Eating disorders - support for families

If you think someone you care about might have an eating disorder, it can be difficult to know when to approach them and how to discuss your concerns. You might even wonder whether your suspicions are correct. Being prepared is the best way to proceed when you are considering approaching a loved one about their eating and their relationship with food.

It can be very hard for someone to acknowledge that they have a problem, and you may find your loved one is reluctant to see a healthcare professional about a suspected eating disorder. Research suggests that early diagnosis and treatment improve outcomes, so making the effort to approach your loved one is important to their recovery.

You are not alone#

Help and support are available both before and after you have approached your family member. Support services for families and peers can help you express your feelings, give you suggestions on strategies that may help, and let you know what types of support are available. There are also services that support family members and other people affected by eating disorders.

It can be difficult to know if your loved one has an eating disorder, because the signs and symptoms can be hard to detect. One common sign is body dissatisfaction or low self-esteem. It is not always possible to tell whether someone has an eating disorder from their appearance — eating disorders are experienced by people of all different shapes and sizes.

It is important to understand the signs and symptoms of eating disorders, so you know what to look out for and are prepared. You have the potential to be a great support to your family member if they are diagnosed. Although the physical signs vary depending on the type of eating disorder, symptoms can include:

• signs of damage from frequent vomiting, such as swelling around the cheeks or damaged teeth
• bad breath
• sores or cuts on the hands

Although some psychological signs of eating disorders can be hidden, others may be more obvious. Behavioural signs and symptoms vary depending on the type of eating disorder, but can include:

• evidence of binge eating, such as the unexplained disappearance of food
• spending a lot of money on food
• hoarding food
• substance use or suicidal thoughts

It is important to think about how best to approach a family member about your concerns.

When you first raise the subject of a possible eating disorder, your family member might react negatively or might not want to speak with you at all.

It can take time#

Some people may not be aware that they are engaging in disordered eating behaviours. The person might feel threatened that you have noticed their behaviours or discovered their situation, and they might need time to respond.

You can be persistent without nagging#

Remember that ignoring the problem will not make it go away. While the first step might be helping your family member acknowledge they may have a problem, the next step is to visit a doctor who has experience with eating disorders. Eating disorders cover a range of conditions, and some people might not fit neatly into one category.

This makes it important for anyone who might have an eating disorder to see a doctor as soon as possible. Other healthcare professionals, such as psychologists and dietitians, can also recognise eating disorders, but they cannot give a physical check-up to determine the extent of any medical or physical health problems.

To diagnose an eating disorder, a doctor will need to do a full physical check-up, may take blood tests, and will ask questions about your loved one’s health — including their emotional health and wellbeing, medical history and lifestyle.

A doctor will also need to make sure any symptoms are not related to another condition, such as an undiagnosed physical illness or another mental health condition. Family and carers can play an important role in diagnosis, particularly because physical check-ups and blood tests alone may not indicate an eating disorder.

Family and carers may be in a position to identify other psychological and behavioural signs that the person may not necessarily talk about with their doctor.

These commonly include co-occurring anxiety, depression or obsessive-compulsive behaviours.

When preparing to speak with your family member, some of the things you can do include:

• Learn as much as you can about eating disorders.
• Find out about the support options available, should they need them.

Be prepared for a potentially negative or emotional response.

If this happens, it may be driven by fear or confusion. Your family member may feel relieved that you are concerned, or they may not be aware of the problem, or they may be in denial about it.

A negative response does not mean there is no problem. It may take a few attempts for your concerns to be heard. Think about what you are going to say, or seek advice from a support service about what is helpful and unhelpful to say to your loved one.

Choose a safe place and time when you are both calm. Avoid raising the topic around food, such as at mealtimes.

Tell your loved one that you are raising your concerns because you care#

Let them know you are worried about them and their mental health. Focus on their feelings and your feelings, and encourage them to express how they feel.

Listen without judgement#

Focus on the wider range of behaviours and feelings you are worried about and that they might be open to talking about and seeking help for — for example, that you are worried they seem sad and withdrawn — rather than putting all the focus on their eating and any physical changes.

Unhelpful things to say or do include:

• making comments about your loved one’s appearance or weight
• making comments about your own appearance, weight, diet or exercise
• giving a list of other people who are also concerned
• demanding change or criticising your family member
• tricking or forcing your loved one to eat
• using statements that label, blame or judge

Examples of statements to avoid are “you” statements, such as “you need help”, “you aren’t eating enough” or “you have an eating disorder”. Instead, it is more effective to use non-judgemental “I” statements, such as “I am worried about you because I care”.

When there is a crisis#

There may come a time when you fear for the safety of your family member and need to take more direct action. A mental health first aid approach can help, and generally includes approaching and assessing the situation, listening without judgement, giving support and information, encouraging appropriate professional help, and encouraging other supports.

If you think your family member is in physical danger or at risk of harming themselves, you may need to act directly. The action you take in an emergency or crisis will depend on the situation, but can include getting advice from a healthcare professional, such as your doctor, calling your local emergency number, or taking your family member to a hospital emergency department.

Signs of a crisis or medical emergency can include disorientation, vomiting several times a day, fainting or collapsing, chest pains, difficulty breathing, an irregular or very slow heartbeat, suicidal thoughts or behaviour, or self-injury.

Looking after yourself#

Your family member’s experience with an eating disorder can also affect you. Caring for a loved one with an eating disorder can be challenging, and you might feel a range of emotions, such as grief, sadness, anger and stress.

You might also feel neglected, because people are focused on your family member and may not be as focused on you.

Getting support to help you manage during this time is important#

Support services, including telehealth or phone counselling, can give you someone to talk to about how you are feeling and how you are affected by your family member’s experience. There are also services that support family members and other people affected by eating disorders.

Key points#

• One common sign is body dissatisfaction or low self-esteem.
• It is important to think about how best to approach a family member about your concerns.
• Anyone who might have an eating disorder should see a doctor as soon as possible.
• Eating disorders commonly occur alongside anxiety, depression or obsessive-compulsive behaviours.
• Tell your loved one that you are raising your concerns because you care for them.

Where to get help#