Advice for Loved Ones

If you are supporting someone in recovery, I encourage you to learn about eating disorders. Start by using the information in this book! It will give you knowledge and insight about bulimia as well as suggestions and guidance for recovery. Also, discuss with the person you are assisting their expectations for your involvement. At the same time, set boundaries that make it clear that he or she* is responsible for their own recovery, yet affirm that you will do whatever possible to help. Here are more general suggestions:

• Remember that your loved one has the food problem, and it is up to her to do the work.

• Make a pact of complete honesty.

• Be patient, sympathetic, non­judgmental, and a good listener. Let her know that you care and have her best interests at heart.

• Accept that recovery is a process and does not happen quickly. Help her to be patient, as well.

• When her behavior affects you, express yourself without placing guilt or blame upon her. Try not to take her actions personally. Use “I” messages, explaining your feelings and concerns. You may need to disengage from her to take care of yourself.

• Have compassion. Your loved one may be overwhelmed as she gets in touch with the painful issues underlying the behavior. She will need your love and support at these times more than ever.

• Continually remind yourself that your loved one uses bulimia as a way of coping with life. Encourage her to find healthier ways.

• Do not try to guess what she wants, but urge her to express her needs and boundaries. Assure her that she can say “No” sometimes! If you have questions, ask.

• Learn about issues related to eating disorders, such as: societal pressures on women, the glorification of thinness, weight prejudice, set point, family dynamics, and self-esteem.

• Campaign for professional therapy, keeping in mind that no single approach to recovery works for everyone. Be available for joint counseling. Be flexible and open in supporting whatever method she chooses.

• Don’t comment on her appearance. You may think you are offering compliments, but they can sometimes be misinterpreted.

• Recognize that she needs to learn to make her own decisions, and that the direction of her recovery is her responsibility. Don’t constantly check up on her unless she asks that of you.

• Consider options for intervention if the bulimia is severely out-of-control.

*Although bulimia affects many males and everything in this chapter is applicable to both genders, we use female pronouns for simplicity.

Food and Eating

Although bulimia is not just about food, developing healthy eating behaviors is an essential part of recovery. In some cases, especially when the person with the eating disorder is a minor, parents are encouraged to provide parent-assisted meal support. This means that in the early stages of recovery from bulimia, they would typically be responsible for providing all meals and snacks, monitoring intake, and staying with their child after meals to prevent additional eating (bingeing) or purging. As the young person becomes more mature and trustworthy, she would be given more freedom—the goal being to learn to make healthy decisions about food and to cope with life stressors without returning to bulimic symptoms.

Whether you are a parent, partner, or another type of support person, the following guidelines are relevant:

• Remember that food is not the problem, and bulimia is a symptom. Look past the immediate situation to the deeper issues.

• Allow her to establish reasonable rules and goals about food and eating, but assert your rights as well. Only make rules that can be enforced; work within a framework that will result in successes rather than failures.

• Make it clear that she is responsible for the consequences of her bulimic behavior. For example, if she binges on the family’s food, she should replace it using her own money. If she vomits, she should clean the bathroom.

• If she binges, she should face it afterwards by talking about why it happened, writing in a journal, or exploring options with you for how to avoid bingeing the next time she is in a similar situation.

• Do not allow meals to be a battleground. Avoid turning her eating into a power struggle. Don’t be confrontational, but instead be calm, firm, nonjudgmental, and try to maintain a degree of levity.

• Mealtime conversations should not revolve around her bulimia.

• Encourage your loved one to develop a safe, healthy, and achievable meal plan on her own or with a nutritionist or dietitian.

• Plan activities that do not revolve around food. Take walks together, visit museums, go to the movies, play sports. If she is uncomfortable about eating in public, then do something besides going to restaurants for entertainment.

Care for the Caregiver

Caregivers usually experience numerous emotions about their loved one’s situation. They may blame themselves for not recognizing the warning signs and intervening earlier, or feel guilty for somehow contributing to the problem. They often “walk around on eggshells” for fear of upsetting the person or making matters worse. Exasperation over lack of communication is common, as is frustration over lack of progress and feelings of isolation and helplessness. Some parents fear that their child will never live up to her potential because of the eating disorder. Certainly everyone worries about health and whether or not recovery is really possible.

