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 admit 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 families (including siblings and friends) 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. These include:
- unusual eating and exercising behaviours that are hidden from friends and family
- feelings of shame, guilt and disgust about their eating behaviours
- denial that they have disordered eating patterns
- inability to ask for help from friends and family.
It is not always possible to tell if someone has an eating disorder based on their appearance. People with anorexia nervosa might have a low body weight, however, people with bulimia nervosa may have a body weight in the healthy rage or just over, while people with binge eating disorder are more likely to be overweight or obese.
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:
- loss or gain of body weight or weight fluctuations
- cold, mottled (spotted or blotchy) hands and feet due to poor blood flow, even in warm weather
- fatigue and 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 or obsession with eating, dieting, exercise or body image
- sensitivity to comments about eating, dieting, exercise or body image
- feelings of shame, guilt and disgust, especially after eating
- a distorted body image or extreme dissatisfaction with body shape – people can think they are fat even when they have a healthy body weight
- low self-esteem, depression, anxiety or irritability.
Behavioural symptoms of eating disorders
Behavioural signs and symptoms will vary depending on the type of eating disorder, but can include:
- unexplained disappearance of food – hiding of binge eating episodes
- secretive behaviour around food – hiding uneaten food or saying they have eaten when they haven’t
- behaviour that is antisocial and withdrawn
- eating alone and avoiding other people at meal times
- chewing and spitting out of food
- frequent trips to the bathroom after eating
- dieting behaviour – obsessive dieting, counting kilojoules, avoiding certain food groups
- intense fear of gaining weight or ongoing behaviour that does not enable weight gain
- use of laxatives, enemas, diuretics or appetite suppressants
- spending large amounts of money on food
- self-harming behaviour, use of substances and suicide attempts.
Helping someone with a potential eating disorder
Your family member’s behaviour and symptoms may also affect you. You might be feeling a range of emotions, such as grief, sadness, anger and stress. You might be feeling neglected because everyone asks about your family member and not about you.
Getting support and help with your emotions is important. Eating Disorders Victoria has a psychology service where you can speak to someone about how you are feeling and being affected by your family member’s behaviour and symptoms.
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. 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 go to visit a GP who has experience with this mental illness.
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 doctor as soon as possible. Other healthcare professionals such as psychologists can also recognise eating disorders, but they will not be able to give a physical check-up to determine the extent of any medical issues.
To diagnose an eating disorder, your doctor will need to do a full physical check-up, may take blood tests, and ask questions about your health, including your emotional health and wellbeing, medical history and lifestyle.
The doctor 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 doctor. These commonly include co-occurring anxiety, depression or obsessive compulsive behaviours.
Approaching a family member about a potential eating disorder
When preparing to speak with your family member, and when speaking to them) some of the things you can do include:
- inform yourself about eating disorders
- inform yourself about the help they might need and the support services available
- be prepared for a negative or emotional response. If this is the case, it may be driven by fear or confusion. A negative response doesn’t mean there is no 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 help from a support service for advice on what to say
- choose a safe place and a time when you are both calm
- 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
- 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 changes in body weight.
The types of things to avoid doing include:
- making comments about body weight, appearance or food
- giving a list of people who are also concerned
- demanding change or berating your family member
- tricking or forcing them 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 for your family member’s situation.
Mental Health First Aid (MHFA) Australia has an ALGEE action plan that includes:
- approaching, assessing and assisting with any crisis
- listening non-judgementally
- giving support and information
- encouraging appropriate professional help
- 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 – thinking that seems disordered, disorientation, vomiting several times a day, fainting, collapsing, chest pains, difficulty breathing, irregular heartbeat, slow heart rate of less than 50 beats per minute or a low body mass index (BMI) (lower than 16)
- 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.
Where to get help
This page has been produced in consultation with and approved by:
Eating Disorders Victoria (EDV)
Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your doctor or other registered health professional. Content has been prepared for Victorian residents and wider Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions.