By Michelle Konstantinovsky, Contributing Editor at Equip
Equip is a virtual eating disorder treatment program built by clinical experts in the field and people who’ve been there. By providing a dedicated, 5-person care team, Equip delivers at-home, evidence-based treatment to patients of all ages. Equip also offers a free resource hub for individuals and families affected by eating disorders.
When a loved one is struggling with an eating disorder, the need for treatment feels—and is—quite urgent. After all, eating disorders are the mental illness with the second highest mortality rate, and the sooner someone receives treatment the greater their chance at lasting recovery. But for the person with an eating disorder, treatment might not feel urgent at all. In fact, it could be the last thing they want.
Once someone is in treatment, typically they start to see what their eating disorder was costing them and the value of treatment. But how do patients ever get to that point if they resist any care in the first place? With the right strategies and resources, friends and family members can successfully guide those they love toward recovery. Read on to learn how.
Why someone might resist treatment
There are two fancy words that help explain why those with eating disorders might resist treatment: anosognosia and egosyntonic. While both are tongue-twisters, they have pretty clear definitions that illuminate what might be happening in the mind of someone who’s struggling.
‘Anosognosia’: “Anosognosia is the lack of awareness that one is ill and it’s a common eating disorder symptom,” says Equip Therapist Lead Lainy Clark. “This is also called a ‘lack of insight’ and creates an inability to recognize the need for help.”
‘Egosyntonic’: Eating disorders are egosyntonic, which means they can appear aligned with a person’s self-image, values, and feelings. Because of this, even if a person knows that they have an eating disorder, they may not want to get rid of it. Of course, this isn’t representative of a person’s true beliefs, but a result of the eating disorder brain.
Because someone isn’t aware of their illness, or feels aligned with their eating disorder behaviors, it can be very difficult for them to accept help. Because of this, Jenna Robinow, LMSW, therapist at Equip, explains, “It can be unfair to assume that someone in the throes of an eating disorder is going to be on board from the start.”
What resistance to treatment can look like
According to Clark, a resistance to treatment can appear many different ways. Here are some of the most common:
- Outbursts of anger, rage, or crying
- Unwillingness to participate in treatment sessions
- Promises to attempt recovery on their own
- Throwing food, or refusing to attend meals
- Giving loved ones the silent treatment
- Accepting treatment at first, then changing one’s mind
While these behaviors are quite common, and even to be expected at times, that doesn’t mean that loved ones are powerless to a resistance to treatment.
How to help someone with an eating disorder who doesn’t want help
While there’s no one-size-fits-all approach that will work for all families, there are some frequently employed tactics that can help subtly motivate individuals to choose treatment:
- Acknowledge and validate their resistance: It can be helpful to reflect back to your loved one the thoughts and feelings you’re observing, and acknowledge that treatment can be a very scary thing to consider.
- Initiate open, honest, collaborative conversations: Without judgment, ask your loved one about some of their fears about treatment. Speaking these worries out loud can actually help diffuse them.
- Allow unconditional space for them to express their feelings: Don’t assume what your loved one is feeling, but rather allow them to come to you with their experience. This can nurture collaboration between you.
- Consider treatment options that are effective despite a loved one’s reluctance: Evidence-based options like family-based treatment (FBT) can deliver loving yet firm care while the patient is still healing from the effects of malnutrition or anosognosia.
Clark says it’s important to focus on what you can control. “Hoping your loved one will ‘get it’ might not be realistic. It’s more helpful to focus energy on being loving and supportive while also remaining firm.” You can also help your loved one start to see how their life might be different without an eating disorder: like through sports, socializing, or family vacations.
If you’re concerned about a loved one struggling with an eating disorder, know that you’re not alone. There’s support for you too, and getting in touch with more resources will help equip you with the tools necessary to get your loved one the treatment they deserve.
This article was originally published on the Equip blog.
 Peckmezian, Tina, and Susan J Paxton (2020.) “A Systematic Review of Outcomes Following Residential Treatment for Eating Disorders.” European Eating Disorders Review 28, no. 3, 246–59. https://doi.org/10.1002/erv.2733.
 Agurwal, R. (2016, June 21). Why India is a nation of foodies. BBC News. https://www.bbc.com/news/world-asia-india-36415078