Helping someone with an eating disorder can be difficult, to say the least. In addition to all the other challenges of accessing high-quality treatment, there’s also the fact that many people with an eating disorder don’t want treatment in the first place. While you’re focused on their best interests, the eating disorder may have caused cognitive changes that make them believe their behaviors are normal, or even positive. When someone is struggling with an eating disorder, it’s important to get them help as soon as possible, as earlier intervention is associated with better outcomes and fewer complications—at the same time, the harder you push, the harder they may resist. But don’t despair and, above all, do not give up.

If your loved one refuses eating disorder treatment, keep reading. First we’ll explain why they might resist treatment, then we’ll discuss various strategies to help encourage your loved one to seek the care they need. Whether you’re supporting a child, a teen, or an adult with an eating disorder, these tips will help you help them, even if that’s not initially what they want.

Understanding why someone might refuse treatment

Two words help explain why people with eating disorders may resist treatment: anosognosia and egosyntonic. While both are tongue-twisters, they have fairly straightforward definitions that shed some light on what might be going on in the mind of someone who’s struggling and better explain why eating disorders are not a matter of choice or “stubbornness,” but rather, serious and complex mental illnesses.

Anosognosia: lack of awareness of the eating disorder

Anosognosia is an ill patient’s belief that they are not, in fact, ill. “Anosognosia is a common eating disorder symptom,” says Equip therapist lead Lainy Clark. “It’s also referred to as a ‘lack of insight,’ and results in a person’s inability to recognize the need for help.”

Someone with anosognosia isn’t trying to be difficult—the eating disorder can cause regions in their brain to actually change, impairing their ability to see themselves objectively. This can help explain why approaches like family-based treatment (FBT) are particularly effective: the person with the eating disorder doesn’t need to be aware of their condition in order to benefit from the treatment.

Egosyntonia: alignment with the eating disorder

Eating disorders can sometimes be egosyntonic, which means they are aligned with a person’s self-image, values, and feelings. So someone with an eating disorder might know that they have an eating disorder, but not want to get rid of it. Of course, it’s only the distortions of the eating disorder brain that make someone feel aligned with the values of their disease, but given the stranglehold an eating disorder has on a person’s mind, this feeling can be quite powerful.

“Without any intention to do so, many patients automatically go to minimizing symptoms and the need for intervention,” says Jenna Robinow, LMSW a therapist at Equip. “Part of anorexia, for example, is ambivalence toward its negative impact on a person's health. Malnutrition gets in the way of clearly seeing the urgency of getting treatment. In that sense, it can be unfair to assume that someone in the throes of an eating disorder is going to be on board from the start.”

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How treatment resistance might show up

Resistance to eating disorder treatment can manifest in many ways. You may notice emotional, behavioral, physical, or psychological signs and symptoms, or some combination of several or all of these. In some cases, a loved one may exhibit outbursts, attempt pleading, or give the silent treatment in response to attempts to help them seek treatment. While these responses can be difficult to encounter and navigate, you’re not alone in facing them.

“The most common form of resistance is emotional dysregulation, which can result in pushback, outbursts of anger or rage, and crying,” Clark says. She adds that your loved one might also exhibit an unwillingness to participate in treatment sessions, aggression, or increased hostility toward others.

In addition to emotional outbursts and aggression, Equip dietitian Tanya Hargrave-Klein says many patients may plead to get out of treatment by promising to attempt recovery on their own. Others may throw food, curse at their support network, or give loved ones the silent treatment. “This might include not returning text messages, not answering their phone, or not acknowledging support people in person,” she says.

While it’s tough to say exactly how frequently this kind of opposition occurs, Hargrave-Klein says she sees it quite often. “It’s expected for a loved one to experience resistance to engaging in treatment,” she says. “It’s also very typical for a loved one to want treatment one moment and then be opposed to it the next moment.”

How to talk to someone who doesn't want help: a communication toolkit

Trying to talk to someone who doesn’t want help for their eating disorder can be a difficult and delicate endeavor. The most important things to prioritize in these conversations are compassion, patience, and non-judgement. Here are some tips to communicate gently and effectively:

1. Educate yourself. Lean in to resources like the Eating Disorder Foundation (EDF), F.E.A.S.T. and Project Heal to empower yourself with critical information and facts about what your loved one may be going through and how you can most effectively help them.
2. Use kind, compassionate language. Approach your loved one with “I” messages, which can help you communicate your concerns, feelings, and needs without putting blame on the listener. The statement typically follows this structure: “I feel (emotion) when (situation/behavior) because (impact)” and may also include “I would like (need or request).”
3. Avoid confrontations or ultimatums. Rather than abruptly or unexpectedly confronting your loved one or using accusatory statements, express what you’ve noticed and why it concerns you.
4. Gently offer treatment resources. Let your loved one know that there are people and places that can provide the help they need if they are willing to get help. Offer your own support and guidance in making those connections, but don’t force or shame them to take advantage of your assistance.

