What not to say to people with eating disorders
This post is dedicated to those of you who know someone with an eating disorder. Are you afraid of saying something wrong, and want to know what you should and should not say?
(It is very long, and for that I apologise.)
Please read the post with respect. This applies to both patients and their family/friends. Remember that no one are perfect. The person with an eating disorder is not using her/his eating disorder as an excuse to “be difficult”, it is a real and severe problem for her/him! Just as important to note is that family and friends are not mind readers, and they are not mean. Knowing that someone you love and care about have a life threatening mental illness, is a terrible situation to be put in, and most parents will do ANYTHING in their power to save their child from illness and death.
Below is a list (with explanations) about what to say, or what not say, to a person with an eating disorder:
- Do not ask yes/no-questions. If you ask a question such as: Can’t you just eat this dinner?, the answer you receive will likely be no, and the conversation abruptly stops. The answer you receive might also be yes, but be a lie.
- Do not ask leading questions. If you ask: There is no way to make you eat this dinner, is it?, the answer will likely be no. Leading questions come with a huge disadvantage: The person can feel forced to lie. Because you are giving her/him an ultimatum, but the eating disorder does not allow this ultimatum to be realized. Please note: I am not saying that family and friends should “play along” with the eating disorder. But I am saying that if you directly oppose it, there is a high risk that you could make things worse (aka make the eating disorder stronger instead of weaker).
- Ask open questions. This is the way to go. As opposed to the two prior examples, you could ask: How are you doing right now? Why do you think this dinner is difficult for you? Are you afraid of something specific? Is there anything I can do to help?
As you can see, neither of these questions are yes/no-questions or leading questions. In other words, open questions like these will make room for honest answers. The person will feel safe that you simply want to help, and that you are trying to understand.
You should also be clear that it is fine if the person cannot, or does not want to, answer the question. Be clear that you just want to show her/him that you care. You can also add that the person can come back to you whenever she/he feels like it, and answer the question later.
- Do not say “I know EXACTLY how you feel!”. Because unless you have had an eating disorder yourself, it is very unlikely that you know that. Ask open questions instead.
- Do not comment on other people’s body or weight. First of all, this is bad manners and can be very impolite. Secondly, for a person with an eating disorder, body, weight, and appearance is by far the most difficult topic for conversation. Body, weight and appearance are topics that can, and should, be limited to treatment settings. Plus; there is a major chance that the person already knows what you think of her/his body.
- Do not say “You look better!”. This is a tricky one. Hard to understand, even for people with eating disorders (believe it or not).
Imagine this: You think you are chubby, overweight, or fat. In spite of this, your family and friends (sometimes also complete strangers) tells you over and over again that you need to gain at least 15 kilos/33 lbs. When you finally do gain, everyone are running in your direction to tell you that they can see you put on weight.
I doubt that would feel nice for any person, eating disordered or not. And this is my point here. Almost all people with eating disorders see themselves as fat/chubby/too big. It is also very common that they want to become healthy, and want to fully recover, but still do not want to gain any weight. You should avoid this comment because it confirms (indirectly, and wrongly too, of course) that the persons greatest fear of all has actually come true, they have now become even fatter, chubbier, or bigger.
It is very easy to understand why family and friends want to tell their beloved one that they look healthier! It is meant as a compliment, meant to be something mutually joyful.
It took me years to be able to handle this comment. Believe me, I have tried multiple times and failed. I tried to feel happy about it, I tried to block out the voice that translated “you look better” into “you are the most obese person on earth”, I tried to control my own reaction to make people happy. It always ended with a fake smile, and a bunch of chaos. And relapse. I have had an eating disorder for years, and it took me quite some time in recovery to be able to handle the comment as well. Before this happened, I had to overcome all the hatred I harbored against my body.
