It is important to remember that while relapse is possible, not every slip is a relapse. It can be discouraging and overwhelming to experience a slip in the middle of recovery. Every day will be the start of a new recovery and will have a new battle attached to it.

Eating disorders can carry a sense of “black and white” thinking and discouragement about slips can hinder recovery. Remember that if your loved one does relapse, this is a normal and common part of recovery. Don’t give up!

Though weight and eating habits may change during treatment, the real battle is overcoming the negative thought processes that were created about food and the individual’s weight and body.

A qualitative study on eating disorders identified six different categories for the success of eating disorder recovery:

1. Internal motivation to change. Many people who have eating disorders will either be in denial that they have an eating disorder or they will deny that it is a problem. It is important to encourage and support your loved one but until they decide to make changes for themselves, recovery will be slow.

2. Recovery is a process: It is important to remember that recovery is a work in progress. Eating disorders are not about food or weight, they are about an internal struggle which is more difficult to change. It will take a lot of time, patience and support. Don’t get discouraged if your loved one slips.

3. Perceptions about treatment: It can be valuable to have support from those who are going through similar experiences (example support groups). Eating disorders hold deeper issues that are not easily talked about or understood unless you have one. One of the steps to recovery is believing that it will work.

4. Developing a life outside of eating disorders: Eating disorders can be all consuming for those involved. Supportive relationships are incredibly beneficial to have during times of uncertainty and recovery. In addition to support during recovery, it can help to develop relationships and a sense of normality outside of their disorder.

5. Awareness and tolerance of negative emotion: Eating disorders carry a lot of shame and negative self-talk. This is one of the hardest aspects of eating disorders to overcome, however it IS possible.

6. Self- validation: In addition to negative emotions, positive reassurance from the individual themselves can also help improve recovery.

The most important thing for you to know is that recovery IS possible. There are several specially trained professionals in Alberta and throughout Canada that can help you regain control of your eating habits and let you live your life to the fullest. Here are the steps that can be taken to facilitate your recovery process.

Psychologists and therapists can help you recognize and manage thoughts and behaviours that are contributing to your disorder. This may include:

• Family-Based Treatment (FBT): Also called Maudsley Approach, family-based treatment be used to help break secrecy surrounding a disorder, rebuild trust, and teach families how to give effective support. This is currently the most effective evidence-based treatment for children and adolescents.

• Group therapy: Group therapy can help the individual feel like they are not alone in their illness. It can help them to cope with disappointments, celebrate their recovery victories and deal with any shame they are feeling.

• Cognitive Behavioural Therapy (CBT): CBT can change negative thought and behavioural patterns and focuses on creating personal coping strategies. This is currently the most effective evidence-based treatment for adults. It can also help to improve perception of body image.

• Dialectical Behaviour Therapy (DBT): Focuses on providing emotional therapy for individuals. This includes teaching mindfulness, increasing negative emotional tolerance, overall emotional regulation and positive interpersonal communication.

• Emotion focused therapy (EFT): EFT teaches individuals how to create safe and healthy relationships with themselves and the people around them3.  Eating disorders can often be caused by past trauma or hidden feelings that the individual may have. EFT can provide the tools to help recognize and deal with the cause of the eating disorder.

Getting Assessed

Talk to your doctor. Most people will want to consult their family physician as a first step of treatment. However, doctors receive very little training in eating disorders. Of the 4,100 registered psychiatrists in Canada, only 12 specialize in eating disorders 1. Therefore, it is important to speak to them openly and honestly about your symptoms. When you speak to your doctor, it may be helpful to bring this questionnaire to help facilitate the consultation.

Treatment

Eating disorder treatment depends on your disorder and your symptoms. There are typically four tiers of treatment offered to Canadians in specialized facilities for those suffering with eating disorders.

• Outpatient Treatment: The individual receives therapy from a psychologist and/or dietician once or multiple times per week.

• Day Treatment: The individual goes to a full-day program multiple times per week where they receive various forms of psychological therapy, meal-time supervision, and nutritional guidance and counselling.

• Residential Treatment: The individual stays in a home-like setting where they receive meal-time supervision and participate in various forms of psychological therapy as well as receive nutritional guidance and counselling from a dietician. There are currently no residential treatment programs offered in Alberta.

• Inpatient Treatment: The individual is admitted to a hospital and is treated and monitored extensively in that setting. This type of treatment is ideally reserved for those who are medically unstable and require constant supervision by medical professionals.

Nutrition

Dietitian's can help you develop a plan to maintain healthy eating habits. This may include:
 

• Education about how nutrition affects your body

• Meal planning

• Establishing regular eating patterns — generally, three meals a day with regular snacks

• Taking steps to avoid dieting

• Helping you to recognize and manage thought patterns that affect your food intake

Talking to Professionals

You will work with trained professionals, who will help develop a treatment plan tailored to your needs. It is important to remember to ask questions, as this is about your future recovery and well-being!

