Submitted by Joanna from Talk ED

In the words of Venables (1) who cared for many people with anorexia at Guy’s Hospital in London, almost a hundred years ago: ’The doctor (carer) must never admit defeat and never lose her/his temper …the opportunities for annoyance will be many.’

Pertinent words that describe a wisdom that hasn’t changed!

Because eating disorder behaviours are so irrational and unreasonable, trying to communicate well over a long period is a heavy load for anyone and the potential for conflict is enormous. Unconditional love is demanded even whilst you are being rejected – which means that you will need a lot of empathy for yourself too, to sustain you and enable you to be at your best with these most challenging of illnesses – eating disorders. Understanding the behaviour more, and how to manage in the moment (and more long term) should help to lighten the load.

The behaviours caused by a hungry and undernourished brain

Starving your brain creates a state of threat which causes behaviour that is out of character. The state of threat manifests itself as being hyper-alert to change and hyper-reactive to perceived threats – in short, a fight or flight reaction. The daughter/son/family member/friend you thought you knew can become aggressive and hurtful and may be shouting or closed off or resisting in any way they know how. When the feeling of threat is high, when big needs are not being met, the person suffering will begin to judge, exaggerate, catastrophise, re-hash the past and fear the future which can result in outrageous behaviours. These extreme behaviours actually need the greatest amount of compassion, care and support – which can be hard to remember in the heat of the moment. These words by Eva Musby (2) in her book ‘Anorexia and Other Eating Disorders’ puts it powerfully when she says:

‘I am devastated by the idea of punishing a kid for behaviours that are driven by their eating disorder. Would you punish a kid in a plaster cast for limping?’

When your loved one’s emotions are high, they will have very little or no access to reason. As well as having an emotional reaction ourselves in response to the behaviour, we as parents or carers often try to take over and jump into sensible solutions and the rational – on their behalf. Both our emotional reaction and our attempt to ‘fix’ the situation are likely to increase rather than decrease the threat. If instead, we can use a kind voice and body language, making them feel loved, listened to and not judged, this is when the nervous system gets the message that the threat is over, emotions decrease and they get access to their whole selves again.

People suffering with an eating disorder seem to have a terrible loathing for themselves; rock bottom self-esteem. They are filled with shame and guilt at their behaviours and the effect they are having on others. On top of this is a distorted body image that causes feelings of self-disgust, unworthiness and sharpens the blade of shame already felt. Rejection of those who are the closest is utterly normal; they feel unlovable.

As a parent or primary carer, we matter enormously – we make everything calmer, safer and we inspire courage to take on enormous challenges. Unconditional love and acceptance is key – no judging, no blaming, no shaming – however withdrawn, blank or angry the response.

Here are some thoughts on responding compassionately:

• Love them at all times, even when they are at their worst.
• Listen carefully; try to understand what they are saying. If you can’t understand, validate the feelings of the sufferer – this is truly how they feel.
• Be interested in their feelings rather than threatened. Avoid stiff upper lips and empty assurances.
• Keep validating emotion in the present, this leads to greater understanding by the sufferer, and eventually their own wise words and solutions.
• When sorrow and difficult and shameful feelings are heard without judgement; healing, clarity and empowerment can follow.
• Don’t be afraid to guess about feeling; in the manner that you ask, you make the anxiety acceptable and not shameful. If you are wrong, you have still built connection.
• A question shows that you have time and care, so that what’s going on for someone can be expressed.
• If the distress is rising and repeated, it could be that she/he is not feeling heard, something has been missed. Listen carefully, their truth needs to matter; it is the place where growth and independence begin.
• Feeding back what you have heard can be very calming.
• Protect your relationship. Displaying anger and frustration will damage it and will deplete your energy. The result will be that the person you are trying to help will feel more guilt and self-loathing.
• ‘I’m sorry and I love you’ can enable you to leave a conversation. Connection will decrease emotion.
• Empathy reduces loneliness in suffering and is shown through body language, tone of voice and words. Silent empathy gives nothing to argue against.
• It can help to know that others have similar hardships to bear, that we all suffer as part of being human – it makes us feel less alone.
• Model how to manage one’s emotional life well.
• If someone has been ill for a long time, they forget who they really are, and have forgotten their strengths. It’s always good to be reminded. Paint a bigger picture of how those strengths will be useful in the future.
• Be consistent and persistently compassionate and remember that recovery is often a protracted and evolving process.
• Always try to be kind to the person suffering and also to yourself…

Self-compassion

When we are anxious about our children/loved one, and they are resisting with all their might, it can be hard to be at our best and even to think about ourselves very much. However, in order to be persistently compassionate, we need to attend to ourselves too, as the compassion you are able to have for your child/loved one, comes directly from your own compassionate state. Some form of self-compassion is essential to be able to be effective, courageous, and resilient in your role as parent, companion, supporter, coach.

Being good at self-compassion will mean that your child/loved one can experience your compassion, trustworthiness and strength – which they need consistently on their journey to recovery.

Some  ways of being self-compassionate:

• As soon as you notice that you are feeling overwhelmed, pause and treat yourself with kindness. What do you need?
• Listen to yourself. Nourish yourself. Build yourself up. Make sure you have contact with kind people – consider therapy.
• Distraction is helpful; do something fun or interesting, or take a break.
• De-escalate your emotions before they can do any harm.
• Don’t make your child/loved one responsible for your anger. Remember that their behaviour comes from a frightening sense of powerlessness and danger. Try to translate their and your anger into needs.
• When things go wrong, mend your connection as soon as you can. Don’t let your emotion simmer. Consider a conversation later in the day to restore things and problem solve. In doing this you are also modelling how to manage your emotion.
• You can have a compassionate response without being a doormat. It is ok to make requests for yourself, as long as they are realistic and achievable.

In the end, you can do little harm when you come from a place of love and acceptance. It is superhuman and unrealistic to expect to avoid conflict altogether, but perhaps what’s more important is the process of de-escalation and the restoration of relationships. From my own experience, I worried that the times of conflict we had (and there were plenty!) would leave a scar on my relationship with my daughter – and her dad felt the same. I’m very happy to say that we were both wrong about that. The scar has turned out to be a mutual respect of what we have been through together – and as time goes by we can talk about it more, and even laugh about some of the moments that best describe the madness of it all.

References:
1. Venables JF. Anorexia nervosa: study of the pathogenesis and treatment of nine cases. (1930)
2. Musby E.  Anorexia and Other Eating Disorders: How to help your child eat well and be well (2014)