What do we mean by externalising the eating disorder?
Separating the eating disorder from the individual can be a helpful and powerful treatment strategy. Derived from Narrative Therapy practices this strategy can help both you and your loved one understand that the eating disorder is a problem your loved one has, as opposed to your loved one being the problem.
This does not mean that your loved one is absolved of any responsibility to challenge the eating disorder, but rather, they are not to blame for it and neither are you.
Externalisation of the eating disorder is an important part of Family Based Therapy (FBT) where parents/carers are encouraged to use this skill when supporting their young person.
However, it can be used by anyone who is working/supporting someone with an eating disorder regardless of the treatment your loved one is engaged in.
By using externalisation you can reinforce that it is the eating disorder which needs to be challenged and changed. This prevents your loved one experiencing feelings of criticism and blame.
Eating disorders thrive on control. Adopting an uncritical attitude is important as feelings of criticism and hostility can lead to increased eating disorder symptoms.
Reasons to use externalisation:
- It helps to focus on the illness not the person.
- It allows us to form an alliance with the person not the illness.
- Reminds us that there is a healthy self that is free from eating disorder feelings/thoughts/behaviours.
- Enables parent/carers to distinguish between eating disorder behaviours, thoughts, feelings and their loved one, in turn enabling parent/carer to stand strong against the eating disorder while remaining compassionate and kind to their loved one.
- Assists in creating an opportunity for parent/carer and loved one to be on the same page fighting for health without the eating disorder
- Can assist your loved one in being accountable for their own recovery – by learning to disagree with and fight the eating disorder mindset.
How to use externalisation?
When communicating with, talking or thinking about your loved one try externalising the eating disorder by referring to it as a separate to them.
Sometimes people find it helpful to give the eating disorder a specific name such as ED or Edi, however, this is up to the individual/family.
When your loved one is engaging in challenging behaviours particularly around food or exercise, ask yourself whether you are seeing the eating disorder or your loved one. This can help you determine when and where to act to support your loved one. It can also help you to remain calm in the face of conflict
Rather than saying “I feel that you are being very difficult this evening.”
Try externalising ….
“I feel that the eating disorder (or ED) is making it hard for you this evening.”
Externalising takes away blame and criticism and creates a more compassionate way of communicating.
“It sounds like the eating disorder is really strong now and that must be very difficult for you.”
“It seems that the eating disorder is taking a lot away from you.”
“Don’t let the eating disorder win. Food is medicine. You need to take another bite.”
Tips when using externalisation:
- Be careful not to negate your loved one’s experience by using externalisation in a negative way such as “that’s just your eating disorder”.
- As your loved one moves further toward their recovery it can help to be genuinely curious in your comments, “It sounds like the eating disorder is tricking you again. What do you think?”
- Sometimes individuals might find externalising dismissive or invalidating of their experience. Others may not like the eating disorder being separated as it means that they are not bound to the eating disorder and they may feel threatened by that. If you receive a negative response to externalising the eating disorder be confident, clear and consistent in how you respond, “I love you very much. I am sorry it distresses you to hear me separate the eating disorder from you when you feel so closely intertwined with it. However, it helps me to stay calm and support you when things get tough.”