Communicating with a Loved One
If you notice the warning signs of ED-DMT1 in a friend or family member, you may be hesitant to say anything out of fear that you could be mistaken. Maybe your hesitation derives from the worry that you'll say the wrong thing or that you'll possibly alienate the person. Although it's undeniably difficult to bring up such a delicate subject, don't let these worries keep you from voicing valid concerns.
The shame and guilt associated with ED-DMT1 makes it very difficult for the person who is struggling to admit they are skipping their insulin. Often they are in denial that their behaviors will lead to severe consequences. They might even be so used to having high blood sugar levels that they think they "feel fine." The sooner you start to help a loved one, the better their chances are of avoiding life-changing consequences. The consequences of prolonged insulin omission are severe, uncomfortable and sometimes deadly.
Do you suspect a loved one is suffering from an eating disorder?
When approaching a loved one about an eating disorder, it's important to communicate your concerns in a loving and non-confrontational way. Pick a time when you can speak to the person in private, then explain why you're concerned. Try to remain positive, calm, focused and respectful during conversations.
Your loved one may deny having an eating disorder or may become angry and defensive. However, it's important not to give up. It may take some time before your loved one is willing to open up and admit to having a problem. Still, as difficult as it is to know that someone you love has an eating disorder, you cannot force someone to change. Unless you're dealing with a young child, the decision to seek recovery has to come from them. But you can help by making it clear that you'll continue to be there for him or her, with your compassion and support, whenever they're ready to tackle the problem.
How to talk to someone living with T1D who may be struggling with an eating disorder
Be careful to avoid critical or accusatory statements, as this will only bring out your friend or family member's defenses. Instead, focus on the specific behaviors that worry you.
- Focus on feelings and relationships, not on weight and food. Share your memories of specific times when you felt concerned about this person's eating behavior. Explain that you think these things may indicate that there could be a problem that needs professional help.
- Tell them you are concerned about their health, but respect their privacy. Eating disorders are often a cry for help and the individual will appreciate knowing that you are concerned.
- Do not comment on how they look. The person is already too aware of their body. Even if you are trying to compliment them, comments about weight or appearance only reinforce their obsession with body image and weight.
- Make sure you do not convey any fat prejudice, or reinforce their desire to be thin. If they say they feel fat or want to lose weight, don't say things like, "You're not fat." Instead, suggest they explore their fears about being overweight and what they think they can achieve by being thin.
- Avoid power struggles. Do not demand that they change. Do not criticize their eating habits or their diabetes management. People with eating disorders are trying to be in control. They don't feel in control of their life. Trying to trick or force them to eat can make things worse.
- Avoid placing shame, blame or guilt on the person regarding their actions or attitudes. Do not use accusatory "you" statements like, "You just need to take your insulin." Or, "You are going to regret this ." Instead, use "I" statements. For example: "I'm concerned about you because you refuse to eat breakfast or lunch." Or, "I'm really concerned about the long term damage you may experience."
- Avoid giving simple solutions. Don't say things like, "If you'd just take your insulin then everything would be fine."
Tips for parents of children who are struggling with ED-DMT1
- Examine your own attitudes about food, weight, body image and body size. Think about the way you personally are affected by body image pressures and share these with your child.
- Avoid threats, scare tactics, angry outbursts and put-downs. Bear in mind that an eating disorder is oftentimes a symptom of emotional instability, extreme stress, or even an attempt to secure a sense of control. Negative communication will only make it worse.
- Set caring and consistent limits for your child. For example, know how you will respond when your child wants to skip meals or eat alone, or when you notice they haven't been taking their insulin.
- Remain firm. Regardless of pleas to "not make me," and promises that the behavior will stop, you have to stay very attuned to what is happening with your child and may have to force them to go to the doctor or the hospital. Keep in mind how serious eating disorders are.
- Do whatever you can to promote self-esteem in your child in intellectual, athletic and social endeavors. Give boys and girls the same opportunities and encouragement. A well-rounded sense of self and solid self-esteem are perhaps the best antidotes to disordered eating.
- Encourage your child to find healthy ways to manage unpleasant feelings such as stress, anxiety, depression, loneliness or self-hatred.
- Remember, it's not your fault. Parents often feel they must take on responsibility for the eating disorder, which is something they truly have no control over. Once you can accept that the eating disorder is not anyone's fault, you can be freed to take action that is honest and not clouded by what you "should" or "could" have done.
"Please don't say that to me."
Watching someone you love slowly kill themselves can be frightening. You will probably experience feelings of distress, anger, guilt and confusion. No matter how much you want to help them, you must remember that only they can make the decision to get help. You cannot force them to do this. You must also be careful with the remarks you make to the person suffering. Below is a list of a few remarks that should never be made to someone who is struggling with diabulimia because they will usually only drive the person away or cause them more inner pain and guilt.
- "Just take your insulin." -- If it were that easy, we would. Remind yourself that there are deeper emotional issues that may be preventing us from taking our insulin.
- "Are you making any progress?" -- If in therapy, a comment like that could lead us to believe that we are not making progress and that we are in fact failing.
- "What have you eaten today?" -- This puts us in a bad position because we either have to lie to make you happy (which causes us to feel worse for doing so) or tell the truth and hear a lecture (which would also lead us to feel like we are failing).
- "You look so healthy! You were always too thin before." -- If you make a comment like that, you are basically telling us that we are getting fat! We may in fact be looking better and looking much healthier, but when we hear comments like that, we will be made to feel that we are in fact getting fat. Please avoid making any comments on our physical appearance.
- "You're going to kill yourself." -- We are not doing this because we want to die. We are trapped. There are deeper emotional problems causing us to do this. A comment like this will only make us feel worse.
- "You obviously are not trying to get better if you are just getting worse." -- Recovery is a long process and the person is going to have slips and relapses. You cannot expect the person to recover overnight and relapses are a normal part of recovery. They should be expected to happen. During the rough times, that is when you need to be positive and support the person, not make them feel worse.
- "Boy, you ate a lot today." or "You were certainly hungry today." -- After a comment like this, you can be sure that the person is going to spend the next few hours or days obsessed with the amount of food they ate and whether it's making them fat. Please avoid commenting on our food choices and how much we eat.
A person living with type 1 diabetes and an eating disorder has the best chance for recovery when they are surrounded by people who are loving and supportive. Treating eating disorders takes a lot of time and hard work, but with the proper treatment, which should include individual, group and family therapy, support groups, medical and nutritional counseling, eating disorders can be overcome.
It is also recommended to the families to get support for themselves. Supporting someone who is healing from an eating disorder can be emotionally exhausting.