Loving Someone With an Eating Disorder

Eating disorders strike men much more often than has been previously believed; men with eating disorders are less likely to be diagnosed and treated than women are, which artificially inflates the gender disparity.

You’ll discover that you cannot heal your partner; you can only offer support as she tries to heal herself.

Someone with anorexia may eat little (a behavior known as restriction), eat bizarrely, or exercise too much.

People with anorexia are profoundly afraid of gaining weight and often obsess about this possibility; sometimes it can be difficult to think about anything else. On top of this, another feature of anorexia (and many eating disorders) is body-image distortion, or difficulty seeing your own body realistically. Your partner may be quite thin, even emaciated, but have difficulty fully appreciating this and even worry that she might be overweight, especially in certain body areas.

If a person only restricts and doesn’t have other disordered eating behaviors, this is known as the restricting type. There is also a subtype of anorexia that includes bingeing and purging. Not surprisingly, this subtype is known as the bingeing-purging type. At some point, the starving brain overrides the fear of gaining weight, leading to a binge. Often this is followed by intense guilt and purging behaviors.

Orthorexia is similar to anorexia in many ways, but the focus here is on the perceived healthiness of the food as opposed to its calorie content. The fear is not of gaining weight so much as of food being contaminated in some way. People with orthorexia may be overly preoccupied with avoiding pesticides or preservatives, or they may obsess over getting enough of some nutrient.

First, someone who eventually develops an eating disorder is often born with a genetic tendency toward it; you are more likely to develop an eating disorder if someone in your family has one.

Because eating disorders are observed in terms of a person’s behavior with food, you may think that it would be easy to stop the behavior and therefore stop the disorder. But the motivations behind eating-disordered behaviors are immensely powerful and often overwhelm a person’s reason. Rational arguments don’t always work with emotionally-based or ingrained patterns. It would be like if you suffered from insomnia, and somebody said to you, “Well, just go to sleep!”

An eating disorder is about using food and the body as a way to cope with deep and complex emotional issues.

Maybe some of the things that you love about your partner—her passion or his dedication—are entangled in the eating disorder. This can feel complicated, but remember that it is okay to respect, admire, and even love a trait in a person while also hating how that trait is being used. In other words, it is okay to have complicated feelings.

It will make it clear that your partner is not the only one with a problem: just the fact that your partner has an ED means you are dealing with something that is clearly a significant stressor. This understanding might help you find more empathy for your partner and reconceptualize the eating disorder as something that you and your partner are trying to attack together. In this way, it can ultimately bring you closer together.

The first thing to keep in mind is that your partner really does come by her way of viewing food honestly. She isn’t trying to be difficult or make life hard—she really and truly feels terribly about herself, her body, and her food.

The objective truth is that these lines are the same length! You can take a ruler and measure them if you’d like. But knowing that they’re the same length doesn’t really change the way you perceive them, does it? Now, imagine somebody telling you not to see the lines as different lengths, that it’s stupid of you to think that the lines are different lengths or that you aren’t trying hard enough to see that the lines are the same length. Wouldn’t that feel terrible? And, would it change the way that the image appears to you? Of course not.

The essence of the disorder is to make thoughts and feelings about food grow out of control until there isn’t much space left for anything else. Ask people with an eating disorder if they’ve had a good day, and they will mentally review what they ate. If they feel like they ate well (not too much and not the wrong things), then it’s a good day. If they feel like they broke their rules about food or gave into urges to binge, it’s a bad day.

If you had a problem with alcohol, although it might be difficult, you could stop drinking. The same goes for many other addictions, such as gambling or narcotics. You could quit, because none of these things is essential to life. But you can’t stop eating food. So people with eating disorders are confronted multiple times a day with the very thing that makes them feel the most insecure, anxious, and uncertain of themselves. Remember, too, that you always carry your body around. You are never, ever, not for a single moment, without it! There is always an opportunity to look down and evaluate what you see—and an opportunity for the eating disorder to make you feel like it isn’t good enough. The inescapability of food and the body makes eating disorders a particularly difficult nemesis to combat. It’s a disorder that you can’t get away from.

