As we all know well, human beings are social creatures. Why this is, we don’t quite know, but it is likely linked to evolution. Babies are “born cute” because they rely on others to take care of them, and nature supplied them with enormous eyes, pinch-able cheeks, and sweet smiles to forge their caretakers into action. From a young age, we are wired to compare ourselves to others to figure out if we “fit in,” likely at least in part because, evolutionarily, staying in a group helped people to stay safe, survive, and thrive. And research on happiness, health and aging suggests that the best predictor of health in elderly men is their relationship satisfaction from decades earlier. Clearly, the need for connection stays with us long after we can procure our own meals and clothing, and all scientific indicators suggest that even the smallest of interactions matter.
It is therefore not surprising that social support, connection and relationship stress matter for adolescents and adults with eating disorders too. In a study of adolescents with eating disorders, when teens reported being dissatisfied with their friendships, wishing they had more friends or fighting with a friend, they were more likely to binge eat. Similarly, in adult women with bulimia nervosa, feeling stress about relationships was predictive of worsening mood and a higher chance of binge eating and purging later in the day.
So, if we know that humans are social creatures, subject to the positive and negative impacts of relationships, and we know that people with eating disorders are no exception, can this knowledge yield some power? I think it can.
How? By thoughtfully constructing a support system, people with eating disorders can harness a powerful, positive force.
Here are a few building blocks to get started, no matter what your social landscape looks like currently:
- Take stock. Map out your relationships and connections by drawing some concentric circles, putting yourself in the middle, and then placing others in the circle that best represents how close you feel to them. People who you feel closest to go in the innermost circle, those who you are close to, but not quite as close, in the middle circle, and so on. Then, evaluate patterns and ways you’d like to see things change. Do you need more people in the inner circles? Has the eating disorder led formerly great relationships to become overridden with arguments? Maybe you can explore how old relationships can be used in new ways to aid your recovery.
- Re-set expectations. Different people can provide different types of support. Perhaps your uncle doesn’t fully understand your eating disorder, but he’s great fun to go to the movies with and very reliable for rides around town. Or maybe your friend says the right thing when you are together, but is spending a lot of time with a new significant other. Out of sight does not mean “out of your life.” Notice (and challenge!) assumptions and preconceived notions about who can help and how.
- Consider what you want to tell, and to whom. If you are participating in a program, it may be necessary to explain why you won’t be answering texts for a few weeks, but might not feel completely comfortable to tell someone all the details of your treatment plan. Write out the pros and cons of sharing, and why. Your boss may need to know that you have an illness if you’ll be taking time off. If you’re working on recovery in individual therapy, people in close contact with you – a partner, family, friends, teachers – may be more supportive if they are in the know.
- Talk it out. As the therapist, I have spent years leading interpersonal therapy groups where patients have bravely addressed difficult situations with parents, teachers, and friends in ways they never thought possible. Too often, we accept unhelpful aspects of a relationship because talking to the person about it seems too scary or unnecessary. But when you get specific about what is bothering you and what you’d like to change, sometimes, things can. Taking a leap of faith and having a difficult conversation at a time when you are both calm can help this to happen. Even if things don’t change in the relationship, how you feel about it – and about yourself for facing it – just might.
- Strengthen your pro team. The lowest point in one’s illness is often the time when it is most difficult to seek help, and insurance and financial barriers can make this hole feel even deeper. Yet mental health professionals routinely offer a kind of objective support that can be uniquely helpful. When things feel overwhelming, take one step at a time. Perhaps the job for this week is making a list of three resources, or scheduling a time to make a call and see where it leads (for more see this related piece). If you are well on your way to recovery, with the start of a professional support team in place, there is another way to strengthen your team. Consider joining our Communities of Healing Study, in which we are evaluating the helpfulness of two types of mentorship on relapse prevention. We are working with Project HEAL to conduct the study, and if you are ages 14 – 45, recently treated at a higher level of care, and have an outpatient team/provider, you may be eligible for this study. For more information, call 646 774 8033 or see this site for more information.