Thanksgiving is difficult for families with a loved one in eating disorder recovery. Oftentimes, the messages of recovery are counter to the messages of our society about food and health. We live in a weight-loss obsessed culture and sadly, this is often the reason the eating disorder developed in the first place for your person in recovery (PIR).
A PIR often treasures returning home for Thanksgiving, because they get to see you, their loving family member, and simultaneously dreads it because the Thanksgiving holiday is centered on food and feasting. Because you are one of the most important people in your PIR's life, your words and actions have immense power to aggravate the eating disorder (ED) voice and cause considerable despair. Have no fear! This article is here to help.
For a person without a history of eating concerns; dieting, calorie counting, “clean” eating, and exercising may be part of your daily routine. If you are like many people, you may have some body dissatisfaction yourself, and you may complain about it or the diet you are on at the moment. These ordinary behaviors are kryptonite for your PIR, who hears what you say and sees what you do, and feels intense internal pain as their own ED voice starts to scream at them on the inside.
The rules for a PIR are different from an ordinary person in that they are never allowed to diet again. This means that recovery means no more calorie counting, restricting foods, or engaging in compensatory exercise, for the rest of their lives. This is a radical shift from the rest of the world, who ebbs and flows in and out of diets, weight loss regimens, and exercise plans. The reason that diets are now off the table for the PIR is because we have learned that that we cannot cure the eating disorder unless we put a stop to the very things that caused the eating disorder.
Just as the rules for a PIR are different from those of an ordinary person, the rules for family members of a PIR are different from ordinary families. Below, I share my top seven rules for families:
1) SPEAK UP! Connect your family member to specialized treatment if they are not already working with a clinical team.
This article is written for families whose loved one is already connected to adequate and competent care. Do not hesitate to advocate for care for your loved one if she does not already have it. If your loved one is not engaged in treatment, appears underweight, and/or seems to have untreated eating disorder behaviors, you MUST speak up. Call 800-RENFREW and request a formal assessment and referrals to local providers, or click here to contact my practice if you are located in the Washington DC area. Untreated eating disorders can be medically dangerous (low body weight and purge behaviors can be fatal!) so speak up immediately if you are concerned.
2) If your loved one is already in treatment, mum is the word. Never encourage weight loss in your PIR.
People in eating disorder recovery come in all shapes and sizes. Oftentimes, the change in body size that is a natural part of eating disorder recovery is very noticeable and sometimes shocking. Because eating disorder behaviors have probably changed your PIR's body to larger or smaller than their natural set point, their body will often undergo lots of physical changes during recovery.
The best rule of thumb is to not comment on your PIR's body shape or size. Even saying something positive can be damaging, as it may mean that they have gained weight (which can be triggering) or lost weight (which can encourage more eating disorder behaviors), so mum is the word, so long as your PIR is engaged in treatment with a competent team.
If your PIR is in a larger body than you are used to, realize that in the eating disorder recovery world, we believe in health at every size. To learn more about health at every size, click here. Your PIR is learning body kindness, and as a family member of a PIR, it may be useful to become familiar with the body kindness philosophies. Eating disorders wreak havoc a person's ability to be happy, and send the stress hormone cortisol through the body at a near constant rate. In eating disorder recovery, health starts with self-love. Your PIR needs your acceptance and approval, no matter their body size.
3) Keep your diet, body dissatisfaction, and exercise a secret.
Eating disorders are secretive, and now you get to be secretive too! For example, if you have to exercise while your PIR is home for the holidays, do it when they are out with friends and do not mention it to them later. If you substitute an ingredient to make your family's meal more nutritious, make it your little secret. When a PIR is aware of your weight loss concerns, their ED voice begins to torture them, demanding that they retreat into their own disordered eating behaviors. This is not only hard on their body, it is hard on their emotional life, making it impossible to enjoy the holiday spirit.
Surprisingly, your PIR may be sensitive to comments about what other family members are eating or not eating. Any reference to what sort of nutritious or “sinful” items are around the table can also trigger your PIR, so in this case, the fewer comments the better.
Similarly, the ED voice may interpret your innocuous suggestion for a morning walk as an insult to your PIR's body. Be ready for the twists and turns of the ED voice, and keep family exercise outings off the table.
4) Hide the scale!
A scale in the house can undo months of treatment. One component of ED recovery is smashing the scale. Your PIR will likely be tempted to step on the scale if it is available in your home, and what it says may dictate how your PIR feels for days or weeks afterwards.
5) Keep your home stocked with the foods that your PIR requests.
Food scarcity is a powerful trigger for a PIR. It is often helpful to talk to your PIR about what kinds of foods he would like in the home for his stay. Most people in eating disorder recovery work with a nutritionist, and oftentimes, a PIR is on a meal plan that requires very specific items. To promote a smooth landing, a little planning in advance can go a long way. Many meal plans require three meals a day with three snacks, and your PIR may be eating by the clock. Be careful not to judge your PIR as she approaches eating in a way that may be different from what you are used to.
Additionally, let your PIR decide if he would like to accompany you to the grocery store. When you are there, do not let your PIR see you checking labels for nutritional content. This can be triggering for your PIR, who is unlearning the idea that food has moral qualities such as “good” and “bad.”
Be aware that your PIR may be watching what you are eating, as well, so do not skip meals. It can also be triggering to comment on your own fullness or hunger. Your PIR is probably struggling with difficulty connecting to hunger and fullness cues, and may be looking to you for guidance on what is a "normal" eating schedule. It may be therapeutic for your PIR to see you eat adequate and full meals frequently.
6) Gently remind your PIR when you hear the ED voice talking.
It can sometimes be frustrating when you hear your PIR's ED voice speaking through her. Try not to attack your PIR or lay a guilt trip. The best thing to do is gently remind her that you hear her ED voice talking. Good phrasing might be, "I think I'm hearing your ED voice speaking, and I am really sorry that you are going through this." After that, simply allow her the time and space to reflect on your observation, or offer your support if she turns to you for empathy.
7) Police your fashion policing.
As a family member of a PIR, you are surely concerned about your PIR's happiness, as well as their self-esteem. Sometimes well-meaning family members might comment on how certain clothing does or does not flatter your PIRs body (or their own body). Your PIR is likely deeply sensitive to these kinds of comments, so when in doubt, stay quiet. Your PIR is likely already hypervigilant about how clothes fit, feel, and look on her body, and typically cannot tolerate others' opinions -- even if they are positive. The ED voice is like a mean bully, twisting even the nicest compliment into a message about how horrible yesterday's outfit must have looked if today's "looks nice."
Your PIR may want to avoid clothing shopping together. It is useful to respect his wishes on this topic, given that his mission at home is to enjoy your company and the joys of the holiday. It can take hours or days to recalibrate from a difficult fitting room experience, so for the time being, keep it off the itinerary.
8) Know that you are loved by your PIR.
Your PIR loves you and needs your support in recovery. What you say and do matters tremendously. If you have read this far, you care deeply about your PIR. If you have broken some of these rules in the past, please do not blame yourself. Offer yourself kindness. When we know better, we do better. We all are inundated with diet culture in our society, and we want to do what is right for the sake of our loved one’s health. However, once an eating disorder has developed, the best thing we can do for your PIR's health is to help reduce the internal anguish characteristic of eating concerns. This is a journey for your PIR, but it is also a journey for you, the support person in your PIR's life. Stay encouraged. Keep learning. Have a happy Thanksgiving in your home this year.