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Eating disorders disrupt every aspect of life, including relationships with life partners, families, friends, and work. Here's how to come back from those changes.

Having an eating disorder can turn your life upside down. There are the well-known threats to physical health that range from changes to skin and hair to heart and kidney failure. There are changes in mental functioning, including attention deficits, memory loss, mood swings, and anger issues. And as if all of that weren't enough, eating disorders disrupt personal relationships, especially in the family and in a marriage.

Here are three things people who live with eating disorders and the people who love them need to know about the impact of eating disorders on personal relationships.

Some people who have eating disorders actually manage to maintain healthy relationships, but not many

A study of patients of eating disorder clinics in Europe found that about 13 percent show signs of maintaining healthy relationships. The percentage varies by the particular eating disorder. Only nine percent of people living with anorexia nervosa were deemed to be psychologically healthy, but good relationships and healthy mental status were found in 25 percent of people who had binge eating disorder. Generally speaking, if the person living with the eating disorder was doing well enough to have avoided hospitalization, there was a much better chance that family relationships and friendships were still intact.

There are three major problem areas for people living with eating disorders and personal relationships

Psychotherapists have made objective measurements of the psychological challenges that cause people with eating disorders problems with their intimate partners, families, and friends. These are:

  • Self-control. This includes both the ability to exert impulse control over a range of activities in life, not just eating or purging, as well as tolerance, which in a very basic sense is the ability to be OK when you don't immediately get what you want.
  • Identity integration. This refers to knowing who you are. People who live with eating disorders who have a sense of self-identity and who see their lives as having purpose have smoother interpersonal relationships.
  • Responsibility. Responsible people aren't quick to place blame for the things that happen in their lives on others. They set goals, and achieve them.
These three characteristics make the critical difference between people who languish in their eating disorders and people who flourish despite their eating disorders. Even if you can't get your eating order under control, the psychologists are telling us, maybe there are still things you can do with the rest of your life, and maybe you can still relate to other people responsibly with kindness and respect.

People really don't recover from eating disorders until they reestablish healthy relationships

What does it mean to have recovered from an eating disorder? Some things about recovery from anorexia, bulimia, binge-eating disorder, and eating disorders not otherwise specified are obvious. The person living with the eating disorder stops bingeing or purging or both, or at least stops doing these things frequently. Weight normalizes. Physical symptoms of metabolic disturbances improve. The person in recovery from an eating disorder starts feeling better about the way they look. But there are other changes that pave the way for healthy living and healthy relationships.

  • Positive affect. People who are in recovery from an eating disorder feel better and they show it. At least some of the time they appear to be calm and peaceful, in good spirits, with a positive attitude toward life.
  • Avowed life satisfaction. People who are in recovery from an eating disorder feel better and the know it. At least some of the time they are able to affirm the ways that their life is back on track.
  • Self-respect. People who are in recovery from an eating disorder accept the realities of their past, and see the ways they have grown through their struggles. They have sufficient self-esteem to avoid denial.
  • Environmental mastery. People who are in recovery from an eating disorder are sufficiently resilient they can deal with the complexities of life. They have the ability to go to "Plan B" when "Plan A" doesn't work out. They can mold aspects of their environment to meet their own needs without taking advantage of others.
  • Autonomy. People who are in recovery from an eating disorder don't let other people press their emotional buttons. They resist social pressures to relapse into bad habits. They are selective in their need for approval.
  • Social contribution. People who are in recovery from an eating disorder find ways to pitch in to achieve shared goals with their spouse, children, extended family, coworkers, and friends. 
  • Social integration. People who are in recovery from an eating disorder have places where everyone knows their name and derive energy and comfort from those relationships.
  • Social acceptance. People who are in recovery from an eating disorder realize that other people have their own issues, that even good people are sometimes inconsistent in their behavior, and life is complicated. They are more concerned about their own integrity than they are about judging other people.
  • Social coherence. People who are in recovery from an eating disorder have a basic sense that relationships are a good thing that are worth the effort to preserve even when not everything makes sense. And if they have been treated with tolerance, they find tolerance for others.
The reality about social relationships for people who survive eating disorders is that the social relationships they have before and during their eating disorders often aren't with the same people once they are in recovery from their eating disorder. But when joy and purpose in life are found again, new relationships can begin.

  • Blijd-Hoogewys, E., Van Dyck, R., Emmelkamp, P., Mulder, N., Oude Voshaar, R., Schippers, G., et al. (2012). Benchmarken is 'werk-in-uitvoering' [Benchmarking is work in progress. Tijdschr. Psychiatr. 54. 1031–1038.
  • de Vos JA, Radstaak M, Bohlmeijer ET, Westerhof GJ. Having an Eating Disorder and Still Being Able to Flourish? Examination of Pathological Symptoms and Well-Being as Two Continua of Mental Health in a Clinical Sample. Front Psychol. 2018 Nov 15.9:2145. doi: 10.3389/fpsyg.2018.02145. eCollection 2018. PMID: 30498463 ,
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  • Photo courtesy of SteadyHealth

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