How to help with sister in law's eating disorder?

[ghosteditor]

I'm hoping to get some advice about how to help SIL, who is in the grips of anorexia. She's been suffering for several years and within the last year she has been receiving CBT and nutritional advice from the NHS. She has very much made the decision that she wants to take control of her eating disorder and has started to open up to DH, me, and her parents and ask for our help.

The short story is that SIL, who's in her mid 20s, has recently moved away from home and is now living quite close to us. She made this move for her career and we've supported her the best we can. This means she has left behind her previous therapist and nutritionist, though they have provided an extensive assessment and recommendation that she continues treatment. SIL has finally found a GP here and they have referred her to an eating disorder clinic, but unfortunately the secretary there told her it could be 3-6 months before she can resume outpatient therapy.This news has sent her into a complete spin; she was coping fairly well and stuck to eating three times a day, but all of this was pinned on getting some professional help soon. Since the news, she's been struggling a lot and is hardly eating (I think perhaps some part of her thinks if she goes in having lost weight again they'll be forced to help her sooner).

SIL is asking us to help her, but I'm very wary of giving the wrong advice. DH in particular wants to help but this tends to take the form of helping her put more rules in place, which I don't think is a good idea. I'm not going to go into details here but SIL's eating disorder is rooted in very low self esteem and some really unpleasant circumstances/relationships, and she's only just started coming to terms with all of that, which is why I think the therapy was helping so much. And she has real problems trusting her own judgment, so she continually asks us to tell her what to eat, how to budget, where to live etc.

So what I'm really asking here is if any of you can point me to some resources, or tell me how I can help her start treatment faster, or tell me what we should be wary of advising etc. Or is what she really needs just someone to talk to?

What a setback and at such a bad time! Poor SIL.

The most logical explanation for the deterioration in her eating is that she is likely to feel out of control without her support and is therefore trying to control her eating.

Ask her how you can help her - that's the best and most important step.

You may want to find out if this secretary is actually right - after all your SIL is transferring her care, not entering it for the first time. I cannot imagine that they leave heart and diabetes patients without treatment for months if they move house? Maybe push for her to be at least seen by someone at the clinic so that they can assess the urgency.

Your poor SIL. And good for you for being so supportive.

I do think that anorexics need lots of unjudgmental support when taking decisions. You might find that your SIL needs to talk over her decisions far more than a "normal"/average person might, but this is quite usual for anorexics who are not autonomous adults. If you are prepared to do this surrogate parenting for her, you need to be aware that you cannot and must not hurry her and that it will be very time consuming.

thanks madmouse, great to get a response, and you're right of course. I'll try to find out exactly what the clinic is called in case I can find out more and maybe I can offer to go with SIL on the day of her assessment for some moral support. I really can't believe that she'll be left that long; I know they'll have to deal with their inpatients and emergency cases, but she was doing so well and it seems awful that she has to get worse before she can be seen quickly.

She has a first appointment booked in a few weeks and it's the bit afterward that she was told could take 3-6 months. I really wish the secretary hadn't said anything at all!

SIL has investigated support groups for sufferers but says she can't really find anything that will work for her - do you happen to know of anything useful?

Thanks!

thanks bonsoir that's really helpful too. My sense was that we just need to keep being supportive and reaffirming that she's come a long way in the last few months (i.e., she's not actually losing weight right now, and she's able to eat in front of a few people). But my DH is very much a do-er and he wants to be useful, so he's helped her to write a budget, is writing her a meal plan so she doesn't have to decide what to eat, etc (all at her request by the way) - I'm really worried about telling her the wrong thing. And if this is all interim stuff to help SIL get back on her feet that's fine, but we can't do this forever.

You're totally right that she seems to want to talk over every single decision a lot more than you'd expect and it makes sense that it's part of the disorder.

I'm heavily pregnant and struggling a bit with the idea of looking after her as well as the baby, and I worry that she'll feel a bit abandoned. But hopefully it will give her something else to focus on for a bit - she really loves kids and will be a big help to us on that front.

Can I suggest for up to date Evidence Based Treatment for eating disorders you go to www.feast-ed.org where you will find an explanation of treatments. For help and support on a peer to peer basis, try www.aroundthedinnertable.org. It is a forum for parents and carers.

