,” Meghan Kacmarcik, RDN, LD, a registered dietitian, nutrition therapist, and founder of New Moon Nutrition, tells Bustle. “If you're not taking taking space for yourself and doing things separate from your caregiving duties, you're likely to get burnt out, which isn't great for either person.” It’s not easy to care for someone you love who's sick, but if you don’t allow yourself space and take the time you need to practice self-care, you can’t be 100 percent present for your loved one. Practicing self-care is also a great way to be a positive example for a loved one with an eating disorder.
“It’s important to remember that when you take care of yourself, you also model good self-care to your loved one,” Zerwas says. “Often people with eating disorders say that that they feel like it’s selfish or wrong to nurture themselves through food or rest. Often we’re given the message that if we take care of ourselves, we’re taking energy and time away from others.” By taking care of yourself, you can show your loved one that nourishment, rest, and moderation are essential to a healthy and happy body and mind.
It can be so raw to ask for help.
While my sister was able to recover from her eating disorder by the end of her freshman year at university, and did not seek professional help, that’s not always the case. For many who have an eating disorder, professional intervention, such as therapy or hospitalization, may be necessary — like with any other mental illness, sometimes love and support from friends and family can only go so far. The National Association of Anorexia and Associated Disorders has a directory of all forms of help.
“Treatment and recovery need to begin as soon as possible, as eating disorders have the highest mortality rate of any mental health condition,” Dr. MacLeamy says. “For that reason, it is vital to pay attention to possible warning signs, which include both behavioral and physical symptoms." Some of the signs of an eating disorder include, but aren't limited to, always being on a diet, obsessively counting calories, making up excuses to not eat or avoiding social situations where food is involved, and a drastic change in weight. With an adult who has an eating disorder, family members may be unsure “with when and whether they should push or listen,” Zerwas says. But at some point, when you feel like you've done all that you can do with words, it's time to intervene. You have to be proactive for your loved one.
"Early intervention, especially in eating disorders, is key," Zerwas says. "The longer things go on, the harder things are to shift. People with eating disorders often describe that they feel like in a deep rut that is really hard to get out of. It can be so raw to ask for help."
Even when people have immense amounts of support, the idea of recovery is one that needs to be approached with nuance.
“There are so many debates from people who say that they are ‘in recovery’ vs. ‘fully recovered,’ and honestly, that distinction is incredibly personal,” Zerwas says. “But often people in recovery from an eating disorder describe it like having an Achilles heel. During times of stress, uncertainty, or big changes, those old eating or thinking patterns can feel tempting to fall back into. The eating disorder can pop in your head like an old frenemy suggesting a quick fix to make it all better."
While there isn't one "definitive cure," Kacmarcik says, "[p]eople can fully recover from an eating disorder or get to a place where disordered behaviors and thoughts are no longer controlling their lives.”
Human beings, whether or not we have a mental illness, are a work in progress. Unfortunately, there's no switch to make some of our journeys easier and less complicated. What's most important is being there for your loved ones, showing unconditional support, but also making time for yourself. To empower others to recover, you need to be empowered and strong enough for yourself too.
If you or someone you know has an eating disorder and needs help, call the National Eating Disorders Association helpline at 1-800-931-2237, text 741741, or chat online with a Helpline volunteer here.