September 5-11 is Body Image and Eating Disorders Awareness Week (BIEDAW). BIEDAW is a national week of significance that encourages conversation and action around eating disorders. The theme for BIEDAW this year is Know the Signs, Act Early.
As someone who is supporting or caring for a loved one with an eating disorder, you may know firsthand how difficult it can be to know the signs. Eating disorder behaviours can often be secretive and discreet. That’s why in today’s newsletter we are focusing on the importance of being alert to new signs or behaviours in your loved one, especially as they move through the different stages of recovery.
The importance of interrupting behaviours
Whilst much of the initial focus of eating disorder treatment is on refeeding our young person, equal attention also needs to be paid to the interruption of emerging eating disorder behaviours. This is important as reliance on these behaviours can often keep our loved one entrenched in the illness longer. Many of the behaviours listed below may seem unremarkable in isolation. It is often difficult to recognise these behaviours in the beginning as they can seem normal when not viewed in the context of an eating disorder.
Why is interrupting these behaviours important?
Some of the behaviours such as excessive exercise or movement, laxative misuse and/or purging will be aimed toward weight loss and some will relate to ‘rules’ that the eating disorder voice is imposing on the young person. For robust recovery, we need our loved ones to initially learn to stand up to their eating disorder ‘rules’ and then eventually eliminate them altogether. This will enable them to be more robust in recovery and live a full life free of the shackles of their eating disorder rules and untruths.
What are some of the behaviours you may first notice?
- Standing a lot (instead of sitting)
- Using tiny spoons or forks to eat their meal
- Needing to eat from a particular bowl or plate
- Obsessive list writing, planning (sometimes tiny writing)
- Difficulty accepting gifts, reluctance to celebrate a birthday
- Cutting or tearing food into tiny pieces, wanting sandwiches cut smaller
- ‘Smearing’ food around the plate and not completing it
- A sudden interest in recipes or cooking shows
- Micro-biting (taking tiny bites)
- Over-use of condiments such as pepper, chilli sauce, salt.
- Microwaving meal repeatedly to make it “hot”
- Wearing clothing with large pockets at meal times (to dispose of food)
- Wearing more clothing even if the weather is warm
- ‘Chipmunking’ food (holding food in cheeks to enable it to be disposed of later)
- Pacing around the table
- Wanting to bake for family or neighbours but not eating it
- Not allowing different foods on the plate to touch
- Chewing ice cubes or gum
- Tapping of utensils at mealtime
- Taking an extended time to get ready in the morning, excessive grooming
- Increased perfectionism
- Body checking in mirror or pinching parts of the body
- ‘Accidentally’ knocking over glasses of juice or dropping plate with meal on it
As carers, we can assist our young person’s recovery by interrupting and eventually helping them to eliminate these behaviours. Young people who have fully recovered usually report enormous relief when their parents have been able to stand up to the behaviours that they were unable to themselves at the time.
How do we help our loved one let go of these behaviours?
Usually, a loving but firm stance is all that is needed. For example, we can gently say ‘we all eat with this cutlery’, (removing tiny utensils) or, ‘yes it’s fine for you to do some baking but you will need to eat some too’ or gently putting a hand on their arm and asking them to stop the tapping or leg shaking etc. Eva Musby’s “Connect before you Direct” video on YouTube has further suggestions for compassionate connection ideas.
Sometimes more directive action is required such as covering mirrors in the home if there is obsessive body checking, removing apps like TikTok or Instagram from the mobile if diet culture or body image focused scrolling is suspected.
It can sometimes be quite stressful for our young person to let go of these eating disorder imposed rules so we encourage parents to seek help from their clinical team to ensure support and alternative coping mechanisms are provided for our loved one during this process.