Even while these profound effects are happening, people who are restricting sometimes report that they are not hungry. Sometimes this may be a fabrication, because eating feels too overwhelming and scary. Other times, though, it represents an honest assessment. There comes a certain point in the development of an eating disorder where the body begins to have trouble knowing when it needs food, so people may truly not get the signal that they are hungry even though their bodies are starving. This is known as losing your hunger cues. Luckily, hunger cues can come back with adequate nutrition during recovery.

Purging can also be done through fasting, exercise, diuretics, or caffeine pills; different feelings associated with each of these methods can have their own addictive qualities.

People with eating disorders often feel that food is the one thing they can control. Even if they don’t feel in control of anything else in life, at least they can be in charge of what goes into their body. Other people simply cannot make them eat or stop eating

Any strategy that increases your partner’s anxiety will increase her likelihood of using the eating disorder to cope with that anxiety.

Actually, even positive comments about appearance often have the opposite effect of what was intended! Any time that you are focused on weight or appearance, even in a positive way, the eating disorder has an opportunity. The words that you are saying get twisted until what your partner ends up hearing isn’t what you meant at all.

Think about the eating disorder like the world’s worst (and meanest) translator. If you tell your partner that she is skinny enough, she hears, Good job dieting (but I bet you can do better)! If you mention that your recovering partner is looking healthier, she’s likely to hear this as You are starting to get fat. If you say, “I think you’re beautiful,” your partner might hear I think you’re beautiful now, and looks are important to me or I wouldn’t mention it. You better not get fat.

Instead, keep your focus on your partner’s inner self, who she really is. If you think that your partner is smart, funny, or kind, let her know about it! And let her know how important these things are to you.

It can be a part of eating disorders to ask for reassurance a lot. This could have to do with certain foods or with body size and shape. At these times, it can be helpful to redirect focus on how your partner feels rather than the disordered eating concerns (looking fat, eating too much, and so on).

The real questions that drive eating disorders—Am I good enough? Am I lovable? Am I at risk for being out of control?—are more likely to be answered if you don’t get sidetracked into a discussion about your partner’s body. When somebody is seeking reassurance about their body or food, it’s really a communication that the eating disorder is activated and that they need your support.

It’s also always okay to decline to comment. If you need to, you can make me the bad guy here: “I’ve learned from that book I’m reading that it’s better if I don’t say anything about that, but I’m here to talk if you are struggling with ED stuff. How are you doing?”

Unhelpful Comments About Weight, Appearance, or Food It Would Be More Helpful to Say “You look great!” “It isn’t attractive when you are so thin.” “I’m so glad you’re looking healthier.” “Gee, that’s a lot of calories.” “I love that T-shirt. It’s such a great band.” “I think you are smart, funny, and kind. I’m very attracted to those things about you.” “I’m so glad you seem less anxious about food.” “Gee, that looks delicious.”

These comments make the person with the eating disorder confused and angry—if you are willing to judge someone else’s body or diet, it follows that you might judge your partner’s as well. How can you tell your wife she needs to love her body as it is, and then make a nasty comment about what some stranger on the subway is eating?

Body Bashing It Would Be More Helpful to Say “I need to lose weight.” “I hate my love handles.” “Carly looks like she lost weight.” “I love my body at any size.” “My body doesn’t have to look one particular way. My health and happiness are what’s most important.” “Carly seems happy.”

Although it has a huge impact on you, the eating disorder is not about you. Similarly, the various struggles and triumphs your partner encounters along the way are not about you. You cannot fix your partner. While this may seem harsh, it is actually quite liberating! Your partner doesn’t have this eating disorder because you somehow fail to love her enough, communicate your love enough, or make her feel worthwhile. Your partner has the eating disorder because she has trouble doing those things for herself.

