This fact sheet outlines the distress felt by individuals with eating disorders and provides some tips on how to help manage individuals distress.

Managing Distress in Individuals with Eating Disorders

Eating disorders serve an important function for each individual, and there is substantial distress experienced by the individual in trying to challenge the eating disorder, engage in treatment and work towards recovery. Eating disorders often function to help the individual manage or avoid difficult emotions, provide a sense of identify and are often experienced by the individual as providing them with support like that of a friend.

It is important to have a good understanding of the individuals experience and understand the function of their illness. This will help you to work therapeutically with the individual to assist them in managing their distress and maintaining their engagement in treatment, while preventing them from reverting back to using the eating disorder to cope.

Distress can also be experienced due to family conflict, low self-esteem or comorbid psychiatric illness. There are certain times which are more commonly experienced as distressing for people with eating disorders such as meal times. Distress can also be experienced when the team is wanting to move quicker through the treatment than what the individual feels they are able to cope with.

Managing distress is an important part of treatment, whether in the community or in hospital. In order to support an individual to manage their distress, it is important that health professionals are able to recognise distress, as this may not always be evident or demonstrated directly. For example, anger may be expressed when feeling sad, rather than crying or looking upset. Additionally, distress can be expressed in engaging in problematic behaviours.

Helping individuals to tolerate distress involves asking the person how they are travelling, empathising with their distress and offering help. For example, ‘You look upset. Is there anything I can do to help?’, ‘Would you like me to help you work out how to calm down?’, ‘How do you generally deal with distressing emotions? Have you had any successes with that in the past that we can learn from?’ or ‘What sorts of things do you enjoy doing that could help you to take your mind away from how you are currently feeling?’.

Tips to managing distress

• Reassure the individual that treatment is for their safety and wellbeing.
• Involve family, friends and carers in treatment.
• Communicate openly about distress management.
• Identify difficult times or situations (e.g., the evening meal) and assist with strategies to better manage these.
• Identify the individuals strengths and skills that they already have and build on these.
• Interpret unhelpful behaviours as a method of coping with distress.
• Externalise the eating disorder so that the individual does not feel blamed.
• Encourage the individual to express emotions in a healthy, appropriate manner.
• Teach strategies to cope with distress such as emotional tolerance and relaxation skills.
• Encourage the individual to experience with different coping strategies until they find one that helps.
• Encourage support from family, friends and carers. Involve the individual in figuring out how their family can best support them.
• Conduct regular risk assessments.