Eating disorders - support for families

If you think that a loved one might have an eating disorder, it can be difficult to know when to approach them to discuss your concerns. You might even wonder if your suspicions are correct. Being prepared is the best way to proceed when considering approaching a loved one about their eating and relationship with food.

It can be very difficult for someone to acknowledge that they have a problem, and you may find your loved one is reluctant to see a healthcare professional about a suspected eating disorder. Research suggests that getting an early diagnosis and treatment improves outcomes, so attempts to approach your loved one are important to their recovery.

You are not alone. Help and support is available before and after you have approached your family member. Eating Disorders Victoria offers support for Victorian families and peers to help you to express your feelings, get suggestions on strategies to help, and to find out what types of support services are available. The Butterfly Foundation also offers support for family members and other people affected by eating disorders.

Understand the symptoms of eating disorders

It can be difficult to know if your loved one has an eating disorder, because the signs and symptoms can be hard to detect. Some common signs include:

• unusual eating and exercising behaviours that may also be hidden from friends and family
• feelings of shame, guilt and disgust about their eating behaviours
• lack of awareness or denial that they are engaging in disordered eating behaviours
• inability to ask for help from friends and family
• social isolation and/or withdrawal from activities they once enjoyed
• body dissatisfaction and/or low self-esteem.

It is not always possible to tell if someone has an eating disorder based on their appearance – eating disorders are experienced by people of all different shapes and sizes.

It is important that you understand the signs and symptoms of eating disorders, so you know what to look out for and you are prepared. You have the potential to be a great support to your family member if they are diagnosed with an eating disorder.

Physical symptoms of eating disorders

Although the physical signs will vary depending on the type of eating disorder, symptoms can include:

• weight loss, weight gain or weight fluctuations
• sensitivity to the cold (feeling cold most of the time, even in warmer weather)
• fatigue, tiredness, or fainting without a reason (such as an illness)
• signs of damage from frequent vomiting, such as swelling around the cheeks and jaw, damaged teeth and bad breath, and sores or cuts on hands.

Psychological symptoms of eating disorders

Although some psychological signs of eating disorders can be hidden, others might be more obvious. Psychological signs and symptoms can include:

• preoccupation with eating, dieting, exercise or body image
• fear of gaining weight
• sensitivity to comments about eating, dieting, exercise or body image
• feelings of shame, guilt and disgust, especially after eating
• anxiety around mealtimes
• body dissatisfaction – with particular body parts, size, weight or shape
• low self-esteem, depression, anxiety or suicidality.

Behavioural symptoms of eating disorders

Behavioural signs and symptoms will vary depending on the type of eating disorder, but can include:

• dieting behaviour – dieting, counting kilojoules, avoiding certain food groups
• behaviour that does not enable weight gain or encourages weight loss
• evidence of binge eating – unexplained disappearance of food, spending a lot of money on food, hoarding food
• secretive behaviour around food – hiding uneaten food or saying they have eaten when they haven’t
• eating alone or in secret, and avoiding other people at mealtimes
• vomiting
• chewing and spitting out of food
• frequent trips to the bathroom during or after eating
• becoming socially withdrawn and/or not engaging in activities once enjoyed
• excessive or compulsive exercise, exercising even when unwell or injured
• use of laxatives, enemas, diuretics or appetite suppressants
• self-harming behaviour, substance use and suicidality.

Helping someone you are concerned about

It is important to research how to best approach a family member about your concerns. When you first approach a family member about their potential eating disorder, they might react negatively or they might not want to speak with you at all. It can take time. Some people may not be aware that they are engaging in disordered eating behaviours. The person might feel threatened that you have noticed their behaviours or discovered their situation, and they might need time to respond. You can be persistent without nagging. Remember that ignoring the problem will not make it go away.

While the first step might be to get your family member to acknowledge they might have a potential eating disorder, the next step is to visit a GP (doctor) who has experience with eating disorders.

Eating disorders cover a range of conditions and some people might not fit neatly into one category. This makes it important for people who might have an eating disorder to see a GP as soon as possible. Other healthcare professionals such as psychologists and dietitians can also recognise eating disorders, but they will not be able to give a physical check-up to determine the extent of any medical or physical health issues.

To diagnose an eating disorder, your GP will need to do a full physical check-up, may take blood tests, and ask questions about your loved one’s health, including their emotional health and wellbeing, medical history and lifestyle.

