Perhaps the idea that you can actively encourage an illness seems a little alien. After all, you can’t encourage a cancer to grow or the flu pathogens in your system to multiply. But with mental illnesses, it is possible to collude with and actively enable the illness. By doing so, youlet ED in. The more accommodating you are, the longer he will stay. This becomes extremely important in recovery from any type of eating disorder, and can generate massive tensions between those struggling with the illness and those attempting to care for that person.
In this article, I hope I can make clear what it means to accommodate and enable an eating disorder, and how individuals with a disorder and their carers can become aware of these behaviours, their consequences and how to stop them.
A Deal with the Devil
“I can’t eat that. How can you even think I could eat that? It’s horrendous, why the hell did you give me this?!” I was staring at plate of (homemade) curry and rice. This was about two years ago, when I was very poorly and carbs, fat, protein, ready-made sauces were all a big no-no according to my eating disorder.
“It’s not that big, Thomas. Just try your best”. I continued to stare at the plate, my body now rigid with anxiety, the colour draining from my already pale face. Mum could see I was losing control, that I was withdrawing into myself. Soon she’d lose me and I wouldn’t eat anything that night.
“OK, let me take some of the rice away, you don’t have to eat all that. Deal?” Reluctantly, I nodded, knowing full well that I was not going to allow myself to eat everything on the plate anyway.
Deal. Mum had just inadvertently done a deal with the eating disorder. A deal with the devil. She didn’t know this at the time: she was trying to help, to reduce the anxiety, to reduce the chance of some emotional breakdown on all sides of the table. But by scooping off just a quarter of the rice on that plate, the eating disorder had won, and had a received the message loud and clear that it was in control and could play the same card in the future. My fear of carbs had also been confirmed and reinforced. ED sat at the dining table with us that night, an unintentionally invited guest.
What Mum did was a seemingly reasonable response to a potentially disastrous situation which carers of people with eating disorders have repeated aroud the world. They give a concession to the eating disorder to avoid a clash and stop the situation deteriorating. People suffering from eating disorders do the same thing too. I can’t count how many times, before and during recovery, that I decided I’d make a meal just that bit easier by removing one boiled potato, or missing out the butter on a sandwich, or chosing a lighter option for a snack rather than that terrifying chocolate bar lurking in the cupboard. I realise now that my attachment to wholemeal bread, low fat sunflower spread, and herbal tea (no milk necessary) was all part of the eating disorder and things I needed to challenge.
In all these cases, the eating disorder is being accommodated. By that, I mean that it is being allowed to thrive, to be in control, to influence the decisions of the person and how they live. The irrational fears, inaccurate beliefs and harmful behaviours of the eating disorder are enabled, reinforced, confirmed by these often small but significant acts. As long as Mum kept letting me take a few spoonfuls of rice away, the eating disorder was going to keep getting its own way, was going to stay in control, and my fear of carbs would continue to be confirmed. And my weight would continue to drop dangerously.
Is it that bad, though? At least I was eating something. At the time, we all thought exactly that. And perhaps at that moment, it was the right thing to do so that I would eat something, anything. But that night, ED won, and the downward spiral continued. Furthermore, when you make the decision to recover from the disorder, to let it go, such tiny acts are even more harmful, putting that recovery in jeopardy.
What are accommodating behaviours?
Accommodating behaviours by carers and by those with an eating disorder are varied and can often be interpreted not as enabling the illness, but just making a situation a little easier for all involved. There are many examples, but I’ll list a few so that you can get an idea of what kinds of behaviours can empower the illness. Some apply only to carers of those with an eating disorder, some are also the responsibility of the person struggling. But it is important for both to recognise when they are letting the eating disorder get its own way and the consequences of that.
Accommodation by those with the illness and their carers:
- Letting the disorder influence your decisions: e.g. making ‘safe choices’. For me, cereal bars were far safer and easier to deal with than chocolate bars, so I would continuously choose these. However, as long as I was avoiding the chocolate bar, I would never overcome that irrational fear of it and what it represented: fat, weight gain, being out of control, greedy. And as long as I stuck to cereal bars, I was hanging onto the illness. Other safe choices included things like couscous over pasta, ‘low fat’ yoghurts over normal ones. Small decisions, big consequences.
