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Loving someone who is battling an eating disorder (ED) can be quite challenging. You may not know what to say, how to act, or in what way your loved one needs your support. While working daily with individuals with EDs, I get asked a variety of questions from family members who are trying to better understand how they can participate in the treatment and recovery process. There isn’t always information readily available for families, more specifically for spouses, on what things are helpful and unhelpful. Inspired by one of my former patients, I created the following list as a general guide particularly for husbands/wives/partners whose significant other is struggling with an eating disorder and is currently undergoing some form of therapy or treatment. Some things on this list may not work for your relationship so I’d always recommend asking your spouse or partner how you can best support him/her and in what ways he/she is willing to let you participate in their treatment.

  1. First things first, know that at their core, EDs are not about weight. There are many causes for the development of an ED and there are many different reasons why these disorders continue to exist, sometimes for years, before an individual seeks help.
  1. Once your spouse/partner has informed you that he/she has an ED, take time to educate yourself about these disorders before drawing conclusions. This is critical as you begin to navigate the road ahead of you. The more you can learn, the better prepared you’ll be to participate in this journey and to offer support to the person who needs you most.
  1. Reduce or eliminate weight or specific appearance-driven comments. While you may be coming at the subject from a place of love, someone battling an ED can misinterpret such comments and the ED can then utilize this to further the disorder. It may be better to comment on other aspects of your spouse/partner that you like or love. Find non-appearance based topics to talk about and remind him/her of the reasons you fell in love.
  1. Be mindful of the challenges treatment and recovery brings. As if battling the disorder itself wasn’t hard enough, going through this process is daunting, confusing, and anxiety-provoking, among other things. If your spouse/partner is extra irritable in the beginning of treatment, know this may be a result of drudging up many emotional issues that have been buried for years. It may also be a result of stopping the ED behaviors. When the behaviors are ceasing, individuals often don’t know what else to do. They can become easily activated until they learn new skills and new ways of coping with themselves, their lives, and the world.
  1. Respect their personal boundaries. Because those with EDs are dealing with many body image challenges, whether related to past trauma, bullying or another reason, intimacy can be very overwhelming. In addition, individuals can experience several body changes as they are learning to nourish themselves in a new and healthier way. Give your spouse or partner time and space to develop a new relationship with themselves and their bodies without pushing them into intimate situations that may activate a deep emotional wound or trigger an ineffective response. This is an area your spouse/partner will likely be addressing more actively in their therapy sessions and is one way he/she may be able to use their new skills to share with you what they are or are not comfortable with.
  1. Treatment is hard and is necessary. Individuals are encouraged to put as much time and energy as they can on their treatment process. Because of the medical complications that can arise when an ED is present, we as clinicians will often recommend that patients prioritize getting better and work on healing the physical aspects of their EDs in order to do deeper emotional work. As patients progress, they can integrate into their lives more fully and more healthfully. This is particularly important when your spouse or partner is in an intensive treatment program such as residential or partial hospitalization.
  1. Get rid of the scale! Having a scale in your bathroom and readily available can reinforce the urge to step on. We encourage patients to permit their treatment teams to track their weight and to bring their scales to session, destroy it or have someone they trust hide it. If you do hide the scale, it may be tempting to share where it is when your spouse/partner asks. The goal isn’t to exert power, but to assist in limiting the access to a key aspect of the ED, so it is best to refrain from sharing where the scale has been hidden. If you feel you must have a scale for your own purposes, then hiding it may be the best option. Otherwise, I would recommend removing it from the house altogether.
  1. Your spouse/partner wants you to understand. One of the most common things I hear from my patients is that family members “don’t get it.” Some feel like they are being yelled at or told what to do versus being supported. Others feel like they’re not being heard or like their spouse/partner is not making any effort to understand their struggle. The bottom line is that you may not be able to fully understand because you’re not the one with the ED. However, you can educate yourself and follow some of the other suggestions here to at least build awareness.
  1. Recovery is possible and it can take a long time. You may assume that because your loved one has been in treatment or therapy for a few months that they “should be” cured. The reality is that full recovery from an ED can take years. There is no “cure” for an ED. Instead, there are various treatment interventions utilized to assist patients in learning new skills to manage their emotions, experiences, reactions, relationships, etc. without turning to unhealthy coping mechanisms. Implementing these new skills then requires practice.
  1. By being open to providing support, you’re playing a large role in the journey toward freedom from an ED. I’d encourage you to open the lines of communication with your spouse/partner. Ask how they are doing, what challenges they’re having, and most importantly how you can best provide support. Fighting back against an ED on their own makes things much more difficult. If you’re being asked to stay out of the treatment process, I’d recommend asking your spouse or partner in what ways they are willing to let you in. As he/she progresses, you may be invited in more openly.

While the above is not an exhaustive list, these may good starting points. By letting you into the ED world, you’ve been given an immense amount of trust from someone who may have much difficulty trusting people – guard this with all of your might and simply do the best you can. There is no perfection in the journey to recovery.

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A friend of mine recently sent me a text about the connection between eating disordered behaviors and the lack of giving or receiving love. It got the wheels in my head turning and I had too much to say to respond via text. I decided instead to send an email with my thoughts. After re-reading my response, I decided to share a more fleshed-out version with the rest of you as it’s a topic that could be good for all of us to consider…

Heart“American psychologist Abraham Maslow created a hierarchy of needs based on his understanding of what motivates people. He postulated that when needs go unmet, the desire grows. Motivation then increases as the person aims to get the needs met.

