How Do I Talk to a Friend or Family Member With An Eating Disorder? (Or You Suspect They Do)

girl-food-s

This is 2017’s National Eating Disorders Awareness Week, and I’m excited to be writing a few posts based on requests.

My first post is how to talk to a friend or family member with an eating disorder or who might have one… from my perspective as someone in recovery. While I was struggling through the years, I heard from friends and family that they felt powerless. It was like watching a sinking ship and not knowing if they could do anything to stop its demise.

While it is impossible to cure another person, friends and family members are NOT powerless. I think about the camp counselor who talked about her own eating disorder openly without shame while I was symptomatic but not yet diagnosed; the friend who reached out to the school administration when she was concerned about me; my mom who spent countless hours trying to understand why I wouldn’t eat. I might have resented them at the time, but now I know that they planted seeds that would bear to fruition later. I didn’t enter recovery in their timing, but it did happen.

I will forever have memories of friends, family members, professors, and co-workers expressing their concern to me over the years. If you think that your words don’t make a difference or impact to someone deep within an eating disorder, you’re wrong.

I will give a cautionary note, however. For every good friend who expressed concern and gave me unconditional love during my journey, there was another who met me with insensitivity and stigma.

Talking to someone with an eating disorder can be a tricky endeavor. On the one hand, you want to express love and concern, but you don’t want to do so in a way that is off putting or hurtful.

In this blog post I will be outlining some “do’s and don’t’s” derived from years of experience of what has and hasn’t helped me.

  1. Do ask about it…

… but try not to probe or make assumptions.

Bringing up your concerns with someone you believe to be struggling can be anxiety provoking. It is a whole lot easier to pretend everything is okay. However, if you have a sinking feeling that something is wrong, and you are close enough to the person to broach the subject, by all means consider it.

Before you do so, consider these two things:

a) Don’t push it– If you bring it up and are met with defensiveness, it might not be the right time to talk. People with eating disorders can be highly secretive. In my deepest stages of denial and shame, I avoided all conversations about how I was doing. I remember how one time prior to admission to residential treatment, a teacher asked if I had an eating disorder. Taken aback, I mumbled something about having a rare digestive disorder. I wasn’t ready to admit how out of control or scared I was. Eight years later, I still remember that conversation as formative. She did not push the issue but expressed concern, and that meant a lot. Even though I wasn’t in a place to talk about it at the time, I respected her for bringing up the subject.

b) Check your assumptions– In society, we tend to associate eating disorders with “thinness” (whatever that means), but that’s just not accurate. Most people with eating disorders are not underweight. Anorexia is the most rare eating disorder, and bulimia and binge eating disorder are more common. People with eating disorders often fluctuate between periods of restriction, bingeing, and purging. I know some of my most symptomatic, out of control times were when I looked healthy. Don’t automatically assume that someone’s thinness is anorexia. It might as easily be a thyroid issue, an autoimmune disease, drug abuse, or simply body type. Similarly, don’t assume that someone doesn’t have an eating disorder because they appear to be healthy.

I have a “spidey sense” in my judgments about whether someone has an eating disorder, but I can be wrong. I am also careful about bringing up the subject of a possible eating disorder. Far before I bring that topic up, I make sure to talk about my own experience, normalize the reality of eating disorders, and check the facts.

. . .

2. Do seek consultation…

… but avoid gossip.

I can’t tell you how horrible it feels to know that people have been talking about you in the whispers you slightly overhear as you pass by and in hushed conversations you know have happened. I think by all means people learn more about eating disorders if they suspect a problem in a family member or friend. Education is important. Talking to a dietitian, therapist, or an organization like the National Eating Disorders Association can be a great move. HOWEVER, when that trickles into gossip and shaming, it stops being helpful.

Sometimes a family or friend group might need to get together to discuss how best to broach the subject with a loved one, but as soon as it turns into judgment and teasing, it can become toxic.

A note about consultation: It is strangely easy to read an article from BuzzFeed or some other reputable source (joke, but in full disclosure, I love BuzzFeed) and think you’re Dr. Phil or something. “Is it about control?” I’ve had people ask me in condescending tones. As if that comment is unique and your therapist hasn’t talked about control 900 times. Eating disorders *can* have an element of control, but it is ALWAYS much more complex. Eating disorders are associated with a cluster of things that may or may not be related: psychological factors, personality types, presence of past trauma, significant stressors, biological predisposition, family history, etc. A cursory look at a non-scientific article or watching a horrible Lifetime movie about anorexia cannot make anyone an expert.

