Eating disorder, my role

[Skeleton]

Without getting too much into the details of when and how (I am willing to go into more detail if necessary but I don't want to flood to flood the thread with two much information), I've been dating for a few months (although I've known her much longer) and it's clear to me that she has an eating disorder, probably anorexia. We started by taking things slow, but last week we were alone in private and we had sex. I understand that anorexia involves feeling unattractive, and is perhaps fuelled by those feelings. I was in two minds about about how to approach the situation in the event that we had sex. I wanted to make her feel better about herself, but I was wary about validating her at the unhealthy weight that she is now (without getting too specific, she has a BMI of less than 17.5). The truth is that overall I do find still find her attractive (not without some feelings of guilt), and usually, when in doubt, I go with the truth. I'm starting to wonder if I've screwed up, chatting with her tonight she came out with this:

"I'm fine, I'm not that under weight youve seen me naked I'm fine I don't need to put on weight"

Now, despite the fact that I am still capable of finding her attractive at this weight, I am aware that it's a problem and I'm aware of the gravity of the problem, that the physical dangers are very serious, and that anorexia is an all-consuming beast which eats people from the inside out psychologically as well as physically. I've told her with complete sincerity that I would still find her attractive if she were to put on a significant amount of weight, and she refuses to believe it.

I've been doing my best to make her aware of the problem and to encourage her to want to fix it, but she doesn't seem to want to. She wants to stay around the weight she is now, saying she was even thinner a few months ago and isn't so bad as she used to be (as if this were reassuring!), that she can still hold down a job, and function day to day, and is terribly afraid of putting on weight.

On the one hand I don't want to enable her, and on the other hand I don't want to abandon her. As far as I can tell there's nobody else close to her who understands that she has a problem, she hides it from her family and friends; if they're not idiots they'll have their suspicions but may not understand the nature of the illness or how to address it (while I have no first hand experience of suffering from the condition, my sister's anorexia dominated family life for several years and I've seen it take its course in someone else). She's also refused medical help that's been offered. And, selfishly, I don't want to lose her.

We're going to discuss things tomorrow evening. I know I can't make her change, that she has to first of all want to change for herself. And I don't want to give her ultimatums or blackmail her, partly because that's a shitty thing to do but mostly because I don't want to lose her again. Is that cowardly of me? I want to do 'the right thing', but I'm just not certain what that is.

Advice would be gratefully received.

[Heather]

There's a lot here, and I'm off today, but just wanted to let you know I saw this and can weigh in in the morning.

But perhaps for tonight you can just think about what you can say and do that is just about your feelings and concerns? For instance, "I feel scared, really don't want to lose you and know that is always a very real risk with anorexia," isn't an ultimatum, nor is it selfish: just a real expression of your love and care for this person.

You also get to have limits, like anyone, and things you can and can't handle. Maybe have some thinks and feels on that, too?

[Heather]

Back again.

So, the first thing I want to do is to throw some easting disorder facts at you. One big misconception is that EDs have to do with looks. Mostly, they don't: they have to do with control, and a person with an ED trying to get some control through food, be it by not eating, limiting food, or binging. For sure, because we live in a world with a focus on looks, and thinness is a common beauty ideal, looks play into it a lot of the time, but they usually aren't what's underneath. What's underneath is usually a reaction TO control and/or an attempt to control.

Sex isn't a cookie or a reward. So, it's not about making someone feel better about themselves, but it's also not about validating something negative about someone. It's about exploring pleasure, expressing sexuality, and, when it's something we do with someone else, about connecting in an intimate way with another person. The fact that your girlfriend has an ED doesn't make it so that anyone having sex with her is or isn't enabling her ED simply by having sex with her. ED or not, she's still a person with a sexuality, so if that's something she wants to do, and someone wants to do that with her, she gets to do that.

Something I'm hearing in this sounds like you kind of thinking about all of this in a way that sounds more to me like the way a therapist, healthcare provider or parent might think. In other words, you're trying to kind of figure out what's right for her with your sex life, rather than thinking about what's right for you, then communicating with her to hear what she wants, what feels right, and what she feels ready for, then making your own choice. For sure, if you don't feel that she's truly able to competently make her own choices here, including taking care of herself in the most basic ways, then, by all means, engaging in sex with her isn't the best idea, because our sexual partners need to be able to do that. Same goes with her participation in things like intimate relationships if what she really needs to do first is learn to care for herself and get well. But I can't tell if that's what the situation is, or if you're just feeling a lack of faith or confidence in her abilities to make these choices for herself and care for herself.

Again, you get to have limits here, be they about concerns for her or for yourself. Two anorexics close in your life is a LOT: like two full-blown alcoholics, like two suicidal people. So, it certainly wouldn't be a shocker if you were feeling very overwhelmed and scared, and didn't have your own issues here. Too, the fact that she won't accept help or medical intervention with very seriously life-threatening stuff is a big deal: it's pretty impossible to have any kind of healthy relationship or interaction with someone who is actively destroying themselves (and let's be real about it: whatever is driving that, that also is someone who's not going to be able to care for you and be sensitive to you, because to do that, they'd have to care more about the impact their behaviour could have on you, a thing no one is doing who refuses to stop actively destroying themselves).

