The Meaning of Eating Disorders Recovery and Help for Family and Friends

Bob M: Good evening everyone. For those of you who are new to the Concerned Counseling Website, welcome. I'm Bob McMillan, the moderator for tonight's conference. Our guest is Dr. Steven Crawford, Associate Director of the St. Joseph's Center for Eating Disorders. Our topic tonight is: What does the word "recovered" really mean when it comes to an eating disorder. And coping strategies for families and friends and how they can best help the eating disorder sufferer. I want to welcome Dr. Steven Crawford back to our chat site tonight. Before we get to the questions Dr. Crawford, maybe you can tell us a bit more about your expertise in the area of eating disorders?

Dr. Crawford: I am currently the Associate Director for the Center for Eating Disorders. I have worked closely with Harry Brandt, MD for the past ten years treating individuals suffering with eating disorders. I appreciate the opportunity to be here this evening to discuss the process of recovery.

Bob M: What exactly does the word "recovered" mean when it comes to eating disorder patients?

Dr. Crawford:Eating Disorders Recovery is not easily defined. It is individualized in many ways. Recovery is a process and not an event. Eating disorders do not develop overnight and are not "cured" overnight. Simply stated, eating disorders recovery is most likely achieved when an individual is able to not have food dominate their every waking moment. Individuals moving toward recovery are able to engage in social activities, work, school, etc. without having their concerns with eating decrease their functioning.

Bob M: So are you saying, "recovered" is not the same as "cured". Even if you have "recovered," you will still have eating disordered thoughts or behaviors, you will just be able to control them better than before?

Dr. Crawford: Yes. Many individuals have told me that they see eating disorders recovery as a daily choice to not act on their symptoms and that they are never completely free of concerns about their weight and appearance. However, they have learned to live with these concerns in such a way that they do not limit their lives.

Bob M: Is that why even someone who has "recovered" is always at risk for a relapse?

Dr. Crawford: Yes. Individuals who have moved toward recovery remain at risk for relapse throughout their lives. This is because they have learned to use their eating disorder symptoms as their means of coping and during times of stress, people tend to revert to comfortable means of coping.

Bob M: We have many people in the audience tonight, so I'm going to get to some audience questions on this part of the conference early. Then we'll move on to helping family and friends cope and how they best can help someone they know handle their eating disorder.

Bry: Is the recovery process the same for all Eating Disorders?

Dr. Crawford: In many ways, yes. Treatment is essential to recovery from all eating disorders. Individuals need to take a two-track approach to recovery. The first track is learning to block eating disorder symptoms. The second track is beginning to understand what is underneath the eating disorder. Both tracks are important and necessary. Developing control over the symptoms usually entails nutritional counseling, with moving towards normalization of eating. It can also include medication management. At times, partial hospitalization and inpatient treatment are necessary to assist individuals in symptom blockade. Understanding what is underneath the eating disorder involves psychotherapy, either individual, group, family or a combination of the above. Support groups are also helpful.

windwood: Dr. Crawford, I have managed to keep from binging and purging or complete restricting for at least 7 years now (after having been anorexic and bulimic for nearly a decade). But I must admit, I still have thoughts of wanting to be thinner. I am in no way overweight. Is it truly possible to stop this nonsense thinking?

Dr. Crawford: As I said earlier, learning to live with the thoughts, and not acting on them, can be a lifelong process. It sounds as though you have achieved this. I sometimes suggest to patients that their eating disorder can actually be helpful. When the thoughts feel stronger and more difficult to control, it can be a red flag that there are stressors building in one's life that need to be tended to.

Elora: When is it imperative to get help?

Dr. Crawford: I suggest that when the eating disorder is interfering with one's lifestyle that it is time to get help.

Bob M: I want to take the time to mention here, that one of the people who frequently visited our website and chat rooms died last week from her eating disorder. She suffered a heart attack. I want to encourage everyone here tonight, that if you are suffering from an eating disorder, please get professional help. This is not something that you will be able to beat by yourself. And I want to stress, as so many of our previous guests have, the longer you wait, the harder it is to recover.

Cie: I heard that in St. Joseph's you almost "force" patients to socialize and keep out as much private time as possible to patients. Is this crucial to recovery and what is the theory behind it?

