Eating Disorder Intervention

Hopeless, distraught, and uncertain are words that many support systems would use to describe the experience of watching their loved one battle an eating disorder. These emotions are maximized when the individual struggling does not want to receive or engage in treatment or is not motivated to let go of their eating disorder.

If an individual is in this position, even the most supportive circle of people cannot recover for them. All of the talking, encouraging, and challenging in the world might make little to no difference.

It is in these moments of desperation that families often turn to the process of intervention, with the keyword being “process.” While TV and movies represent these as singular moments of confrontation, they are actually a much longer step-by-step procedure that must be handled intentionally.

What Are the Signs of an Eating Disorder: Does Your Loved One Need Help?

Before an intervention occurs, it is important to identify the eating disorder behaviors that are causing concern and that the support system wants to address. While it is impossible to say these behaviors are solely indicative of an eating disorder, they should be considered red flags, particularly if you are witnessing a loved one experiencing more than one of them.

Physical Warning Signs of an Eating Disorder

Eating disorders are psychological and physical and have a notable impact on the body. Some physical signs that your loved one might be struggling with an eating disorder include:

• Loss/fluctuation of body fat and muscle.
• Dry and/or brittle hair, skin, and nails.
• Low blood pressure and pulse.
• Yellow/gray and dry skin.
• Loss or irregularity in the menstrual cycle (amenorrhea).
• Chronic constipation.
• Abdominal pain and gastrointestinal issues.
• Impaired immune system.
• Difficulty regulating temperature or tolerating the cold.
• Lethargy and low energy.
• Dental erosion.
• Growing fine hair all over the body (lanugo).
• Scarring or scrapes on the knuckles due to purging.
• Dizziness and/or fainting spells.
• Increased musculoskeletal injuries from over-exercise.

What are Common Eating Disorder Behaviors to Look For?

There are specific behaviors that indicate an individual is engaging in disordered eating. Some of these may be blatantly obvious while others involve asking further questions to understand. Behavioral indications of eating disorders include:

• Hyperfixation on food consumption, caloric content, and impact of food on body weight, size, and/or shape.
• Calorie counting.
• Skipping meals.
• Reporting not being hungry or having already eaten on a consistent basis.
• Hoarding diuretics and/or laxatives.
• Replacing meals with coffee.
• Focusing on “health” in regard to food.
• Exercising despite injury, fatigue, or inappropriate weather.
• Obsession with altering one’s appearance.
• Leaving mid-meal or after meals to use the bathroom.
• Spending excessive amounts of money on food in one sitting.
• Eating in secret or alone.
• Hiding food.
• Declining to attend social functions where food is present.

Eating Disorder Intervention Plan

As mentioned above, an intervention is not a stand-alone experience. Instead, it involves detailed preparation before as well as continued work afterward. Nothing that occurs in an intervention should be spontaneous as this leads to opportunities for miscommunication and conflict.

Education & Professional Guidance

It is inadvisable for a support system to ever plan an intervention without the support and help of a professional. This could mean an individual’s current treatment team or therapist, however, there are individuals that specialize in behavioral intervention and it is recommended that a support system contact and include one of these professionals.

These professionals are particularly helpful as they have experience with these specific discussions related to straddling the line between challenging and supporting a loved one. It is not easy to bring the painful truth to a loved one and ask them to change while still allowing them to not feel judged and to feel supported. Receiving insight and guidance from a professional that specializes in this helps to make that conversation easier.

Intervention

Contrary to media portrayals of interventions as surprise moments that lead to inevitable conflict and pain, interventions are actually loving and powerful moments when planned appropriately.

Individuals engaging in the intervention should all have met previously with any treatment team and intervention professionals to plan what message is trying to be communicated as well as how it can be communicated lovingly. The goal is not to shame or bully the individual into making a change. Instead, the focus should be on helping the individual realize and accept the severity of their problem and that they need help. Meeting and practicing together beforehand allows the team to support one another, be aligned in their messaging, and prepare themselves for what will undoubtedly be an emotional and challenging discussion.

For the family participating, it is important to consider whether they are prepared to have this conversation. If a participant cannot have this discussion without becoming negative, shaming, or accusatory, it is best that they are not in attendance at the intervention. This is not because their feelings of anger or frustration are not valid, however, they are not effective in an intervention setting, as they will likely reduce the likelihood that the individual will be open to listening and changing. American Addiction Centers recommends an individual process the following questions before agreeing to participate in an intervention:

• “Can I lay out the points effectively without enraging my loved one?
• Will I be able to form an inner circle of his or her loved ones to assist me?
• Will I be able to follow through with this even if there is a negative outcome from the event? [1].”

Building off of the importance of having a positive and supportive disposition, interventions should not focus on blame. While individuals with eating disorders absolutely make choices that contribute to the consequences of their behaviors and the impact on others, “the point is not to blame them for causing harm. Instead, it is to point out that the addiction causes negative changes in behavior [2].”

Regardless of preparation and professional guidance, an intervention may still have a negative outcome. Eating disorders are insidious disorders that are difficult to let go of. As such, a crucial aspect of an intervention is to align clear consequences to an individual refusing treatment and to follow through with these if necessary.

The American Addiction Centers specify that “if the person refuses treatment, relationships with friends and family must change. Everyone present should commit to ending codependency and enabling behaviors. Be clear that there will be consequences if the person refuses help [2].”

Ultimately, it is impossible to predict the outcome of intervention so any individual participating must do their own therapeutic work to process their thoughts and feelings, goals, and their ability to follow through with the support or consequences that might result.

Choosing The Right Eating Disorder Treatment for Your Loved One

The goal of an intervention is to ultimately get your loved one to be willing to receive the treatment they need to recover from their eating disorder. Convincing a struggling individual to seek help is an incredible victory, however, there may be a deadline to this willingness. Ending an intervention without immediately implementing support could mean losing the moment of willingness.

Intervention or treatment professionals should be consulted to help the support system come up with the options for a plan. This might look like an individual immediately entering a previously arranged treatment setting, going to the emergency room for evaluation, or attending an intake with a treatment center to determine the level of care needed.

The “right” treatment center for your loved one depends on the severity of their eating disorder, the individual aspects of their disordered beliefs and behavior, and their insurance coverage.

Consider all of these aspects for your loved one with professionals prior to the intervention so that any of these questions or possible barriers to treatment are taken care of and cannot be used by the individual to return to disordered behaviors.

There is no “perfect” way to plan an eating disorder intervention. While you might plan and have the best intentions, we cannot predict what the outcome will be. Ultimately, lead with l9ove and non-judgment while maintaining boundaries and holding the goal of supporting your loved one as a top priority.

Resources

[1] Juergens, J. (2020). How do I hold an intervention? Addiction Center. Retrieved from https://www.addictioncenter.com/treatment/stage-intervention/how-do-i-hold-an-intervention/

[2] Editorial Staff (2020). The step-by-step guide to staging an intervention. American Addiction Centers. Retrieved from https://americanaddictioncenters.org/intervention/guide.

Author: Margot Rittenhouse, MS, LPC, NCC

Page Last Reviewed and Approved By:  Jacquelyn Ekern, MS, LPC 12.21.21