Eating disorders

What should I say to my friend who may have an eating disorder?

By Abigail H. Natenshon, MA, LCSW, GCFP

Are you a close friend to someone who may be starting to display symptoms of an eating disorder? If so, you are in a prime position to support your friend, helping her to recognize that she is in danger and to seek the help she needs from loved ones and health professionals to heal. It is important to mention here that though I use the pronoun she, the person you know who suffers from anorexia or bulimia may very well be a male.

Eating disorders start out resembling normal enough diets; for some, however, dieters can end up with:

• weight loss that doesn't stop
• obsessions with calorie counting
• compulsive exercising
• preoccupations with food and eating and self-hate that renders a person unable to concentrate
• depression and social withdrawal
• purging behaviors
• addictions to laxatives, diet pills and diuretics
• an inability to concentrate in school
• limiting the food items they will eat
• lying and becoming secretive about restricting food, about purging what she eats
• feeling uncomfortable eating in front of others and may refuse to join others for communal meals. Does your friend join up with your group for evenings out only after everyone has gone out to dinner, claiming she has already eaten or doesn't feel hungry?

This person may not realize that what she is doing can be harmful to her health and her emotional well-being and can evolve into a disease that is the most lethal of all the mental health disorders, taking the lives of its victims in 6 to 13 percent of cases.

Your friend with an eating disorder may not know she is sick. She may think that her behaviors are normal because in some ways they do appear to be a benign enough outgrowth of the "thin is in" concerns that we see in so many people in our society today. She may assume that "everybody skips meals" or that "nobody puts dressing on salads." She may feel afraid to consider letting go of her disease because she thinks that eating dysfunction, even if it means being sick, is the only way to look thin or be popular and accepted. She also may not realize that an eating disorder, once developed, is totally curable. She may think it is a sign of being crazy or insane and that it is forever. She is so wrong about all of these things.

In talking to her about your concerns, you need to recognize that many of her assumptions are based on misconceptions. You need to know what healthy eating actually is, what are the early warning signs of disease, etc., to first educate yourself enough so as to be able to educate your friend.

Friends worry that their eating disordered buddy will take offense at the mention of her disease and become angry. They worry that their intervention could make things worse, or may not turn their friend against them. You may choose to confess to your friend as you speak to her that this is a risk for you, that these are not easy things to say, but that you feel compelled to do so because of how much you care about her. Remember, you are speaking from your heart, your feelings, and your observations. It is possible (though not probably) that the assumptions you make about what you see are incorrect, but you need to be assured that your feelings and observations are your own and are valid by virtue of being just that.

If you feel something needs to be said, don't wait. Get ready to take action. Trust your instincts. Perhaps you might consider having this discussion in the company of other close friends. This is called an intervention. Wait for the right time—when you and your friend are relaxed and able to hold a private conversation. Perhaps you could go for a walk together and talk while you walk. Walking is a good way to relieve stress for both of you.

• Speak from your heart and your own feelings. "This is what I see. This is what concerns me. This is how I feel about you and what I see happening to you; here are my concerns.
"
• Let your friend know that fully 80 percent of people who get treated early and treated effectively get well—100 percent well.
• Encourage your friend to speak with her parents, her school counselor, her doctor. Perhaps you could go to talk with these people with her.
• Listen carefully. Hear what she says and help her to hear herself and her own feelings better.
• If her goal is to lose weight, let her know there are healthier ways to do so, that dieting and restricting food is the worst way to become and to stay thin, damaging the metabolism.
• Don't get into an argument. If she is resistant to hearing you, just restate what you feel and what you hope to see. Respect that "timing is everything in life." She may need a little space before taking responsibility for her own action. If you do nothing more during this first conversation than "plant a seed" in your friend?s mind and heart, that?s an accomplishment.
• Don't place blame on your friend or on her behaviors, or make demands or give instructions about how she should eat. Remember, she has become eating disordered as a means to feel safer and look better. She has simply chosen the wrong way to execute both of these otherwise sound and legitimate goals.
• Remember that she cannot just stop. This is a disease that acts, in many ways, like an addiction. It is going to take some time and she will need assistance.
• Let your friend know that you are there for her whenever she can see her way clear to being ready to accept help.
• Lastly, don't blame yourself if your efforts do not work. You can only lead a horse to water, but cannot make him drink. You should feel good, though, in knowing that you have done all you can do. You've tried your best and that is the best you can do.
• You may want to speak with your friend's parents and/or the school social worker if you feel that her life is in danger and she is not planning to mend her ways. You should let her know that you are planning to do this because you love and care about her and you don't want her to hurt herself.

An excellent resource for your friend and for her parents to read is the book, When Your Child Has an Eating Disorder. (Abigail Natenshon, author) It will answer all of their questions in a very optimistic, supportive and practical way. Chapter Three of this book offers a more in depth look at the things you might say that would be helpful to the friend you are confronting.

What a good friend you are!! Your friend is lucky to have you. By the way, the manner in which you have chosen to approach and solve this problem provides wonderful role-modeling for friend, as well. Good luck!