At this time when so much of life feels ‘out of control’, we realise that many people who are carers might be struggling to know how to support those who are suffering with eating disorders. The truth is that people suffering with eating disorders might feel like their preoccupation with food, weight and shape is worse at the moment. From your point of view, this might feel so frustrating and like their recovery has taken a giant step backwards. Remember the important thing: eating disorders are about feelings and not food. All of us are feeling more scared and anxious at the moment, so people with eating disorders are likely to be feeling like their symptoms are worse as they are learning to process their feelings without using their eating disorder. Your loved one might need some reassurance around this.
Staying on the path to recovery
A lot of the treatment for eating disorders is changing at the moment. Some appointments are being cancelled and others are no longer face-to-face. But the person you’re supporting still deserves and should be getting care, even if the way this is delivered needs to change for a while. Try to empower your loved one to take responsibility for their treatment, but, let them know you are there to support them.
- Encourage your loved one to ring their treatment team to ask about current provision. If they feel unable to do this, try to explore how you could support them to communicate with their team.
- If you are concerned about the state of your loved one’s physical health, ring their treatment team. If you are seriously worried about them, ring their GP and inform them that you are concerned. In some circumstances your loved one might not have given permission for you to be involved in their treatment; however, anyone can ring a treatment team or GP and give them information.
It could be good to talk to your loved one about meal planning, what foods they feel comfortable with, and what support you can put in place during mealtimes. You could also help them to think about substitutes for things they’re really struggling to get hold of.
- You could try a traffic light system on meal plans, noting which foods are safe (green), challenging but manageable (amber), or very challenging (red) – meals involving more red or amber foods could require more support, and you could plan how you could put support in place with them for the more challenging meals. You can do this even if you’re not with them in person – for example, by video calling them during meals so you can “eat” together.
- People with eating disorders might be struggling with thoughts of compensation after meals such as exercise or purging. Try and have a conversation (away from meal times) around how you can support them with distraction techniques post mealtimes.
- Now might be the time to set up a support network of trusted people you know who might be able to get hold of safe foods that your loved one might need for their meal plan. Once again, check in with your loved one that they feel comfortable about you doing this.
The current guidance to help avoid bingeing involves regular eating – three meals and three snacks per day is ideal. It might be helpful to not assume that your loved one accepts this idea. However, you could ask permission from them to make a suggestion. Remember, we want people with eating disorders to feel as ‘in control’ as they can be at the moment.
- If your loved one is not physically hungry, they are less likely to binge. Restricting foods and not eating can cause bingeing because the person is hungry. If you’re already making a plan for the day, you could ask your loved one whether it’s helpful to make a meal plan too.
- If their binges are triggered by emotions, a way to support your loved one could be thinking through BLAST – are they Bored, Lonely, Angry, Stressed, or Tired? Ask them whether it might be helpful to write a list of distraction techniques for each scenario.
- Remember, try to support them to make a plan of their own, rather than ‘fixing it’ or imposing your own ideas. They are more likely to follow through on the plan if they come up with the ideas themselves.
Binge foods – do I lock food away?
This is a really tricky one to navigate. We would suggest that you approach a conversation with your loved one about this very carefully.
- We are getting some feedback from people who are suffering with binge eating that they might find it really helpful if carers supported them to lock food away at this time. However, this may not be useful for everyone, so talk with your loved one about this possibility calmly and without assumptions.
- Perhaps agree that you’ll check in about this regularly. If you keep this guideline in place at this time, it will need to be reviewed when situations calm down and food is more accessible. Maybe agree a timeframe for how long you’d like to put this in place for. For example, you might agree that you lock certain foods away for one week and then you will review it together after that and it might change.
- You might also find that only certain foods need locking away, or that after a week your loved one would like access to those foods again. At the moment things are changing regularly, so constant reviewing and reassessing will be needed in the weeks to come.
