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My son’s girlfriend has anorexia and I worry about the effect on him. The Guardian.

Dear Annalisa

My adult son is in a long-term relationship with his girlfriend, who has a serious eating disorder. When he first met her she was slim but healthy. Unbeknown to him, she had recently recovered from anorexia. Sadly, over the past few years, the anorexia has returned and she is now extremely frail and underweight. She has recently committed to an inpatient plan but it will be a long process and she is still entrenched in her eating habits and resistant to change, despite having had therapy for almost a year. I am very hopeful that she will be successful, but if she isn’t I worry how this will affect him.

I know that recovery from anorexia is a long and painful process and inevitably her illness will have a great impact on both their lives. Although her friends and family are supportive, he is the one who sees her every day and has to watch her starve herself, which must be very painful. I don’t often see him on his own and try not to talk about it too much as he seems to prefer to deal with it by pretending it’s not happening and making elaborate travel and holiday plans for the two of them, which seems to me a form of escapism. I suggested he might want therapy or to go to a support group but he says he has a few good friends he can speak to if necessary.

Outwardly, he seems to be coping but I sense his worry and think he is too young to be dealing with this complicated mental illness on his own. I don’t want to interfere and alienate them both. I am very fond of his girlfriend and would love to see them both happy and well.

I feel so sad for both of them but, as a mother, I worry about my son, my instinct is to warn him of the responsibility he is taking on and the possibility of his girlfriend never getting well, with all the implications that will have for their life together. What advice should I give him and how much should I get involved?

You are being very sensitive and caring, but I can see this is a real concern for you, for valid reasons. Anorexia is a particularly tenacious mental illness. The mention of the fact that he didn’t know she had anorexia before he got involved, makes me wonder if you feel he wouldn’t have got involved had he known.

I consulted Dr Jane Morris, a consultant psychiatrist at the Royal Cornhill Hospital in Aberdeen and a specialist in eating disorders (rcpsych.ac.uk). She feels that the problem facing you is multi-layered and that you need to consider whether “your well-meaning advice is likely to inflame the situation and whether you may regret it if it is reported to your son’s girlfriend”.

Morris feels it is crucial to “maintain an attitude of proper compassion towards the girl – her illness can certainly pose a threat to her own health and happiness, and to that of those who love her, but anorexia is an illness, not a crime”.

But, of course, he is your son and while it’s great that he is so caring and compassionate, I suspect you fear the burden may be too great. Whatever you do, don’t make him defensive. Try very hard to support without judgment – he is far more likely to come to you with problems if you can do this. If he becomes defensive he may be driven to prove he can make it work, even when – or if – it becomes unworkable for him.

“Much depends on how severe his girlfriend’s illness is,” says Morris, “and the availability of and response to the best treatment and how long she remains ill.”

I’m sure you know how serious anorexia is and how pernicious its effects are on all concerned. “But,” says Morris, “while we should never underestimate the power of an eating disorder, recovery from anorexia is possible – about a third of sufferers recover fully and my team often point out that the finding of a boyfriend is often an important step in such recovery and a strong motivation to stay well.

“We also meet with women whose husband or partner has felt obliged to tolerate the demands of the illness (loving parents often find themselves in the same situation), but when they are encouraged to behave in ways that support the patient, while rejecting the demands of the illness, recovery at last becomes a possibility. This is the basis of a therapy pioneered by Professor Cindy Bulik. She calls it Ucan – Uniting Couples in the treatment of Anorexia Nervosa.”

Morris recommends Janet Treasure’s book, Skills-based Learning for Caring for a Loved One with an Eating Disorder: The New Maudsley Method. She also suggests, if at all possible, that you to get to know “the girl outside of her eating disorder”.

All of this said, if your son really doesn’t want to talk about it then you can’t make him. But you can support him in other ways. And be there for him. Things change. His girlfriend may – we hope – get better. If you can manage to maintain a quietly supportive role, he will know where you are if he needs you.

It isn’t going to be easy, so try to get some support for yourself, too.

This article first appeared in The Guardian Family section on 7 May 2016.