Help GF deal with recurring ED thoughts?
March 19, 2012 10:28 AM   Subscribe

My girlfriend confided in me that old thoughts from her days of having an active eating disorder are cropping up again. Help me help her.

Over 7 years ago, when my GF was ~21, she was anorexic and a emotionally abusive boyfriend that totally fed into it. The relationship ended, she told her parents and friends what was going on, went to some therapy which she says didn't do much. I don't think she was every formally diagnosed by a physician. Her metabolism slowly recovered but she basically stopped exercising because it would trigger her ED.

Fast forward 7 years, (4+ of which we've been in a really solid relationship), she's suddenly feeling those feelings come on again more strongly. She's currently an insured grad student (in California), although she graduates in a few months. So here's my questions:

-What course of action should I encourage her to take with regard to therapy? Will there be any insurance repercussions if she gets formally diagnosed months before losing her current insurance? (She's skeptical of therapy but I think it's mostly based off her really mediocre previous experience, who seemed to be someone with little experience with EDs)

-How do I help create a trigger-free environment for her? (For example, I brought home some donuts the other day, which sort of set off her telling me about this)

-I know it's not within my power to help her get through this, this stuff comes from within and needs to be dealt with professionally, but if there's anything else I should know, let me know.
posted by anonymous to Health & Fitness (9 answers total) 5 users marked this as a favorite
She needs to see a therapist who is experienced in treating people with a history of eating disorders. If she doesn't like the first therapist, she needs to see another therapist. There are crappy therapists out there, but that doesn't mean she doesn't need a good therapist. If her car was broken, and she went to a shitty mechanic, would she give up on trying to get her car fixed? No, she'd find a good mechanic. Same with the brain.

You can't create a "trigger-free" environment for her. But you can ask her what are some specific triggers she'd prefer you to avoid.

A really good book about living with someone with a restrictive eating disorder is Harriet Brown's Brave Girl Eating. Now, it's not going to be relevant in every way to your experience because it's about Brown's experience of parenting a teenage daughter with anorexia. But Brown (a science and health journalist) did some great interviews that really highlighted the ways in which disordered eating changes the brain. I am someone with a history of disordered eating, and I found Brown's book eye-opening in ways that my previous 30+ years of recovery and research hadn't been.
posted by Sidhedevil at 10:38 AM on March 19, 2012 [8 favorites]

Response by poster: Eating disorder triggers can be so damn complex you really cannot eliminate them all. Probably the only two things you can do:

1) No unprovoked comments about her body
2) Let her lead with any food

For (1), obviously no "You don't look fat" or "Have you lost weight" or "Have you gained weight" business. If she asks "Do I look fat?" or complain about her appearance or her weight, unless you are top-notch at charming comments just don't respond or say "I'd think you were beautiful even if you wore a dress made of rotting meat" or something to that effect. Even something innocent like "It's not fat, it makes you cuddly!" will not help. It's OK to give compliments, but make it about how the color of a dress brings out her eyes, how great her hair looks today, how much you love her smile, her nose, stuff that is not tied to her weight at all.

For (2), no bringing home obvious junk foods. When you're eating together, ask what she wants and get that. It might be healthy, it might be pizza and ice cream. No comments or questions. Yes, eating disorders are about control, but they're about control of the self, not other people. Removing involuntary temptation and struggle over "good" or "bad" foods helps work around that. Just do the best you can, you shouldn't feel compelled to totally give up eating what you want, but not bringing in tubs of ice cream and stuff will help a little.
posted by Anonymous at 11:45 AM on March 19, 2012

What helped me was to give the voices in my head that encouraged the anorexia a name. That made it easier to ignore those feelings.

Also, big life changes can be a huge trigger for eating disorders.
posted by luckynerd at 12:06 PM on March 19, 2012

IANA doctor or therapist. I have had an eating disorder, so my answer is coming from that, but keep in mind that everyone's experience is different.

She needs to find a therapist with ED experience, whom she likes and trusts. The bulk of her treatment will have to come from there. True, one ineffective round of therapy can put you off the experience, but it doesn't mean therapy doesn't work; it just means that particular therapist didn't work.