- Do not comment on other people’s eating habits or -patterns. People with eating disorders are fully aware that they have different eating habits (or –patterns) than you, whether the difference lies in amounts or food types. First of all, the comment is unnecessary. Secondly, comments like these only contribute to the person feeling guilty: (S)he does not want to bother anyone, but now receives a clear message that that’s what (s)he does. Knowing that you worry people who love you, does not make the eating disorder loosen its grip. What it usually leads to, is the person wanting to eat alone or in secret, lie about food intake, or resort to purging/laxative abuse/(excessive) exercise. The same rule applies when/if the person eats what you think of as “too much” or “unhealthy”. Don’t bring it up. Just don’t. Leave the person alone.
- Do not talk about food during meals. I am not saying you should not express your joy over fabulous, tasty sauce/gravy. What I am saying is you should avoid saying things like: “I am so stuffed!”, “You must be very hungry!”, “Aren’t you having one more portion?”, “This is healthy!”, or “Nah, this is quite unhealthy!”. If the person actually tries to finish his/her dinner plate, you are transforming the effort into a house of cards: It could collapse any second.
If you say “this is healthy”, the person might experience trouble eating tomorrow’s dinner as it is “less healthy” (because it contains more carbohydrates, for example).
If you say “this is unhealthy”, you have potentially ruined dinner with immediate effect. In many cases, the person might resort to purging, (excessive) exercise, etc. to rid him-/herself of this “unhealthy” thing. The person might also “transfer” the unhealthy-label to many other food types similar to the one you just called unhealthy.
If you say “aren’t you having one more portion?” it could make the person stop because it is made very clear that (s)he has already consume one whole portion. (While portion sizes are unlimited in recovery, because (s)he needs all the energy (s)he can get.)
If you say “I am so stuffed!”, there is a chance that the person will make sure to eat just a fraction of the amount you eat. If eating less than you is too late, the person might resort to purging, (excessive) exercise, etc. to get rid of the “unnecessary” food.
- Do not talk about dieting, diets, healthy/unhealthy food, weight loss, or exercise. This is triggering to almost everyone. If you don’t feel too thin (to be “allowed” to do any of these things), why would a person with an eating disorder feel too thin? (This is how the illness works.) If you think you should diet, why shouldn’t the person with an eating disorder diet? It is very likely that the eating disordered person feels like (s)he is at least twice your size – even if YOU are twice HER/HIS size, for that matter. Be careful!
- Do not assume you need to tell other people what they are doing. It is not your duty, it is none of your business, and you are not the first one to point out what they are doing either. Most patients, no matter what illness/condition they suffer from, receive well-meant advice every single day. Sometimes even from people they have never met before.
Another important factor regarding this topis, is (well-meant) advice.
People with eating disorders receive tons of (well-meant) advice day after day. We who have eating disorders, of course know that the advisor means well. That, however, does not necessarily mean that any of these advices actually help, and it is not necessarily a good idea to give the advice either. In fact, you should try to avoid giving advice as often as possible.
I am not saying one should never offer good advice, but there may be several reasons as to why you should not give the advice at all. I recommend you use the following questions as a guideline:
- IS this good advice? If so, why? In what way do you feel certain that this will make a (positive!) difference?
- Do you think the person has received this advice many times before? If so, do you really find it necessary to repeat the advice for the forty-fifth time? The least you can do is ask the person if (s)he has received the advise many times before, and if (s)he has, then drop it. Completely.
- Is your advice medically safe? Guaranteed? Or is there possibly any (slightest) chance that you are wrong?
A good example here is exercise. Many patients in recovery are encouraged to start exercising. The argument is that exercise strengthens bone mass and increases muscle mass. That is true, of course, but it only applies to people without an active eating disorder! In reality, people with eating disorders should’nt exercise at all (in spite of all the wonderful health benefits), simply because exercise very often keeps the body in starvation mode (making it impossible to recover), and also because muscle- and bone mass are already broken down – if they are broken down even more (yes, this is what exercise does, it breaks down muscles), they are never given the chance to heal.
- Is there a chance that your advice has a triggering effect? If no, how confident are you? Have you had an eating disorder? Has the person told you in detail what triggers her/him? (If you feel any doubt at all, mention the topic first and ask if this could potentially trigger.) If the advice turns out to trigger despite trying the opposite, do your best to debrief the situation afterwards.