In the New Maudsley Skills-Based Training, this is conceptualised as the Red and Blue Balloon: with the Blue Balloon being the healthy, resilient part of your person, and the Red Balloon, being the unhealthy, eating disorder side.
On our family support services, we hear that carers can find it difficult to separate their person from their eating disorder, particularly when navigating thinking patterns and deciphering behaviours. Sometimes carers fall into the trap of overly focusing on the Red Balloon, giving more attention to the unhealthy behaviours rather than the healthy person. Moreover, carers can have very unique and imaginative ways of externalising the eating disorder.
What are the Challenges?
Carers shared about their experience externalising the eating disorder during this session of Conversations with Carers, and the main challenges included:
- Managing their person’s resistance to externalising the eating disorder
- Insistence from their person that it is their own voice
- The ED voice drowning out the healthy part of the person
- Resistance to accept help from the carer
- The person feeling like you are attacking their friend
- Only focusing on the eating disorder
What’s Helpful?
Externalising the eating disorder can be done in many ways, depending on what resonates most with your person. For instance, you can separate out the ED from your person by giving it a name, such as ‘Jeffery,’ or by calling it something else, like ‘the liar.’ It can also be achieved by distinguishing between your person’s ‘logic self’ versus their ‘non-logic self,’ which other carers have found helpful. If your person voices that ‘they are not just an ED’, this is very positive, as it shows your person may be seeing themselves as something different to the eating disorder.
Carers recommend many methods to reinforce the idea that your person is separate to their eating disorder. For example, it can be valuable to highlight the positive aspects of your person, distinguishing between their personality traits versus the eating disorder thoughts and behaviours, to boost their self-worth outside of the ED. It can also be helpful to encourage your person to draw their eating disorder, or what their eating disorder means to them, as a way of visualising it. Other strategies like painting by numbers, using charts with stickers, and giving your person a lot of affirmations can be very powerful.
Although externalising the eating disorder can difficult and may not be well received by your person, carers stress how valuable it can be to help you cope better. It is important to not overly personalise your person’s actions, keeping in mind that it is not them, but the eating disorder. Carers emphasise the benefit of expressing empathy, as even when your person is under a lot of stress and the ED voice is very loud, they are still themselves.
Blowing up your person’s Blue Balloon can be very useful when externalising the eating disorder. This can be done in different ways, such as reminding them that you are by their side, reframing situations in a positive way, and highlighting good gestures from others. You can also boost their self-esteem with affirmations, and by organising activities that don’t focus on food or eating, such as painting, attending a show or concert, and visiting a museum or gallery.
Above all, practice is key. Some helpful phrases to keep in mind are ‘talk to the person, not the illness,’ and ‘give more attention to the behaviours you like, and less to those you don’t like.
It can be hard to externalise as often the person can’t separate themselves and can feel more threatened. Resistance is common, and conversations can often upset the person. For a young teenager, they may find it hard to make the distinction. What can be helpful is to always keep the feelings you have for the person you love front of mind even when it is tough and all you want to do is argue beck with the ED. I always remember my girl saying “Mommy what did I do to deserve this?” She did nothing and that’s why I need to stay strong to help her when the eating disorder voice gets tough.
‘Externalising the eating disorder’ was an interesting session. The fact that for the most part, no person wanted to separate themselves into two sides – saying that all the thoughts were theirs. I had the same issue with my daughter down the years (SEED). Sometimes she could and more times she couldn’t externalise the eating disorder. The big break-through came with the term ‘Liar.’ This is the one that has held firm and believable for months now. The eating disorder has orders: “don’t eat this, don’t eat that. You don’t need this, you could wait a while more to eat.” These are not true facts; they are lies. Sometimes when I recognise that the ED is very loud, I will say “is that Liar bullshitting again?” It helps her to take a step back.