. . .

3. Do express concern about eating habits…

… but don’t do so during meal time. 

Eating with someone you’re almost sure has an eating disorder is difficult and uncomfortable.

It is SO tempting to reach across the table and critique a meal choice, or say something like, “Is that all you’re having?”, or, “Why aren’t you eating more?” In my experience, those conversations are never helpful. The person with an eating disorder, who is likely anxious from the experience eating out, is on guard and gets defensive fast.

I get it– meal time seems like the most logical time to express concern. After all, it is commonly thought that meal time is in fact the problem. When I was deep into my eating disorder, going out to eat was SO MUCH more than an hour at a restaurant. It was the fasting before and after; it was the fear of eating in front of people; it was planning a binge later in the night so I didn’t have to eat in front of people; it was looking up the menu online beforehand; it was counting calories hours before I stepped foot in the restaurant.

It is better to bring up the specific behaviors later in the day when meal time is over. Stick to the specifics about behavior and don’t make it personal. An example: “I noticed when you were at dinner tonight, you ordered a low calorie entree, and you kept putting parts of the meal in the napkin on your lap.” –> I know, easier said than done!! I’ve been the recipient of a lot of insensitive mealtime comments, but I’ve also given some insensitive mealtime comments to friends I knew were struggling. I get it: Frustration can mount in the moment at mealtime, but try to hold off until later. You’ll end up having a much better conversation.

. . .

4. Do focus on food…

… but look at the greater picture, which has a whole lot more to do than just food.

Someone I knew in graduate school said something to the extent of, “I don’t know why families don’t lock the family member with an eating disorder up and force the person to eat.”

While that is absurd, I have heard so many comments that are similarly invalidating and off base:

“Just eat.”

“It’s not that hard.”

“Don’t make this such a big deal.”

That approach doesn’t work.

Eating disorders are both about food and not about food. Of course, eating disorders are highly related to weight and food habits (that’s why they’re called eating disorders) but in some respects have little to do with food.

Restriction was my teenage coping mechanism to deal with a lot of internal chaos– undiagnosed generalized anxiety, crippling OCD, existential anxiety, depression, and feelings of hopelessness, and worthlessness.

In my years of being symptomatic, I was way more likely to talk about those things than my eating habits. I hated when people would make it seem like gaining weight or eating would solve all of my problems. My eating disorder served multiple functions in my life, and until I dealt with those, I didn’t get truly better.

On the other hand, eating disorders are necessarily about eating.

If someone is underweight or malnourished, it is impossible to look adequately at the big picture. Medical, nutritional recovery is a precursor to psychological recovery.

Sometimes in more psychoanalytic approaches to recovery, it is conceptualized that when a person deals fully with the psychological parts of the eating disorder, the symptoms will dissipate. That also doesn’t work.

If you are bringing the subject up with someone, consider the rather paradoxical statement that eating disorders are about eating, but they don’t give us the full picture of what’s going on.

. . .

5. Do take action if necessary

… but think it through first.

Eating disorders are dangerous.

Period.

It is well-known that anorexia has one of the highest mortality rates of all mental health issues, but it is definitely possible to die of bulimia or binge eating disorder too.

The first thing I tell people who haven’t gotten into treatment is: SEE A DOCTOR.

Eating disorders can be associated with some serious medical complications that can kill including (not an exhaustive list): potassium/ electrolyte imbalance, low heart rate, low blood pressure, and general heart abnormalities (that’s why people with eating disorders must have regular EKG’s).

I will reiterate here that someone of average weight, overweight, or obese can die of an eating disorder as well. All of the above medical problems can happen to a person at 70 pounds or 370 pounds.

That is why if you truly suspect a loved one or friend has an eating disorder, don’t stay silent.

In all three of my three major anorexia tail spins, the initial descent into the illness and two subsequent relapses, I needed intensive medical intervention to get back to normal. Two of those times, it was not of my own choosing. Friends, family, and even my school had to intervene on my precarious downward spirals, and thank God they did. Otherwise I might not be here right now.

