What Hinders Eating Disorder Recovery
Following from an earlier post about what helps. There are also things that don't work for recovery.

Having a label pinned to your chest.

Too many therapists label you as anorexic or bulimic, or an addict. Having a diagnosis doesn’t fully describe who you are or how you got the problem. We don’t call depressed people “depressives”. The ED is an illness, but you are not the disorder. Discovering the pathway into your disorder and what is keeping you stuck is better than a label for aiding your recovery.


Trivilialising your symptoms and experience.

Some support systems are not supportive, with family members ignoring the eating disorder altogether or not taking it seriously as a difficult issue that needs attention. Some people call it stupid or vain. They might say “Don’t you know better, you are an intelligent girl.” Or they say you are not fat or thin enough to warrant concern.
Families and friends need to understand what an eating disorder is. They may think that if you just eat more, the problem will be fixed. One girl said that if her parents had come and said lets all talk about this, how you are feeling, what is our role in this, it would have been awesome.


Too much focus on food or on weight.

I’ve heard it said, it’s not about food, it’s about feelings. It is both of course. Your weight might be important, but it is not the only thing we have to attend to. Many people say that the scales are too powerful. So many people don’t feel good enough because they are not thin enough according to their value system. So feedback about their weight can be hurtful.

Focus on health trumps focus on weight for sufferers and no-one must make a big deal of small changes in weight. Emma Woolf, writing in the Times said that focus on weight is crazy. Half the population is given brownie points for losing weight, while people with anorexia are told that to gain is good. How is it helpful to have one rule for some and one rule for others? Therapists must pay attention to overall health and wellbeing. Weight is part of that of course because you cannot be healthy too thin or morbidly obese. Moving focus away from weight and weighing fosters self acceptance. You can learn to stop using the scales as a way to gauge if you are OK, or not.


Being secretive.

Some therapists listen to what you have to say without giving you any feedback. They take notes about your story without helping you to make sense of it. Talking on its own isn’t helpful. Practical skills are helpful, like teaching someone how to eat healthfully and, significantly, how to reconnect to their natural appetite. (how many therapists know how to do Appetite Sensitivity Training?)


Isolation hinders recovery.

But I’m not sure if being in a group with other people with an eating disorder is the best company. There are times to stop thinking and talking about eating disorders and get on with life. Relationships suffer as a result with eating disorders and repairing these relationships is one reason why people decide to try and get better. Helping people to make these repairs and especially helping someone to forgive themselves for all the wasted time and family disruptions must be major part of treatment.

It also helps if we can teach our clients to eat with other people, and socialize without having to put on acts with other people. Learning to be comfortable with other people breaks the wall of isolation that can keep someone trapped in an eating problem.

Being stereotyped and stigmatized.

Feeling ashamed puts up a barrier between the sufferer and other people and we know that poor connection makes the disorder even worse. If someone had cancer, people would have been there for them, but people think that an eating disorder is self inflicted. If other people can’t always be kind, start being compassionate toward yourself.
Make sure that everyone around you learns what an eating disorder is and why some people fall ill, not others. Carers and friends all need to have this information so that they can be a source of help.


The wrong treatment.

While some people get good treatment, others get treatment from judgmental professionals who do not know how to work effectively with eating disorders. Being patronized and criticized destroys your confidence that therapy can work. Providers can inadvertently look down on someone who is struggling with food, and even make threats or hurtful comments rather than trying to understand. Working shoulder to shoulder together rather than face to face is how providers should behave.
Therapists who don’t even talk about food (it’s about feelings, not food) aren’t helpful. Patients express appreciation for learning how to start eating safe foods, and how to listen to their bodies for hunger cues. Getting in touch with hunger and satiety in recovery is important, as well as learning how to eat in front of other people, changing eating rules, and learning how to cook.

It’s really sad that very few people know what good treatment really is, they just have to take what they can get. If a sufferer is difficult, angry and combative, this is the disorder speaking. Good therapists should be able to work around this.

Eating Disorder Recovery - What Helps
This is how it is from the view of sufferers

Its not just about being a good therapist. Or having the right tools. We must realise how scary change can be. We must know what isnt helpful - that's the subject of my next blog!