Myth vs. facts

Before approaching your loved one, it can be helpful to reframe your mindset and dispel any myths you may have heard about eating disorders. Knowing these facts may also help you communicate to your loved one that they deserve help:

Myth: All people with eating disorders are visibly thin or emaciated.

Fact: Eating disorders can affect people of all shapes and sizes, including those in “average” and larger bodies. You cannot tell if someone has an eating disorder by looking at them.

Myth: Eating disorders are a choice.

Fact: Eating disorders are complex psychological illnesses influenced by a combination of genetics, environment, and psychosocial factors. There is no single cause of eating disorders, and they have nothing to do with choice, vanity, or attention seeking.

Myth: Eating disorders only affect young girls.

Fact: Eating disorders do not discriminate. They affect people of all ages, genders, sexual orientations, ethnicities, etc.

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Practical steps to encourage treatment

Understanding eating disorders is the first step in communicating to your loved one that they need help; taking action to initiate the conversation is next. So, what do you do if someone you love refuses eating disorder treatment? While there’s no one-size-fits-all strategy that will work for everyone, there are some tried and true tactics that can help you gently encourage someone who is struggling in the right direction.

Acknowledge their feelings and concerns

“It’s helpful to acknowledge what you are observing and validate your loved one’s feelings,” Hargrave-Klein says. “That might sound something like, ‘I can see that you don't want to start treatment. That makes sense because it feels scary, and because you don't know what to expect, and because it isn’t something your friends are having to do.’”

You can empathize with their experience while still encouraging eating disorder treatment. Express that you care about them and their feelings, and validate how hard it must be.

Use open and honest communication

It can be difficult to talk about eating disorders, but treatment requires ongoing conversation. To open up the discussion, it helps to come prepared. Educate yourself about the various eating disorder treatment options, as well as the psychological components of eating disorders that can make treatment feel scary.

“Help your loved one fact check or reframe some of their greatest fears about stepping into treatment,” Robinow advises. “Processing and getting curious about their resistance may diffuse some of their fears, which feel enormous in their head but may be broken down into more manageable hurdles that can be overcome with support.”

As your loved one talks, listen without judgment. This will make it more likely that they’ll continue talking to you or maybe even initiate a conversation with you another day. Remember, this probably isn’t a one-and-done discussion—you may need to have several talks together, so keep the lines of communication open and don’t get discouraged if the first few conversations don’t go far.

Problem-solve collaboratively

Work with your loved one to come to a solution rather than trying to force them toward treatment. Do this by allowing unconditional space for them to express their feelings, expressing your concerns in a nonjudgmental way, and then working together to find a plan you both feel good (or at least okay) about.

“Don't assume you know how your loved one is feeling,” Robinow says. “Using ‘I’ statements, tell them what you are noticing in their behavior and allow them to tell you what their internal experience is like. This may support a more collaborative effort.”

When your loved one is an adult: navigating legal and medical crises

When it comes to helping a loved one who refuses eating disorder treatment, there may be a variety of unique legal obstacles to consider. According to Equip’s Director of Psychiatry, Maria C. La Via, MD, it’s important to understand that adults are able to consent to treatment for themselves and, conversely, are able to refuse treatment as well. “This includes refusing to see a primary care or other medical provider as well as a mental health provider for assessment and/or treatment,” she says. “Adults are able to refuse recommendations provided regarding treatment which can often be frustrating for loved ones.”

Anyone navigating this situation may wonder what the legal options are for helping an adult who refuses treatment. La Via says she always recommends speaking with an attorney who deals with issues of adults who may not be making good decisions about treatment. “This may include issues around competency,” she says. “You can get advice on finding a local attorney who can help with this by looking at your state's bar association website, and the National Alliance on Mental Illness (NAMI) can also help with this. There is also the option of pursuing involuntary treatment—this goes by different names in each state—which involves submitting paperwork through the court system to have an individual evaluated for an involuntary hold and decision about involuntary treatment.”

If an adult loved one is experiencing (or on the verge of) a medical crisis as a result of their eating disorder, there are options as well. “If your adult loved one is at risk of or experiencing a medical crisis, your first course of action would be to reach out to their primary care provider to express concern and to ask for recommendations,” La Via says. “You can also encourage your loved one to make an appointment to see their PCP. While the loved one’s primary care office may not be able to share specifics on their particular situation, you can always share your concerns, even without a release of information from the identified patient.

“In the event of an urgent or emergent health crisis, you should encourage your loved one to go to either urgent care or to the ER and ideally accompany them to either,” La Via says. “If your loved one refuses to go voluntary and you are still concerned, you should call 911 and explain the immediate concerns.”

In terms of overall advice to anyone struggling to know how to help their adult loved one who refuses treatment, La Via emphasizes the importance of patience and empathy. “Let them know that you understand how difficult it can be to pursue treatment and that you are there to support them in any way that you can,” she says. “Ask or offer to speak with members of their treatment team or to help them find a treatment team if they don't have one. Get educated about eating disorders, read about risks and treatment options, reach out to providers to get information. Consider therapy for yourself to help you manage the distress of supporting a loved one who is struggling with an eating disorder.”

