How To Speak To Someone With An Eating Disorder

How To Speak To Someone With An Eating Disorder
by Marissa Sappho, LCSW, BCD, CEDS

It's the Holiday season and while many people are filled with joy and excitement for the decorations, food, family, and social events, those with an eating disorder are filled with a silent anxiety.
What can I wear that won't make me look fat? What can I wear that will hide how much weight I have lost? What is Aunt Jen going to serve at Christmas dinner and how much of it do I have to eat to appear 'normal'? I'm so uncomfortable. I'm so uncomfortable. I'm so uncomfortable. I want to leave. I want to leave. I want to leave. Why don't they understand? Mom keeps saying the wrong the thing. I hate this. I remember when I used to like the holidays. I can't remember the last time I had a good day...

As a friend, family member or loved one, what can you do to help during this time (and year round!)? Here are some examples of things to say and do (or not say and not do) to a person with an eating disorder.

Things Not To Say:

  • "Just eat like a normal person." (If they could, they would)
  • "You'd do anything not to eat wouldn't you." (No, but the persons eating disorder might do anything not to eat)
  • "Why are you doing this to me/us?" (Comments like this just fuel guilt & shame which inevitably make eating disorders worse)
  • "You've put on weight...you look great (or worse...the dreaded "you look healthy")." (Even "benign" comments about a persons appearance are harmful to an eating disorder. Take the focus off of someones physical appearance and pay interest to other aspects of this person and what it is like to spend time with them)
  • "Are you making any progress? What does your therapist say?" (This can be interpreted by the person as though you feel they aren't working hard enough or you are feeling resentful of them.)
  • "You're ruining our family." (No. The person isn't ruining anything. The eating disorder is creating chaos and disharmony)
  • "What have you eaten today?" (Unless you are this persons nutrition or meal coach, or you have an expressed plan with their treatment team to be the point person to check in around this...don't ask about food intake. It puts the person in a tough position as the truth may be embarrassing or result in a lecture and a lying to try and please you isn't useful for anyone)
  • "Ugh, if you think you're fat you must think I'm obese!" (The main image distortion happening for people with an eating disorder is of themselves, not other people)
  • "I wish I had that problem! I just love food too much." (Eating disorders are not about not loving food, they are a mental disorder that changes the way a person views food. You wouldn't wish you had the "problem" of Schizophrenia or Major Depression, don't "wish" you had an eating disorder. These are serious diseases that represent the leading cause of death of all mental illness.)
  • "You don't look like you have an eating disorder." (This one is extremely dangerous and shaming. Eating disorders exist in all shapes and sizes and kinds of people. This comment can be a life-threatening trigger to someone.)
  • "OMG I was soooo bad today, these holiday foods are just so fattening...diet starts tomorrow!" (Avoid at all costs any "diet-talk", conversations about "good vs. bad foods", weight, shape, or appearance. We are too caught up with these topics as a cultural way to relate to one another...find something of substance to talk about. Eating holiday foods does not make you a bad person and is not a bad thing to do.)
  • "Wow you ate a lot today/You were really hungry." (After a comment like this, you can be sure the person is going to feel flooded with shame and may restrict their food intake for the rest of the day or longer as a result.)
  • "Everyone feels bad about their body sometimes, just buck up and get it together." (Body dysmorphia in the context of an eating disorder is very different than just having a momentary negative feeling about how you look...it feels like you are coming out of your skin...it can be anguishing. This kind of comment minimizes that experience and doesn't help move the person forward.)
  • "You are so strong, I'm not worried about you." (Again, another well-intention-ed statement but this can put a lot of pressure on the person that they must appear strong all the time or risk disappointing you. Sometimes it's okay to not be okay.)
  • "Why don't you go work out? Go to the gym. It will make you feel better." (People with eating disorders will not magically feel better if they start moving their body, in fact this can be very triggering to most people with an eating disorder and those with an exercise addiction.)
  • "You have to just make yourself do it, you're not even trying." (Trust me, this person is trying with everything they've got.)
  • "We have spent thousands of dollars on your treatment and you're not getting better/wasting our money/not even trying!" (Every time I hear comments like these, my heart breaks a little. I understand the tremendous financial burden and sacrifice that people make to help loved ones recover from an eating disorder, however your exasperation and desperation will not make the person heal more quickly. Comments like these fuel the feelings that the person and their eating disorder is an unwanted burden.)

Things Not To Do:

  • Don't watch the person eat. (They have a treatment team who does that with them in a clinically supportive way)
  • Don't make any comments about the persons appearance (good or bad) OR the appearance of anyone else! (Comments about weight, shape and food are extremely triggering for those with an eating disorder -- at best they are unhelpful, at worst they are harmful. Find something more interesting to talk about!)
  • Don't put food in front of the person or fix a plate of food for them (unless you are doing Maudsley treatment).
  • Don't touch the person without permission or expect/assume that they want to have physical contact with you in the moment just because you are their friend/lover/parent/long-lost-cousin/Beyonce. (This should be a standard rule for everyone, even people without an eating disorder...our bodies are sacred and each person has the right to decide who touches their body, when they touch it, and how they touch it)
  • Don't tell them they need therapy or need to go to the doctor. (This doesn't work, and saying it at a family event, social gathering or at the dinner table is just shaming)
  • Don't try to be their therapist! (Hopefully they already have one and you will be much better served working as a partner with the persons treatment team, than trying to become their therapist)
  • Don't talk about how many calories are in the food or list out all the ingredients. (This can actually interfere with a person who wants to try a risky food by triggering their eating disorder mind)

Things To Say and Do:

It is normal to be concerned about someone with an eating disorder and to want to express that concern. The language you use, timing of the conversation, and the setting where it happens really determine whether it will be helpful to the person or triggering. Often people can say and do triggering things without intending to.

  • Offer to share the menu with the person in advance and if they prefer talk it through with them.
  • Offer to be a support person during the meal or social event and discuss ahead of time a signal between you (a gesture, hand squeeze, code word), so you will know when the person needs help or a break.
  • Plan holiday events that do not revolve around food! Make new traditions that are focused on togetherness.
  • Timing of holiday meals can be tricky & disruptive (dinner at 2pm! what?!) to a persons recovery process...as much as possible, try to stick with a schedule and don't just "wing it". I recommend "flexible structure" -- a plan that is in place which can be adjusted based on changing needs in the moment.
  • Ask the person how they are feeling and ask them what they need instead of assuming you know...watch your tone of voice to avoid sounding exasperated or judgmental.
  • Reach out for help! Talk to members of the persons treatment team or visit NEDA for more resources.