As I recall, too, the history here isn't great when it comes to this being something healthy or this person interacting with you in emotionally healthy ways. I'm remembering a pattern of this person...well, not really seeing you through their own needs and mess, and not seeming to demonstrate much real care for you, and instead, seeming more focused on what they can get from you for themselves. Do I have that right, or am I off-base?

I have a thought: since your sister has had the same struggles, is there a therapist your family has used anywhere in this process? If so, is there any chance you could go and see this person for yourself to talk to them about your relationship with your girlfriend, and how to make choices with this that are safe and sound for both of you? Who could help you sort out what limits you need and help you set them in a way you felt good about?

[Skeleton]

I went red reading that.

Well. I mean, I know that control is a huge thing with anorexia. But she more or less drew a straight line between me having seen her naked and not being visibly upset and her therefore not needing to gain any weight with that comment. She previously said something like 'being fragile is the only reason anyone ever liked me' and I think the way she perceives herself as being valued for being thin is affecting both her illness and her relationship with me. I mean, my actions and attitudes are likely to have some kind of influence. And presumably that includes my attitude toward sex which could well be conflated with my attitude toward her body.

And yeah it's a pretty big deal her being sick. And the question of whether or not we have sex isn't strictly relevant to the question of whether she recovers. And she has to want to recover, and she seems too scared to try. I mean isn't that the nature of the thing? You may know intellectually that you aren't eating enough to be healthy but are still afraid to eat and gain weight. Whatever the case, it's inherently difficult to understand.

But I feel that I should try to persuade or influence her toward recovery. That is of course the outcome I'd like, that she accepts the seriousness of the problem and finds the will to change it. Anything else is unthinkable.

And yes one could well question the wisdom of resuming my involvement in the first place. But it's not entirely a choice who you fall in love with. She did talk a bit about how her problems have always been the bigger focus in our relationship and wanted to express her concerns for me. I do pay more attention to my own life when she is a part of it.

More or less I don't want to break up with her and I don't want the illness to continue. I want to do something about it and I'm not certain what it's in my power to do.

And no, there's no such therapist, that all happened years and years ago in another part of the country.

[Heather]

So, here's what I have to say about this: if you feel that your relationship with her, or your own actions, contribute to or hold up her eating disorder, or are keeping her from healing, then by all means, I think you have to seriously evaluate that and do what you need to in order to evaluate that. And if you feel that anything you're doing is doing or part of any of that, then yeah, I think you need to figure out what you need to change so that the only thing you're contributing to is her well-being, not her illness or her self-destruction.

Perhaps obviously, that's some big, big thinks, and likely not something you're going to be able to suss out in one conversation with her, or in the next day or two.

For sure, it's not a choice who we fall in love with. But what is a choice is what we do with those feelings in our actions. So, sometimes, we fall in love with people where it's not sound, for any number of reasons, to pursue a certain kind of relationship -- at a given time, or period -- or to do certain things. So, again, this is all just stuff for you to think about and deeply consider.

But I do feel like I have to say that trying to go this alone -- and without really even help from her, if she's not willing to act in the interest of her own care -- really isn't wise, and is actually pretty dangerous for both of you. dangerous for her health and emotional well-being, dangerous for your emotional well-being. Life-threatening illness, as I know you know this is, is never anything to try and go alone or manage by yourself. We're always going to need more help than that.

Have you sought out a therapist just for yourself? Many therapists are well-versed with eating disorders, so you could get some help just for yourself that will come from an informed place. If not a therapist, I'd say if you're going to stay in her life in such a huge way, and she's refusing to be part of getting any help, you are going to need to find someone, if not a couple someones, who know their stuff, including getting how to be supportive of YOU. If you are super resistant to that yourself, or that feels impossible, then my best advice is to step seriously way back from this relationship, period, until that changes.

Just FYI, when we're very close to someone and in a sexual or romantic relationship, our choices aren't just to stay in that or go poof. We also have the option of changing the nature of that relationship so that, for example, it shifts to being a platonic, but close, friendship for a while, or period. I think that this is one example of where it sounds like she might not be the only one kind of limiting options or things from the front: I'd make sure you do all you can to open your mind up around a lot of this, particularly when it comes to your own choices that are within your control, so you can really see all the possibilities, and be much more likely to make choices that are best for both of you. Two minds stuck in limited frameworks and thinking or passivity together are never a good thing in relationships, you know?