Understanding the importance of early intervention

No matter how reluctant your loved one may be about treatment, keep trying. Research shows that the sooner someone enters treatment, the less likely they are to struggle long-term with an eating disorder. Early intervention also increases the odds of a full recovery and encourages help-seeking behaviors.

You cannot pour from an empty cup: support for the caregiver

In many cases, caregivers give everything they have to their loved ones, often at the expense of their own well-being and the well-being of the rest of their family. Caring for someone with an eating disorder who refuses treatment can be mentally, emotionally, and physically draining, and it’s absolutely okay (and expected) to feel difficult emotions like anger, exhaustion, and frustration. While you may feel guilt or shame for needing a break or feel helpless if your efforts are met with resistance, your well-being is just as critical as theirs, and you deserve help and support too.

Equip understands the stress that many caregivers are under, which is why we provide care and resources for the entire family system. Family members receive their own support through family mentors (people with lived experience supporting a loved one), support groups with others navigating similar experiences, and helpful content for navigating recovery challenges (like supporting a loved one through meals)

Advocacy and support networks

You don’t have to go through this alone. Advocacy and eating disorder support groups are here to not only provide education but also help you realize you’re not the only one facing resistance when helping someone with an eating disorder. Also, many people find it beneficial to hear what worked for others.

Here are some resources for ongoing support and education:

• Eating Disorder Foundation (EDF)
• F.E.A.S.T.
• National Alliance for Eating Disorders

You can also sign up for the Equip newsletter to learn about support group opportunities and get other information and resources about helping someone with an eating disorder.

The Equip takeaway: have hope

When your loved one refuses eating disorder treatment, you may feel scared, frustrated, or unsure what to do next. But don’t give up, because your support is one of the most important things to help them recover.

Continue to keep the conversation about treatment open. You can validate their experience and concerns while also educating them about the very real risks of eating disorders and the various treatment options available. You can also help them find providers, make appointments for them, or be their personal Uber to appointments to help reduce any friction or excuses for not getting help. No matter what, be persistent, because the sooner your loved one enters treatment, the better.

FAQ

What are common reasons why someone might refuse treatment for an eating disorder?

There are a number of different reasons that someone might resist treatment for an eating disorder. These may include that they don’t think they are ill, or that they believe the eating disorder aligns with their self-image, values, and feelings, so they want to keep it as a part of them. They might also have fears around entering treatment.

How can families support a loved one who refuses to seek treatment?

Families can support a loved one who refuses to seek treatment by maintaining open communication, being nonjudgmental, validating their feelings, and learning about treatment options together so you can find solutions as a team.

What strategies can help in encouraging someone to accept treatment for an eating disorder?

Encouraging someone to accept treatment for an eating disorder can be challenging, in part because everyone responds differently to various strategies. Overall, it helps to educate yourself about eating disorders and the different treatments available, use “I” statements, be curious about their resistance (rather than placing any blame or blowing off their fears), and remain firm yet caring.

Are there effective treatments for eating disorders that don't require patient buy-in?

The most effective treatment that doesn’t require patient buy-in is family-based treatment for eating disorders (FBT). In this modality—developed for children, teens, and young adults with eating disorders—a professional teaches the caregivers how to help their child regain weight (if necessary) and reduce their symptoms. This empowers parents to be active in their child’s recovery and take the reins initially to decide what their child eats and stop disordered behaviors.

What resources are available for families dealing with eating disorder treatment resistance?

Resources for families dealing with eating disorder treatment resistance include support groups and organizations like Eating Disorder Foundation (EDF),F.E.A.S.T.,National Alliance for Eating Disorders, and Equip.

Can I legally force my adult child into eating disorder treatment?

In most cases, you cannot legally force an adult child into eating disorder treatment, but there are exceptions. Depending on their mental and physical state and local laws, you may have the option to pursue involuntary treatment, which involves submitting paperwork through the court system to have an individual evaluated for an involuntary hold and decision about involuntary treatment.

How should I handle mealtimes when they are refusing to eat what I've served?

While every situation is unique, it can be helpful to remain calm but firm when offering your loved one meals. Communicate that you are not intending to fight with them or make them angry or upset; you are doing what you know will help them fight their illness. Ensure that you have the support you need to navigate difficult mealtimes by seeking out a therapist with eating disorder knowledge and experience, and/or support groups.

What if my loved one agrees to treatment but then doesn't fully participate?

Ambivalence is a common component of eating disorder recovery. Because eating disorders can be egosyntonic, those affected may not want to recover. While this feeling is a symptom of the eating disorder itself, it feels real and legitimate to the person struggling. It’s important to acknowledge your loved one’s efforts but to let them know you’ve noticed their lack of participation and you worry it might undermine their recovery. If possible and allowed, consider communicating with their treatment team and find out if there are additional ways you can offer your support and guidance.