With that said, if you are seriously concerned about someone who is NOT getting treatment for an eating disorder, there might be cases in which you should advocate for medical consultation or even hospitalization.

For someone with a SEVERE and UNTREATED eating disorder, it could be that lovingly suggesting a trip to the doctor or ER for a medical evaluation is what is needed in the moment. Or, perhaps looking up residential treatment options and calling the person’s insurance company for help.

** Now: Before you attempt this kind of conversation with someone, heed caution! Most people who are diagnosed with an eating disorder have a treatment team or are getting support of some kind. If that is the case, step back and offer support in other ways. Suggesting hospitalization or a doctor consultation additionally has a high likelihood of pissing off the person’s eating disorder, so be prepared that you will likely be met with resistance.

There are some cases when this kind of conversation happens more organically: For example, if a friend passes out or complains of heart palpitations.

. . .

I think the reason many people don’t express concern to a friend or family member about what they’re seeing is out of fear. I get it– it’s scary. People don’t inherently know how to bring it up or what to say.

You are brave and caring to consider having a conversation that might save a life. Sometimes simple comments can go a long way, things like:

“I love you, and I’m concerned about you.”

“It seems like you’ve been struggling lately, and I want to help.”

“If you ever want to talk more about what’s  been going on for you, I’m here for you.”

For more information or to take a free screening, check out NEDA’s website.

In keeping with the National Eating Disorders Awareness Week slogan for this year, I’ll finish with this: “It’s time to talk about it.”

A Letter To My Former Therapist

medium_yfznl7

Dear J,

The three years we worked together were the best and worst of my life. I knew at the beginning– in my bones, I knew— that you were it. You were my ticket out of misery and into living a full, rich life. My first thought about you was, Wow, this woman seems like the reincarnation of Carl Rogers. Your empathy was unprecedented.

I didn’t have a solid enough sense of self at the time, but I could feel that you believed in me. When I doubted myself, when I slipped back into old patterns, whatever happened, you were there. You treated me like I was a worthy, capable, real human being.

Sometimes, I could believe that. Other times, I relied on your strength, and you believed that for both of us.

You cared about my feelings– no — you loved them. You acknowledged whatever I was feeling and took it seriously. I was stunned by how much you cared about me. Maybe even by how much you loved me (in the most platonic of ways).

In your eyes, I was a capable, intelligent therapist, prone to struggles, yes, but worthy of love. You trusted me not only as a human but as a professional.

Words cannot describe how you changed my life for the better. You helped patch my ragamuffin, broken self into a mosaic of messy parts. The mosaic was in the making.

But then again, words cannot describe how you changed my life for the worse.

In a whirlwind, what became a healthy, therapeutic relationship led to your emotional unraveling and at the end, a break up via email, with no closure.

To say that the end of our relationship destroyed me is cliche but true. My life, just like yours, unraveled at the seams, and everything was turned upside down.

You, the person who believed in me, who laughed and cried with me, who I would send my most personal writing, who was my rock, disappeared into thin air. In a moment, you were gone.

Just as I was starting to trust you and the walls were down, you left me without defenses. I was raw, cold, crying, emotional, and numb all at the same time.

I developed a disgust for therapy. I left graduate school. I moved back home to be closer to family. I changed my life completely because I didn’t believe in people anymore, and I didn’t believe in myself.

Almost 3 years later, the scars are still there, and sometimes, they bleed. I cannot trust my new therapist of almost 2 years. She reminds me so much of you, it’s scary. I see you in her sometimes, in her mannerisms and words, and I quiver. I don’t know if I can let anyone into my heart again. Not after you. 

“I wish I could do something to make it safer for you to open up,” my new therapist tells me.

“People always leave, just when you count on them,” I respond.

This has become our therapeutic struggle. I can’t trust, and I think about abandonment constantly. Would I get hurt now if my new therapist leaves? What about now? I can’t hurt again like I did with you. My sense of self can’t sustain another loss of that magnitude.

I think about you less and less over the years. I don’t cry every time I go into Ann Arbor anymore, nor do I listen on replay to Sia’s “Titanium,” a song I remember playing at the time of our relationship’s demise.

I still grapple with this: What happens with all the memories, the loving, painful, bitter, scattered memories?

