Knowing what to do when you have a loved one with an eating disorder is very difficult.  This is especially true because the early stages of the illness don't necessarily provoke high levels of concern.  Sometimes the ED starts with a person wanting to "eat healthier" or "get in shape" and it eventually crosses the line into an ED.  Also symptomatic of the ED is that the person will often deny that there is a problem or minimize the severity of it.  "I'm fine" becomes their mantra.

It is extremely common for families to inadvertently accommodate and even collude with their loved one's eating disorder.  This often happens out of fear, lack of understanding the illness, anger, or panic.  Here are some examples of ways that families accommodate the ED:

• Allowing their loved one to dictate what foods are and are not allowed in the house.
• Preparing a separate meal that is "safer" to the person with an ED. 
• Letting the person with the ED choose what restaurants the family will go to. 
• Purchasing and restocking large quantities of binge foods. 
• Not going to social gatherings because the person with an ED doesn't feel comfortable.
• Bargaining with their loved one about what s/he will eat.
• Bribing their loved one to gain weight if underweight.
• Cleaning up the bathroom after the person with an ED purges.
• Exercising with their loved one when she is clearly doing it just to burn calories. 
• Monitoring their loved one's eating – playing the role of food police.

This list could go on and on, and it is so easy to see how families can fall into this trap.  After all, they love that person and want him/her to be happy, and not accommodating the ED can have dramatic results.  

I often compare the ED to a toddler throwing a temper tantrum when the ED doesn't get it's way.  ED gets loud, kicks and stomps and makes life miserable not only for the individual but also for everyone around.  The thing is, giving in only perpetuates the issue in the long-run.  Buying the tantruming kid a toy to make him shut up only reinforces that throwing tantrums is a way to get what he wants.  Same with the ED.  

Accommodating the ED not only allows the person to stay sick, it actually makes it more comfortable for him/her to do so.  For example, if I don't want to eat at restaurants because I am afraid it will make me fat, and the family stops going out to eat, it's no big deal for me to avoid restaurants. But if my family still goes out to eat on a regular basis, even though I refuse to eat it is an uncomfortable situation for me.  Dr. Michael Berrett, CEO and founder of the Center for Change in Utah says that pain + hope = change, so we need the person with the ED to be uncomfortable enough in their illness to want to change. Otherwise, why bother?

I'm not saying that you should be mean to the person with the ED.  In fact, the opposite; people with ED's need a great deal of love, compassion and support.  You may need to redefine what support looks like though.  Here are some ways:

• Support the treatment process.  This might mean attending therapy appointments, helping pay for treatment, driving him/her to session even if you just wait in the waiting room.  Be sure to ask the person what is helpful and to follow the treatment team's recommendations regarding your role in therapy.
• If family therapy is recommended, do it.  I know it might be a financial burden, an extra item on your busy calendar, and something that is very uncomfortable, but it is incredibly beneficial.
• If you observe your loved one engaging in ED behaviors check in with him/her emotionally.  Chances are s/he is using the ED to cope with uncomfortable feelings.  Ask what's going on and how you can help.  
• Noticing and listening are simple but powerful tools.
• Demonstrate unconditional love and acceptance of who s/he is as a person.  The ED does not define who s/he is.  
• Be authentic about how you feel and how the ED impacts you.  Family therapy is a good place to have these conversations.
• Find ways to bond that have nothing to do with the ED.  People with ED's are constantly thinking about food and weight.  Distracting them with other activities can be helpful, and it is a way for you to connect outside of the illness.
• Show her that she does not need to have an ED to receive your love and attention.

Above all, be compassionate.  Have empathy for the fact that your loved one has an awful illness that s/he did not choose.  No matter how angry, upset or frustrated you get, remember that the behaviors are symptoms of the illness.