Within the category of social needs, Maslow places love. When we don’t experience love, we long for it. We want to know we’re the apple of someone’s eye; to know that we’re cared for unconditionally. Without this, we can convince ourselves we’re not worthy of ever being loved and therefore hold love back from others.

This is where an eating disorder (ED) can enter the picture. Those with EDs may aim to get needs met through the behaviors they use. EDs are often about what the person is not saying…rather, they act out thoughts and feelings via restricting, binging, purging, overexercising, etc. What others, and sometimes those themselves with eating disorders, can’t see is that they may be crying out. They may be trying to say, ‘Love me! I need you to love me. I need you to understand me.’ And they can become broken when others are not able to do this. Enter in more ED behaviors and self-defeating cognitions.

Love is complex, but it’s something we all want/need; even when we can’t or don’t admit that. We can convince ourselves we don’t need love (or belonging, or community, or security, or…), but as Maslow explains, that’s not necessarily true. We’re motivated by such a need. It’s not a matter of ‘Eh, that’s not something I’m really interested in.’ We NEED love.

Because people in our lives are just that – PEOPLE — sometimes they don’t have the ability to love us in a way that makes sense to us. They may not even be aware that their own life story has contributed to this. What we find, however, is that we can look at those people and assume they know and are holding love back purposely. We can assume that people are doing things on purpose and we’re asking ‘What is wrong with this person?’ But the bottom line is that sometimes, many times, people aren’t aware of how their actions are influencing others, nor are they always aware that others aren’t necessarily doing something wrong, but it’s perceived as such based on their own thoughts and feelings. It then FEELS wrong.

It makes a lot of sense that the lack of love contributes to the development and maintenance of an ED. The disorder can then become the thing turned to for the things that are lacking. Somehow the ED will give what is needed. This is a complexity of ED. It becomes an identity; a security blanket that wraps itself so tightly around those who have found it.

Love is something everyone needs and when that feels like it’s not there, it can be as detrimental as not having shelter, drink, sleep. At the same time, however, we can’t be so quick to assume we’re not loved at all…”

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Last week I read an article on things to let go of before the New Year begins. I was so moved that I immediately printed out several copies to share with clients I was seeing December 30th; as the article, in a sense, summed up many of the things I encourage my clients, as well as myself, to do on a regular basis. Since then, I’ve thought a lot about what it means to “let go”, and that for many of us the first thing we can ask when we hear those words is “how?”

IMAG0680Simply put, letting go means no longer allowing things to impact us. I don’t believe there is a quick way for any of us to let go of things that are holding us back or creating uncomfortable emotions in our lives. In fact, it can be quite complex; which is why for many who seek counseling, the process isn’t over within a few sessions. I do believe, however, that the first steps in letting go are being able to acknowledge and accept that there is something affecting us in a way that is unpleasant.

To acknowledge and accept is to recognize and then to believe something as valid. In session, I often explain this concept using the example of my water bottle sitting on the table, stating “The water bottle is on the table. That’s it. It just is. We know this because we can see it sitting there.” However, if we enter into a judging or emotional mindset we can begin to create questions about the water bottle and our relationship to it, such as “It’s still completely full so I obviously have not drank enough water today. I’m so mad at myself.” In doing this, we’ve shifted from acceptance to judgment, and may then find ourselves in a place of blame or self-sabotage.

Acceptance isn’t an easy task, but it’s possible. One reason is because we can take a look at the evidence around us that suggests something is true, and then convince ourselves that it’s false or not completely true by putting judgment and emotion into the picture as stated above. Or we can judge ourselves based on what we see before us. This is where we can fall apart in our daily lives; we’ve created something that may not actually be there, and is based on perception and feeling, rather than on evidence and truth.

Another important aspect to mention with regard to acceptance is that it does NOT mean we like something or are even okay with something. I can’t stress this enough. If we’re struggling with an eating disorder, for instance, we may not like that we have an eating disorder, but we can accept that we do based on the evidence that supports this as true. It’s only after we’re able to accept, that we can then determine if we need/want to make changes in our lives. For example, “I have an eating disorder (acceptance). The eating disorder is creating problems in my life (acceptance again).” We can then dissect this further to determine what those problems are, and what we want to do to change/improve them.

This is important in order to begin letting go. To let go we must first acknowledge and accept that something is affecting us in a way that’s unhelpful, and make a choice to not allow it to affect us further. We make changes in our thinking, feeling, and behaviors. If we don’t want to continue being affected by something, we must accept it, and choose not to dwell on it continually or use it to manipulate ourselves. We can allow thoughts to slide through our minds (like an egg in a Teflon pan) and not grab hold of them. Another way is by acknowledging ineffective thoughts and learning to respond differently/talk back to them (notice that in this response there is also a healthy choice being made):

Ineffective thought: “You must lose more weight.”

Response: “I have an eating disorder. I no longer want to be controlled by it and am choosing health over sickness.”

It’s at this point we find ourselves more able to let go…

If we live our lives in denial or continually allow things of the past to control our lives, we can lose so much of our today. In starting this New Year, may we each learn to accept and let go of the things that are proving to impact us negatively and are causing us to be less than we were created to be.

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