I have tried locking them all in a box, and it never works. The moments we spent together spill over, sometimes through tear-streaked eyes, and sometimes with a smile.

I’m not back to normal following this experience. I have occasional flashbacks of you, and I remember every moment from when our relationship turned sour. I remember the angry emails we sent back and forth. I remember where I was when you broke up with me.

Then, I remember your face and how you used to laugh at my weird humor. I remember your expressive eyes, and your frown. I remember how you advocated for me. I remember the good things sometimes, and I don’t want to forget those. You were a huge part of my life and my story, and I can’t only hate you and have that be the end.

You weren’t just the “bad object,” you were the “good object” too. 

And yet, what you did and how you ended things caused me so many abandonment issues and trauma, I have needed years of therapy for years of therapy.

The sad thing is, nobody talks about the death of a therapeutic relationship. Nobody talks about a loving, trusting therapeutic alliance gone south.

If I was grieving the loss of a best friend or family member, it would be socially acceptable to feel grief. With a therapist, not so much. Does one ever hear, “Hey, I am a wreck, my therapist broke up with me today”?

Psychotherapy can be wonderful, yes. It can be healing and transformative and beautiful. 

… but it can also hurt. It can cause trauma and pain. It can sting, hurt, and wound on a gut-level. Nobody talks about the latter. 

But you know what, J, I am coming out of the closet. I want to say goodbye to you, but I also want to publicly acknowledge my grief. For years, I was quiet about the matter. No longer.

I am left, almost 3 years later, with no answers, ambiguity, and lots of pain. For a long time I thought it was me. Something I didn’t do. Maybe, despite all odds, you could come back to me if I did x or y.

Now I am learning that it was never about me.

It was about you.

It was your baggage and emotional issues that ended our relationship, and it wasn’t my fault. We will likely never meet again. On a good day, I can be okay with that.

So goodbye, J. You were a great therapist… one of the best. You started me on a path to healing that I hope I’ll one day finish. But I won’t finish that journey with you.

Sincerely,

Charlotte

 

 

 

Bikini Season, Body Shaming, and Other Stupidities

Bikini season is coming!

We know what that means… Lots of bikini/ fitness/ diet Pinterest boards leaving people feeling horrible about themselves. Article titles like, “How to get ‘bikini ready”. Or, articles about kale smoothies and how good they taste and while you’re at it,you should exercise like 18,000 calories a day. Pictures of “best/ worst” celeb bikini bodies. It’s already begun with “shocking” pictures of Tara Reid in a bikini and talk show hosts telling Kelly Clarkson she “could stay off the deep dish pizza” after she… gained weight (WHAT!!!!) after having a baby (um, you’re supposed to lose that weight in 2 weeks, maybe less, everyone knows that *heavy sarcasm*).

I don’t know what is more sad: 1) That a bunch of tabloid dipshits judge and mock people’s bodies, how much they eat, and their weight struggles/ triumphs/ how they’re “letting themselves go,” or 2) That somehow these magazines are selling! People are reading articles by said dipshits.

I just have to ask: What is this world?

What kind of weird society do we live in that deems terms like “fat,” “dessert,” “seconds,” and “full” shameful? What is so disgusting about women’s bodies? Side note: my focus for this post will be about body shaming women because I am one and have more to say on the topic, but men are also victims of body shaming.

All of the mean twitter posts… the cyber bullying… the incessant fat shaming… WHY? The stigmatizing body shaming comments casually zinged about, they hurt. We may not acknowledge that body shaming comments hurt inside, but they do.

Body shaming hurts.

There is endless interpersonal and internalized shame about what we look like– that number on the scale what we eat what we don’t.

Culture tells us appearance defines our worth.

People are ashamed of their own bodies, and then collectively, we shame the body of others. With all this body shaming going around, it is no wonder that the diet industry is so prominent. And here’s where things get more disturbing. In 2014, the U.S. diet industry raked in $60.5 billion. More disturbing yet: that astronomical number is a DECLINE from the year before.

This video is a good visual of how much $1 billion really is. So take that video’s visual and try to wrap your mind around $60.5 billion. This is, by any standard, a lot of money. How many social ills that much money could solve in the world? Water sanitation, poverty, racial, sexual, policy to promote gender equality, and so much more! Maybe we could even put a dent in the United States’ massive debt.

