by Michele Siegel, PhD., Judith Brisman, Ph.D., and Margot Weinshel, MSW
Rule #1: Accept your limitations. In order to be able to disentangle yourself from food issues, you must accept your own limitations. You will not be able to make someone eat or stop him or her from bingeing, purging or restricting. It is a part of the recovery process that you resolve your wishes to do so. The feelings you have of powerlessness, helplessness and frustration are natural, realistic reactions to a problem you have little control over. Regardless of your good intentions, your attempts to control someone else’s behavior always makes the problem worse and interferes with her capacities to change. You can’t argue someone out of an eating disorder, and nagging and criticism just makes someone more secretive. Women don’t have eating disorders because they don’t have the facts about how destructive and unpleasant they are.
The person you can change is you. The first step is removing yourself from the problem. This doesn’t mean ignoring symptomatic behavior and irresponsible actions. It does mean however, allowing the sufferer to make choices about her behavior unencumbered by power struggles and control battles.
Rule #2: Accept the other person’s right to in independent life — Don’t take charge. You can offer opinions and suggestions and exert an influence based on your relationship to the person. Keep the channels of communication open. Eating disorders thrive on isolation, secrecy and avoidance. Sometimes conflict and appropriate ways of expressing difficulties can make a relationship stronger. When there are problems, discuss them openly. But ultimately, each person has to make her own choices about how to conduct her life.
Until you can accept Rules 1 and 2, you will not be able to disengage from the eating disorder sufficiently for change to to take place!
Sharing A Household
When sharing a household with an eating-disordered person, the problems that arise about food and related household chores need solutions that respect everyone’s rights while not encouraging or provoking symptomatic behavior.
Rule #3: Don’t purchase (or avoid purchasing ) food solely to accommodate the eating-disordered person. Household food is to be shared by everyone. However, binge foods are to be supplied by the binger, not by you. Housemates are not to be deprived of foods they enjoy despite the possible temptation to the binger. On the other hand, ‘health’ food, diet food or the like should not suddenly be introduced as part of the household diet to entice the binger or restricter to eat better.
If your daughter, spouse, roommate, friend or relative is anorexic, you may be tempted to have food on hand that may entice her to eat, or foods you know she used to enjoy. Unless it is at her request, do not provide food with the purpose of seducing her to eat. lt won’t work!
It is crucial that the eating-disordered person not be the focus of the household’s food decisions. You may feel like you are helping her by eliminating all sweets from the house. This does not help. What you are doing is preventing her from facing the seriousness of her problem and thwarting her motivation to do something about it.
In some households it is helpful to establish food shelves for each household member. Members choose foods they want for themselves and these become non-shared items. If these item are missing or eaten by the eating-disordered person, she is responsible for replacing them.
Rule #4: Each household member decides individually what he or she will or will not eat. No one should be forced to eat anything nor be restricted from eating anything. Do not encourage the eating disordered person to eat foods she may not want. On the other hand, do not withhold foods from her because they are fattening or unhealthy. Making someone else’s diet decisions in the home leaves her unprepared for making those decisions outside the home. Questions like, “Do you want a taste” or “Would it satisfy your craving just to have one bite” are not helpful and should be avoided.
Rule #5: Don’t make mealtime a battleground. Mealtimes need not be tense. The eating-disordered person should be treated like everyone else and invited to join at meals if this is how the household generally functions. If she chooses not to come to the table, make it clear that she needn’t eat, but you would like to have her company. Say it in a calm voice and if she still won’t come, say, “Okay, but I hope you’ll join us next time.” Don’t stop asking her to join you, even if she keeps refusing.
Rule #6: Be willing to negotiate household chores involving food. In some households the eating-disordered person may be responsible for cooking either all the time or on a rotating basis. If this is uncomfortable for the household member with the eating disorder, consider swapping chores for something that does not involve food.
Rule #7: The eating-disordered person is responsible for her behavior whenever it effects others. BATHROOM MESSES: If someone is vomiting, they are responsible for leaving the bathroom clean and usable for the next person. This is inflexible and not negotiable. REPLACING FOODS: If someone binges, she is responsible for leaving the kitchen clean and usable.
Rule #8: Don’t monitor someone else’s behavior (even if you’re invited to do so). Decisions about whether you are going out or staying home should be based on how you would like to spend the day or evening. The decision should not be based on being available to control someone’s eating.
Rule #9: Do not use money to control another person’s eating behavior. If the person you are concerned about weren’t eating-disordered, what would you feel was appropriate behavior regarding payments, allowances and shared expenses? We know many families in which the women have been offered money to gain or lose weight.
Don’t do this! This never works and will only increase your daughter’s feelings of failure in the long run. Additionally, it treats her serious eating problem as if it were simply a lack of motivation.
There are times when money can and should be used as leverage to encourage women seeking treatment for her disorder. When money is considered leverage, professional guidance should direct your behaviors.
