Dealing With Family Members With Eating Disorders Who Won't Admit It

We all have a member of the family who has an eating disorder and won't admit it. The number of people, both male and female, with eating disorders is rising, especially among youth as new fads come and go. The key is to take it slow (but not too slow) and remember a few basic rules of thumb:

Beware of restricting behaviors

If your loved one restricts their food to lose weight (except for obesity treatment), this can indicate a preoccupation with image and or a control issue. They are often intertwined. Restricting alone indicates an investment of time and energy in image or control but restriction in combination with a significant weight loss indicates a serious health threat.

Monitor food consumption

Always monitor your loved one's eating behaviors. Keep note of when they are eating and what they are drinking so that you know if they are restricting their diet, if they are just restricting certain things, only drinking liquids, only eating in front of people, or binging and purging etc. Be aware of their caloric intake in relation to the calories they are burning and how much they should weigh in relation to their height. The best way to judge this is based on their weight before the eating disorder.

Offer food

Always offer food. This can help you in the feeding and monitoring process. If you offer food you can either ensure that they eat in front of you or use the moment to show your loved one that you see what is going on. Try offering something they have always liked historically and asking them about the change in preferences. If they eat what you are offering, watch to see if they go to the restroom after eating, this may indicate purging and bulemia.

Notice behavioral changes

Eating disorders can alter the brain, create anxiety and influence behavior. Behavioral changes may include changes in food, clothing and other preferences. You may notice that individuals are not eating certain foods they once loved very much, that they are spending time with a new set of friends or dressing in a new vein of fashion. They may also abandon long held values and beliefs. It is significant if these changes coincide with weight loss and other symptoms of an eating disorder.

Monitor attitude

Usually someone who is healthy will not mind if you are looking out for their health. Note if your loved one seems to have an inability to appreciate the severity of the situation, is defensive when talking to you about their eating habits and if they are willing or unwilling to undergo therapies to regain lost weight. If they are unwilling to regain lost weight chances are they have some form of eating disorder.

Watch image behaviors

Image disorders and eating disorders often go hand in hand, sometimes feeding off one another. Indicators of an image disorder include the pursuit of clothing and hair trends or a specific image, behavioral changes in voice, posture and carriage, increased time spent with others who value image choices, being very specific about clothing choices, reporting a feeling of discomfort in clothing which does not match their image etc. Remember that even if your loved one does not show signs of an image disorder they may still have an eating disorder. Reluctance to maintain or achieve a healthy weight is a key feature.

Check Facebook

A lot of people with eating disorders will post images of themselves. Look to see if they are self fixating, if they post or went through a phase of posting "selfies" and if the images they are/were posting are intended to make them look especially thin. This is an indicator of image orientation and approval seeking behavior and suggests an image disorder based eating disorder when taken in conjunction with a change in weight.

Take note of clothing choices

Clothing choices can tell you a lot. If your loved one seems to be very thin but wears large concealing clothing this may be an indicator that weight loss is motivated more by an inner need for control. If they wear tighter fitting clothing, this may be an indicator that they are satisfied with their weight loss, are image fixating and seeking the approval of others. Image fixation and control are often mutually reinforcing variables and can trigger one another.

Watch for low self esteem

Many people with eating disorders and image disorders will have low self esteem. Watch to see if your loved one looks for praise or is upset by criticism, especially about their image, clothing, hair, or other aspects of appearance or lifestyle. An inability to deal with differences in opinion, especially about personal esthetics can be an indicator.

Identify life changes

Eating disorders can come about as the result of a major life change such as a break up, death in the family, graduation, loss of a job etc. A traumatic event can trigger anxiety and depression, loss of appetite and deliberate or subconscious restricting. Your loved one may enjoy the adrenaline or the compliments, which may distract them from their problems, provide a sense of control and/or boost self esteem.

Avoid bargaining behaviors

You may find that your loved one has a tendency to bargain, to refuse to discuss their eating disorder with you unless you agree to recognize that they "do not have an eating disorder", "are healthy" etc. You can indulge this within reason to prevent them from pulling away but they must eventually understand that you believe they are not healthy and do have an eating disorder, especially if they are still under the dilution that people don't see what they are doing to themselves.

Manage behavioral reinforcement

Try not to reinforce negative behaviors. If your loved one is fishing for compliments or taking many self portraits, you will likely want to limit the praise. While you may want to maintain good relations, too many image compliments may be counter-productive to their mental health. Let them know that their new mini skirt or muscle shirt is a nice piece of clothing but they look too thin for your tastes.

Don't be an enabler

While it may be tempting to just ignore the problem to avoid contention, you have the ability to set boundaries. Let your loved one know that when you get together for dinner you expect that they all also be having dinner and that you are willing to forgo dinner if that is not the activity they plan to engage in.

Hide the scale and mirrors

If your loved one has either a fixation on weight or on their image, help them break the fixation by getting rid of as many reminders and temptations as you are able. Get rid of the scale, the mirrors, the fashion magazines, the home fashion network and HGTV. Get rid of the social reminders that tell you how to fit into a cookie cutter mold. Find the image they are buying into and eliminate examples from their surroundings.

Set a good example

You can be a good example by exhibiting behaviors which are healthy for your loved one. If they see you engaging in them they may be more likely to join you. Make sure you eat the foods they are cutting out of their diet, offer to make dinner and include them. Eat realistic portions and go to the fitness center. Eating and working out is always a better alternative to simply restricting your diet. If they are underweight drink some protein formula and let them know they are available.

Pay attention to anxiety and depression

You may notice that there is some anxiety or depression. These tend to go hand in hand with eating disorders and may also be catalyst to an eating disorder. Remember that the less food being consumed, the more anxiety and depression are likely to occur. If the brain does not have enough nutrients it will be foggy and cannot function in its best interests. If your loved one cannot act in their best interest there is little you can do but encourage eating until the brain has enough food to realize what it felt like before the depravation.

Watch for major life traumas

Major life traumas come in all shapes and sizes and can trigger an eating disorder. Just as one person controls their anxieties through drugs another may control them through eating or exercise practices. Examples of major life traumas are deaths of family or friends, break-ups, failures in school or career, physical traumas such as accidents etc. Large life changes such as marriage, graduation or having a child can also spur on an eating disorder.

Watch for other unhealthy coping mechanisms

Unhealthy coping mechanisms often go hand in hand and the presence of one increases the chances of others. Other unhealthy coping or control mechanisms which often go with anorexia include drug use, smoking, cutting, other forms of self harm or mutilation, self isolation from family and friends, denial or running away from rather than facing life's problems, physically moving locations, bouncing from job to job, denying one's self small pleasures or inflicting upon one's self small discomforts. Remember, one need not exhibit other unhealthy coping mechanisms, one is all it takes.

Don't be stupid

If you hear over and over again that your loved one is eating, that they don't have a disorder, don't be stupid and just take their word for it. You have eyes for a reason, use them. If they are eating, chances are they will look like they are eating, they will reduce their image and attention seeking behavior and will start to seem like their former self again. Remember the more severe the eating disorder, the more prolonged the recovery.

Call it like it is

You should let your loved one know you see whats going on. The more often they hear it, the more likely they are to believe it. Sometimes people with eating disorders will hide from others or convince their family and friends they do not have an eating disorder. Sometimes this comes from a place of control and sometimes it comes from a place of denial, either way it needs to be addressed. Don't be afraid to speak up, the longer the disorder lingers the harder it is to recover from and long term consequences are sometime unforeseeable.