HELP FOR PARENTS AND FRIENDS

This article contains suggestions from the Eating Disorders Association as to how parents and friends of someone who suffers from anorexia or bulimia nervosa can understand and respond helpfully to the situation.

Anorexia and bulimia nervosa are outward signs that something is wrong inside. The problem really relates to a crisis about self identity. Eating disorders provide a way of trying to reach a position of independence when this feels very difficult. Taking control of the body and food intake can seem perhaps the only way of achieving this.

Parents or people close to a sufferer can be very helpful in this struggle. But it is not easy. Parents can often feel that home has become a battleground, with food as a very powerful weapon. It may seem as though conflicting messages come from the sufferer to the parents, such as: "Leave me alone, let me live my own life, I hate you" and: "Don't ever leave me, I can't cope on my own, I love you". This kind of ambivalence, and these contradictory feelings, are hard to live with. However, it is important to allow these conflicting and painful emotions to be expressed. Periods of depression, anger, hopelessness and despair are all part of the experience of growing up.

Parents also have feelings and may give out conflicting messages, such as: "It must be my fault. I'll do anything to make you better I love you so much" and: "I can't bear to see you unhappy. I worry about you all the time. You are ruining my life, I want to shake you. At times I hate you". Parents often end up feeling guilty and totally responsible for everything which has happened. This is not a good point from which to begin to tackle the problems presented by anorexia or bulimia nervosa.

Parents usually do what they think is best at the time, and everyone can be wise in retrospect. Accept what has happened in the past, and concentrate on what can be done now and in the future.

Barriers

One of the barriers which sufferers have to overcome, in order to get help with the problem, is their own resistance to acknowledging that their problem is really very complex and there is no short cut to recovery. Although it may not be possible to make the sufferer overcome this barrier, at least do not collude with it and look for miracle cures. Accept that at present this is the only way the sufferer feels that life is in control, the only way of coping.

Acceptance

Accept that the sufferer will probably react badly to whatever approach you make, but do not let this put you off doing what you feel is right. The sufferer needs affirmation in every way, and unconditional acceptance, not just for achievement. The sufferer needs to know that their company is valued, whether they eat or not.

Try to avoid confrontations over food. Do not leave lots of tempting goodies around, or give extra or reduced helpings without being asked. Remember that the aim is to help the body eat what it really needs.

Seek professional help, and persist if it is not forthcoming immediately. Read about the problems to increase your understanding. The idea of recovery can be frightening, so it is difficult for the sufferer to hear things like "you look better", "good, you've put on weight". The response to this sort of comment is likely to "I've put on weight, help, if I don't lose it again quickly I'll get fat".

Trust and friendship

Anorexia and bulimia nervosa are problems which affect not only the sufferer but the whole family and the circle which surrounds the sufferer. Try to continue living your own life as much as possible. Do not let the illness rule your life as well. Look after your own needs and desires. You are entitled to your feelings. If you are to encourage the sufferer to express feelings openly and honestly, start off by setting an example. Accept that the character changes are part of the illness. The sufferer may become deceitful or start shoplifting. She needs help rather than to be judged.

Progress may mean difficulties between parents and sufferer, because it will involve a more assertive attitude and a degree of separation. This will be a struggle for everyone involved. It may be a temporary period of difficulty whilst changes are being made. You may feel that you, as well as the sufferer, need some counselling or other help with your own feelings. Do not be afraid to ask.

The men in the family should not opt out by thinking this is women's work. The sufferer and the rest of the family need their help.

Useful literature

For more detailed discussion of the issues involved, refer to:

• "Anorexia Nervosa", by R.L. Palmer, published by Penguin Books
• "Families And How To Survive Them", by John Cleese and Robin Skynner, published by Methuen Paperbacks
• "Surviving An Eating Disorder: Strategies For Family And Friends", by Siegel, Brisman and Weinsbel, published by Harper and Row