- Making something easier by taking away: getting rid of a potato, or not finishing that last square of a Dairy Milk, or making porridge from water rather than milk, only eating the good cuts of meat and not the ugly ones with a bit more fat on them – these all empower the illness even if they are done to minimise distress or guilt.
- ‘One last time’/’this is a one-off’: there are no one-offs with an eating disorder. As long as you let the eating disorder influence one decision, it is still there and has the potential to make your life a misery. One last binge, one day off the recovery meal plan, one safer option (when in recovery) all amounts to accommodating the disorder.
Accommodating behaviours of carers:
- Ignoring behaviours: carers of people with eating disorders may often feel too scared to confront the person about harmful behaviours for fear that it will make them worse. For example, a parent may be quite aware that someone is stealing food in the middle of the night, or being sick after meals, but they will not talk about it. This is giving the illness free rein to take control of that individiual. The illness needs to be challenged – but remeber, there is a time and a place, this is a delicate situation, professional help is needed.
- Being over protective: carers of people with eating disorders can be over protective. My Mum letting me take away some rice is one example. Another may be to be over-comforting when an individual is distressed by a plate of food or social situation; for example saying over and over that it’s ok to feel this way, that you are there for them when they are upset. Of course you need to be there to offer support, but you also need to be firm when that person is being irrational so that they can learn through exposure that the rules that the disorder is making are wrong, that what they are feeling is irrational and can be overcome. The individual needs to take some personal responsibility in their recovery: the parent or carer can’t do it for them.
- Adapting your life to fit the rules of the disorder. The illness can come up with all sorts of absurd and irrational rules by which you have to live in order for you to feel that false sense of control. For example, it may prohibit you from eating after a certain time at night (even though there is no evidence to support that eating later leads to weight gain), or that you have to cut everything up into tiny pieces or eat so slowly that the food goes cold. It’s easy for carers of those with eating disorders to allow these rules to slip into their lives, maybe by making dinner earlier, avoiding certain ingredients etc. In my example above, my parents only ever making homemade curries rather than buying curry jars (much easier and quicker), is a good example of adapting your life to suit the illness. But as long as these rules are followed by anyone in the life of the ill person, then the eating disorder continues to win and to maintain control.
Make your life recovery-friendly
Here’s another example, from when I was a lot further on in my recovery. I was at a hotel in York with my family. Breakfast was included. I had been dreading this. Hotel breakfasts equal fry ups and croissants and all sorts of foods I was still finding tough to face. We got down to the breakfast room, and there, laid out before us, was the buffet. At one end was the Full English. At the other, there were things like yoghurt and fruit and muesli. That was actually really appealing. It had been a stuffy night in the hotel room, yoghurt and muesli and fruit sounded like a great, refreshing option. But would I be choosing that just because it was safer/easier than a Full English? Would choosing this potentially lighter option be letting the eating disorder win, by accommodating for the disorder? Would it be a step backwards in my recovery?
In the end, I chose to go with the fry up, because I was at that stage in recovery where that was the right decision to make, to ensure that I was challenging the disorder and not giving in to it. There was a reason I felt anxious about it, so I had to face up to it. But I couldn’t help but wonder, what if I really did just fancy muesli and yoghurt that morning? Would that be such a bad thing? Would it really be accommodating? Now that I am further along in my recovery, I hope I would be able to make a real decision between the two, rather than instinctively going for the option which I knew I should take, but which I might not actually want. It’s a tricky balancing act, and one I am yet to perfect. But I am learning. I refuse to accommodate this illness any more. I won’t let it be part of my life, so if that means a few more fry ups before I can choose fruit instead, then so be it – who doesn’t like a bit of eggs and bacon (and hashbrowns!)! I need to be sure that it is ME (Recovery Me) and not the eating disorder that wants the less challenginging option.
The important lesson is, as long as ED has any foothold in your life, the potential to relapse is real. For me, that’s just not an option now. And it can be like that for you or for your loved one too. But as long as you accommodate for that illness, ED will remain in control.
For carers, I found this article by Eating Disorders Norther Ireland really interesting, even if the animal labels are a little off-putting! It shows how different types of accommodation feed into the downward spiral of the illness. Carers don’t accommodate willingly, they are just doing what they think is best. But for your loved one to get better, you need to be aware that all your actions and attitudes have a consequence.
If you have any questions or any suggestions, please don’t hesitate to get in touch or comment on this post.