[Skeleton]

Well we had a talk yesterday, mostly just going over the same things

"I'm not ready to put on weight", "I'm okay, I'm not in danger", "I'm not as bad as you think I am", "what if I just don't lose any more weight", "what would be the point (of seeing a dietician), they'll recommend I put on wieght and give me a plan and I'll ignore it"

But today she did make a phone call to get an appointment with a dietician. So that was encouraging. She's been on holiday the past week or so seeing family and friends and has been eating more than usual because of social requirements. And as long as she doesn't try to eat less now to compensate that should be a good thing. As long as she doesn't try to lose the weight again.

So, obviously none of this is ideal but I do think she might move toward recovery with support and encouragement.

I went to the doctors late last year about my own mental health, I got some medication that didn't seem to do very much, and referred to a CBT practitioner, but I don't think CBT is particularly appropriate or relevant to me, and there are no other kinds of therapy available in my area without payment. I'm planning another visit, to try medication again, but I think that's all that's on offer.

So I'll wait and see. Obviously she can't get better overnight, but I'm hoping she makes progress over the next couple of months.

[Heather]

Here's hoping the dietician is a good one who knows she needs to be referred to specific mental healthcare and physical help with anorexia: thinking the best for you both with that.

Have you looked into community mental healthcare services, including through the NHS if you don't have your own income, or room enough after your living expenses, for therapy you need to pay for yourself? Another option: what about splitting that bill with your girlfriend to get couples counseling around this particular issue? Sounds like it's needed, and that certainly would be another avenue for you to get support and perspective, as well as another voice to support you with your girlfriend per her getting the urgency and danger of her ED (since it sounds, unfortunately, like she's in very serious denial about it).

[Skeleton]

Dietician is a compromise, really. I'm hoping they can explain to her the risks of being as underweight as she is because if they just tell her it's somebody elses job then it will have been a waste of time - she's going to see a dietician precisely because she can't face the idea of seeing a psychiatrist. I think she's afraid of getting diagnosed as mentally ill and losing autonomy. Even if they're not qualified to address the psychological factors they should have an understanding of the physical affects of starvation.

The apparent lack of self awareness baffles me because she's had problems before but she's always been able to admit to it/recognise that they are problems. I often feel like I'm not talking to her, I'm talking to her anorexia which is why it's so difficult to reason with her. But at the same time I think that even though it's the anorexia responding, the healthy part is still following the conversation. I got a message this morning "sorry for being so difficult, this is just tricky for me". Sometimes she will seem aware of the problem and other times she won't.

I'm embarrassed about my own living situation. I talk to her nearly every day because of the magic of the internet but it's at least 40 minutes on the train to meet in person - over the last seven weeks we've seen each other four times. Between that and two leaving parties for old friends who were moving away all the money I've had has gone as soon as I had it. I live with my parents and I'm not on benefits - the plan is to get a job in web development, but I don't have any experience. So the intention is to replace the website for my father's company in order to be able to make realistic attempts to find a job, so I can at least sign on for benefits, but that's been put aside while I've work on his accounts for an hourly rate just to be able to afford to attend a minimum of social functions. It's stifling because he clearly wants me to get involved/take over when he retires and I have no interest in that whatsoever and find him impossible to work with, but that's a whole different story. (Forgive me if this is in poor taste but you can see that she'd have to be mad to be interested in me in the first place).

At this point I'd be struggling just to attend regular counseling sessions never mind paying for them. I mean, hopefully that changes but I've just been feeling a bit helpless.

[Heather]

You're breaking my heart here, Skeleton.

By all means, I think talking about yourself here is not only fine, it's for the best. After all, we really can't do much for someone we can't talk to, and while your partner is the one with the ED, you have your own big stuff, including having a partner with not only an ED, but an untreated ED, and a life history that includes a family member with one, too. Like I said earlier, that alone is a lot.

The way you're talking about yourself and your value as a partner is what is making my heart hurt. You know, what I hear from you, and have in your tenure here on the boards, is someone very attentive, caring, dedicated, compassionate and understanding. Having a job or your own place doesn't give someone those things, and *those* things are the things that tend to make someone an amazing partner, and they're often in short supply in the world. Finding someone with a place of their own and a job is easy: finding someone bringing all that to the table? Not so much.

So, no, she wouldn't have to be mad to be interested in you, and neither would anyone else. You seem pretty fantastic from where I'm sitting.

I think you not really seeing your own value is not only really sad, it's also something that's going to make it very hard for you to figure out what YOU need, and to feel able to set whatever limits and boundaries you need. For example, it really isn't out of line to have a limit with a partner with a life-threatening condition that they get qualified help with that and take that kind of basic care of themselves. I understand you might not be there yet, but I do hope you can get there, for yourself, or to other places like it. Because that's also about your own self-care. One person not caring for themselves is bad enough: both people in a relationship not doing that is pretty awful.

If you want to keep talking about you, by all means, I'm available.

Incidentally, volunteers able and willing to do tech work here is always something we have a very hard time finding. So, in the event you might be interested in getting some more experience on that resume, how about considering volunteering for us? We have a pretty good track record of volunteers picking up experience here then getting work in the field they want to be in.