Families can bolster the motivation needed by those battling an eating disorder. Setting boundaries is vital, writes Anne Dempsey
'So many people turned up at the eating disorder lecture last year that we had to get extra chairs and even then some were turned away. We kept all the questions, noted the phone calls during the year and as a result have included the subject again this year from a family perspective," says Imelda Redmond, clinical nurse specialist in eating disorders at St John of God Hospital, Dublin, one of just two such specialists in the State.
Her talk last week on how families can help in the recovery process from eating disorders was part of the hospital's Minding the Mind lecture series.
"Recovery from an eating disorder is a gradual, long, unpredictable process which can take up to five years. Research suggests that between one third and one half make a full recovery, about one in four recover after a number of relapses. Some unfortunately only manage their illness rather than recovering, and some die, in fact the highest number of deaths from a psychiatric illness occur in those with eating disorders, often through suicide," says Redmond.
"The benefits conferred by an eating disorder include control, self-esteem, specialness, gaining attention, numbing and diminishing of fears and feelings which can be helpful if these are intense. It can serve as what is seen as a deserved punishment and gives a purpose in a life that may lack goals. There can be a feeling of achievement in resisting intake of food, in exercising three to four hours a day."
This glimpse into the mindset of a a person with an eating disorder offers insights to families struggling to cope.
"The mistakes families often make is confronting the person, 'if you don't eat you will die', 'see what you're doing to the family'. Unfortunately, such threats often just make the person more secretive in their behaviour. Many patients are very guilty already about what they put their families through and yet feel powerless to change. Becoming more informed leads the family to a realization of the psychological basis of the illness. They see it's not just about food."
So how should they best address the issue? "Plan the approach, pick a suitable time, show concern. Be firm, gentle or calm even though this can be hard to do, don't attack or judge. You may be met with denial, defence - 'I don't have a problem' - but maybe also with relief that someone is voicing it. Allow time for response, make supportive suggestions such as offering information on eating disorders, set up another meeting time."
Recovery, says Redmond, has two essential factors, acceptance of the problem and a desire to change behaviour. "People may be motivated to change typically when they feel they are missing out on life, when the disorder is all time-consuming, when they become tired of feeling starved, cold and isolated. They may worry about medical complications, become fed up with food-exercise regimes, they may be low, suicidal, getting hassle from other people and just tired of it."
Families will help bolster this motivation if they stay consistent keeping normal family routines. Negotiating mealtimes can be a particular minefield.
"Avoid emotional discussion at mealtimes," advises Redmond. "Continue to ask how you can give support, provide a variety of foods, anticipate eating rituals. Set necessary boundaries. If someone is binge eating, having them replace family food is better than locking the press."
When someone finally agrees to accept treatment whether as a inpatient or outpatient, fears of loss of that crucial control may soar again. Here too, a family will help best if they understand this and continue to support and reassure. Relapse can be distressing but it should be seen as a stepping stone to recovery.