Eating Out, Entertaining and food
Rule #10: Do not anticipate someone else’s needs. Ask! You cannot know and should not anticipate for someone else what will cause discomfort. The only way to be sure is to ask. Be willing to negotiate. There are many activities you can share with someone that are not food or weight related. Consider museums, lectures, long walks… Try not to take things personally. It is not to hurt you that the person is not eating. When you feel hurt, it means the food problem is escalating to a problem in your relationship.
Rule #11: Don’t make eating out a battle of wills. This is tricky business: if you love to eat out and she is uncomfortable eating in restaurants, talk with her about it. Can she be in a restaurant without eating? Are there certain restaurants that feel “safer” for her than others? You may find you’re uncomfortable if your companion is not eating and you are. Don’t push her to eat to ease your discomfort, and next time plan to do something else.
Giving Advice and Opinions
Rule #12: Do not offer advice or opinions. People with eating disorders are often searching for approval from those around them. It is very tempting to reassure them that they look fine or to offer your advice about weight or clothes. It may also be tempting to tell them to lose weight if they are overweight or in other ways influence their behavior with suggestions, like telling them what to do in a given situation.
These requests are signs of anxiety and insecurity. Your reassurances or suggestions may at best provide temporary relief. But in the long run, they further interfere with the person developing her own capacity for judgment and self-worth.
Be supportive. Tell the person you care about them and feel badly when they emphasize their weight and looks to the exclusion of their other qualities and traits.
Rule #13: Do not play therapist. Be on the lookout to see if you have taken on the role of therapist, thereby minimizing the need for your daughter, wife or friend to talk with someone on the outside. Do you feel the burden of having to say the “right” thing, ask the “right” questions, listen to unending conversations about eating with the hope of erasing the problem? If you notice yourself doing this, step back from taking on these responsibilities and tell the other person you cannot help her in this way. This will encourage her to look elsewhere for help. Since she is in treatment, stepping back will ease the burden you are inevitably feeling and relieve some stress in the relationship. You may feel you are abandoning the person you care about. Be assured that this is not the case. When she talks abut her troubles with food and/or weight, remind her that you know these preoccupations indicate she is feeling badly about herself. There are ways of resolving those feelings and achieving a more positive sense of herself and, as much as you care, you’re not the best person to help her out with these matters.
Signs of over-involvement: difficulty following these rules; even though you don’t want it to, eating behavior and/or weight fluctuations of your daughter, spouse, lover or friend determine how you feel during the day, making it a “good day” or a “bad day” for you; you are preoccupied with the eating-disordered person’s behavior; your preoccupation results in neglect of other things you should be doing (especially for yourself); acting like a detective, you engage in secretive behavior, looking and listening for signs of bingeing, purging, exercising or the like. If over-involvement pertains to you, then get help for yourself. Sometimes it is important to have someone you feel will listen to help you with how things are for you. It is very common for parents/husbands/partners to seek counseling for added support. Also, keep up your own friendships and interests. Not only with this nurture, it will demonstrate to your wife/daughter/lover/friend that taking care of oneself is important.
Rule #14: Do not comment about someone’s weight and looks. Telling someone with an eating disorder that they look good or thin is not necessarily received as a compliment. Such statements can be understood to mean that their weight and looks are being observed and assessed. And, while at the moment they may meet with approval, these remarks can generate a good deal of anxiety about how they have looked previously and how they will look in the future. So, while you may give a compliment in an offhand manner or mean it to be supportive, it can have effects beyond your intent.
Oftentimes when women leave treatment, they have very mixed emotions. On the one hand they are excited to get on with their lives, but on the other hand, they are anxious about what their families may expect from their having been in treatment. Most likely, family members have similar excitement and concern. We commonly hear from women, “I’m afraid my family will expect me to be cured.” From family members we hear, “I want to do what is best for my daughter/wife/partner/friend, but I’m not sure what this is.” It is normal for the woman and family members to feel tentative, scared, angry, hopeful, disappointed–almost any feeling you can imagine. It is a very fine line to walk between being concerned about someone and trying to control their behavior or being polite and blatantly ignoring behavior that seems to cry out for comment. It is a line that patients have to walk with other patients while in treatment and many will say, “Now I know how my family feels with me.”
Although everyone would like the treatment to be a cure, the reality is that recovery from an eating disorder should be seen as a commitment that requires a two to three-year recovery process, including individual therapy, couples and family therapy when appropriate, and support groups. Your daughter/wife/parlner/friend has not “failed” in her recovery if she still struggles with symptoms like vomiting and/or restricting.
- The exception to this is in extreme cases when someone is afraid she may harm herself. In these situations, you should be acting under the supervision of a professional.
The bulk of this material was adapted from:
Surving an Eating Disorder: New Perspectives and Strategies for Family and Friends
by Michele Siegel, PhD., Judith Brisman Ph.D., and Margot Weinshel, MSW
(Harper & Row Publishers, New York, 1988)