Anorexia Nervosa almost killed me
My wife has become more irritable and withdrawn since she became ill with anorexia, and I have difficulty communicating with her. Her eating disorder symptoms seem to compound this problem so that when we do talk, it’s often about her weight concerns. How do I talk comfortably with her?
Communication is an important part of any marriage or familial relationship, and many parents, siblings, children, and friends would echo your uncertainty of how to communicate effectively with an anorexia patient. Unfortunately, as you have observed, anorexia can limit a person’s ability to engage in meaningful exchanges, both because of the preoccupation with food and weight and because of the physiological effects of starvation and the resulting cognitive and affective changes.
Marital therapy can be quite helpful and is highly recommended, if your spouse is willing to attend. If that is not feasible, I can suggest some strategies for encouraging effective communication in marital and other familial relationships:
• Openly express your love and affection for your spouse or loved one.
• Listen to her feelings without judgment. Try to reflect what you hear her saying to you (e.g., “I hear you saying that you feel scared” or “I am hearing you say that you feel you must be perfect”).
• Show compassion and empathy for her feelings. You can do this without agreeing with the beliefs your loved one holds about food and weight.
• Do not get drawn in to questions about weight and conversations about food. Instead, attempt to gently guide the conversation to other topics (entertainment, a planned activity, or another subject of interest to your loved one). Sharing in non-food related activities can be a source of pleasure for both of you and may allow for a wider range of conversation as well.
• Do not try to read your loved one’s mind. If you want to know what he or she is feeling or thinking, ask directly.
• If an argument ensues, take a break from the conversation and come back to it when you are both calmer. Do not simply insist that your viewpoint is correct; instead attempt to understand all points of view, even though you may not agree.
• Disagreements are okay. It can be healthy for couples to have and express their varying opinions. Insist on mutual respect at all times.
• Avoid blaming the other person or making accusatory statements such as “If you would just eat, we wouldn’t have any problems.” Do not try to induce guilt. Do not try to argue or lecture your loved one into changing his or her behavior. Do not threaten the withdrawal of your love or affection.
• Do not give advice, unless requested.
• Avoid exaggerations such as “you always” or “you never.”
• Be willing to acknowledge your own mistakes in an argument, and do not hesitate to apologize for them.
• Try using “feeling language” or “I” statements, which are ways of expressing how you feel about a situation without placing blame on another. For example, the statements “you are slipping again” or “you are in danger of purging” can make your spouse feel defensive or hostile.
“I” statements can help you communicate your own feelings and experiences, not another’s (e.g., “I am worried about what I have been witnessing lately” or “I get scared when you say you think you are fat”). The key is to discuss your own feelings without trying to assume what the other person is feeling.
As a basic guideline for “I” statements, you can try following this three-part format:
1. I feel _________ (name your feeling)
2. When ________ (provide nonjudgmental description of behavior)
3. Because _________ (give the effect the behavior has on you or on others).
Example: I feel upset when you withdraw to the other room at dinner time because the kids and I don’t get to have your company.
What about eating out? My family used to do this regularly, but now my son doesn’t want to go with us because of his eating disorder. Should I insist he go?
The experience of eating out in a restaurant can indeed be a very positive and many people enjoy doing so frequently. Just look at the popularity of eating out as a social experience-on dates, for special occasions, and as family outings. However, for the person with anorexia, social eating can be fraught with intense feelings of fear, anxiety, and shame. Asking your son about his specific concerns may give way to a resolution. For example, you may ask him if there are any restaurants in which he would feel “safe” and comfortable. Let him choose one accordingly. It may be hard to understand his reasoning, but try asking your son what his feelings are on the matter and listening to his response-it could open up lines of communication in a new way.
If he is using a food exchange system, his dietitian may be able to provide helpful advice for applying this information to social eating situations. If a compromise cannot be reached, then for now, it may be best to respect his wishes on the matter. Try not to take his decision personally; instead remember that it is a symptom of his anorexia and will likely change as he takes strides in recovery. As your son progresses in treatment, he will probably once again become comfortable with eating in social situations.
I’m concerned about my college roommate. I really think she has an eating disorder, but I’m scared to approach her. What should I do?
I created the acronym ALIVE for using a caring approach in speaking with a loved one about anorexia: Ask to speak to your loved one in private. Let your loved one know what makes you feel concerned (e.g., discuss specific times when you observed symptoms or behaviors that led to your concern). Invite your loved one to examine helpful resources about eating disorders and to speak with a caring professional who is knowledgeable about eating disorders.
It can be helpful to come prepared with names of Web sites, books, or local treatment professionals. Voice your concerns without engaging in a power struggle, assigning blame, or offering simple solutions (e.g., “If you would just eat, everything would be fine”). Express your desire to support your loved one. Remind them of your love and of your concern for their well-being. Keep in mind that your goal for sharing is to encourage your roommate to get help. Toward that end, there are a few more things to consider. First, try not to argue with her if she refuses to get help. Instead, express how it makes you feel to see her engaging in behaviors that may be harmful to her health. Using “I” statements can be helpful here. If it appears the conversation may turn into an intense argument, simply suggest that you talk about the matter again at another time. Realistically, you do need to prepare yourself for the possibility that your roommate may react in denial or become angry at your suggestion to get help. Instead of trying to push for change, reinforce that you are there for her should she ever wish to talk about it again, then consider backing away from the issue temporarily.
Second, give your roommate the opportunity to respond to your concerns. Perhaps she will welcome the display of care and concern you show. You can ask if there is anything you can do to be helpful; however, know your limitations. Do not attempt to give professional advice or take on a role beyond that which would be appropriate to your relationship. Be sure to direct your roommate to speak with a school nurse, coach, teacher, or parent. Third, if the situation calls for an emergency response, do not hesitate. If you are aware of the potential for a suicide attempt or physical harm due to the effects of starvation, assist your roommate in getting appropriate help at a hospital or other urgent care facility. Wishing to avoid offense, wanting to not appear intrusive, and fearing angry responses are frequent reasons why people hesitate to share concerns with others. However, while you are under no obligation to share your concerns, your helpful action may steer your roommate toward getting help. The knowledge that someone is willing to offer helpful resources and come alongside as a caring source of support can be a powerful impetus toward getting help. If you feel you can no longer keep your concerns to yourself, I hope the information presented here will help you prepare to speak with your roommate.
Sarah shares:
When approaching a friend who you think might be in trouble, expect the worst. Even when I sincerely wanted help, I responded to people who reached out to me by brushing off their concern or getting mad at them for “falsely” accusing me of being sick. No matter how stubborn and mean your friend is, don’t give up on them. Understand that deep down, they don’t want to push you away and refuse your help. Let them know you’re not going anywhere, and when they get angry with you, know that it is their eating disorder talking, not them.
Term:
Food exchange system – A dietary approach or special meal plan in which foods are categorized by food group (e.g., starches, vegetables) and serving size.
For the person with anorexia, social eating can be fraught with intense feelings of fear, anxiety, and shame.
