Supporting a Loved One with Mental Health Struggles: A Guide

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Hello, my girlfriend has always been an outgoing person.
To outsiders, she appears to be intelligent, generous, extroverted, empathetic, and able to bring joy to others.
Due to her good looks, she has had many admirers over the years.
However, she also has high standards for herself and lacks confidence in various aspects.
Since the second half of last year, possibly due to work pressure and lack of interest, she has started to feel insecure about her job.
Although she gets along well with everyone at the company and her abilities are recognized, she constantly feels worthless and often breaks down in tears when alone.
Additionally, she lacks confidence in her body image, feeling that she is ugly and overweight (even though she is neither).
This has led to symptoms of binge eating, followed by purging.
After leaving that job to take a break, her condition has been fluctuating.
In front of others, she still tries hard to maintain a cheerful demeanor, making people think she is a sunny and optimistic person.
Privately, she understands the situation and often tells herself to think positively and that she is not that bad, but she struggles to follow through and easily falls into despair.
After leaving her job, she often feels useless and worthless, yet she is afraid to try looking for a new job, wanting to escape from it all.
Whenever the topic comes up, she starts to emotionally break down.
On the other hand, she has begun to lose confidence in her relationship with food.
Although she has forced herself not to purge for the past couple of months, she still experiences urges to binge eat, especially when feeling down, which makes her anxious around food and difficult to establish a normal relationship with it.
She continues to feel that she is overweight (which is not true) and constantly criticizes her body, believing that others are judging her appearance when she goes out.
As a result, she has become resistant to going out or meeting friends, even though she knows rationally that it is not as exaggerated as she thinks.
She struggles to control these thoughts and spends her days in tears (though she can still put on a cheerful facade in front of others).
She has always known that she should work on self-love, but she cannot help but hate herself, feeling as if there is a demon inside her.
Recently, she has noticed that the aforementioned symptoms worsen before her menstrual period, while she can manage them better at other times.
Additionally, her physical condition has changed over the past year; she has developed a craving for sweets, enjoys coffee, and has irregular menstrual cycles.
1.
Should I encourage her to seek psychological counseling? She has attended a few sessions before but felt there was no significant effect and believes that only sick people need to go, which affects her self-esteem.
2.
Does this qualify as premenstrual syndrome (PMS)? I have encouraged her to exercise more and take calcium supplements, but she often gives up easily and falls into despair.
How can I encourage her? Should I take her to see a doctor?
3.
Is it possible that her emotional state has been influenced by PMS from the beginning, and she does not realize it, leading her to lose confidence in her entire life?
4.
As her boyfriend, I have done my best to encourage and support her.
What other ways can I help her?
5.
Do you have any other suggestions? Thank you.

Mr. Wang, 20~29 year old female. Ask Date: 2014/03/31

Dr. Ding Shuyan reply Psychiatry

Hello, from such a detailed and heartfelt description of the issues, it is clear that you are very considerate of your girlfriend's well-being.
Eating disorders are generally best treated with a combination of psychotherapy and medication.
Exploring personality and psychological factors is also very important, as emotional issues often accompany these disorders.
Medication can help her return to a more stable life more quickly, as severe impacts on her social and work situations can further exacerbate her mood, creating a vicious cycle.

Psychotherapy is not typically a quick fix, as it involves delving into deeper personality aspects, which cannot be resolved in just a few sessions.
This is not necessarily a reflection of the therapist's abilities; sometimes, the client needs time to warm up and build a trusting relationship before they can comfortably discuss and confront their issues.
Considering your ages, she is likely in her twenties, which is a good time to engage in psychotherapy; it can become more challenging as one gets older.