With so much stress on you, the caregiver, it is mandatory that you take care of yourself even as you support your loved one’s recovery process. Here are some suggestions:

• Consider getting professional counseling for yourself.

• Take quiet time everyday to be alone with your thoughts. Just as activities like meditation and journal writing are important for her, they can also benefit you.

• Be open to the possibility—without blame—that, despite your best intentions, you might be somehow contributing to her problem. You might need to challenge some of your own behaviors and beliefs.

• Recognize your strengths and limitations. Don’t try to do more than you are willing or able.

• Be a good role model by eating healthfully (but don’t diet!), exercising regularly, and expressing positive self-esteem.

• Don’t allow the eating disorder to be the only focus of your life. Try to maintain regular routines around meals, housekeeping, responsibilities, friendships, etc.

• Indulge yourself from time to time with hot baths, massages, and doing activities just for you.

• Don’t deny yourself the pleasure of dessert or foods that she fears, but instead model healthy enjoyment for her to see as normal.

Specifically for Parents

Nothing hurts worse than seeing your child suffer, regardless of his or her age. Most parents would do or give anything to help their child recover from an eating disorder. We’ve known of parents who have had to sell their homes and go into debt to finance treatment, and we’ve spoken to countless mothers and fathers who have been scared, confused, and desperate about what to do to help their children.

Your pain is very real and the task at hand is enormous. Here are some suggestions:

• Share the burden with other family members, and also let friends know what you are going through so that they can support you.

• Be willing to re­evaluate your family dynamic and make changes to accommodate the recovery process.

• Feel compassion not only for her, but also for the entire family and especially yourself.

• Read some of the numerous books for and by parents of children with eating disorders (a few are included in the bibliography and many others are easily found at bulimia.com.

• Consider joining a family support group through local therapists, or investigate online resources for support.

• Determine whether family­based treatment or parent-assisted meal support techniques would be appropriate for your family’s situation.

• Become an advocate by seeking out groups such as the National Eating Disorders Association, which have programs specifically for families.

• If possible, pay for treatment for your child.

Specifically for Spouses and Life Partners

Compared to parents, little has been written about the roles of spouses and life partners or the topic of marriage and eating disorders. However, these are vitally important subjects for the many couples involved with recovery. Bulimics are often secretive and self-shaming, and these characteristics—and others like poor body image, low self- esteem, and guilt—get in the way loving relationships. Also, bulimia and its treatment can be expensive and the process of recovery can take a long time, putting stress on even the best of marriages. Faced with such burdens, most spouses and partners are eager to actively participate in their loved one’s recovery.

As discussed at the beginning of this chapter, couples can work together to overcome an eating disorder—or see their relationship deteriorate if they don’t. They share a common cause, and by supporting each other through the healing process, recovery rewards them both. In addition to the suggestions previously listed in this chapter, the following recommendations are for spouses, lovers, boyfriends, and girlfriends of individuals with bulimia:

• Make your partner’s recovery your top priority.

• Love her unconditionally.

• Ask how she wants you to help.

• Listen without judging or trying to get in the last word.

• Share the shopping and cooking.

• Eat meals together when possible.

• Attend couples therapy.

• Tell her that you love her.

• Be affectionate and let her know that you find her beautiful and sexually desirable.

• Be honest about your needs and, if necessary, improve your sex lives together.

• Be accessible and compassionate during setbacks, help her process them, and remind her why you think she’s so wonderful.

• Be a supportive coach, cheering her on and offering constructive input.

• Let her know when you are overwhelmed and need her to support you.

• Deal with disappointments and distrust without blame or placing guilt on her.

• Communicate directly, honestly, and punctually without holding on to problems for days without speaking up.

• Acknowledge any ways in which you enable or contribute to her bulimic behaviors, and be willing to change.

• Do not hide the basic facts from your children about Mom having an illness and needing treatment.

Reprinted with permission from Bulimia: A Guide to Recovery
By Lindsey Hall and Leigh Cohn

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