Support for family and friends
Some of the behaviours to look out for:
- Becoming excessively busy on purpose to avoid food, hunger and meals
- Continually disappearing after meals
- Throwing away large amounts of food or never fully finish a meal
- Hoarding or secretly hiding uneaten food in bags, pockets or under beds
- Laxative left lying around
- Cooking elaborate meals but not taking a mouthful themselves
- Taking a sudden interest in cooking and food preparation and hovering around the kitchen while others prepare a meal
- Showing a great interest in ingredients or in how a dish is cooked: steaming or boiling giving them reassurance, whilst roasting or frying prompting trepidation
- ‘reading’ packets and counting and noting calories
- Coming up with never ending excuses for not eating – “I ate earlier” or “I’ll have something later”
- Altering food habits – piling plate high with vegetables, almost to the exclusion of protein and carbohydrates
- Avoidance of certain food groups, such as fatty foods – not eating cheese, butter, salad dressings or mayonnaise, and certainly no chocolate, biscuits or cake
- Low mood, anxiety, mood swings
- Restlessness, inability to sit still
- Excessive exercise; developing strict routines around exercise and becoming agitated if schedule is interrupted
- Isolation, decrease in social interests, such as hobbies and friends
Some signs to look for around the home:
- Sinks and toilets constantly blocked
- Large quantities of food going missing from cupboards
- Smell of vomit in bathrooms or toilets
Physical symptoms to look out for:
- Rapid weight loss in someone who has anorexia (though this occurs at the later stages of anorexia)
- Swollen glands, puffy face
- Tooth decay
- Pale, dry skin
- Irregular or absent periods in girls
An individual with an eating disorder may seem distant and disinterested in others. An eating disorder takes precedence over everything and everyone. Food, meals, exercise and weight are their main interests; the eating disorder becomes their main priority.
People with and eating disorders don’t often seek help, largely because they don’t recognise that they have a problem. Many have hidden the condition for a long time. The most important first step is for someone with anorexia to realise that they need help and want to get better.
If you suspect someone you know has an eating disorder, you should try to talk to them about your worries and encourage them to seek help. This can be a very difficult conversation because they may be defensive and refuse to accept they have a problem. But it’s important not to criticise or pressure them.
Talking to someone about their condition can be very difficult, especially if they still can’t accept that they have a problem. However, communication is essential to help with recovery, so keep trying.
Try to create openings for the individual to talk freely. For example, you could say:
- “I’ve noticed that things are quite difficult for you at the moment, would you like to talk about it or is there anything I can do?”
- “Is everything OK at home/work/University, at the moment?”
- “You seem slightly anxious/low/distracted at the moment...”
Even if you’re met with denial or excuses, don’t give up and continue gently challenging, voicing your concerns and watching.
- Let the individual know you know they have a problem
- Breaking the secrecy of the illness removes some of its power
Make a list of signs that you have observed and make you think the person you’re concerned about has an eating disorder.
- Talk to them about your confusion, worries, and uncertainties
- Give them the opportunity to express their point of view
When you want to talk to them directly about the eating disorder
- Prepare what to say
- Don’t blame or judge
- Concentrate on how they’re feeling
- Stay calm
- Have resources to refer to
- Be prepared for a negative response
It can also help to:
- Learn as much as possible about eating disorders. It helps you understand what you’re dealing with.
- Emphasise that no matter what, you love them and will always be there for them.
- Avoid talking about other people’s diets or weight problems.
- Talk to them about the range of professional help available, and say that you’ll support them through it when they’re ready.
- Talk positively about activities they could be involved in that don’t involve food, such as hobbies and days out with friends.
- Try not to feel hurt if they don’t open up to you straight away, and don’t resent them for being secretive. This is due to their illness, not their relationship with you.
- Ask them what you can do to help.
- Try to be honest about your own feelings. This will encourage them to do the same.
- Remember that the feelings behind the eating disorder may be really difficult for them to express. Try to be patient and listen to what they’re trying to say.
- Be a good role model by eating a balanced diet and taking a healthy amount of exercise.
- Try to use sentences starting with "I", such as "I'm worried because you don't seem happy", rather than sentences beginning with "you".
The New Maudsley Approach introduces carers to a general model of health change and introduces a therapeutic approach known as Motivational Interviewing (MI). Motivational interviewing has been found to be particularly helpful for people who are ambivalent about change. MI provides carers with a framework in which they can reflect upon and build more adaptive forms of communication to use with their loved one.
- Remember that your friend is a person first and someone who has difficulty with food second. So continue with whatever activities you would normally engage in together, and don't let issues of food dominate the friendship.
- You may have noticed your friend has changed; they may no longer go out or want to be included in things. Keep trying to include them, just like before. Even if they don't join in, they will still like to be asked. It will make them feel valued as a person.
- Tell them of your suspicions - and be prepared for them to deny it
- Don’t isolate them because you are frightened or frightened of saying the wrong thing. Don’t expect to get it right all the time. Your friend will thank you for trying. If you get it wrong, admit it and ask them to help you understand.
- Be supportive and encourage your friend to seek professional help. Ultimately, the problem is your friend's; if they won't seek help the consequences will be theirs. Your responsibility is only to encourage them to seek help.
- You might want to encourage them to speak to someone about it and offer to go with them for support if they want you to.
- Try not to give advice or criticism. Give your time and listen to them. This can be tough when you don't agree with what they say about themselves and what they eat. Remember, you don't have to know all the answers. Just being there is what's important. This is especially true when it feels like your friend or relative is rejecting your friendship, help and support.
- Be available to listen when your friend can express his/her distress, but don't take on more than you can comfortably cope with. We all have limits - of knowledge, ability to help, understanding, time, etc. - so offer the level of support you feel able to sustain. If you try to offer more than that, you are likely to feel burdened and in time, perhaps, annoyed or angry, which is unlikely to help either of you, or the friendship.