Let’s just sit here for a moment and realize how fucked up this all us.

People are spending more money than the GDP of many countries on diets that become popular and unpopular as fast as hashtags or the latest in social media… Atkins is old school (the N’Sync of diets), but kale is in (the Taylor Swift of food). People are going Paleo, organic, and gluten free. Egg white omelettes are the new black. Diet pills remain comparable to the quirky and questionable relative at many family gatherings. Constantly changing options for people who are essentially wasting their money considering that DIETS DON’T WORK!!

Body insecurity is a given in today’s culture. Between 40 and 60% of young girls ages 6-12 are already expressing concern about their weight or are worried about being fat. The body-shame cycle starts so young. The same girls memorizing Let It Go and wearing Elsa costumes around the house might be considering going on their first diet. Maybe they already have.

In our culture, we are not at peace with our bodies, and how can we be with all this propaganda and equating body size and looks to worthiness? We think, maybe that next fad diet will make us enough. Maybe, then, we can feel okay and good about ourselves. Maybe, then, we’ll be worthy.

I follow an Instagram page called “Bye Felipe” which was created to call “out dudes who turn hostile when rejected or ignored.” The site usually focuses on people who are interacting on dating web sites. You can see for yourself the number of fat-shaming comments doled out to girls on this page. It is horrifying to open up my Instagram and seeing how guys degrade women by playing on body insecurities and playing the “fat” card.

These comments hurt, and they are dangerous.

So here is my message, and I wish I could put this in size 200 font:

LET’S PUT DOWN THE SWORDS.

Let’s stop shaming ourselves and others about the way they look.

Let’s treat our bodies with acceptance and compassion.

Let’s humanize each other’s bodies. Let’s humanize our own bodies.

Do we have body flaws and faults? Do some people need to gain or lose weight? A resounding yes. But can that be okay? Are we still worthy? An equal and resounding yes. It is possible to take care of our body struggles with a posture of love and self-care.

When people talk about how so-and-so is too thin/ skinny/ fat; what’s with her butt/ boobs/ nose/ ears/ mouth/ teeth/ hair, they don’t know who they’re affecting. Little girls (AND little boys) see the disgusting way people are body-shamed, and we’re breeding new generations of body-shamers.

An app exists in which you can “fit the fat girl crown”, and there was an app (thankfully it was TAKEN DOWN) that was designed to “rescue the anorexic girl.” All this when some reports suggest that incidences of eating disorders may be on the rise.

Disgusting, disgusting, disgusting.

You don’t know what the person across the street or next to you or in the cubicle over from you is dealing with, body-wise or life-wise. Be kind, for everyone you meet is fighting a hard battle. Often you know nothing about it, and it is better to be KIND and COMPASSIONATE, rather than shaming and potentially triggering. This spring marks the 14th year of my eating disorder, and frankly, I think people have to mind their own fucking business. I realize this does not sound kind, but one negative comment can set off a slip or relapse or a passive-aggressive text to my therapist about how much I hate her guts. NO ONE wants to hear a passive aggressive, “Do you really need that slice of cake?”, or, “Wow you look huge in that picture!” And especially not someone who has struggled with an eating disorder.

PUT DOWN THE SWORD.

So in conjunction with this blog post’s title, I’m going to tell you a secret about bikini season. Here is how to have a bikini body:

People are at war with their own bodies and the bodies of others. It is a war that no one will win, but there will be many casualties.

So, in sum: be kind, compassionate, and please:

Confessions of a Girl in Recovery

Many teenagers and young adults measure time with hugs, laughs, and kisses; with tears, heartbreak, and belting out Taylor Swift songs; with midnight donut runs and staying up all night talking.

I measured my life in calories, compulsive exercise, and setting my alarm to 3 AM, because that was a “safe” time in my mind to binge. I spent my moments daydreaming of endless buffets– plate after plate of spaghetti, followed by cookie dough ice cream caves. I would “go to the bathroom” at least 5 times during class for an excuse to walk.

I fantasized about food similar to how teenagers fantasize about a first crush or first kiss. Anorexia was my comfort… my everything. In the little world I made for myself, I felt safe. At least I knew this.

Most of my memories for a good 10 years centered around food. I remember only one thing about my high school graduation: the internal debate about whether I was going to eat lunch that day.

