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Family & friends' FAQs about eating disorders

Can I make someone have treatment?

It is important to remember there is always at least a part of a person with an eating disorder that does not think they have a problem and so does not see a need for treatment. This is extremely difficult for those who love and care about them and may be a source of anger, frustration or despair which makes it even harder to relate to the sufferer.

Treatment almost always involves getting alongside a person with an eating disorder and working with them towards recovery. Sometimes this is impossible, especially in the early stages, and particularly when starvation makes their brain work less well. So it's important to help a person with an eating disorder get treatment as early as possible, and then encourage them to see a health professional such as their GP.

When a person's physical safety is at risk because of an eating disorder or any other mental health problem, treatment can be imposed against their will. Doctors can use the Mental Health Act to require treatment in hospital if necessary. Others in the community, including family, can apply to the courts to have a person assessed with a view to being committed for hospital treatment if necessary.

Once patients are safe to be out of hospital they are seldom treated against their will. It is very unusual to commit patients for long periods of treatment. To do so risks damaging the relationship treatment providers have with their patients and may make long-term recovery more difficult or impossible.

How do I approach someone who has an eating disorder?

An eating disorder is an illness that affects a person's thinking and behaviour – it is not a consciously naughty behaviour to gain attention or to control others. So you should approach a person with an eating disorder with concern and compassion.

Eating disorders, like other illnesses, can make other people feel awkward or afraid. It's always appropriate to try to understand what is happening to the person suffering from an eating disorder and to offer to be involved in helping towards recovery.

Pretending that nothing is wrong or ignoring behaviours that promote the eating disorder are unlikely to help.

How much you become involved in helping a person who has an eating disorder depends upon your relationship with them. Obviously if they are a family member you are likely to be deeply concerned and involved in helping them recover. In other situations, asking "what would I want this person to do to help me if the situation was reversed?" is a useful guide.

I suspect a colleague has an eating disorder, what should I do?

As with any illness in a person you know and care about, it is usually best not to ignore the problem. But neither should you be intrusive, and there are special difficulties with eating disorders.

If the answer to the question "Would I ask about this person's health if they had a serious physical illness such as cancer?" is yes, then approach them about the problem.

As with other illnesses it is usually best to express general support and concern. People with eating disorders are seldom willing to discuss food or weight. It is usually better to express concern about their general wellbeing or their energy levels, for example, and to ask if there is any way you can help.

If they refuse such support at first, you can offer it again. Be guided by your relationship with the person in terms of what further involvement you have. For example, if you have mutual friends or know their family, you can raise your concerns with them. If their illness creates a managerial or performance issue you should discuss this frankly and ask for a medical opinion if this is appropriate.

Is it safe to let my child exercise?

First, you should get a health professional such as a GP or a dietitian to confirm that your child is underweight. Then agree on a plan to restore their body weight to normal – this should be guided by a health professional, never by coaches or instructors.

Your child's energy balance should be adjusted once medical causes for being underweight have been excluded. This will mean extra food to compensate for any exercise or sport they do. If a child (or indeed an adult) is underweight and is not recovering to a healthy weight, exercise or sport is not appropriate until they start gaining weight.

Some sports are notorious for encouraging girls to maintain body weights far below their healthy range. You cannot rely upon those involved in these sports to act in the best overall interests of your child. Any concerns you have about your child's health, including their weight, should be managed by independent health professionals such as GPs and dietitians.

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The GP said not to worry, what should I do?

It is very easy to underestimate the severity of an eating disorder, especially if you have only a snapshot of a person. Families will often have a deeper awareness of what is going on. They must be prepared to observe and review the situation over time and to report on what is happening. You might need to visit the GP more than once to point out changes in eating, exercise patterns, behaviour and weight over time.

If you are worried about your child having an eating disorder, ask your GP to review this situation after a time and to include physical measurements such as weight, height and blood tests in the review.

If you are still concerned, it is reasonable to ask your GP to refer your child for a second opinion or to a specialised eating disorders service.

What if someone with an eating disorder doesn't want help?

It is normal for a patient with an eating disorder to appear to not want help or to refuse offers of help. Usually a part of them does want help but is afraid of treatment or recovery and especially of giving up control to others. They may mistrust the motives of others, including health professionals, and they will need reassurance that others understand their dilemma but are concerned about them.

Continuing to express concern compassionately is helpful. Gentle confrontation by people they respect, including friends, relatives or school counsellors, can be useful, especially if the focus remains on wanting to understand and to help.

When a person with an eating disorder appears physically unwell, is losing weight rapidly or has stopped eating and drinking almost altogether it is important to seek advice from a health professional. It may be necessary in the short term to treat them against their will. GPs should be able to advise in these situations and can seek extra support or information from specialist services. Agencies in the community such as the Eating Awareness Team are also a useful source of information and advice.

What is going on inside their head?

This is an extremely complex question.

Many factors contribute to the development of an eating disorder. Some of them involve the uncertainty, lack of control and unpleasant feelings that go with moving from the safety of home and childhood into the world and adulthood. Traumatic experiences and possibly anxiety and mood disorders may also be involved.

As an eating disorder becomes established it promises a solution to all these problems with a single idea of controlling shape and weight. Because the decision to manage things in this way happens unconsciously, a person with an eating disorder may be confused and not know why things are the way they are. They simply know that to eat or to gain weight raises terrifying feelings and emotions. They resist these feelings at all costs, including the risk to their health or things they previously enjoyed.

Eventually, their identity can be so closely aligned with the eating disorder that to give it up may feel like disappearing altogether, as it is the only part of themselves they know and trust and the only certainty they can rely on.

Written by the South Island Eating Disorders Service. Endorsed by HealthInfo clinical advisers. September 2013

See also:

Children of parents with a mental illness or addiction


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