The Role of Family and Friends in Recovery

People in recovery from an eating disorder need the kind of help most people would need when healing from a chronic, severe illness. Family members and friends can offer love and care while showing expressing their concern with time and attention. Most loved ones wouldn't interfere with the medical and clinical plan other than to be sure that care is adequate and proficient. 

However, it is hard for families and friends to resist meddling in treatment for eating disorders. In general people have very strong personal opinions and feelings about food and weight. Despite every intention of following clinical care, loved ones have ideas about what recovery ought to look like. 

More often than not, those opinions come from a place of love. Adding seemingly useful advice to a treatment plan can seem helpful and constructive. 

However, the person with the eating disorder almost universally experiences the guidance as intrusive and judgmental. The advice comes across as harshly critical and detrimental and is counterproductive in ways that won't make much sense to the family member or friend. 

Clinical guidelines and meal plans come from an objective caregiver with experience and knowledge about how to approach eating disorder recovery in a caring but non-judgmental way. There is no way for a loved person in the patient's life to express opinions about food that are purely supportive. 

The easiest way to explain this paradox is that for a person with an eating disorder, discussing food and meals is the most  personal, exposing and potentially shameful thing to open up to others. Nothing else compares. For people without eating disorders, food is largely impersonal, but people with eating disorders would discuss anything else first. So offering love and support can help the loved one use her own strength for recovery. Objective opinions about food only leads to a feeling of exposure and shame which only strengthens the eating disorder. 

The basic premise is that support for someone in recovery needs to involve love and care. Advice, like with any other illness, belongs to the clinical treatment team, not with loved ones.

Body Size and Shame in Recovery

The markers of success in our society are fairly clear: money, power and education all rank high on the list. But to a large degree, the people who are successful are most often born into that world. Realistically, movement into and out of that world is very limited. 

The powerlessness of daily life has reinforced a new marker of success: thinness. For people without any indication that life can change, dieting and creating an enviable body has become a way to mark accomplishment and then display it to the world. 

Although the eating disorder epidemic began in a wealthier, more successful class, all indicators show that these illnesses no longer discriminate. The generalization of dieting throughout all first world communities opens the genetic door for all people to develop eating disorders.

One consequence of the drive for thinness, ironically, is the increase in obesity, in part from binge eating disorders. Chronic dieting triggers overeating and binge eating for many people. Being overweight is seen as the antithesis of thinness, not only in terms of body size but as a sign of success or failure. 

Meanwhile, the reality of dieting and overeating is that they are flip sides of the same coin. As I have written many times in this blog, longstanding restriction triggers a very powerful hunger response which often leads to binging. In addition, slowed metabolism from restriction triggers the body to react by storing energy as fat to preserve against future limited food intake. In other words, thinness and being overweight are two of the body's reaction to not feeding oneself properly. The opposite to both of these is normalized eating. 

This thought process confirms a crucial part of recovery from binge eating disorders, eliminating the shame. Society may impose harsh criticisms about weight, and a necessary step in treatment is to quiet those voices. The reality is that one's body will handle the effects of disordered eating to survive, whatever that means about weight.

Facing any source of shame or negative feelings needs to be a cornerstone to therapy while also trying to separate the personal feelings from the societal sense of blame. Inevitably, recovery includes finding a sense of personal peace irrespective of body size. Health and wellness means both normal eating and psychological well being. A strong focus on body size will only reinforce the illness. 

Disorders of Overeating and the Place of Blame

I have written many times about Binge Eating Disorder, compulsive overeating and obesity in this blog, and the central message about these illnesses is that these compulsive behaviors are not a matter of willpower. This false belief perpetuates a feeling of shame and responsibility and a pervasive sense of blame, secrecy and, most sadly, a long delay in seeking help. 

Almost always, eating disorders or disordered eating stems from a combination of a genetic predisposition to the eating symptoms combined with a powerful emotional and chemical response to the behaviors. All disorders comprised primarily of overeating are the exact same way. 

In fact, the symptoms and treatment for people with these illnesses are essentially identical to the treatment for bulimia. The exact expression of the eating disorder symptoms relate mostly to physiology and biological response to eating disorder behaviors, not to a difference in willpower or personal responsibility. 

Not only are eating disorder symptoms an attempt to manage hunger and weight, they also have powerful effects on mood and thought processes. Starving, binging, purging and compulsive overeating all change someone's mood very quickly and decrease anxiety significantly. The positive effect is brief, however, and the long term result inevitably is worsening mood and anxiety. But, like anyone who uses a behavior or substance to change their immediate state of mind, the urge to use that symptom overrides any logical conclusion that it won't work. 

People with eating disorders of overeating have the added societal bias that their behaviors are primarily from a personal flaw and that the world around them judges their symptoms more harshly as failure. In addition, the bias about weight often leads to being overlooked in both personal and professional parts of their lives.

Accordingly, recovery from these disorders needs to incorporate ways to challenge or circumvent this bias, to assert self-confidence and to refute the assumptions around them. Accepting judgment only reinforces the illness and extends the period of being unwell. The next post will address how treatment can focus on this component of recovery.