Managing day to day
Good communication is going to be really key. While it might be tempting to want to ‘step in’ and ‘fix things’ we would encourage you to stand by the advice we give to carers on how to communicate. It’s really important that you keep the conversation open and ensure that you are checking in with your loved one to ensure you have understood what they have communicated with you.
- Listen. Your loved one might be feeling very scared at this time. A lot of people with eating disorders say that they find it incredibly hard to open up and ask for help, so if they do open up please do thank them for sharing how they are feeling with you. Listen to them and then try to acknowledge how they are feeling.
- If they say, for example, “I’m scared about getting access to my safe foods right now,” you could respond with something like “Thank you for being honest with me about how you feel. I can totally appreciate that you might be feeling anxious at the moment – this is a scary time. How I can support you to make a plan moving forwards?”
- Don’t try to jump in and fix things, try to ensure that they feel heard. It might be wise to not assume that your loved one would like support, but maybe ask them the following open questions. Try not to bombard them with questions but let them know you are there.
- How can I support you at this time?
- How can I support you with your meal plan at the moment?
- What would you like me to do/not do at the moment?
- Is there anything I’m doing currently that is heightening your anxiety?
- If you’re not sure about what they’ve said reflect the sentence they’ve just said to you back to them and ask them if you’ve understood correctly.
- If you’re not physically with your loved one at the moment, consider video calling them so that you can pay attention to their body language while you’re having conversations.
We encourage people who are suffering with eating disorders to create a structure to their day. One way you could really support them is by writing this structure with them and joining in with it where you can. If you’re not living with your loved one, you could ask them to message their plan for the day and then agree times that you’re going to check in with them.
An example of a daily structure might be as follows:
|09:30 - 10:30
||Suduko, crossword, Journalling etc.
|11:00 - 12:00
||Needlework, drawing, play music etc.
|13:00 - 14:00
||Box set episode
|14:00 - 15:00
||Laundry, minimal cleaning
|15:00 - 15:30
||Garden if you have one, sit by open window
|16:00 - 17:00
|17:00 - 18:00
||Planned Exercise Time
|19:00 - 21:00
||Phone friend/ online book club
|21:30 - 22:00
||Wind Down Time
||Listen to music/ watch film
Eating disorder talk
If you are all in self-isolation at this time together it might feel like you’re living in a bit of a ‘fish bowl’. People who are suffering with eating disorders might feel frightened that you’re going to challenge them on eating disorder behaviours and you might have noticed yourself that you’ve become more fixated on their behaviours. Anxiety is rife at the moment and all of us might feel we’re not communicating as well as we could.
One way to try and combat this in the family home might be to agree to have eating disorder talk ‘free time’. Maybe you could agree when you will talk about it during the day. Try to stick to these boundaries so that you don’t feel like you’re all ‘walking on eggshells’.
What can and can’t be controlled?
It might be helpful to sit down with your loved one and make a list of what you can and can’t control. By recognising that some things are out of their hands, they may be able to focus on things that they can have a positive impact on.
For example, they can’t control:
- What kind of food is available in the shops.
- The fact that they may not be able to access treatment the way they would normally.
- How long things will be like this.
- What other people do with regard to coronavirus guidance.
But they can focus on:
- Getting support to make adjustments to meal plans.
- Staying in touch with their treatment team through other means.
- Putting plans in place to make things easier while this situation goes on.
- Following guidance themselves.
We are all trying to adapt to new routines at the moment. Lots of us are trying to work from home and possibly put new boundaries in place to separate work from home life. We would really encourage you to look after yourself more than ever through this time.
- We advised you to look at putting in a structure with your loved one; however, this will be beneficial for you too. Try to structure in some self-care in your day.
- It may also be helpful to ask a few close friends if you could check in with them and chat through how things are going with your loved one. It might feel difficult to have these conversations in the house, so perhaps you could go and sit in your car or in the garden so that you have time and space to have honest conversations and offload about how you feel.