Every birthday party, including my own, I would be “too full” for birthday cake. Sometimes I would swear to anyone who probed, “I just hate sweets.” Lies.

Sometimes people would respond with jealousy, “I wish I could be like that,” or, “I wish I could look like you.” No, no you don’t. 

It is hard to describe what the living hell of an eating disorder is like to someone who has not personally heard the eating disorder siren call. I can’t count the amount of times others have said to me, “Can’t you just eat?” In my mind, that comment was akin to, Can martians become elected officials? Can Michigan be warm during the winter? Can I please teleport? Can there be peace in the Middle East? Anorexia had a neurobiological, psychological, emotional, and spiritual stronghold over my life. It was this gravitational vortex pull mixed with a sensation similar to being held down by the Boogey man.

Being asked to give up my eating disorder felt like asking to give up me.

At some point, I had to realize, No, this is not sustainable. I cannot maintain even a facade of normalcy. Despite the denial, I admitted that what I was doing was killing me. If I was compliant to the incessant demands of anorexia, I would either die or have everything be taken from me. I decided to give the having-a-life thing a shot.

Eating disorder recovery felt like being asked to move to a distant land, a strange, odd place where people would eat cake voluntarily. It was absolutely mind-blowing. Why would someone eat dessert? Willingly no less??? I ate celery voluntarily. I compulsively exercised voluntarily. Voluntary dessert was belching the alphabet at tea with the Queen of England, or  showing up to a job interview with mustard all over my face. It made no sense. I had to trust people who told me, This is normal. This will get easier. This is okay. You are okay.

Stabilizing my weight and food intake did not address the root issues, but it needed to come first.

After time in treatment, I finally admitted that fat free cheese was disgusting. I mean, really disgusting. It should barely count as cheese. Or not count at all. How could I have “preferred it” for years? I could say similar things about sugar free Jello (one word: gross), Molly McButter (I mean, what IS that really? is it edible? should it be?), and Splenda (confession: still trying to fully wean off that one).

Consequently, I found that cake is actually delicious. In fact, now it is one of my favorite foods. Dessert is really underrated when you have an eating disorder. I had this false dilemma in my mind: I could eat a slice or pie OR I could die. It seemed that dire of a situation. But it doesn’t have to be. At treatment for the first time, I started eating cake as often as I could. After years of severe nutritional deprivation, it just tasted so good!

Photo on 2011-12-25 at 18.01 #2

Me with cake… because it is delicious.

Recovering in terms of weight restoration and achieving medical and nutritional stability were important… but the hardest work came later.

In addition to the important eating component of ED recovery, I also had to learn how to live. Surprisingly, that has been a motherfucker of an obstacle that is ongoing.

So these things are works in progress:

I learned that there is more to life than the prison of anorexia. I learned not only to enjoy food but to enjoy people; to fall in love and fall hard; to open up to others; to experience happiness but also sadness; to feel and to feel it all, the spectrum of human experience, both the good and the bad.

Subsisting indefinitely in an eating disorder netherworld hardened me. The thawing work of recovery and subsequent therapy has hurt like hell, there’s no other way to describe it.

But I am learning how to live.

I didn’t do that for a really long time.

In the process of obsessive exercise videos and “being too tired” to go out for ice cream with friends, I missed so many moments… so much time. I missed the taste of gelato in Italy, and wine and cheese in France. I missed taking deep breaths and soaking up the sunlight. I missed years; in fact, over a decade of my life. I hurt others and myself.

The years…

the memories…

the bodily damage…

the relationships…

the lost opportunities…

I will never get any of that back.

I am still in the process of figuring out the labyrinth that is the sum of my life experiences and feelings. I have to tear off the (emotional) bandaids that I kept on for safety and address the pain that such a process produces. Not to mention the fact that the body does not do well with over a decade of abuse. I take steps forward and steps back. I like to think the overall trajectory is forward, though.

Sometimes I’m growing, and sometimes I’m not. Sometimes I feel motivated, sometimes not. Sometimes I feel like I am exploding with feelings, and I want to gauge my eyes out. Sometimes I laugh until it hurts, and sometimes I am limping in agony. Sometimes my pace of recovery is that of a turtle.

I am learning to believe that is all okay. Sometimes.