Chapter 6

Treatment can save the life of someone with an eating disorder. Friends, relatives, teachers, and physicians all play an important role in helping the ill person start and stay with a treatment program. Encouragement, caring, and persistence, as well as information about eating disorders and their dangers, may be needed to convince the ill person to get help, stick with treatment, or try again.

Family members and friends can call local hospitals or university medical centers to find out about eating disorder clinics and clinicians experienced in treating these illnesses. For college students, treatment programs may be available in school counseling centers.

Where to Find Help

If you are in crisis, go to a hospital emergency room or call a crisis hotline. Find the number in the yellow pages under Crisis Intervention.

If you are not in crisis, ask your family doctor for an evaluation and referral. You can also ask people you trust, and who have been in your situation, for the names of physicians and counselors they found helpful. If you are a student, check with the school counseling center. Services may be low cost or free.

To find low-cost resources, look for community service agencies in the Counselors section of the yellow pages. The organizations listed there may not provide formal eating disorders programs, but they do offer basic assistance to people who have no other options.

Family members and friends should read as much as possible about eating disorders, so they can help the person with the illness understand his or her problem. Many local mental health organizations and the self-help groups listed at the end of this brochure provide free literature on eating disorders. Some of these groups also provide treatment program referrals and information on local self-help groups. Once the person gets help, he or she will continue to need lots of understanding and encouragement to stay in treatment.

How to Help Someone You Care About

Your biggest problem will be convincing the person that she needs help. At first she will not admit there is a problem. She will fear weight gain. She will be ashamed and not want to admit what she is doing. She has used the eating disorder to protect, comfort, and empower herself. In the beginning at least, she will not want to give it up. Here are some suggestions to help you plan how you will talk to her.

If your child is younger than 18

Get her professional help immediately. You have a legal and moral responsibility to get your child the care she needs. Don't let tears, tantrums, or promises to do better stop you. Begin with a physical exam, a dental exam, and a psychological evaluation.

If the physician recommends hospitalization, do it. People die from these disorders, and sometimes they need a structured time out to break entrenched patterns. If the therapist asks you to participate in family sessions, do so. Children spend only one or two hours a week with their counselors. The rest of the time they live with their families. You need as many tools as you can get to help your child learn new ways of coping with life.

If your friend is younger than 18

Tell a trusted adult—parent, teacher, coach—about your concern. If you don't, you may unwittingly help your friend avoid the treatment she needs to get better.

If your child or friend is older than 18

Encourage professional help, but expect resistance and denial. You can lead a horse to water, but you can't make it drink if it doesn't want to—even if it is thirsty.

Some Things to Do

• Provide information. Give her this book.

• Be supportive. The greatest gift you can give is a listening ear with no strings attached.

• Encourage professional help, but be prepared for denial, resistance, and stubborn, sullen hostility.

• Do what you can to persuade her that a normal life is worth the hard work she will have to do to recover.

• Realize that recovery is her responsibility, not yours.

• Realize that she won't change until she wants to, until she finally accepts that being thin will not get her the happiness and power she wants, and until she finds some other way of dealing with problems.

• If she refuses treatment, you get help for your fears and anxiety. Show her how healthy people use professional resources to help solve problems.

• Be kind to yourself. You are doing the best you can. No one, not even you, should expect more than that.

Some Things Not to Do

• Never nag, plead, beg, bribe, threaten, or manipulate. You will get stuck in a power struggle, and you will lose.

• Never criticize or shame the person. She will withdraw. Don't pry. Respect her privacy.

• Don't try to police her. She will become resentful and even more secretive than before. Also, she will outwit you.

• Don't give advice unless you are asked for it. Even if she does ask, don't expect her to act on it.

• Don't tell her she has lost weight and is too thin. She will be pleased, and you will reinforce the problem.

• Don't congratulate her on gaining weight. She will think, "I've gotten too fat. Now I'm not special. I've lost, and they have won."

• Don't let her run your family: e.g., decide what, where, and when you will eat.

• Don't ignore stolen food and bathrooms stained with evi- dence of purging. Make her replace the food and clean up her messes.

• Don't overestimate what you can accomplish. You can provide support and encouragement, but you can't make her recover if she does not want to recover.

QUESTIONS TO ASK POTENTIAL THERAPIST

These questions are organized around three themes. You may want to ask all or only some of them, or design questions of your own.

Background of the therapist

How did you get involved in treating eating disorders? How long have you been working in this area?

What is your training ( psychiatrist, psychologist, social worker, nurse, etc.)

