Witnessing a friend struggle with an eating disorder can be very confusing. This life-threatening illness can have serious impacts on one’s physical health, and you may be questioning whether your friend is ready for you to bring up the issue.
Look for the signs.
Weight and diet can be a touchy subject for anyone, and it is important to decide first whether your concern for your friend is supported by observations. Does your friend appear more depressed, irritable, or fatigued than normal? Do they make frequent excuses to use the bathroom after a meal or refuse to eat in anyone’s presence? Do they become noticeably upset when a conflict interferes with plans to exercise, or when they are not in control of the food being served? Do they seem to talk excessively about diet, food, or exercise? Do they often make excuses to avoid going out? Environment can also provide clues that someone is struggling; has he/she experienced personal trauma? These are only some of the signs that suggest that someone has an eating disorder.
Helping a friend who has not asked for help.
Oftentimes, the person with an eating disorder may not want to seek help, regardless of his/her physical and mental condition. They may experience derealization, which can alter their perception and make them unaware of their disordered thoughts and behaviors. Eating disorders can be life-threatening, and it is important that the patient gets help sooner rather than later. This can be a difficult conversation to start, and the person may feel exposed, embarrassed, or overwhelmed at the thought that their condition has reached a certain point.
Starting the conversation.
Shoot them a text or a call beforehand to let them know that you want to express a real concern with them alone. Probably, they have not opened up about their illness to anyone yet, and being in that situation can feel confrontational and emotionally overwhelming.
Write down some of your main points to address so you don’t slip up in the heat of the moment; hypersensitivity is pervasive amongst people suffering from mental illness. When it’s time to talk, open up the conversation in a private environment. Express your concerns gently, let them know you are available to talk at any time and remind them that you love them. Tell them you understand that they didn’t choose this. Prepare for the possibility that there may be a lot of crying.
The Do’s and Don’ts of directing a friend toward recovery.
Eating disorders can reach a point where the decision between getting assistance from a professional and refusing help can be life and death. Judging the condition of a friend who does not want to open up can be very difficult, and not all eating disorder subjects are underweight. Some signs may signal that a person is in critical condition and need an intervention; it is important to do your research on the different types of eating disorders.
- If you are concerned for a friend who is not seeking help themselves, do not point out anything about their outward appearance (i.e. “you’re too thin,” “you look like you’re starving yourself,” etc.), as it may only exacerbate their symptoms and further prevent them from getting help.
- Do not say anything along the lines of, “people will think you’re more attractive if you gain some weight.” That is far from the point, and will only offend your friend and delegitimize the issue.
- Do not express anything that can be taken as a personal attack (i.e. “your portion sizes are ridiculous,” “your exercise addiction is absurd,” etc). Meta-shame is not a good feeling for anyone.
- Most of all, do not say anything that can make them feel like you are downplaying their condition, or the reason for their condition (i.e. “I understand, everyone gets insecure about their bodies sometimes,” “I see you eat, so you must be eating something,” “if you lost any more weight than you have, then I’d be concerned”). This will only make the person feel like they aren’t “sick enough,” or that their condition was their own choice that was based on conventional reasons. The disorder is very complex, and you must understand and address your limitations on the subject.
- Rather, do let them know that you are here for them and that they are not alone; this issue is an epidemic, but they may feel very alone in their struggle. Do let them know that you are having difficulty understanding their condition, but that they have nothing to be ashamed of and you just want them to be happy.
- Do try to sway them to consider getting help from a professional. Let them know that professionals who are trained to work with people with their conditions are the best way to help them be both healthy and happy with themselves again. If they fight back, refuse your advice, or make excuses, consider speaking with their parent(s)/caregiver(s).
The Do’s and Don’ts of supporting a friend in recovery.
Recovery for an eating disorder patient can be like a blindfolded, starless journey back to the light. If your friend is receiving outpatient treatment, you are likely going to see them eating with you as a part of their physical recovery process.
- Do not make comments about their food, whether they are good, bad, or just simple statements. Do not even ask what they are eating or cooking. Do not talk about exercise, dieting, or weight, in any context whatsoever. These subjects rule his/her constant thoughts, and bringing them up will only make it more difficult for your friend to work on psychological recovery.
- Do not make any comments on his/her outward appearance. Yes, even if they are positive comments, such as, “you look healthier.” Your friend is coming from a history with very disordered thinking that cannot vanish overnight and certainly can’t vanish once their weight is restored. Hearing that they look healthier, better, or anything of the like can trigger a relapse. Using outward appearance to judge someone’s mental state takes the focus away from the root of the problem.
- Do not open up a discussion on recovery unless they start one. Sticking to recovery can feel derailing for an eating disorder patient, and recovery is likely on their mind all of the time.
- Do not discuss their past habits or appearance with them, even in a joking sense (e.g. “I remember you had lettuce as a snack!”). This can trigger unpleasant flashbacks.
- Do not pressure them to eat certain foods or to go out to eat with you. They will do those things when they are ready, and their care team is working on it with them. Transitioning from very abnormal behavior to normal behavior is a long process, and any sudden drastic changes to behavior can trigger a relapse.
- Do let them know that they seem happier and that you are proud of their courage and available to talk at any time. If they open up a discussion on their recovery or their past condition with you, it can be useful to ask them about their triggers. Eating disorder patients can very easily be triggered into a relapse. If you notice they are very disturbed, remind them that because they are in recovery they are on the way to full freedom and happiness. The disordered mind can often forget this.
The most helpful thing you can do.
Speak out. There is a lot of shame and stigma associated with this very complex disorder. Speaking out can give courage to millions of strugglers, survivors, and patients in recovery. Learn how you can get involved here.
Preventative measures.
Learn how you can prevent the onset of eating disorders for yourself and those around you. Educate yourself on the effects of trauma, the nature of diet culture, and the negative implications of stress in childhood and adolescent development.
(NEDA) Eating Disorder Helpline: (800)-931-2237
Helpful Resources:
Signs your friend is struggling with Anorexia Nervosa
Signs your friend is struggling with Bulimia Nervosa
Signs of other Eating or Feeding Disorders/Eating or Feeding Disorder Otherwise Specified