The key here is to find a healthy middle ground, where you don’t take ownership of your partner’s food behaviors but you do understand and speak about the effect that they have on you and your relationship. The eating disorder is not about you, but it does affect you.

Although it might look easy from the outside, it’s extremely difficult to change disordered eating behaviors. When you offer pat solutions, it can make your partner feel like he isn’t really understood.

Even if she believes you on a thinking level, the eating disorder just won’t let her get there emotionally. With an eating disorder, completely illogical ideas can make perfect sense—they just feel true.

When you’re tempted to use logic to convince your partner not to engage in ED behaviors, try approaching her about her feelings instead.

Usually strong-arming takes the guise of “putting my foot down” or “not putting up with this nonsense any longer.” It doesn’t really feel like you are bullying your partner; it feels like you are taking a strong stance against the eating disorder. But unfortunately the eating disorder lives inside your partner, so you can’t attack it in this way without attacking him.

Nagging It Would Be More Helpful to Say “Have you called the therapist yet?” “Just have some muffin. Just a bite? What about this other muffin? Oh, come on. Just a little bite?” “I know we’ve talked about this before, and I just want to let you know I still think that treatment is a really good idea. If you want me to help you find someone, let me know.” “I know muffins are a fear food for you, but I really think you’re up to it. Would you like to try? No? Okay. If you change your mind, I’ll do what I can to support you.”

One type of guilt-tripping that is commonly seen is pleading. Saying “please” or “for me” may seem like a good idea because you’re using your relational capital to get your partner to engage in healthier eating behaviors. Unfortunately, however, pleading works only in the short term and, as a by-product, your partner will feel bad about himself or resentful of you for using emotional manipulation to get your way.

A person with healthy boundaries might think, This person is upset. Is there anything I can do for him (without sacrificing my own sense of well-being)? In the same situation, someone with loose boundaries is more apt to think This person is upset, I must drop everything to try to fix it. The problem for people with loose boundaries is that they end up doing things that they don’t really want to do and things that get in the way of their own well-being. Therefore, they can’t help but feel resentful in the long run. They may also feel guilty when they advocate for their own basic needs.

Never ever discuss loaded topics during a meal, when your partner is about to eat, or when he’s just eaten. Food situations make people with eating disorders extremely anxious, and you want to have your important conversations at a time that is as calm as possible. To that end, it can be helpful to remember the acronym HALT, which comes from the substance abuse field: don’t pursue the conversation when either you or your partner is hungry, angry, lonely, or tired.

when you really want to know about your partner’s mental life, be sure to ask lots of open-ended questions along the lines of “What is that like for you?” or “How are you doing?” This allows your partner to offer up the things that are really important to him, not just whatever piece of information you happen to ask for.

After your partner has said something, repeat what you think to be the important parts back, using slightly different wording to make sure you’ve gotten it right.

Be as specific and supportive as you can. If possible, focus on the food behaviors rather than on any changes in weight or appearance that you may have noticed.

It isn’t enough to talk about your partner’s eating disorder once and then drop it. Set aside a regular time to talk about the eating disorder and its effect on your relationship. This will keep emotions from being bottled up for too long and keep you from waiting until it’s too late to alleviate problems. Not every conversation has to be a heartfelt tearjerker; sometimes a little check-in is fine: “Hey, how were you doing during dinner tonight?” or “Oh, you need to buy jeans? Yikes, that could be a field day for your ED. Let me know if you need me around.”

It would be helpful for you to remind your partner that you believe in her competence and efficacy. You can remind her of difficult challenges that she’s faced successfully in the past, or just simply a well-timed “I believe in you” can go quite a long way.

There are two types of support, and understanding their differences can help you know when to offer which kind. Instrumental support is tangible. It involves doing actual tasks that help make your partner’s life easier. This could include grocery shopping, preparing meals, paying for treatment, offering rides to treatment, or providing child care to allow for treatment. Emotional support is just that—emotional. It’s less about doing than about being—being available, being there, being empathic, being loving. People entering into recovery from an eating disorder need both these types of support.

