Parents and Carers

“What would I do if I saw my son, daughter, loved one, or someone in my care slowly killing themselves or their chances for a happy life?”

As a mother and grandmother myself I can begin to imagine the pain of watching our loved ones destroy their lives and the effects of this destructive behaviour upon the family. I can imagine too, the frustration that comes with the difficulty in accessing appropriate services and with trying to fund specialist help. I can also readily imagine the resentment that can build when all of this focus of love and attention appears to be both insufficient and unappreciated, in fact often even resented by the sufferer and the rest of the family.

Eating disorders can occur at many ages and is not just the generally perceived adolescent focus on food, image and weight. It is accepted now that it is the silent language of emotional pain. This can be seen initially as the only alternative to dealing with stress, depression and anxiety coming from a need to be seen as “perfect” and an inherent low self esteem. Fears about food, “…if I start to eat I will never stop” or “ …..if I eat bread/chocolate/ice cream, it will always lead to a binge and then I have to get rid of it…” are just two of the much repeated patterns of thinking which are associated with an eating disorder. I have heard so often from my clients that it is much easier to count calories than to face the emotional pain that this illness is masking or suppressing. This pain is being literally purged or starved in the hope that it will go away.

Of course this does not work.

An eating disorder is an abusive relationship, and as such it is at least familiar and predictable. As the voice of the disorder will say to the sufferer, “ You know that you can rely on me, I am your only best friend, when all else fails, I am here for you.”

Parents can sometimes blame themselves for the illness and in my experience this is very rarely true. However, a deeply loving relationship can turn into one that can be experienced by the sufferer as either restrictive or as an alternative to facing the fears of growing up. These feelings can produce a sense of shame and guilt as it can also be believed that they are unappreciative of what has been given to them. It is important to understand that apportioning blame serves no useful purpose, but an acknowledgement of events can help in the re-construction and understanding of them.

I have observed the following qualities to be present in those suffering with all kinds of eating disorders, or at least those who seek help or have it sought for them:

• They tend to be intelligent and are not aware of it.
• They tend to be attractive and not aware of it.
• They are seen by themselves and others as being “too sensitive” as though this is a negative thing.
• They often have a sense of responsibility for everyone else’s problems.
• They are extremely “perfectionist” and judgemental about their achievments.
• They suffer with low self esteem that usually has no reflection on a loving and affirming upbringing.
• There may be a family history of eating disorders and depression.

What should I look for?

• Restricting certain foods and the increase of this restriction.
• Attempting to control the eating environment.
• Mood swings not seen before.
• Withdrawal from normal communication or social events.
• Losing or gaining excessive weight.
• Disappearing after meals.
• Seeing themselves as fat when they clearly are not.
• Counting calories and becoming obsessive and controlling around food preparation.
• Admiring the very thin images of celebrities and comparing themselves negatively.
• Food disappearing and no evidence of it being eaten.
• Compulsive behaviour around exercise even when they are exhausted.
• A general sense of low energy and mood.

What should I do?

• The very first thing to do if you suspect that your child or loved one is displaying any worrying behaviour around food is to face the problem in a loving and non-judgemental way.

• You are not the therapist and you can spend hours and a vale of tears trying to persuade the sufferer to eat/ not eat or trying to persuade them that they are not fat when they weigh 5 stones.

• Understand the complexity of the situation and recognising the signs are of paramount importance when caring for someone with an eating disorder.

• Know what signs to look for and then what to do with the gathered information is one of the first essential steps.

• It is important to trust what you are seeing and not allow the insidious behaviour that has crept into the family to lull you into a false sense of security.

• Eating disorders do not disappear by themselves. I have heard of cases when the sufferer does recover alone but this is very rare and generally speaking the longer the delay in seeking help, the more entrenched the illness becomes, the harder it is to overcome.

• A safe, therapeutic environment, a skilled therapist and often the support of the multi-disciplinary team are essential components to aid recovery.

• The underpinning issues as well as the behaviour must be addressed in a non-judgemental but not all-excusing way. Strategies for dealing with the anxieties and stresses of life must be explored and developed as an essential aid to recovery.

• For families and loved ones, the sense of the loss of the person they knew is a painful one and family therapy can assist in understanding the many processes and effects of the recovery programme.

• Even before a young person may be willing to accept that they have a problem, support offered to the other family members can help to provide the very necessary united front essential to challenging the voice of the illness. It is often the case that the whole family, including siblings can benefit from this advice and support.

• It is of course essential that carers other than families and parents have this same kind of understanding of an eating disorder and can identify the early warning signs.

• Boarding schools are breeding grounds for the infiltration of this kind of behaviour between peer groups and behaviour is copied often without being spoken of in the dormitory at night. Home-sickness, loneliness, stress about exams, competition about looks and image, are all there to be dealt with by this destructive behaviour when the sufferer feels that they have no right to have any of these emotions.

• Day schools, holiday camps, health clubs, gyms, all have an inherent responsibility to offer a high standard of care and appropriate training must be part of any induction package. In this way a responsible and enlightened approach can be part of the awareness of an increasingly worrying situation. This must be in place if we are to reduce the escalation in the numbers of admissions to hospitals and the subsequent distress to all of those involved.

• Consider attending our parents seminar.

Statistics

Eating disorders express themselves in different ways and cover a large range of severity, from causing distress and reduction in the quality of life, to life threatening and even, in some cases, fatal. There are a number of ways of getting support and treatment, and conversely many sufferers never seek help. For all these reasons, meaningful and comparable statistics are hard to find. However, the statistics that are available show that the issue is serious and growing. B-eat estimates that there are some 1.1 million sufferers in the UK.

Cases of bulimia and anorexia among girls under 18 admitted for treatment have leapt by 47 per cent from 562 in 2004 to 825 last year. Worryingly, there has also been a 25 per cent rise in girls under nine being treated for eating disorders.

The new figures show the number needing hospital treatment has risen by 25 per cent to 1,740 compared with 1,398 in 2004. The number of men being treated for eating disorders has also gone up, rising to 226 last year from 183 in 2004.

We must keep in mind that these figures only represent those who are being treated under the NHS, and are not really indicative of the seriousness of the situation but they do give an idea of the scale of the increase. The chart on the left shows the increase over time in the number of 'finished consultant episodes' (the most serious cases) in English NHS hospitals, where the primary diagnosis was anorexia or bulimia. Please note these figures represent individual cases and not the actual number of patients, some patients will have had more than one admission.

In a survey of 600 young people with eating disorders, b-eat, the eating disorder charity, found:

• Only 1% of children felt they could talk to their parents about their eating-related concerns.
• 9% of children felt they might be able to talk to someone at school.
• 17% of children felt they might be able to talk to a doctor or nurse.
• 92% of children felt they couldn't tell anyone.

B-eat currently believes the number of people receiving treatment for anorexia or bulimia to be near to 90,000, in the UK while many more people have eating disorders undiagnosed, in particular those with bulimia nervosa.

Conclusion

It is only through education and understanding that we can have any hope to reduce these growing number of sufferers. It is omnipresent in most walks of life here in the West. It seems that many other cultures do not have the same issues.

We must all adopt a responsible stance and work in a united way to address this issue and only then can we begin to feel that we have responded with the commitment and care to support recovery in today’s society.