Are your treatment friends helpful when it comes to eating disorder recovery?
Written by ‘Ai Pono Hawaii Staff Writer
When you’re in a formal eating disorder treatment program or a recovery community (in-person or online), you end up making friends. When you spend so much time with people who already know and understand your “big secret,” you’re bound to get close to them. The experience of a shared reality is scientifically proven to be highly valuable and motivating in terms of making and keeping friends.
But are your “treatment friends” always helpful when it comes to your recovery — especially after you leave a program or support group?
If you are friends with someone else from treatment, you want to consider:
The pros and cons of having treatment friends post-treatment
Factors that indicate how healthy your treatment friendships are
How to maintain constructive friendships with treatment friends in recovery
What to do if your relationship is more harmful than helpful
It’s not that you should never be friends with someone else who has an eating disorder. It’s more about preserving your recovery, which is the most important part of treatment and your life in general.
Pros of keeping up with treatment friends after you go home
Your friends from eating disorder treatment are a source of connection and understanding. They know what it is you are facing — probably more than anyone else at home.
So they can offer a safe space to talk about challenges, accomplishments, and strategies for maintaining your progress in recovery. They can share different coping strategies that work for them, recovery influencers they follow on social media, and different services they have received in the past.
They also have a similar "therapeutic toolkit" from treatment. Your treatment friends can remind you about DBT skills, how to stop body checking, and other therapeutic tools you all learned from treatment. This is really helpful in times of crisis, when it's hard to think about what will help you in the moment.
Related: Read more about DBT and other evidence-based treatments used by holistic eating disorder programs.
You can also plan to have some meals and snacks together, just like you did in treatment. Each of you gets structure and accountability. You can do this with friends in person, on the phone, or (increasingly over the course of COVID-19) on a video call.
Related: This is how to take the meal support you get in treatment and apply it at home.
If you feel the urge to use behaviors, you might also be able to call them to talk calmly with you until the moment passes.
Cons of maintaining treatment friendships after you go home
When you’re in an intensive eating disorder treatment setting, everyone around you is in a similar stage of recovery (unless a weight biased insurance company refuses to cover the level of care you need.) It’s great at the time being, because they know exactly what you’re going through. They can relate to the day-in, day-out activities that come with treatment at a certain level of care. They can make you feel less alone.
Related: Insurance companies aren't the only sources of weight stigma in eating disorder treatment and recovery.
But recovery is not linear.
After you go home, you can all be in different stages of recovery. You may progress in your recovery, while your close friend from treatment may still be struggling, even after discharge. Recovery may be going great for you now, but you may slide back later on (an unfortunate but common occurrence).
What happens when someone is doing well and someone else isn't?
As anyone with an eating disorder can tell you, eating disorders are competitive illnesses, where "doing well" might not seem like a good thing.
So even though you know logically that you are on the right path, and that eating disorder behaviors are destructive, you might feel jealous or get triggered when you notice that a friend is using behaviors. This is especially true if you see that they are losing weight but you (being in recovery) remain in your healthy recovery body.
When you realize a treatment friend is relapsing, these are common (maladaptive) responses:
I have to "save them."
They are relapsing, so why should I keep trying?
I'm so jealous that they're "getting away" with relapsing.
It feels like a competition to see who can fast/exercise/lose weight the fastest.
Your eating disorder may really use these emotional and cognitive responses to try and lure you back in. If you are the one slipping back into old behaviors, you may inadvertently put someone else at risk for relapse.
How to tell whether your relationship is good for your recovery
In a healthy relationship, your friend is a source of strength and support for your recovery. In a potentially harmful relationship, you might:
Worry more about your friend's state of recovery than your own
Feed off of each other's destructive thoughts and behaviors
Feel a sense of competition between each other to "get worse"
Feel drained by the relationship
Harbor resentment or jealousy towards your friend when they use behaviors
Are embarrassed or ashamed to share your positive steps towards recovery (e.g. willfully doing exposures, feeling more relaxed around food) with them
Obsess over their social media (especially pictures, which are often just body checks)
Are encouraged to use eating disorder behaviors
Receive (or give) tips on using eating disorder behaviors
Engage in negative self-talk or comparison with them
Actively engage in behaviors together (e.g. fast together, overexercise together)
The difference between a healthy and unhealthy relationship really comes down to, does the friendship serve you and your recovery well?
You can feel jealous about someone's appearance and maintain a positive relationship. You can support your friend and support your own recovery. But once you or your friend's actions start to cause eating disorder urges and behaviors, the relationship no longer serves you. If your recovery is threatened by the friendship, you have to step back. It's not your fault or your friend's fault — it's the damaging nature of eating disorders.
How to maintain healthy relationships with your treatment friends
Set boundaries.
A lot of the time, you or your friend might say or do something and not even realize that it could be triggering. That's why it's really important to set boundaries, even if your treatment friend seems really positive in general. Think of it as a preventative measure.
Setting boundaries requires you to:
Communicate those effectively
Maintain your set boundaries
Use interpersonal effectiveness skills when you set your boundaries.
Find common interests outside the realm of eating disorders.
People naturally bond over common interests, activities, character traits, etc. In treatment, your common area of interest is the world of eating disorders and eating disorder treatment.
While talking about your eating disorder and recovery can definitely be helpful, find some other things to talk about with your treatment friend.
As you start to identify less with your eating disorder, it stops becoming an area of interest. Having another activity to do or subject to talk about together will help facilitate the process of separating yourself from your eating disorder. The process of finding a life completely outside of your eating disorder is a key part of recovery.
If your only topic of conversation is your eating disorder, recovery will either make the relationship boring, or you'll just feel the need to talk about it for an unhealthy amount of time.
Related: Who are you outside of your eating disorder? If you're not sure, this will help.
Doing something else together can also:
Improve self-esteem as you build skill mastery
Act as a coping skill in times of distress or hopelessness
Cut down on unscheduled time that your eating disorder might try to convince you to binge, exercise, body check, etc.
Lift each other up when you can.
In the right conditions, your treatment friends can give you:
Praise when you meet your recovery-oriented and general goals
Motivational statements when you need them
Reminders about how you have faced challenges and survived hardships in treatment, so it's possible to do it at home
Advice for something you are struggling with
Kind words of understanding when you need to vent about diet culture, feeling misunderstood, etc.
Positive affirmations that are not related to how you look
Of course, you support them in these same ways. That said, don’t rely on each other too much — you are not each other’s therapists. While venting is healthy and normal in a friendship, it has to be balanced and not risk anyone's recovery. If you feel like your friend's emotions are too hard to handle, or that you are draining your physical and emotional resources by focusing on them, then it's time to reevaluate the relationship. Set venting/complaining/advice giving boundaries. And, if your friend is really struggling, gently encourage them to speak with their issues with their treatment team.
What should you do if a friendship is no longer healthy?
Find a time to talk to them about it.
When you do ask for space, assure them that they’re not a bad person and don’t blame them if you start to slip. It doesn’t do either of you any good.
Don’t obsess over their social media: ignore posts with body checks or mental health updates.
Unfollow your friends if you have to.
It is not your job to “fix them.” It is also not your friend's job to fix you. It’s not selfish to create the space that both of you need to heal. Later on, you may reevaluate the relationship. With all your relationships, remember that your recovery has to come first, and that's okay. In fact, putting recovery first is the exact right thing to do.
If you or a loved one is suffering from an eating disorder, take the first step today and talk to someone about recovery or simply learn more about the holistic eating disorder recovery programs we offer.