Friends, Families, Carers
Family, friends and carers play a crucial role in the care, support and recovery of people with eating disorders.
They are also in the unique position of, in many cases, being able to detect the first signs and symptoms of an eating disorder, leading to early intervention and better long term outcomes.
The importance of early intervention
It is important to realise that anyone can experience an eating disorder. However, it is not always easy to detect evidence of an eating disorder in another person, as eating disorders cannot be identified by someone’s size or shape. This may make the characteristic behaviours of the illness difficult to recognise. It is also often very difficult for the person with an eating disorder to ask for help, and they may behave as if there is nothing wrong.
Being as informed as possible about eating disorder warning signs and symptoms will help you identify the early stages of the illness in someone you are concerned about. This may be a matter of reading the information on this website or seeking out further information from other, trusted sources.
The earlier you uncover an eating disorder in someone you care about, the sooner you can seek help, access treatments and begin working towards recovery.
You can also talk to a professional who has specialised knowledge about eating disorders and who can provide advice and support and help you determine whether or not someone you care about has an eating disorder. You can talk to your family doctor or GP or you can call the National Helpline for advice and support.
Understanding the stages of change
There are five stages of change that a person with an eating disorder may go through. Everyone is different, and some people may pass backwards and forwards between these stages. Throughout each stage there may be behavioural signs which will help you identify what stage the person is in and how you can best approach them.
In the pre-contemplation stage a person with an eating disorder will most likely be in denial that there is a problem. You may have noticed some of the warning signs and feel concerned about the person, but they will have little or no awareness of the problems associated with their disordered eating.
Instead, they may be focused on controlling their eating patterns. A person with an eating disorder in this stage may not be willing to change or disclose their behaviour and may be hostile, angry or frustrated when approached. This is because the person’s eating disorder is currently serving as a way to control or avoid strong and unpleasant emotions. The person may feel unwilling or afraid to let go of these behaviours.
What you can do:
• Stay calm and try to see things from their point of view using active listening techniques.
• Show compassion and understanding.
• Take the focus off their disordered eating. Talk about their interests, goals in life and the things they may be missing out on as a result of the eating disorder.
• Don’t give up on the person you are supporting, perseverance pays off in many cases in getting someone into treatment.
• Become familiar with our tips for talking to someone you are concerned about, which you can find here
• Encourage or support access to medical treatment if their health is compromised, especially in children and adolescents.
A person with an eating disorder in the contemplation stage will have an awareness of their problems and may be considering the benefits of changing some of their behaviours. They swing between wanting to change and wanting to maintain their disordered eating habits. This can be difficult and confusing for you and the person you are caring for.
What you can do:
• Listen to what the person has to say. Demonstrate that you are listening to what they are saying, and you understand their struggle. You can even say it back to them e.g. “I hear you saying that part of you feels like you want to change, while another part of you feels scared of changing...”
• Show them you respect their ideas, particularly the ones in favour of change.
• Highlight the discrepancies in their thinking/actions and amplify the positives for change.
• Try to boost their self-esteem and confidence. This will help them believe they can change.
Preparation / Determination
In this stage the person with the eating disorder has decided they want to change their behaviour and is preparing to make these changes.
What you can do:
• Be informed. Learn as much as you can about the steps you and the person you are caring for need to take in order to recover.
• Work with the person to identify their goals and develop a detailed approach of how you will manage the changes together. This may involve developing a treatment plan including wellness and crisis support plans.
A person with an eating disorder in the action stage has decided they want to change and will need support to help them take the first steps towards recovery. The person can move backwards and forwards in their development during this stage and relapse can be common.
What you can do:
• Acknowledge how difficult it is to change and recover from an eating disorder.
• Support the person through challenges and let them know you believe in them. This will help build their confidence.
• Review and refine goals and treatment plans as progress is made.
In the maintenance stage a person with an eating disorder will have changed their behaviour and may be focusing on maintaining their new, healthier habits while learning to live without an eating disorder. This takes time and requires commitment. It is still possible for a person with an eating disorder to relapse at this stage.
What you can do:
• Work together with the person to identify triggers that may impact their recovery.
• Accept relapse as a part of learning and the process of recovery.
• Put systems and strategies in place to help avoid relapse.
• Show care, patience and compassion.
Helpful tips for carers
Recovering from an eating disorder can be a very slow process and can sometimes take many years. Each stage will bring its own triumphs and challenges to both the person with the eating disorder and to those caring for them. Here are some tips to help you along the way.
Learn as much as you can
Having a good understanding of eating disorders will help you to identify what is happening to the person you are caring for. There is information available to provide you with skills and coping mechanisms to help you throughout this difficult time. You can find a useful overview of eating disorders here.
Remember who the person is
Do not let the eating disorder take over the person’s identity. Remember that they are still the same person they have always been. Separating the person from the illness can be helpful for you and the person you are caring for. This is called externalisation and helps all involved to see the illness as the problem and the person you are caring for as part of the solution. This can be very empowering for everyone involved, as the target of all treatment is the problem not the person.
Communicate openly, without judgement or negativity and allow the person to express how they are feeling. Avoid focussing on food and weight and instead try to talk about the feelings that may exist beneath the illness. Pay attention to the person’s non-verbal reactions and body language and encourage them to trust and speak openly with you.
Draw attention to the positive attributes the person has. Talk about the things they enjoy and are good at and the things you love about them. Reminding the person of their life outside of their illness can help them to realise there is more to them than their eating disorder.
Make time for yourself
Prioritising “time out” for yourself will help restore your energy and rejuvenate your mind. Make the time to see a friend, go for a walk, do some exercise or see a film. The better you care for yourself, the more you will be able to help the person you are caring for.
People with eating disorders can experience a range of different and conflicting emotions all in one day. This can be very hard for you and the person you are caring for to manage. The road to recovery is littered with emotions and setbacks and can be a long journey. It is important to be as calm and patient as possible throughout their recovery and remember that there is no quick fix. Recovery takes time and patience.
Seeking professional support can reduce the amount of stress you carry and improve your capacity to care for someone with an eating disorder. Community based organisations and respite centres are equipped with specifically trained professionals who can assist you with skills based support, support for your physical and psychological well-being, help with employment and also provide information booklets, brochures, peer support groups and networks.