Dr. Crawford: During hospitalization, patients need to be monitored closely to assist them in not acting on their eating disorder. "Private time" may leave vulnerable individuals with an opportunity to act on overwhelming eating disorder impulses.

Bob M: We are going to take a few more questions on the subject of "what is recovery" and then move onto helping family and friends cope and how they can help someone close with their eating disorder.

AshtonM24: I'm Anthony and I'm an Anorexic. I am 27. I am also the Connecticut contact for the American Association for Anorexia Nervosa and Associated Disorders. (ANAD). What would your opinion be of a Serious Clinical Trial using THC, marijuana, as an appetite enhancer for the beginning stages of medical weight restoration in the early part of treatment for anorexia nervosa?

Dr. Crawford: This was actually done in the late 1970's at the National Institutes of Health. Appetite stimulants actually increase the anxiety of persons with anorexia. Further, marijuana is a potent Central Nervous System depressant. This strategy to deal with anorexia does not work and is ill advised.

Shy: When a person starts going through the eating disorders recovery process and has a setback, could the setback be worse than the original problem?

Dr. Crawford: Yes. Commonly the disorder progresses with periods of illness and periods of improvement. However, when people do relapse, the disorder can progress and be more disabling.

LDV: After 20 years of eating disorders, is recovery possible?

Dr. Crawford: Yes. I have seen patients recover who have been ill for decades.

Chrissyj: Is there a certain amount of time people have to not think about food to be recovered? Like cancer remission?

Dr. Crawford: Recovery is a process and individuals who have struggled with eating disorder thoughts and behaviors often still have some obsessional thoughts about food, weight, and appearance even after they are heading toward recovery.

Maureen: Do eating disorders seriously hurt your heart?

Dr. Crawford: There are a number of cardiac problems that can result from starvation. However, most resolve with normal eating behavior and weight gain. If you are having any symptoms such as shortness of breath, fatigue, palpitations, irregular heart beat, chest pain, etc., you should see your physician ASAP.

Bob M: For those just joining us, our guest is Dr. Steven Crawford, Associate Director of the St. Joseph's Center for Eating Disorders. Our topic tonight is: What does the word "recovered" really mean when it comes to an eating disorder. And coping strategies for families and friends and how they can best help the eating disorder sufferer.

wickla: How does a person take the first step? Where can they go? What will happen?

Dr. Crawford: The first step is acknowledging that there is a problem. Then they must be willing to accept help from friends, family, and professionals.

Bob M: I get emails everyday from family and friends of those with eating disorders asking what can they do to help and how difficult it is for them to cope. The second half of this conference will concentrate on that. I can only imagine how difficult it must be for parents, siblings, husbands, wives, and children who are in the same house as someone with an eating disorder. As I mentioned, I get letters from these people everyday talking about how their lives have been impacted. What can they do to cope, Dr. Crawford?

Dr. Crawford: First, and most importantly, family and friends need to be patient. They need to recognize how powerful an eating disorder can be. They need to remember it is an illness and that the individual needs compassion. Family and friends can support the individual in getting treatment and may consider getting help themselves, if needed. Finally, asking the individual how one can best be helpful is an important step.

Bob M: From some of the letters Dr., it seems it's very frustrating for those who are close, when they tell the person "you need to get help" and they don't. How would you deal with that?

Dr. Crawford: We generally suggest to the person that they tell the patient that nothing can be lost from getting some professional input. They may find out that they don't have a problem, but when others are concerned often they do.

Bob M: I understand. But how are those close to the person with anorexia, bulimia, or a compulsive overeater, supposed to cope. What tools can you give them?

Dr. Crawford: First, it is important for friends and family to recognize that while they can provide access to treatment, and support treatment, they cannot recover FOR the individual. We recommend that family members and friends develop their own coping mechanisms and support structure. In our area, many family members benefit from our open support groups, where they do not feel as alone.

nholdway: How should a friend answer the constant question of "Do I look fat?"

Dr. Crawford: I would tell the individual that there is no good answer to this common question. If they were to say "no," the individual will likely discount the response. I would encourage the family member to confront the patient's continual over focus on body shape, weight, and appearance. In general, it is best to avoid conversations related to these topics.

Shy: Every afternoon when I get home, when my husband asks me if I have eaten that day and I tell him the truth, which is usually no, he acts like he is depressed about it and doesn't speak to me the rest of the evening. How do I handle this?