- Look after yourself! Maintain your normal range of friendships and balance in your activities. You can’t be there to support the person you care about when you’re exhausted, drained, feeling low and anxious?
- If you are unsure whether your style of supporting your friend is actually helpful, or are quite concerned for your friend, you can seek out a professional (such as a counsellor) yourself, just to check out these things.
Treatment for eating disorders varies around the country. Different types of help may be offered depending on where you live and depending on the severity.
Treatment includes dealing with the emotional issues as well as the physical, but this must be done slowly so your friend or relative is able to cope with the changes.
Treatment will involve your friend or relative talking to someone about the emotional difficulties that have led to their eating disorder. It will also explore their physical problems, general health and eating patterns. Help with eating and putting on weight is usually not enough.
Most people with eating disorders are seen as outpatients. This means they visit the hospital – for example, one day a week. In severe cases, they might need to visit the hospital more often, or be admitted to hospital for more intensive support and treatment (known as inpatient care). The earlier your friend or relative embarks on the treatment programme and the more they engage with it, the better their chances of making a good recovery.
If your friend or relative has lost a lot of weight, they may be in danger of starving themselves and developing serious complications. They may not be able to think clearly and may refuse life-saving treatment.
In these circumstances, their doctor may decide to admit them to hospital for specialist treatment. This can only be done after the doctor has consulted colleagues and they agree with the doctor's decision. This is called being sectioned and it is done under the rules of the Mental Health Act.
Your friend or relative will still need your support. Most people with an eating disorder do recover and learn to use more positive ways of coping. But recovery from an eating disorder can be very difficult and can take a long time. Your friend may want to get better, but they may be very scared about giving up the eating disorder. They might think, "I want to get better, but just don't want to gain weight." They will probably have good days and bad days. During times of stress, the eating difficulties may return. Changing the way people with eating disorders think and feel is never easy and it takes time.
If you need further support, there are a number or organisations that can help you. It's important that everyone understands the situation and gets support.
University of Exeter's Wellbeing Service
The Wellbeing Services offers short-term counselling and psychotherapy. We will work with students to enable them to find the most appropriate support both inside and outside of the University. If they are already linked in with local services we can still support them in accessing University services.
Eating Difficulties Peer Support Group
An Eating Difficulties Peer Support Group run by Exeter Student Minds at the University of Exeter. For more information click here.
Exeter Depression and Anxiety Service (DAS)
A free, confidential, NHS talking therapy service, offering effective treatments and therapies, including Cognitive Behavioural Therapy (CBT), which can help you get your life back on track. You may self-refer for a range of difficulties including eating disorders, by completing their online registration form. Click here for the website.
Telephone: 01392 675630
Somerset & Wessex Eating Disorders Association (SWEDA) offers a range of services throughout Somerset and the surrounding area.
Based at Shepton Mallet in Somerset, in the Southwest of England (UK), they provide support to anyone affected by eating disorders, including anorexia nervosa, bulimia nervosa, compulsive eating, binge eating disorder and all related conditions.
Their services include Counselling Services, and a monthly Self-help Support Group.
British Association of Counselling and Psychotherapy (BACP)
If you would like to find a private counsellor who specialises in eating disorders to help you cope with your difficulty and make positive change, you can find a qualified, experienced therapist in your area by using the Find a Therapist search tool - http://www.itsgoodtotalk.org.uk/
British Association for Behavioural and Cognitive Psychotherapies (BABCP)
The BABCP provide details for accredited therapists working within the Cognitive Behavioural Therapy model - www.babcp.com
The Mental Health Foundation provides up-to-date research and studies to help people understand, protect and sustain their mental health. There are links to articles, blogs and research.
The NHS Choices website has information about conditions and treatments as well as services and hospitals.
NHS Direct provide 24-hour medical advice and information. They have comprehensive information and advice on all types of eating disorders, videos of people’s experiences, an eating disorder forum, and other useful links.
F.E.A.S.T. is an international organisation of and for parents and caregivers to help loved ones recover from eating disorders by providing information and mutual support.
"Around the Dinner Table" is an online community of parents of eating disorder patients around the world run by F.E.A.S.T. ATDT is a moderated 24/7 Forum that has connected and supported parents since 2004.
Student Minds is the UK’s student mental health charity. Its aim is to empower students with the knowledge, confidence and skills to look after their own mental health and support others.
Mind are a national charity who offer information on all mental illnesses. They have specific leaflets and information sheets on eating disorders.
Tel: 020 8519 2122
Information Line: 0845 660163
Fixers offer online support and have a range of young people’s stories, family’s personal experiences and expert information about eating disorders and body image.
If you have an eating disorder or body image issues, or know someone who does, you may find it useful to contact a support group such as B-eat for information and advice.
- a confidential helpline on 0808 801 0677 – they also have a designated youth helpline on 0808 801 0711 (all year round, 4– 10pm)
- live chat and online support groups, where you can talk to others in a similar situation
- a national network of volunteer support groups
You can also use the Beat HelpFinder directory to find eating disorder support services in your local area.
Samaritans offer a 24 hour online and telephone support service, when you need emotional support and someone to talk to anytime. You can call their free and confidential helpline 24/7 on 116 123.
The National Centre for Eating Disorders (NCFED) provides information and advice about eating disorders, including recommendations for treatment options, as well as, support for carers, recovery workshops, residential treatment and professional training.
Provide on-going care, emotional support and practical guidance for anyone affected by eating disorders. We support and care for those struggling personally and resource and equip parents, families, friends and professionals. There is also a helpline run by trained staff, who have both professional and personal experience of eating disorders.