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Eating disorders affect millions of people and their families each year. From the outside, it may seem simple to treat an eating disorder; however, these disorders are complex illnesses that can seriously interfere with all parts of a person’s life.

Eating disorders are complex because they can affect anyone regardless of body size, social class, ethnic background, gender, sexual orientation or level of education. To make it even more difficult to help, you may never know that someone is struggling with an eating disorder because a surprising number suffer in silence. As someone who wants to help, you’re up against a person’s secrecy, their avoidance of the situation and not to mention, the deeper symptoms of this disorder. It may feel like the odds are stacked up against you. But don’t worry, I’m here to help.

First, it’s important to understand that Anorexia, Bulimia, and Binge Eating Disorders are mental illnesses. They impact much more than a person’s physical appearance. Symptoms affect a person’s mind, body, and behavior. This makes it incredibly difficult to find the right words to support your loved one when they’re struggling. Certain comments, suggestions, or advice offered with the best of intentions are often misinterpreted. This can leave you feeling lost about how to support your loved one.

Here are 5 tips from past clients on what to avoid saying to someone suffering from an eating disorder and what to do instead.

1) Don’t assume you know what your loved one is thinking or feeling.

One former patient shared that she found it especially unhelpful “when someone assumes, they know everything about your eating disorder (what the thoughts are, where they are coming from) without first asking for information.”

Each person has their own unique story beyond their disorder. Something that may be disordered behavior for one person may serve a completely different function for another. By assuming that everyone’s struggle with an eating disorder is the same, you miss an opportunity to learn about your loved one’s unique experience and areas of difficulty. Add to that, the reaction from your assumptions could cause your loved one to withdraw and keep their suffering a secret.

What to do instead:

Listen without judgment
Ask for clarification if something is unclear
Avoid assumptions about why the disorder developed or with what your loved one is struggling
Allow space for your loved one to share their story and their specific thoughts, interpretations, or struggles

2) Avoid making threats, using ultimatums, or imposing irrelevant consequences.

A common frustration for both parents and patients happens when seemingly irrelevant consequences are imposed for Eating Disorder related struggles. One patient explained that her parents “threatened to take away therapy if [she] didn’t eat dinner” and another shared that “taking away [her] phone was not helpful and only made [her] want to rebel and restrict more.”

Families often try many different approaches to help encourage their loved one to challenge the disordered thoughts and nourish their bodies. Responding to eating disorder behavior from a place of frustration may lead to the use of threats, ultimatums, or consequences in hopes this will motivate change. Unfortunately, we often see the opposite effect occur. Using threats, ultimatums, and consequences, especially when you are unable or unwilling to follow through on these actions, can backfire dramatically. It can create distance in your relationship, trigger increased secrecy surrounding unhealthy behavior, and lead to your loved one resisting your future attempts at supporting them.

What to do instead:

Set limits from a place of care and compassion rather than frustration
Collaborate with your loved one on ways to respond rather than reacting to their behavior
Truly listen to learn what types of support and limit-setting have been most effective in helping push through their struggles
If you find yourself often frustrated and uncertain of how to respond to your loved one’s struggles, seek guidance from a professional who specializes in treating eating disorders
Ensure that if/when consequences are given, the consequence is congruent with the problematic behavior being addressed. And most importantly, that you are ready and willing to follow through on these consequences

3) Don’t forget that an eating disorder is a mental illness, not a diet, phase, or simple choice.

My clients tell me that when they hear statements such as “why can’t you just eat,” or “why is it so hard for you to follow your meal plan” oversimplifies recovery and what is needed to be able to achieve goals.

To outside observers, an eating disorder may appear to be superficial. It can seem like it’s based on body image and food choices. This causes many to believe recovery from an eating disorder is as simple as following a meal plan or caring less about appearance.

In reality, eating disorders go much, much deeper than “the food.” Eating disorders are mental illnesses, not a phase, a diet, or a choice. For some, behaviors or associated symptoms may have started as a choice. Then, as the eating disorder takes over, the continuing behaviors feel like the only option. For others, disordered eating develops as a way to cope, avoid, or communicate their wants, needs, and feelings. Regardless of how or why the behaviors begin, once an eating disorder develops, they feel a loss of control over their behaviors.

What to do instead:

Learn about the medical consequences and long-term negative effects of an eating disorder
Read books written by authors who have recovered from an eating disorder (ex. Life Without Ed by Jenni Schafer)
Connect with local organizations that offer educational seminars or support groups
Participate in family therapy
Attend a nutrition education session with your loved one to better understand their struggle

4) Don’t assume a person cannot have an eating disorder based on their age, gender, race, or career.

Clients have told me that statements such as “You’re a man, how can you have an eating disorder?” or “You’re too old to care that much about how you look!” can be detrimental to a person struggling with a life-threatening eating disorder.

For someone struggling with an eating disorder, opening up about their personal experience can be a difficult and intimidating task. When reaching out for support is met with criticism, rejection, or denial–rather than care, compassion and support–the likelihood of overcoming the disorder decreases. Social stigma, fear of criticism or judgment, and rejection strongly contribute to those needing treatment not reaching out for help.

What you can do instead:

Reflect on your own judgments about weight, body, and assumptions about what an eating disorder “looks” like
Acknowledge how your own assumptions may prevent you from truly understanding your loved one’s experience
Examine how your own views on weight, health, and body image developed and the role society, media, and stigma play in your views

5) Avoid focusing on your loved one’s weight, body, or changes in physical appearance. Don’t use weight as the sole or primary indicator of progress or struggle.

Patients commonly report feeling triggered by seemingly positive statements made by their loved ones. Comments such as “you don’t look like you have an eating disorder,” or “you’ve lost so much weight, your diet is working great!” can fuel obsessive thoughts about weight and body, negatively impacting your loved one’s recovery journey.

Many people struggling with eating disorders maintain a “normal” weight throughout their illness. Significant components of an eating disorder that are not always visible to an outside observer. Simply because a person appears to be a healthy or “normal” weight does not mean that these underlying issues are resolved. Additionally, comments or statements about weight and body are likely to be misinterpreted, even after your loved one recovers from this illness.

Here are some of the invisible symptoms:

Negative thoughts about food
Irrational fears
Irrational anxiety
Manipulation
Secrecy
Avoidance
Guilt
Shame
Self-disgust

What you can do instead:

Refrain from commenting on physical appearance and eating patterns.
Instead, focus your attention on the non-physical changes you notice in your loved one. Such as changes in energy, attitude, or your relationship.
Use statements such as “I feel like I can connect with you again” or “I feel like I have my best friend back” rather than commenting on weight, body, or appearance.

See what I mean? Eating disorders are complex. Here are some final thoughts to keep in mind during your next encounter with someone experiencing an eating disorder. In times when you can’t seem to find the right words to say, just listen. Often times, the best way you can support your loved one is by being there to listen in a caring, nonjudgmental way. If and when you do say something, remember to be mindful of how you approach the subject. Stay away from any criticisms or calling out appearances.

And always remember, you don’t have to face the battle on your own. Organizations such as The Alliance, NEDA, and F.E.A.S.T. provide education, group therapy, and professional support to help you break free from the disorder and find recovery. If you are seeking help from a therapist or nutritionist, look for someone who specializes in treating eating disorders.

Or call me. I’d be happy to support you in your time of need.

Dr. Toni Falcone is a Psychologist who rents space from The Psychology Group Fort Lauderdale and owns her own psychology practice. Dr. Toni specializes in anxiety, depression, and eating disorder therapy. Call (954) 488-2933 x5 or email today to discuss how her services can help you.