Support “How-To’s” for Loved Ones of Those with Binge Eating Disorder
By Debra Gill, PhD
When I ask my patients who struggle with binge eating to identify triggers for their episodes, they frequently point to words and actions of family members and loved ones. Often the report sounds something like this, “I know he/she was trying to help me lose weight, but when he/she asked me ‘should I really be eating that piece of cake’, it just made me want to devour the whole cake and then see what else was in the pantry.”
Family members (including parents, spouses and siblings) and friends of people who binge eat are in a tough spot. Even when their intentions are good, the comments they make about the binge eater’s food choices or body size can trigger emotions in the binge eater that trigger urges to eat.
Shame is one such emotion that is commonly triggered. Anger, resentment, and fear are others. Even when the family member is not being overtly critical or shaming, someone who feels ashamed about their eating or body is easily triggered when these topics are commented upon. Sometimes an intended compliment from a family member observing that the binge eater “ate less than usual” or “made a healthy choice” or “seems to be getting thinner” can trigger shame for past behavior that was less optimal. Binge eaters are typically sensitive to attempts by others to control their eating and body, and a resistant part of the binge eater may respond with a desire to eat fast and furiously as an act of rebellion.
Loved ones who want to be helpful can usually find the best guidance by talking with the person struggling with eating. Start by expressing your desire to help and simply ask “what, if anything, could I say that would help you if I see you starting to eat inappropriately?” Many of my patients will ask family members and friends to offer to do something together that soothes and distracts without calling attention to the eating. For example, one may offer to take a walk together, go out somewhere, or engage in a mutually enjoyed activity that is not compatible with eating, such as a game. Each patient is different in what they need but many agree that a genuinely compassionate desire on the part of the family member or friend to be helpful along with the absence of judgment or frustration with the binge eater are most important.
Sometimes, the impact of loved ones is through the environment rather than words. Parents or spouses might bring food into the house that tempts the binge eater. Sometimes the family member doesn’t realize the food will be too tempting for the binge eater but feels justified because they or other people in the family want that food to be available. Here, too, a family member faces a challenge to find the right balance between trying to help the binge eater and meeting other needs. There is no single solution to the problem of what foods to keep in the home, and this is best discussed openly and honestly so fair compromises can be reached. For example, there could be a certain time frame when some foods are avoided, and then, at a later time when skills for resisting binge urges are better developed, those edibles can be reintroduced. Or perhaps some types of “fun foods” can be identified that are less tempting for the binge eater and can be substituted. Almost always, one thing that can be done is to keep typical binge foods out of sight (e.g., in the back of cabinets, fridge or freezer, or in the basement or in someone’s car trunk) and therefore, hopefully, out of mind. Though binge urges are often triggered by thoughts, emotions, and body sensations, the sight of tempting food can sometimes become the difference between a patient giving in to a binge or not.
The environment created by a binge eater’s loved ones is not only through food and direct comments, but also through the way that bodies are discussed. For example, a friend that frequently comments on people’s appearance and weight sends a message. Making statements about a movie star who gained or lost weight, or a family friend or acquaintance who is “looking good,” whether the judgments are positive or negative, conveys the idea that people are being primarily judged based on appearance. This type of communication sticks with many binge eaters and adds to self-disgust and self-judgment. Binge eaters, whether they are obese, overweight, or normal weight, are acutely aware of the impact that their eating patterns could potentially have on their weight. A family environment that keeps the focus on weight is a shaming environment, regardless of how much love for the binge eater is expressed in other ways.
Family members will often ask me how they can help their child or spouse reduce binge eating. Often, the answer is to hold an attitude of genuine compassion for the binge eater’s struggle with their habits and urges and a genuine acceptance of the binge eater as a lovable person, even if their body size causes the parent or spouse anxiety or disgust. Binge eaters by definition feel self-disgust. Often asking the binge eater what types of comments or actions would be supportive and what types of comments or actions are triggering will give the family member important information. For example, being a good listener when the binge eater wants to talk about something bothering him or her, or spending family time in ways that don’t revolve around food are often identified by my clients as ways their family members have been helpful to them.
As a therapist for people who binge eat, I usually assume that there will be no significant change in family dynamics, at least in the early phases of treatment. I, therefore, don’t send the message that symptom improvement depends on a family member changing. Rather, my job is to teach the binge eater skills to resist urges to binge and these include skills for managing emotions triggered by family dynamics. This is where skill-based therapies such as Dialectical Behavior Therapy and other Mindfulness-based therapies have so much usefulness. These therapeutic approaches for binge eating center around the skill of observing emotions, thoughts, and body sensations that arise in one’s self moment to moment. Noticing urges-to-eat that arise in response to a loved one’s comment can then allow a choice to be made about whether to act on the urge by eating or whether to take a different path. Taking a different path requires strategies for soothing oneself without escaping into a trance of eating and for mindfully absorbing oneself in activities and sensations that will reduce one’s urge to eat. Also, interpersonal skills, such as assertiveness in asking for what one wants or does not want without threatening the relationship can often reduce the impact that family and other relationships have on the binge eating illness. It is helpful to view binge eating as an illness that can be improved by skills, perspectives, and strategies, rather than a flaw in the character of the binge eater.
Before ending this article is it important to point out that binge eating is complex and often very stubborn to change, like other addictive behavior patterns, and is certainly not caused by family dynamics. If someone is binge eating, it does not mean that his or her family or friends are doing something wrong. Many of my patients describe their loved ones’ compassion and support as the one thing they are lucky to have, otherwise their problem would be significantly worse.
About the author:
Dr. Debra Gill is a clinical psychologist with a full-time private practice in Livingston, NJ. She has been specializing in issues related to obesity, body image, disordered eating and health-related lifestyle change for 22 years. She received her Ph.D. in clinical psychology at UCLA and completed a post-doctoral fellowship at the University of Pennsylvania in Weight and Eating Disorders.
Dr. Gill runs groups and individual programs teaching Mindful Eating, Body Acceptance and Dialectical Behavioral Therapy skills for Binge eating and Bulimia. She is also a certified practitioner of Cognitive Behavioral Therapy for Eating Disorders.
Dr. Gill has conducted over 500 psychological evaluations for people seeking weight-loss surgery. She has worked since 2009 as a consulting psychologist and adolescent specialist on the bariatric surgery team at Barnabas Health/RWJF and in that role she co-leads monthly support groups for bariatric surgery patients. From 2005-2012, Dr. Gill was the founding director of the Healthy LIFE Program at Saint Barnabas Medical Center which became an award-winning child, adolescent and family weight management program, focused on non-diet approaches to treating and preventing pediatric obesity.
Dr. Gill has been featured three times as a panelist on the television program Caucus NJ (with Steve Adabado) as an expert in weight management, bariatric surgery and pediatric obesity. She regularly gives seminars and writes for professional organizations and community groups on topics related to weight and eating.
In addition, Dr. Gill is a certified fitness instructor who has been teaching exercise in the water and on land for 26 years.
Learn more about Debra Gill through her website: www.debragill.com.