Furthermore, anyone can benefit from psychotherapy or counseling, not just those who are considered "sick." In fact, some therapists regularly seek counseling from their peers to enhance their self-understanding.
The distinction between "normal" individuals and those with mental health issues can be somewhat subjective and blurred.
If life were not so busy, I personally would also appreciate having a counselor or spiritual guide for regular psychological support, as it is very beneficial.
Premenstrual syndrome (PMS) is something many people experience, generally related to hormonal changes, and it does not always require treatment.
However, if her symptoms exceed the typical definition of PMS, I agree with your perspective that seeking medical attention would be advisable.
As her boyfriend, you are already doing a lot of good.
In the long term, she may need more understanding and reassurance, as those who are unwell often require additional support from us.
You might consider discussing with her doctor or therapist about incorporating some dietary habits into her treatment plan.
It’s important not to solely follow your girlfriend's wishes; there are certain boundaries that should be maintained for her well-being.
As for your next steps, it would be beneficial to consult with the therapist and hear their recommendations, as each individual's situation is unique.
Wishing you all the best,
Dr.
Ding Shuo-Yan

Reply Date: 2014/03/31

More Info

Supporting a loved one with mental health struggles can be a challenging yet rewarding journey. Your girlfriend's situation, characterized by emotional distress, self-esteem issues, and disordered eating behaviors, is complex and requires a compassionate and informed approach. Here are some insights and suggestions based on the information you've provided:
1. Encouraging Professional Help: It is crucial to encourage her to seek professional help, such as therapy or counseling. While she may feel that seeking help indicates weakness or a lack of self-sufficiency, it’s important to frame therapy as a tool for personal growth and healing. You might suggest that therapy is a safe space to explore her feelings and develop coping strategies. If she has had previous negative experiences with therapy, it may help to explore different therapists or modalities (like cognitive-behavioral therapy or dialectical behavior therapy) that might resonate better with her.
2. Understanding Premenstrual Syndrome (PMS): The exacerbation of her symptoms around her menstrual cycle could suggest a link to premenstrual syndrome (PMS) or even premenstrual dysphoric disorder (PMDD), which is a severe form of PMS. These conditions can significantly impact mood and emotional regulation. Encouraging her to track her symptoms in relation to her cycle may provide insights into patterns that could be addressed with a healthcare provider.
3. Promoting Healthy Coping Mechanisms: You mentioned that she has been encouraged to exercise and take calcium supplements. These are great starts, but it’s essential to make these activities enjoyable rather than obligations. Engaging in physical activities together, such as walking, dancing, or yoga, can create a supportive environment. Additionally, exploring mindfulness practices, such as meditation or deep-breathing exercises, can help her manage anxiety and improve her relationship with food.

4. Building Self-Compassion: It’s vital to help her cultivate self-compassion. This can be done through positive affirmations, journaling, or engaging in activities that promote self-care. Remind her that everyone has flaws and that self-worth is not determined by appearance or productivity. Encouraging her to focus on her strengths and achievements, no matter how small, can help shift her perspective.

5. Open Communication: Maintain open lines of communication. Let her know that it’s okay to express her feelings and that you are there to listen without judgment. Sometimes, just having someone to talk to can alleviate feelings of isolation. Encourage her to share her thoughts about her body image and emotional struggles, and validate her feelings without trying to immediately fix them.

6. Avoiding Pressure: While it’s important to encourage her to take steps towards improvement, avoid putting pressure on her to change quickly. Recovery is often a gradual process, and setbacks are normal. Celebrate small victories together, and remind her that it’s okay to have bad days.

7. Seeking Medical Advice: If her symptoms persist or worsen, it may be necessary to consult a healthcare provider. A medical professional can assess her overall health, including hormonal factors that may be contributing to her emotional state. They can also provide guidance on whether medication might be appropriate.

8. Support Groups: Consider suggesting support groups where she can connect with others who are experiencing similar challenges. Sometimes, knowing that others share similar struggles can be incredibly validating and comforting.

9. Your Role as a Supportive Partner: As her boyfriend, your support is invaluable. Continue to be patient and understanding, and remind her that she is not alone in this journey. Encourage her to take small steps towards seeking help and making positive changes, but also respect her pace and readiness to engage in those steps.

In conclusion, supporting a loved one with mental health struggles requires a balance of encouragement, understanding, and patience. By fostering an environment of love and acceptance, you can help her navigate her challenges and work towards healing. Remember, it’s okay to seek support for yourself as well, as caring for someone with mental health issues can be emotionally taxing.

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