Your SIL has a brain disorder and is not able to make decisions easily. I am more than happy to explain things further, if you wish. xx

charlotte - thank you - I'm looking into the links now. I think the evidence based stuff will really help, especially for DH. I'll take a look at the links and maybe I'll post again if I still have questions. Thank you.

This website has good CBT based tools for all sorts of mental health problems such as eating disorders and self esteem issues. They are worth a look.

It sounds terrifying what your SIL is going through, and for you guys too. To be told she may have to wait this long will make her feel abandoned and that her condition is not all that serious. The more she gives in to the disorder though the more grip it will take. Maybe in the short term the meal plan will be useful. It is critical she continues to eat and perhaps in this meal plan she could be supported to eat some challenging foods, meals, drinks or eat in more challenging situations. This can start her to progress and can boost self esteem when she can start tackling some of her fears. It can be useful to undertake these challenges with people close to her. Maybe going out for coffee and a cake with yourself or having her over for dinner and making something she would normally avoid. She should be encouraged to give herself credit for making these steps however this can be difficult as someone else giving this credit can do the opposite and make her feel worse. Another way to approach these challenging situations is to look at the benefits of being able to complete them. For example going out for coffee and cake would make meeting friends more enjoyable. Being more flexible about eating times and venues could make life more spontaneous and open up more opportunities. Being more able to choose from a range of foods means she could buy lunch out when at work as a treat. Being able to eat at McDonalds would mean being able to take your little one, when aged, out for a Happy Meal. Having popcorn at the cinema makes the experience. Having the odd slice of cake above her mealplan would make birthday parties less stressful.

When I was in treatment we had a list of terrifying situations and foods. We prioritised them in order of how terrifying they were and began tackling them. Repeating each until we were comfortable with it and concentrating on two or three at a time. We did things like cooking scary foods, ordering from a menu, going out for lunch, out for a three course dinner, getting a takeaway, eating above our mealplan, eating in front of people, ordering the full fat version of something we normally chose the light version of, baking a cake an following the exact recipe then eating some. It took a long time but gradually these things became much easier. They are only the side effects of the eating disorder the real disease is whats going on inside her head and only the professionals really know how to help that best. I would make enquiries as to how she can be seen quicker. Maybe a letter from her GP would help to move things along?

I wish you well. It is a huge task you are confronting and it will take lots of patience. If you are your DH do alot of the support you may have to expect the frustrations, upsets and setbacks that come along with the disease. My parents and DH have bore the load of many of my anorexic outbursts and taken the blame for many bad thoughts I have had in my brain. I lashed out at them alot when they tried to force things on me or tell me what was best for me. You will need help. You must fight hard to get it.

Ooooops forgot the link to the CBT www.cci.health.wa.gov.au/resources/consumers.cfm

sharond101, thank you so much; it's helpful to hear what worked for you and I think the list of scary foods situations might be helpful for SIL. She's actually come a long way already - eating in front of anyone at all was a stress for a while, but she's now ok in front of family and a few key friends, and is even managing a sandwich at work at her desk. So it might be good to write out the full list and she would be able to cross some of the items off already.

A big step for her would be to eat more than half of anything. It almost doesn't matter what it is, but she's compulsive about only eating half (for example, she could eat two kit kat fingers if she bought a 4 finger version, but can only eat one finger if she buys the two-finger version). She's doing very well with the range of foods and the only things she really avoids now are foods she used to binge on right at the start of the whole thing.

Interestingly on one of the above websites I just came across an anecdotal account of acne medication being somehow indicated in the onset of eating disorders - SIL was in fact on various kinds of acne medication for several years. Does anyone know if this is just a correlation or whether there are any studies? But as you've all said, there are deeper cognitive issues that need to be addressed, not just her behaviour patterns.

I've now found a local CBT eating disorder specialist whom SIL could go to privately if necessary. DH really wants to wait until after her referral at the end of the month to find out the facts about her treatment and the timeline, but if it looks like it will be a long time after that we will definitely have to rethink.

Thanks for all your time and help - I hope it means we can help to provide the right kind of support for her.