A family's guide to tackling eating disorders

The long road to recovery

Learning that someone you love is suffering from an eating disorder is never easy. Yet it's the aftermath that's often hardest to deal with. It's like a fall-out from war, only in this case, there are no quick promises of peace. For every five steps your loved one takes forward, she'll take 10 steps backward.

"Progress in an eating disorder is measured in years," says Carolyn Costin, MA, MEd, MFCC, director of the Monte Nido Treatment Center in Malibu, California. "Recovery will take a long time, and you have to prepare yourself for that."

Just don't give up hope. Bulimics and anorexics who want to get better can recover. "Recovery is attainable, but it's a matter of being patient and allowing that recovery process to happen," says Julie Clark-Sly, PhD, co-clinical director at the Center for Change in Orem, Utah.

Understandably, though, there will be times when your patience is tested. When you watch your loved one engaging in destructive behaviors. When everything you say or do triggers a defensive response. So what can you do?

Educate yourself

Perhaps the first step in helping your loved one recover is educating yourself about eating disorders. People often assume that eating disorders are about food and weight, but that's not true. "Eating disorders are about underlying issues," says Julie DeLettre Holland, MS, an Atlanta-based certified eating disorder specialist and director of outpatient professional development with the Renfrew Center.

To deal with those issues, hopefully you've encouraged your loved one to seek professional counseling. If her health is in jeopardy, you may have forced her into counseling. Consider asking her therapist to set up educational sessions for your family. The therapist may also suggest family counseling.

As you read books or attend educational meetings or family support groups, don't let the eating disorder consume you. "You have to take a break from the problem, especially if your loved one lives at home," Clark-Sly says.

Dismiss guilt

Guilt may eventually catch up with you, as it does for many families. How could you have let her suffer with this eating disorder for so long? How could you have prevented it? What did you do to contribute to it?

Experts say you shouldn't blame yourself. "There's no single cause for an eating disorder," Clark-Sly says. "You have not created the disorder." Every family makes mistakes, she adds. And certainly, if you're doing things that are contributing to the problem, such as being abusive, then you need to correct those things.

But you can't blame yourself for what you have—or haven't—done. "If you're focusing on that," Holland says, "then you won't be able to move forward and learn how to help."

Costin encourages families to stay solution-oriented. "You can have all the insight about why someone needs to control her food intake," she says, "but that won't change anything."

The dos and don'ts of helping her recover

The best thing that you can do is provide support. "She needs the family to be a steady, stable force of love and support," Clark-Sly says.

Yet there are things you can do to make things easier for you and your loved one:

• 1. Don't let your relationship with her be one-sided.
• When you're talking about her day, for instance, share information about your day, Holland says.
• 2. Keep the focus off of food.
• Whether you're at a family reunion or the dinner table, "focusing on food creates disaster," Clark-Sly says. Talk about the day's events, go for a walk, or play board games. Costin, a recovered anorexic, also suggests offering to serve something she'll eat if you're hosting the event. At holiday meals, her mother used to serve vegetables and salad so that it was less conspicuous that she wasn't eating gravy and stuffing.
• 3. Legalize all foods.
• "It's not healthy to cater to the belief that foods are good or bad," Holland says.
• 4. Be a good role model.
• Don't criticize your eating habits, encourage anyone to pursue slenderness, admire weight loss or excessive exercise, make negative comments about your own weight, start dieting, or keep a scale around the house. "You have no idea how much this affects her," Costin says.
• 5. Don't change the family's eating patterns.
• If, for example, you always keep M&M's in the pantry, don't stop. "She can always buy M&M's at the store," Costin says. "She has to learn how to live with M&M's in the world."
• 6. Ask her how she wants you to support her, Clark-Sly says.
• You don't have mind-reading abilities. Talking about how you can help is the healthiest way of dealing with things.
• 7. Don't try to take a certain behavior away from her.
• "You can't take a behavior away until there's a healthier one to put in its place," Holland says.
• 8. Avoid responding to "I feel fat" comments.
• She isn't in the frame of mind to receive feedback so don't give it. Instead, Clark-Sly says, tell her you're in a bind. Say that you think she looks great but you know she doesn't feel great and you don't know what to say.
• 9. Don't ignore destructive behaviors.
• Doing this empowers the eating disorder, Holland says. When you see her engaging in odd behaviors, show that you care. Ask if anything is going on or if she wants to talk.
• 10. Make her accountable for her actions.
• If she eats all your food or vomits in the toilet, ask that she replace the food and clean up her mess, Costin says.
• 11. Don't be afraid to approach her therapist with your concerns.
• Therapists won't reveal confidential information but they can discuss your concerns, Costin says.
• 12. Remember that there's no right or wrong reaction.
• "If you're always worried about how to relate, then you'll be fake and rigid," Clark-Sly says. "Be yourself and follow your heart."