At home, don't make things about her ED or fuss over her too much. You can avoid triggers that you know about, and avoid common-sense triggers (like ordering pizza or watching The Biggest Loser), but don't make it obvious that you're pussyfooting around the ED. At a certain point, eating disorders kind of trigger themselves just by existing. Often, the impulse is to hide the ED, thus keeping it going; if you ask or talk about it, she may withdraw, but if you refrain from judgment, she might feel more comfortable talking to you.

I'd have to recommend against the "pushing back" Seymour Zamboni mentions; it sounds like he doesn't recommend it anyway. Eating disorders are often about control in the sense that the sufferer feels like food and weight are the only things s/he can control. They're a response to a perceived lack of control over one's environment. So if you remove things from her control, she may cling harder to the ED.
posted by Metroid Baby at 12:27 PM on March 19, 2012

As others have said, you can't avoid triggers altogether, because practically anything can be triggering for an eating disordered person. But here's a significant and relatively easy thing that you might not have considered: Avoid visibly noticing when, what, or how often she eats. Encouraging comments when you see her eating could make her feel like her eating habits are conspicuous and that she therefore eats too much. Telling her you're worried that she's not eating enough might make her feel pressured to keep it up. Just try not to comment about it at all. I think it's okay to offer food, though. "I think I'm going to make myself some toast, can I make you some?" is nice and nonjudgemental.

Eating disorders often crop up again when the sufferer feels helpless or out of control. Are there parts of her life that are effecting her negatively, that she feels powerless to improve? If you can identify those and help her come up with solutions to them, you'll be addressing the actual problem, rather than its symptom.
posted by milk white peacock at 2:54 PM on March 19, 2012

I have seen people triggered by exposure to misogynistic media, especially shows featuring a lot of commentary about women's appearances. It doesn't matter if the commentary is positive or negative. And of course you should refrain from this kind of talk yourself, but since you sound like a sensitive person, you are probably already doing that.
posted by gentian at 4:03 PM on March 19, 2012

Seconding Brave Girl Eating. That book really changed how I look at EDs and those that have them.
posted by dawkins_7 at 6:00 PM on March 19, 2012

Excellent advice so far.
Just popping in to add that if you are going to continue (or begin?) cohabitating and/or being seriously involved in this gal's life (and why shouldn't you, you sound like a really solid dude/gal), it might be appropriate to consider doing some therapy/counselling yourself. It can be really,really hard being the rock for someone who is going through an ED. It can be damaging (for both of you) in ways that are not possible to forsee at the outset of the issue. Many/most programs and clinics that specialize in ED also offer support groups or counseling for the loved ones of ED-affected folks. I've never taken part in one, but when I was deep in the depths of my ED and still living at home, my Mom was involved in a group that really helped her to understand what I was going through and (much more importantly) deal with her own feelings/fears/anger which was a result of living with an ED person. She would not have survived my ED without professional help of her own. You may find yourself needing someone to help you sort through some shit, not only to allow you to be a positive part of her support system (which it sounds like you're already becoming), but also to remind you that you have a life and an identity and an existence outside of her disorder.
You'd be surprised how quickly such things can be eroded...
posted by Dorinda at 7:08 PM on March 19, 2012

I am recovering from an eating disorder myself, and I live with my serious girlfriend.

In my opinion, the most important thing you can do for her is encourage her to seek/support her in seeking therapy with a therapist who is competent with eating disorders (they MUST have experience with eating disorders) and who she connects with.

Then, it will be very important for you two to have open communication about how she is doing. She should set the boundaries for this, but it's SUCH a good sign that she's willing to talk to you about how she's feeling. If she becomes unable or unwilling to talk to you about how she's doing or feeling, it's a red flag that she's probably struggling, and it would be good to gently encourage her to open up.

You should listen to her when she says what bothers her and what is okay with her, and respect her by taking her word for it. If doughnuts bother her, believe her and respect that. If talking about celebrity bodies bothers her, respect that. If she says that going out to eat doesn't bother her at all, respect that too, and believe her if she says something is okay.

It's important to establish a relationship where she is comfortable asking for support when she needs it, but you also trust her to take care of herself when she asks you to let her be.

The one specific thing that comes to mind that people could do for me when I was really struggling was when we were in groups with people who didn't know about my ED. When the conversation turned to something like diet, food, weight, etc, my friends would gracefully change the subject so I didn't have to. I really appreciated that.
posted by insectosaurus at 9:09 PM on March 19, 2012

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