Are you affiliated with any hospital and/or organizations important in this field?

What percentage of the people you see have eating disorders?

Are there any former or current patients I might be able to talk to?

How much time will be spent focusing on food, weight and diet issues?

Will you restrict any of my behavior in order for me to see you? ( i.e., can I come to therapy if I throw up, exercise, do drugs, etc.)

Do you believe people can get better for life, or will I always have this disease?

What is your attitude towards self-help groups ( OA, ACOA, AA)?

What is important for me to know about you? Why should I see you?

Do you think you would want to work with someone like me?

Process of change

What can I expect during a session? How interactive are you?

Will you monitor my weight?

When, if ever, do you hospitalize?

Will you involve my family?

What role, if any, will medication play? What percentage of people who see you take medication? Which ones?

How would you describe your approach?

What would you see as a healthy recovery for me?

What goals would we set for change?

Nuts and Bolts

How often should we meet? For what length of time? How long is a session?

How difficult will it be for me to schedule meetings at a convenient time to me? Do you have after work or early morning appointments?

Do you charge for cancellations?

Do you accept insurance assignments? Are you reimbursable by insurance?

How and when do you request payment?

Are you available for telephone calls during the week. Is there a charge for telephone consultations?

What other services do you provide ( groups, lectures, sessions, etc.)?

There are many different approaches to the treatment of eating disorders. No one philosophy works for everyone. And sometimes patients must try several types of treatment before finding one that is helpful. If you are looking for a therapist you should first decide which treatment approach makes the most sense for you. Finding a therapist or group that is good for you can be a matter of personal chemistry_a feeling of trust must exist in any therapeutic relationship if it is to be beneficial. Don't be afraid to interview more than one therapist. Visit more than one group, and in the last analysis_ trust Your Instincts!!!

PREVENTION IS EASIER THAN RECOVERY

Eating and exercise disorders are much easier to prevent than to cure. Remember that what you do speaks much louder than what you say. Give your friends and family the gift of a good role model. If you are a woman, get comfortable with your body no matter what its size and shape. Never criticize your appearance. If you do, you teach others to be overly concerned about externals and critical of their own bodies.

If you are a man, never criticize a woman's appearance. Phrases like "thunder thighs" and "bubble butt," even if they are meant in jest, can wound deeply and puncture self-esteem. Remember that women are more than just bodies. They have talents, abilities, hopes, dreams, values, and goals—just like you do.

Most important of all, show—don't waste your time telling—people how you take care of yourself in healthy, responsible ways. Demonstrate how a competent person takes charge, solves problems, and builds a satisfying life.

All of this demands a great deal of consciousness and vigilance on your part, but healthy role modeling is the most effective way to help people grow into health and strength.

NIMH continues its search for new and better treatments for eating disorders. Congress has designated the 1990s as the Decade of the Brain, making the prevention, diagnosis, and treatment of all brain and mental disorders a national research priority. This research promises to yield even more hope for patients and their families by providing a greater understanding of the causes and complexities of eating disorders. 

Continue to the next chapter.

FOR FURTHER INFORMATION

For additional information on eating disorders, check local hospitals or university medical centers for an eating disorders clinic, or contact:

National Association of Anorexia Nervosa and Associated Disorders (ANAD)

P.O. Box 7

Highland Park, IL 60035

(708) 831-3438

Anorexia Nervosa and Related Eating Disorders, Inc. (ANRED)

P.O. Box 5102

Eugene, OR 97405

(503) 344-1144

American Anorexia/Bulimia Association, Inc. (AABA)

418 East 76th Street

New York, NY 10021

(212) 734-1114

Center for the Study of Anorexia and Bulimia

1 West 91st Street

New York, NY 10024

(212) 595-3449

National Anorexic Aid Society (NAAS)

Harding Hospital

1925 East Dublin Granville Road

Columbus, OH 43229

(614) 436-1112

Foundation for Education about Eating Disorders (FEED)

P. O. Box 16375

Baltimore, MD 21210

(410) 467-0603

Bulimia Anorexia Self Help, Inc. (BASH)

6125 Clayton Avenue, Suite 215

St. Louis, MO 63139

(314) 567-4080

Overeaters Anonymous

P. O. Box 92870

Los Angeles, CA 90009

(310) 618-8835

For information on other mental disorders, contact:

Information Resources and Inquiries Branch

National Institute of Mental Health

5600 Fishers Lane, Room 15C-05

Rockville, MD 20857

Sources: National Institute of Mental Health