Reactions of carers to eating disorders

Reactions of Carers to Eating Disorders Th-ere are many possible ways carers respond to th eir love d ones who have developed an eating disorder. In their book Skills-based Learning for Caring for a Loved One with an Eating Disorder, Janet Treasure, Grainne Smith and Anna Crane (2007) developed animal metaphors to illustrate com mon behaviors and emotional responses that carers can get drawn into when caring for someone with an eating disorder. Loved ones may find themselves providing care that is characterized predominantly by one of these animal metaphors, while othe rs may provide care characterized by several of the animal metaphors depending on the situation.

Kangaroo Care

Kangaroo care draws you in to protect the person wi th the eating disorder. You will find yourself accommodating the demands of the person of the disorder and protectin g you r loved one from any upsets. A downside of this is that the person with the eating disorder won't learn how to take on th e cha llenges of life and gain independence. She or he can become trapped in the role of infant like a baby kangaroo envelo ped in Mom's pouch. The message is that the world is threatening and it is the carer's job to prevent harm.

Solution: Step back a little. Let your loved ones fi ght for thei r own health and find out what they can do for themselves.

Rhinoceros Care

Because you are stressed, frustrated and exhausted you may adopt too much control and take over too much direction.

Tempers may erupt and attempts may be made to change the eating disorder behavior by "charging" with arguments. You may think the eating disorder will understand and res pond to logic. This does not work. The eating disorder is usually not rational. The more coercion that is applied, the more frustrated the carer becomes. The person with the eating disorder will likely respond to arguments and battles with hackles up and defenses mounted. Or she or he might obey out of fear of upsetting you but have developed no real "muscles" to keep the eating disorder in check.

Solution: Recognize that eating disorder beliefs are rigid and tightly protected . To avoid building resentments, let go of coercion and trying to force a change. Try the dolphin approach. Step back and calm down . You can say you don't agree with the behavior of the eating disorder and at the sam e time respectfully agree to differ.

The Ostrich

Ignoring the Problem s

Sometimes family and friends take the "ostrich approach" when dealing with the eating disorder. In the midst of distress there may be temptation to ignore or underestimate the impact of the eating disorder on the person with the eating disorder and on involved carers. Carers taking the ostrich approach may find themselves disconnecting. They may avoid going home or otherwise dealing directly with the problems created by the eating disorder. Families may feel ashamed and secretive.

They may isolate and not reach out for help. They may blame the person with the eating disorder and say, "It is your problem , not mine."

Solution: It is best to work to reduce avoidance and escapism. Eating disorders are family affairs. They affect friends and everyone who cares. Eating disorders are diseases of disconnection. To reduce isolation and loneliness, work to increase connection and communication. Reach out to help and support.

The Jellyfish

Emotional Response is Too Transparent

Sometimes family, friends and carers experience an overwhelming intensity of emotions. They become too sensitive about the eating disorder. They feel like a jelly fish because they are "engulfed" in their emotions and feel helpless and adrift. For parents, this can come from self-blame for the eating disorder. There may be a great deal of self-criticism related to mistaken beliefs that poor parenting has caused the eating disorder.

Solution: Learn to harness anxiety and manage emotions. This takes time and patience. Carers often need their own support to prevent burn-out and exhaustion.

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The St. Bernard Dog

Providing Warmth and Nurturance until Change Occurs

Carers who are St. Bernards find themselves in an optimal po sition . Carers are often overwhelmed at first. However, with time they can adopt the calm and steady nature of th e St. Be rnard . When this happens, they become warm, caring , consistent, available, and nurturing. It is hard but parents and carers can learn to respond in an even, consistent, loving fashion even though the situation may be dangerous an d frig htening. A loyal and helpful St. Bernard seeks the lost loved one with the eating disorder. He is a good listener an d provide s empathy for the struggling person with an eating disorder.

The Dolphin Response

Gentle Nudging and Guidance from Behind

Rather than falling into the extremes of the Rhinoceros or Kangaroo, try modeling a dolphin. This way you can nudge the person with the eating disorder to safety instead of tryin g to fo rce her or him to give up the safety of the eating disorder.

Dolphins coach and gently persuade. They may swim ahead or alongside. When the person with the eating disorder is making progress the dolphin may simply swim behind.

The Vicious Circle of 'Too Small', or Avo idant Emotional Response "Ostrich" Care Ostrich Respon se to ED Not want to argue with her Not want to go to treatment Nothing will help Embarrassing Family may be shamed and blamed It is up to her-I can't do anything

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Unhelpful Consequence Isolates self and family Tum away and cold to ED and family Collude with ED symptoms

Worsen how they Feel

\ Create or Wors en Pro blems

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ED symptoms worsen Lonely and disconnected

Ignoring th e {Jiroblems

Adapted from Skills Based Learning for Caring for a Loved On e 11路it!t an Eating Disorder by Janet Treasure, and Anna Crane.

Grainne Smith

The Vicious Circle of Over Responsibility " Rhinoceros" Care Rhino R esp onse overly responsible Anxious about ED/fear of death Want to take control/sort things out Talk ED out of it or make them see reason Analytical approach to pro blem

/ Worsen how they Feel

Unhelpful Consequence Argue/rage to control or "win" Coercion, "ban" from going out

\ Create or \Vorscn Problems ED feels rejected/unl oved Trust is lost-not listened to, validates, understood Aggression escalates, emo tionally draining Focuses unhel pfully on fo od as the only issue

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Using Threats, Aggression., Bullying to Pursue their Cause Adapted from Skills Based Learning/or Caring for a Loved One with an Eating Disorder by Janet Treasure, Grainne Smith and Anna Crane.

How a Too Intense Emotional and P ersonalized Catastrophic Response Can Feed into a Negative Cycle 'Jellyfish' Care Jellyfish Response to ED It is all so sad I'm a failure, I should be able to feed/nurture my child How dare this happen The family is not going to be rul ed by ED

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Unhelpful Consequence Burst into tears Unable to sleep Cut self off from people Shout, angry, rage Blame, recrimination

Worsen how they Feel

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/ Create or Worse 1 Problems ED upset that family is in pain Parents overwhelmed by extreme emotions Depleted Other family members frightened and upset by anger/misery

Emotional Response js Too Transparent Adapted from Skills Based Learning for Caring for a Lo ved 0 and Anna Crane.

11 :!

with on Eating Disorder by Janet Treasure, Grainne Smith

T he Vicio us Ci 路de of Compulsive

" Kangaroo" Care Kangaroo Care

Anxious about ED/fear about death Aim for high standard of parenti ng Fear of saying the wrong thing (mistakes)

/ Worsen how they Feel

Unhelpful Consequence Become overly/unhelpfully supportive No opportunity for growth of personal responsibility or autonomy Burnout

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/ Crea te or \Vursen Problems Protect from challenges Gives message world is a threat Stifles and fru strates Emotionally dra ini ng with rebound inconsistency

Creating a 'Pouch' of Care

Adapted from Skills Based Learning for Caring for a Loved One with an Eating Disorder by Janet Treasure, Grainne Smith and Anna Crane.