Anorexia. Bulimia. Binge-eating. All types of eating disorders are torturous for the sufferers. If someone close to you has an eating disorder, what can you do? If you suspect something’s wrong, how are you supposed to act?

Watching someone you care about suffer from an eating disorder is its own kind of hell. The psychology of eating disorders is so complicated, knowing what you should do to be supportive can feel impossible.

There’s no one answer on how you should behave in every situation, or with every sufferer. Someone with anorexia does have a lot in common with someone with bulimia or other eating disorders, but they have a lot of differences too. Those in early and later recovery will respond differently to whatever you do. So, will those who have had good or bad days.

What we do know is that the support of family and friends can make a huge difference in eating disorder recovery. A 2006 North Carolina University study showed that partner support lessened the symptoms of depression for 20 participating ED sufferers. Stanford University is one of the many institutes that has found that family-based therapy is helpful in adolescent ED recovery. Various cultures and communities, such as Latinos in Puerto Rico, show the same results.

You’re never going to get everything right. Acknowledging that and giving yourself a break is important. Recovering from eating disorders is a long and bumpy road. Supporting someone who is working on recovery works the same way. The key is that you keep trying.

Form a Team

Creating a team to care for the individual with disordered eating is essential. The sufferer might be defensive at some points and compliant at others. They might feel more comfortable discussing specific issues with different people. Both you and they need a good team around you. And as much as others seem to help you, you’re also part of the team and will be doing the same for them.

Besides having a group of supportive loved ones, involving professionals is really important. Therapists, dieticians, psychiatrists and other doctors can play a huge role. Staying in a rehabilitation centre might be a good idea too. Your relationship to the sufferer will determine how active you are in assembling this team. A parent or partner will probably do more than an adult friend.

Find Out as Much as Possible

Within the support team, you’ll have the chance to talk to the professionals involved. You can ask questions and get appropriate feedback. They won’t break patient confidentiality, but they can give valuable advice.

There are also plenty of online resources about eating disorders. The behaviour might seem incomprehensible; it looks like it’s just about food, but it’s actually about so much more. Personal and professional explanations the specific ED types can help you understand.

Focus on People, Not Disorders

Recovered anorexic Dr Emily Troscianko, writing for Psychology Today, stresses how important it is not to give the ED too much power. You can’t reason with a disorder. The behaviour is unreasonable. The thinking is irrational. When you’re speaking with a sufferer, make sure you are talking to them and not to their illness.

For example, if you ask how you can support them at mealtimes and they say by only serving low-calorie foods, you’re probably talking to their ED. If they say by serving a variety of foods, with different calorie counts, you’re speaking with a sufferer who wants to work on getting better.

Focusing on people rather than disorders also means remembering that someone is more than their disease. Sufferers often feel entirely defined by their illness. Ask for their opinion on different things and talk about their previous interests. Don’t police their meals too much, as this is anxiety-provoking. Instead of asking how much they’ve eaten, try asking how they’re feeling.

Recovery Takes Time

At the start of the healing journey, everything can feel insurmountable. The person afflicted with the ED is not the only one recovering from the damage it caused. Friends, families and partners will also need to change how they communicate and relate.

Troscianko advises patience with yourself and the loved one you are trying to help. Keep talking, involve your team, and take care of yourself. Try to learn more, but don’t take on too much information at once. This is a marathon, not a sprint, and you’ve definitely started the race.

Quick Tips on Supporting ED Sufferers

• Choose a good time to discuss the issue. Make sure you won’t have to end the conversation to get to an appointment, and that your loved one is calm enough to hear what you have to say.
• Use specific incidents to show their behaviour.
• Demonstrate sensible eating in your own diet.
• Explain how you feel using “I” statements, such as “I feel frightened when I hear you purging”.
• Don’t blame them; avoid “you” statements like “you frighten me when you purge after dinner”.
• Expect a defensive response but keep trying to talk. At the same time, be careful of pushing too far. You need to keep communication lines open.
• Try to have meals together, but don’t focus on eating behaviour.
• Plan activities for after meals, to distract sufferers from overeating, purging, over-exercising or obsessing about what they ate.
• Keep including the ED sufferer in invitations and plans. The nature of the disease is to isolate people, and they might refuse you often. Show them you care by continuing to invite them.