National Eating Disorders Association

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Advice on addressing adult sister's denial?

Hi everyone. I only made an account because my sister has refused therapy and continues to deny having an issue. Our mother and I both confronted her about it (she tried to turn me against our mother in an argument about whether she is anorexic or not), but she isn't buying it. I'm well aware that denial and an unwillingness to go through treatment is a big part of eating disorders, so I'm not surprised. I just don't know what to do about it.

She can't really be forced to go to therapy because 1) it would be cruel of our mother to do the whole "become independent or cooperate with therapy" trick during the pandemic, and 2) she is 18 years old. My sister lives with our mother and has never had a job before if that communicates her lack of independence enough. She was diagnosed with autism when she was little, so the idea of using ultimatums like the one I mentioned above is even more difficult than it normally would be.

I'm 22 and live on my own (with my fiancé). I actually live on the other side of the U.S., away from the rest of my family (I'm not close with my mother at all, long story). This means I don't have a lot of opportunities to confront my sister about it in person. I haven't tried anything after the first conversation because I have low tolerance for stuff like this, and I don't have the energy to field someone else's serious mental health issues when I am dealing with my own; I have severe OCD and a specific phobia that I am undergoing Exposure Response Prevention therapy for.

I know I am improving, and I know that anyone is capable of doing the same if they bother to try. Problem is, she won't. She won't even imagine a world in which she is wrong or in denial. She thinks she's healthy when she is wire-thin and hardly eats. She obsessively reports her unimpressive snacks or small meals to me when she has them to "prove" that I'm wrong about her anorexia, or at least that's what it seems like she's doing since she never did this before I talked to her about it.

What course of conversation or way of communicating is helpful when trying to get through that denial? I wonder if she finally sees the light, maybe she will do something about it.


It's true, people with EDs can worry about family members becoming aware that they have an eating disorder. And it often turns into the situation you've described. Denial, and anger towards those who are trying to call them on it.

At the same time, she knows that the cat's out of the bag now. And that you guys do know what the story is. So as much as she may try and prove that "everything's fine", she's aware that you already know that it's not.

Alternately, I suppose it's just possible that she believes that she's on a regular diet. But I kind of doubt it. And like you said, sending you pictures of her meals, that's a little obsessive, you know ? As an aside, people with EDs often do this - take pictures of their meals I mean. So it was interesting to hear you mention her doing that.

In any case, I hope you guys don't end up stalled in the "everything's fine" stage of things for too long. It's a big waste of time and energy, when you could be talking about more productive things instead.

Which is something you may want to try with her. How's she doing with getting out of the house, for example ? Or pursuing that sorts of hobbies which may have once interested her ? Or keeping in touch with her friends ? People with EDs often find that the breath of their lives is becoming narrower and narrower, and that is something which can become a concern for them. So maybe she'd be more willing to talk about the non-food angles of her life with you ? Because those sorts of things can effect people's eating disorders as well.

Also, might the be things going on to cause her to feel like she's not in control of her life ? Feelings of not-being-in-control cam lead to eating disorders as well, so that's something you might want to enquire about, if she'd be willing to talk about such things.

This all may seem like you are coming at the issue indirectly, but such things may play into this in important ways, and if she can talk with you about those things, it may end up providing the both of you with the sorts of openings-of-communication that you're after.

Keep in touch ?

Maybe Health Results Would Open Her Eyes?

Obviously denial is major in this illness, but for me the scary realization was the undeniable medical evidence that I was quite literally killing my own body by starving it. If I were you, I would ask her to get a wellness check up, "just to be safe", but you would want to make sure that she is honest with the doctor about her limited food intake, even if she thinks "it's fine/no big deal". This is because, even if as of right now, her blood work or other lab results are not critical, the doctor will still express concern and be able to warn her about the dangers she is bringing upon herself, and recommend a safer level of food intake. Would there be anyone who could attend this appointment with her, to make sure she does mention the disordered eating to the physician? Perhaps your mother or another sibling if you have one.