The client is the expert, not us, as Emma Woolf showed us in her memoire of recovery, “An Apple A Day”. But, the client still needs us by their side as what… A therapist? A mentor? A guru? They need our wisdom alongside their own. They need our sense of humour and basic optimism. They dont necessarily need our University Degrees. They certainly dont need "what worked for us".

This is what they tell us aids their recovery; in no order of importance

Reconnection: – but not, I think the pro anorexia, community. People way that doing things like YOGA JOURNALING and SPIRITUALITY helps them to reconnect to themselves. Therapists take note!

Close relationships: Knowing that your family and friends really care about you and you are in reach.

Statements of support: "I know you're trying" “I’m there for you” – what other statements are useful and what are not.? If someone says “You are looking better these days” it can send your client into a spiral of worry.

Empathetic Friends: Its useful if your friends know what they can and can't do and say.

Compassion: Eating disorders are such hard work.Compassion must flow from us to them and they need to learn to be compassionate for themselves whatever they are doing.

Therapy: it’s good to know that therapy helps as well, but looking forward is more important than looking back. Beware of therapists who don't know anything about nutrition, or the link between food and mood. But beware of therapists who focus on food instead of your general wellbeing.

Learning HOW to eat healthfully: Now there's a big chunk. There are so many food rules inside eating disorders, like being scared of carbs and counting all your calories. Wisdom, education, experimenting and reconnecting to natural cycles of hunger and satiety must be given by an expert not just someone who wants you to start eating more (or less).

Supporting your loved one through an eating disorder

By BodyMatters’ Psychologist Kellie Hodder

Living with or knowing someone with an eating disorder is enormously challenging. It can be difficult to know how to support your loved and through the recovery process. At BodyMatters we often speak to parents, friends and relatives who want to know how they should help their loved one through an eating disorder. The aim is always the same- to help their loved one through and make them feel better. The best way to do this is often less clear.


The first step of approaching your loved one about their eating disorder can be very difficult. Your loved one may not necessarily want any help to change their behaviours. They may be scared of changing and have trouble imagining a life without their eating disorder. They may be aware that they are causing you heartache but are caught between easing your pain, and wanting to maintain their eating disorder. It is important that your loved one acknowledges that there is an issue. Ultimately they will need to make the choice to relinquish the eating disorder and move towards making changes. Making the choice to recover is a difficult one and can be made easier if they have a sense of support from the people close to them.


Once the choice has been made to recover, it is normal for your loved one’s motivation to fluctuate between wanting to change and wanting to keep their eating disorder. Eating disorders usually develop over a prolonged period of time and often serve to help the person cope with distressing or unwanted emotions. Thinking about an eating disorder as a form of coping mechanism can help you to understand why it can be so difficult for your loved one to make the choice to give it up. An eating disorder can serve to work as providing a feeling of security and safety and your loved one may feel that by giving up their eating disorder, they are giving up something that has kept them safe and secure.


Therefore changing their eating disorder behaviours can be frightening and anxiety provoking as they will experience both mental and physical changes. These changes can prove to be challenging and may result in your loved one acting out in ways that can be confusing and hurtful for both them and yourself. At times you may feel fed up, frustrated, sad, resentful, frightened and exhausted. These are normal feelings and finding ways to manage these emotions and not blame yourself or your loved one, is one of the most beneficial things you can do.

Other ways you can support your loved one through their recovery are:

Provide them with unconditional love, support and acceptance. Show them that you will be there through every step of recovery.

Ask them how you can support them and help them through.

Allow and expect that your loved one will experience fear, resistance and uncertainty among other uncomfortable emotions.

Understand that progress may be slow and not be at the pace you may like or expect. Try to be patient.

Understand as much as you can about their eating disorder. Ask them what it is like if they are willing to share.

Move the focus off food and onto feelings.

Express your concerns about their health and wellbeing.

Let your loved one know how you are feeling too.

Try to remember that your loved one is distressed and has not stopped caring for you.

Don’t be afraid to ask for help. If your loved one’s recovery is becoming overwhelming, seek professional treatment and support for them as well as yourself.