Dr. Crawford: Perhaps he withdraws because he is concerned about your health. If you avoid eating because of fear of weight gain, you have a problem that warrants your serious attention.

AnnMarieg: As the husband of a 20 year bulimic, what's my best approach when severe depression sets in?

Dr. Crawford: For the patient or for you?

Bob M: Dr. Crawford, I believe this person is the husband...and is speaking about his wife-who is a long-time bulimic patient. How does he deal with his wife's depression?

Dr. Crawford: I was genuinely wondering if he was wanting help with the depression that family members often feel, or whether he wanted strategies to deal with his wife's depression. I'll address both. First, the husband should try as best he can to recognize the signs of depression in his wife and he should try to be as compassionate and understanding as he can. He should try not to be judgmental, although this can be quite difficult at times. He should encourage her to follow the treatment program that has been developed by her care providers and he should try to avoid power struggles and conflicts related to food and eating. Most importantly, he should constantly remind himself that his wife has a serious illness and she lacks certain controls at times. In terms of his own depression, he should recognize that the chronic stress of a serious illness in the family can take its toll, and no one is immune from depression. If significant symptoms are present, he should seek help right away.

Ann: Is it often that someone with an eating disorder has a co-conspirator, and should the co-conspirator be kept away from the recoveree?

Dr. Crawford: It is not uncommon for persons with eating disorders to get together and defensively support the illness in each other. This is a real problem, but usually, deep inside, the patients know what is going on.

Bob M: An audience member wanted me to ask this question very directly: Since no one can make another person do something they don't want, like go to a doctor for treatment, for their own sanity, should a family member/close friend just say "the heck with it" and go on with their lives? After all, what more can you do if you've encouraged the person to seek help and they don't want to get it?

Dr. Crawford: I wouldn't give up easily because many times patients are in stages of denial for months, or even years, and suddenly turn the corner and recognize that they have a serious problem. I do think that family members need to meet their own needs and not let the eating disorder ruin their life too. This is one of those "fine line" issues where one needs to strike a balance between "appropriately concerned," but not "consumed".

Jenshouse: Would it help someone to get treatment if you offered to go with them or is that not a good idea?

Dr. Crawford: Patients are often brought in by supportive friends who are quite helpful. Frequently friends and family will attend our support groups with the patient.

Bob M: Here are two similar questions:

SilverWillow: I think that I have an eating disorder and I am seriously thinking about seeking some help, but my boyfriend/fiancé doesn't know anything about this. I am frightened to let my secret out, but I really think I need some help. Should I tell him about this? If I do decide to tell him, can you suggest a "gentle" way to break the news?

Keensia: How can I tell someone that I have an eating disorder?

Dr. Crawford: Our view is that being secretive about an eating disorder is a sign of avoidance and denial. If your boyfriend genuinely cares for you, he should accept you as you are, but also should support you toward a healthier life. We believe that honesty is the best policy.

smiup: As a parent of 17-year-old daughter with an eating disorder, what are the chances of this being a phase teenagers go through, like drinking or drugs?

Dr. Crawford: I would fear that viewing the problem as a "phase" might be a way to minimize the seriousness of it. However, many adolescents with eating disorders do recover in adulthood. Many adolescents are very concerned about body image and weight, but do not have a full syndrome. If these symptoms are interfering with everyday life, then help is needed.

Bob M: Here are a few audience comments relating to what we are talking about:

LDV: When my husband comes home from work and asks about the food? he thinks I am not trying when I can't eat.

LMermaid: My wife has anorexia and admits this but will never, ever admit that she is depressed and this has contributed towards her not taking meds which are linked with Serotonin reuptake. Should I be convincing her she is depressed or supporting her stand? She does seem depressed to me from time-to-time, due to her eating disorder and complications stemming from it.

Dr. Crawford: The medications can frequently be helpful for anorexic patients regardless of whether depression is present.

Bob M: It's getting late. Thank you Dr. Crawford for coming tonight. And to everyone in the audience, thank you for your participation and your questions. I want to again urge everyone...if you need help recovering from you eating disorder, please take it seriously.

Dr. Crawford: Thanks, Bob. As always, I've enjoyed being part of the conference.

Bob M: Good Night everyone.