The behaviors of an eating disorder are obvious, if confusing, to people with limited understanding of these illnesses. People either stop eating and lose weight or binge/overeat regularly and then try to compensate by purging or exercising or a variety of other measures. What drives these behaviors is much more murky.
But there is a reason eating disorders are classified as psychological. The maladaptive thoughts and emotions form the engine that drives the illness. The cure seems straightforward--to just eat--yet clearly that seemingly sage advice is ineffective in eating disorder recovery. The underlying psychological process makes the mundane chore of eating impossible.
Describing the thoughts and feelings of an eating disorder is difficult. The specifics are confusing even to the most open-minded. We are programmed to view food and meals as necessities, like sleeping and breathing. Even for those trapped in the cycle of disordered eating, food isn't the enemy, only for those with eating disorders.
The level of fear, if not terror, associated with food for someone with an eating disorder is very heightened. The actual thoughts about food reflect as much: you don't deserve to eat; you aren't worthy of food; everyone else gets to eat, just not you. Facing food several times per day feels like going into battle. Since food and terror aren't linked for most people, these thoughts just don't make sense.
It takes a leap in imagination to understand the psychological prison of an eating disorder. We all go through our days with an internal thought structure about ourselves and our lives. These thoughts can range from positive to critical, arrogant to self-deprecating, conscious to mostly out of awareness. Our internal world affects how we live and decisions we make.
Now try to imagine one's mind hijacked by a powerful, harsh dictator. The resulting thoughts aim constant barbs criticizing everything about you, putting down every aspect of your life and insisting you're worthless and your life is pointless. These are the thoughts of an eating disorder. After reaching a crescendo of punishment, this internal monologue insists on retribution to confirm how awful the person is, namely either by restricting or binging. The harsh thoughts are the driving force of the illness and make the suggestion to just eat, as if it were that simple, absurd.
Once the psychological suffering of an eating disorder is clear, the actual help and care the person with the illness needs shifts markedly. These punishing thoughts are not the thoughts of the person who is ill but the symptoms of a disease. And when a person is bludgeoned by constant punishment, the instinctive reaction at first is to fight but, without any success time and again, it is to cede power and just to try to survive.
The most effective tool to counter the punishing thoughts is kindness. A period of being punished and being alone leads the person to crave kindness and compassion. Often uncomfortable at first, regularly receiving kindness offers an alternative to the punishment of the eating disorder. It reminds the sufferer of a forgotten way of living in the world and of how to reflect on oneself. It opens a door to a life no longer dominated by punishment and starvation or binging.
The protracted course of an eating disorder actually leads family and friends to frustration and, if anything, harsh responses. Years of watching the person stay sick with multiple aborted attempts at recovery prompt anger and resentment. It's hard not to believe the disease is self-inflicted, the grief of lost time self-pity. It's a logical step to interpret the internal punishing thoughts as a sign of not wanting to get well, not as the symptom of a relentless illness.
These false assumptions only isolate the person more, thereby strengthening the illness. Alone with the internal dictator, the ill have no chance at recovery. The education of loved ones must include two steps to help them provide needed support.
First, the psychological component of eating disorders needs to be reinforced repeatedly. The behaviors may be clear, but the punishing thoughts are too hidden and too powerful to be ignored. It's essential to understand how the thoughts function and to see them as symptoms, not self-sabotage.
Second, families and friends must understand that the only successful counterpoint to criticism is kindness. Regularly asking how she is doing and how you can help goes a very long way. Offering regular support without judgment means more than words can say. Sticking it out with her even during hard days and weeks can weakens the internal dialogue. The outside pressure of kindness can speed up a recovery more than almost any other personal support.