A trigger is anything that initiates disordered-eating thoughts and feelings. Triggers are not the cause of the eating disorder, but they make the eating disorder rear its ugly head. A trigger could be almost anything, food related or not.

When your partner is triggered, you can help by prioritizing feelings over food. In other words, focus on the feelings that come up for your partner rather than on disordered eating behaviors.

if a certain meal or moment seems hard, it can be really helpful to be a distracting presence taking energy away from the anxiety.

Engaging Your Partner in Nonfood-Related Activities

Of course, you can’t avoid food-related issues completely; they are everywhere. The idea here is to find some fun activities where food is not the focus of attention.

The math that is used to determine the BMI is meant for population statistics (these fifty thousand people should be within this weight range on average) and not individual statistics (this particular individual person, with this genetic tendency, this bone structure, and this metabolism, should be within this weight range).

I recommend using the I-statement. The basic idea is that when you want to communicate how you are feeling, you focus on your own feelings. This ensures that you are only speaking for yourself, not your partner. Other people are likely to be receptive to I-statements—after all, who can argue with you about what your feelings are? ... A good I-statement would be “I am worried about your health when I don’t see you eat much.” If you are talking about something your partner is doing, try to keep your focus on the behavior instead of the person: “I feel upset when you miss dinner” or “I am sad that you are struggling so much.”

many people with EDs frequently ask their partners if what they are eating is too much, whether it is okay for them to eat particular food items, and the most dreaded question of all—“Do I look fat?” I encourage you not to entertain these questions, but to redirect the conversation to the powerful feelings that are likely driving them. ... You can say something along the lines of “I’ve learned it’s better for me not to answer these types of questions, and I know that’s annoying. But are you feeling really anxious? What do you need?” or “Is your eating disorder piping up?”

The all foods fit philosophy counteracts the fear-based, disordered idea that certain foods are totally bad, wrong, and off-limits.

The bottom line is to stop thinking of different foods as either punishments or rewards—they’re best when embraced as part of a balanced diet.

Eating disorders can negatively affect libido both emotionally and biologically. Sexual desire is largely based upon chemicals in the brain and body, and having a very low or high body weight can decrease the production of these chemicals. So can poor nutrition, even if a person is at a healthy body weight. These same chemicals result in vaginal lubrication for women and, without them, sex can become uncomfortable or even painful.

Given the complexity of recovery, it can be helpful for you to think of the recovery process in terms of stages of change. This idea actually applies to many types of change that people make in their lives. However ready someone is to change their behavior determines the stage of change they’re in, whether it is the precontemplation, contemplation, preparation, action, or maintenance stage

Again, remember that the eating disorder does something for your partner: it solves some emotional problem and makes the world more manageable. Of course it will be hard to give that up, and deciding to change will be difficult.

A relapse can actually be an important part of recovery by pointing where understanding or healing may have been incomplete in the first stages of treatment. Maybe a significant relationship was left unexamined, a traumatic experience was not processed, or not enough support was put into place. A relapse is like recovery saying, “Hey, you missed a spot!”

When the body gains back weight after a significant period, it first deposits fat in the midsection to protect our vital organs. This can take an especially difficult toll on those entering into recovery because belly fat is so strongly vilified in our culture. Your partner will need continued reassurance that body changes are a normal part of recovery and that the body will redistribute the weight, once it is able to trust your partner to feed it well and consistently.

to deal with an ED on your own can be difficult and potentially harmful. It is absolutely vital to work with a team who knows the terrain, often a psychotherapist, dietitian, medical doctor, and perhaps a psychiatrist. Attempting recovery on your own after a prolonged period of restriction can even be dangerous, because the body may have difficulty adjusting to having normal amounts of food again. Having food intake monitored by a professional is important to make sure that recovery doesn’t put the body through more trauma.

when it comes to an eating disorder, making light of it does not strike the right chord. It will likely make your partner feel like you don’t understand the depth of his struggle or how painful it is.