Understand that your relationship will change over the course of recovery. While these changes can be painful and difficult to deal with, they are a sign of progress.

For parents, it is important that the limits you set continue to be maintained. While this may be difficult, try not to overlook behaviour that is unacceptable. Aim for consistency and unity in your approach.

Continue to engage in shared activities.

Setbacks are also inevitable. Help them learn from these and choose different behaviours next time.

Reframe these setbacks as part of the recovery process.

Remember it is not your fault.

Supporting a loved one through an eating disorder can be difficult, distressing and take a toll on your own wellbeing and health. It is crucial that you maintain awareness of your support needs and find your own ways and resources to nurture yourself and replenish your energy.

http://bodymatters.com.au/2012/10/supporting-your-loved-one-through-an-eating-disorder/BodyMatters

What NOT to Say to a Friend With an Eating Disorder
By Maddie Ruud
March 27, 2013

So you've just found out that your friend or family member is struggling with an eating disorder. You want to be supportive, but you're not sure what to say, and before you know it, your friend is defensive and angry or (perhaps worse) completely shut down. What went wrong?

The fact is, eating disorders are complex mental illnesses. Without a basic understanding of how an eating-disordered mind works, you can easily stumble into trouble. As someone with a long history of personal struggle, I've used my insight to compile a list of the most common mistakes people make in this area.


The Top 10 Worst Things to Say to Someone With an Eating Disorder

1. Why do you do that to yourself? There are many causes that feed into eating disorders, including cultural, emotional, and physical factors. Chances are, your friend or loved one isn't happy about the thoughts and behaviors holding him or her hostage. This kind of question feels like an accusation, and immediately puts people on the defensive.

2. You don't look like you have an eating disorder! Eating disorders affect people of all shapes and sizes. In fact, 70 percent of women with eating disorders are at or above a healthy weight, but there is a lot of internal pressure to fit the stereotypical picture of a starving anorexic. It's easy for the eating-disordered mind to take a comment like this as a criticism, even if you don't mean it that way.

3. Just eat healthy and be active. Food and weight are not the real problem. Telling someone with an eating disorder that he or she should just diet and exercise is like telling a drug addict to only shoot a little heroin. It minimizes the problem, and may very well be impossible advice to take!

4. It's what's on the inside that counts. Even to people without eating disorders, this often sounds like, "You're ugly. Get over it." You might think it's reassuring, but trust me. It's better to move away from talking about appearance altogether, because it's not the core issue.

5. You look great right now! You don't know what your friend's natural weight would be if he or she were not practicing eating disorder behaviors. What if that natural weight is much higher than his or her current weight? You've just reinforced the idea that the eating disorder is a necessary evil for looking good.

6. What was the last thing you ate? Once again, focussing on the food is just a smoke screen, a distraction from talking about the real problems causing the disorder. You should also be careful in assuming what behaviors your friend practices. Remember, not everyone with an eating disorder stops eating. There are many different kinds of eating disorders, and within each diagnosis, many different symptoms a person might have.

7. I know someone else with an eating disorder, and s/he said... While there might be time down the road to share about the other eating disordered people in your life, when you first find out that your friend is struggling, you should focus on his or her experience alone. No two people are the same, so avoid making comparisons, and just listen.

8. Just eat whatever you want. If only it were that simple. If you have no problems eating what you like without judging yourself, congratulations! But this conversation isn't about you, and clearly, it's more difficult for your friend. Instead of giving advice about a subject you don't know much about, try to learn more about your friend's struggles.

9. So who are you taking to prom? Don't change the subject. Moving too quickly to another topic will make your loved one feel like you aren't interested, like you don't care. I know it's a hard thing to talk about, but try to honor the bravery it took to share, and stick with the conversation.

10. ... ... ... Silence may be golden, but there's a time and a place for it.

The bottom line: If you can't think of anything to say, just listen. Ask open-ended questions about the important things: How do you feel about the eating disorder? Does anybody else know about it? What are your biggest fears about getting help? What can I do to support you? You might be surprised by the responses you get.

Huffington Post