A GP will also have to make sure that any symptoms do not relate to another condition, such as an undiagnosed physical illness or another mental health condition.

Family and carers can play an important role in the process of diagnosis, particularly as physical check-ups and blood tests alone may not necessarily indicate a diagnosis of an eating disorder.

Family and carers may be in a position to identify some of the other psychological and behavioural signs and symptoms that the person may not necessarily talk about with their GP. These commonly include co-occurring anxiety, depression or obsessive-compulsive behaviours.

Approaching a family member about a potential eating disorder

When preparing and speaking with your family member, some of the things you can do include:

• Learn as much as you can about eating disorders.
• Access information about the support options available, should they need this support.
• Be prepared for a potentially negative or emotional response. If this is the case, it may be driven by fear or confusion. Your family member may feel relieved that you are concerned, or they may not be aware or are in denial that there is a problem. A negative response doesn’t mean there is not a problem. It may take a few attempts to have your concerns heard by your family member.
• Think about what you are going to say, or seek advice from a support service on what is helpful and unhelpful to say to your loved one.
• Choose a safe place and time when you are both calm.
• Avoiding broaching the topic if you are around food (such as mealtimes).
• Tell your loved one that you are raising your concerns because you care for them.
• Let them know you are worried about them and their mental health.
• Focus on their feelings and your feelings – encourage them to express how they feel.
• Listen without judgement.
• Focus on the wider range of behaviours and feelings that you are worried about and that they might be open to talking about and seeking help for (for example, that you are worried they are sad and withdrawn), rather than putting all of the focus on their eating and any physical changes.

Unhelpful things to say or do include:

• Making comments about your loved one’s physical appearance or weight.
• Making comments about your own appearance, weight, diet or exercise.
• Giving a list of people who are also concerned.
• Demanding change or berating your family member.
• Tricking or forcing your loved one to eat.
• Using statements that label, blame or are judgemental.

Examples of statements to avoid are ‘You’ statements, such as ‘You need help’ or ‘You aren’t eating enough’ or ‘You have an eating disorder’. Instead, it is more effective to use non-judgemental ‘I’ statements, such as ‘I am worried about you because I care’.

Mental health first aid for eating disorders

There might come a time when you fear for the safety of your family member and you might need to use mental health first aid.

Mental Health First Aid (MHFA) Australia has an ‘ALGEE’ action plan that includes:

• A – approaching, assessing and assisting with any crisis
• L – listening non-judgementally
• G – giving support and information
• E – encouraging appropriate professional help
• E – encouraging other supports.

If you think your family member is in physical danger or at risk of harming themselves, then you might need to take direct action.

The signs of a crisis or emergency include:

• a medical emergency – disorientation, vomiting several times a day, fainting, collapsing, chest pains, difficulty breathing, irregular heartbeat, slow heart rate of less than 50 beats per minute
• suicidal thoughts or behaviours
• non-suicidal self-injury (self-harm).

The direct action you take in an emergency or crisis will depend on the situation, but can include:

• calling an ambulance (000)
• taking your family member to the emergency department of a hospital
• getting advice from a healthcare professional, such as your doctor.

Self-care when a family member has an eating disorder

Your family member’s experience with an eating disorder can also affect you. Caring for a loved one with an eating disorder can be challenging. You might be feeling a range of emotions, such as grief, sadness, anger and stress. You might be feeling neglected because people are focused on your family member and may not be as focused on you.

Getting support to help you manage during this time is important. For Victorians, Eating Disorders Victoria has a range of free services for carers, including telehealth counselling services, where you can speak to someone about how you are feeling and how you are affected by your family member’s eating disorder experience. The Butterfly Foundation are a great national service and also have support options for families and carers.

Where to get help

• In an emergency, always call triple zero (000)
• Eating Disorders Victoria Hub Tel. 1300 550 236 – support from Monday to Friday, 9.30 am to 4.30 pm
• A GP with experience treating people with eating disorders
• Community health centre
• Lifeline Tel. 13 11 14
• SuicideLine Tel. 1300 651 251
• Kids Helpline Tel. 1800 55 1800
• Butterfly Foundation Tel. 1800 ED HOPE (1800 33 4673) – support from 8 am to midnight (7 days)