Keep in mind that you are interviewing the practitioner and they will be open to answering any questions you have. They are here to aid your recovery process and provide support.  For more information on how to find the right professional for you, see our resource page.

What Are Eating Disorders?

Eating disorders are real, complex and devastating conditions that can have serious consequences for health, productivity, and relationships. They are not a fad, phase or lifestyle choice and are often misunderstood.. Below is a list of general facts to understand more about eating disorders.

Eating disorders are:

• Negative changes of eating habits that can result in mental or physical harm

• Often accompanied by concerns about shape and weight

• Usually the result of deeper psychological turmoil

• Serious illnesses that deserve considerable attention

Eating disorders are NOT:

• A choice

• A sign of vanity

• Primarily caused by concerns about appearance

• Only recognizable by low weight

• Only experienced by young women

Types of Eating Disorders

Eating disorders are a change in an individual’s eating behaviours that negatively affect their health. It is possible to have more than one eating disorder at the same time. Below are the main types of eating disorders:

• Anorexia Nervosa (Anorexia): refusing to eat or severely restricting one’s diet in order to maintain a low body weight
   

• Bulimia Nervosa: Eating large portions of food in a short period of time and then purging that food in an attempt to prevent weight gain (such as vomiting or excessive exercise)
   

• Binge Eating Disorder (BED): Eating excessive portions of food in a short period of time. This is not the same as overeating
   

• Avoidant/ Restrictive Food Intake Disorder (ARFID): Refusing to eat certain foods due a negative past experience or an extreme dislike of the food's characteristics (appearance, smell, taste, texture, brand, presentation) to the point that nutrition needs are not being met
   

• Rumination Disorder: Bringing back up and re-chewing partially digested food that has already been swallowed
   

• Pica: Eating non-digestible items for at least one month

Although this list contains all known eating disorders, not all eating disorders are the same and can have characteristics that are different than the types listed above. If a disorder does not fall into one of the above categories, there may be a diagnosis of “Other Specified Feeding or Eating Disorder (OSFED)” or “Unspecified Feeding or Eating Disorder.”

Based on the fact that earlier treatment for EDs is strongly correlated with more successful outcomes, it is an important shift that individuals can now receive a diagnosis of Atypical AN, Bulimia Nervosa (low frequency/limited duration), or even Binge Eating Disorder (low frequency/limited duration), and get professional help before they get “sick enough” to meet meeting dangerous weight or behaviour-related criteria. 

More detailed definitions and descriptions of symptoms can be found on the NEDIC website. 

*The DSM-5 is the manual used by healthcare professionals in Canada and the United States to diagnose mental illnesses.

Seeing someone engage in destructive eating patterns is scary, frustrating, and hard to understand. It is common to experience anger, fear, confusion and guilt. Individuals experiencing an eating disorder often do not recognize or admit that they are ill. As a result, they may strongly resist getting and staying in treatment. Ongoing emotional support is necessary for the individual, as recovery can be a long process and relapse is common.

Remember: eating disorders are not due to failure of will or behaviour; rather, they are real, treatable mental illnesses in which certain maladaptive patterns of eating take on a life of their own.

Before you do anything, take some time to think about your best course of action, get educated and seek support!

The most important thing to remember when caring for your loved one is to practice self-care. It can be extremely draining and scary to see someone you love suffering from an eating disorder and it is easy to let the illness take over your life.

It may seem unfair to take breaks when someone you love is suffering, but it is crucial for you to be in your best health in order to provide the best care. Remember that you are doing the best that you can and take a moment each day to distress and reset yourself.

The following is an important list of Dos and Don’ts:

DO:

• Learn about eating disorders so you are able to recognize the signs

• Remember eating disorders are potentially fatal diseases and should be treated accordingly

• Listen to your friend or loved one with understanding, respect and sensitivity

• Tell the person you are concerned and that you care and would like to help
  

• Encourage the person to seek professional help from a physician and/or therapist
  

• Be available for support
  

• Discuss feelings rather than food, weight or exercise
  

• Empower the individual to make their own decisions and be accountable for their decisions

DON’T:

• Don’t take any action alone- get help!
  

• Don’t try to solve the problem for them- they need a qualified professional
  

• Don’t blame them for doing something wrong or tell them they are acting silly
  

• Don’t focus on weight or any particular eating habits
  

• Don’t comment positively or negatively on appearance or weight
  

• Don’t force the person to eat or tell them to “just eat”
  

• Don’t reject or ignore them, they need you
  

• Don’t give up! It takes time and they need your support!

To learn more on how to support someone you love with an eating disorder visit www.EatingDisorders.info  This video is funded and produced by the Eating Disorder Network of Alberta (EDSNA) and Silver Linings in collaboration with Alberta Health Services.

Also, an excellent tool for parents to help them navigate their child’s eating disorder: https://www.mentalhealthfoundations.ca/ed-parent-webinar.