The Challenge of Compliments for a Person in Eating Disorder Recovery

Compliments generally have a universal effect on people. They smile, feel better about themselves or feel more connected in the moment. Families and friends, recognizing the challenges in recovery from an eating disorder, want to acknowledge small successes and encourage their loved ones through the process. Yet compliments to a person in recovery usually backfire. The patient tends to feel worse afterwards and pull away from the relationship, a confusing response to a gesture of love and caring and, in light of my recent posts about relationships and intimacy in recovery, somewhat paradoxical. But a more careful understanding of the social dynamics of a compliment explain the situation more clearly.

In order for a compliment to be helpful, the receiver has to be able to do several things. First, she has to believe the statement comes from someone being genuine. Second, she has to understand that the statement might very well be true. Third, she must allow the closeness that comes with accepting the statement and must allow herself to express the vulnerability of gratitude. In other words, the seemingly automatic and easy responses to a compliment don't come naturally to someone with an eating disorder.

Wary of relationships, the person in recovery isn't facile at believing a positive statement from someone else can be authentic. It's hard to imagine a compliment is real when one's internal thoughts are constantly negative and critical. If a positive comment doesn't represent true caring, the next alternative is to assume the other person has an agenda. The internal criticism can cook up many stories to explain the comment from wanting something in return to veiled competition. Sizing up another's motivation for a compliment will only reinforce the negative thoughts associated with the eating disorder and confirm the world is just as harsh and cruel as the disease itself.

Even more difficult for a patient in recovery is to assume the opposite of the critical thoughts, that a compliment may in fact be true. A lot of work in recovery is explicitly geared towards imagining a positive statement about oneself is true. At the core of the illness is the absolute belief that one is a horrible person. Although the patient can live in the world and fake being "normal," a word frequently used by people with a chronic eating disorder, the underlying identity is a complete negative self-image. There are almost no positive thoughts to find in someone with longstanding illness. And so it takes time, patience and a lot of repetition to begin to replace those critical, automatic negative thoughts. Positive comments from others seem irrelevant, not connected at all to the identity of the sick person, and learning how to accept and believe these statements is a central part of recovery.

The last step in accepting a compliment is the hardest. The social norm in responding to a positive statement is a subtle but powerful engagement. The complimenter is extending a hand and showing some personal vulnerability with the praise. Compliments generally come with eye contact and an expectation of a response. The complimentee is likely surprised and will smile and be gracious. That response necessitates returning the eye contact, a smile and an extension of the vulnerability by allowing a moment of connection, likely leading to a sense of emotional closeness. For many reasons, this short, subtle exchange taxes the patient's ability to engage in the intimacy of relationships, something that generally terrifies someone in recovery from an eating disorder.

Left without the natural response to help a loved one in recovery, family and friends can feel powerless to say anything. A compliment pushes the person away and any even subtly critical comment certainly hurts. Yet not saying anything at all will send the message that one doesn't care. Often, emotional distance in all relationships precedes the step into recovery so these once close relationships are already strained and much more distant than in the past, a fact that puts significant pressure on making communication work. Confusion and tentativeness are the most common response for loved ones close to the person in recovery. 

The best approach is to continue to compliment the loved one while also recognizing how difficult that interaction might be. It's best to preface the statement by saying a compliment is on its way or that this statement might not be so easy to hear. This will give the person a moment to prepare for the emotions that follow. Even commenting that it might be hard to believe the statement will help the person feel understood. Steps forward in recovery can be challenging and the process of improvement leads to mixed feelings, as I have written often in this blog. Sensitivity to the challenges in recovery, even in something as hard to understand as taking a compliment, will only help the person in recovery continue down that path and feel supported and loved.