Eating disordered behavior is a way of coping when deeper problems are too painful or difficult to address directly. Some of the underlying issues attributed to an eating disorder include low self-esteem, depression, feelings of loss of control, distorted body image, identity concerns, and difficulty coping with emotions. Even though you can see your friend's disorder as unhealthy and unproductive, she* may view her eating behavior as a lifeline. Controlling her eating in a particular way often gives the individual a feeling of control and security when other aspects of her life feel out of her control. It is also a cry for help.
Changing eating disordered behavior is not a question of willpower. No one can force an anorexic to eat, prevent a bulimic from purging, or stop a compulsive overeater from bingeing. Depending on how long it has been going on, changing it may involve addressing medical, emotional and nutritional concerns. There is no "quick fix."
*The pronoun "she" is used since eating disorders are statistically more prevalent among women than men and to avoid the cumbersome use of "he or she." This information is relevant for male friends, also.
Sharing Your Feelings and Concerns
Eating disordered behavior is often a cry for help. However, the eating disordered person often feels afraid, unsafe or that she does not deserve the help. She may be afraid that friends and family will abandon her if they learn the truth. You may be the one who has to initiate the conversation. Talk openly and honestly about your concerns. Try to convey concern for her health while still respecting her privacy. (www.raderprograms.com/).
Choose a comfortable, safe, and private place to talk. Begin by telling your friend how much you care about her. Speak from your heart, using "I" statements. Gently offer some specific observations about her emotional well-being and about her behavior to explain why you think she might have an eating disorder. (www.hedc.org). Here's an example:
YOU: "Jane, I care about you a lot and, lately, I feel concerned about you. You seem distant (or preoccupied /anxious / unhappy / angry). I see you eating very little (or I watch you run to the bathroom / I hear you criticizing your body / you talk about being afraid of being fat). I had a friend who was struggling with eating issues and it really helped her to see a counselor (or I worked with a counselor and it was very helpful)."
JANE: "I don't have a problem with it. Everyone around here is on a diet."
YOU: "Your preoccupation with food seems different than a diet to me. You seem to be really struggling and feeling unhappy a lot. I believe in you and I know you deserve to have help working this out rather than suffering and struggling alone."
JANE: "I told you it's not a big deal. I don't need to talk with anyone about it."
YOU: "I'm worried about you because I care about you. Even if I can't convince you to get help now, I can't stop caring." (www.hedc.org)
Some "don'ts" include:
Blaming, shaming or guilt-tripping your friend regarding her actions or attitudes.
Using accusatory statements like, "You just need to eat," or, "You're acting irresponsibly."
Simplistic solutions do more harm than good. "If you'd just eat, everything would be fine!!"
Taking on the role of therapist.
Making rules, promises, or giving ultimatums that you cannot or will not uphold. For example, "I promise not to tell anyone," "If you do this one more time I'll never talk to you again."
More Than Her Weight
When talking with your friend, focus on feeling, relationships, academics - anything but weight and food. Avoid all comments - even compliments - about looks, weight, food intake, or clothes. This includes hers, yours, and other people's. It will only reinforce the focus on weight and body image. If you complement her on having gained a little weight or looking healthier, she will probably interpret your comments as "you're fat." If she expresses feeling fat or wanting to lose weight, instead of saying "you're not fat," suggest she explore her fears about being fat, and how she thinks her life will be different if she is thin.
Listen to your friend's thoughts and feelings about herself. It is healing and comforting for a person to share her own perspective without feeling judged. Acceptance and understanding can go a long way. Focusing only on the disordered eating behavior may result in her feeling misunderstood and ignored in terms of their emotional pain. Avoid giving her advice on changing her behavior. She will probably hear such suggestions as critical.
Most people with eating disorders feel embarrassed about them. They feel safer when friends do not try to get involved in the details of the disorder or the recovery. Express your continued support. Remind your friend that you care and want her to be healthy and happy. Encourage her to seek help from a professional - a counselor, nutritionist, or doctor.
Don't Give Up
Keep in mind that she might not welcome your concern and may even react with anger or denial. Denial of the disorder and downplaying the seriousness of eating disorder behaviors is common. Try to stay calm even if she gets angry. Avoid getting into a power struggle.
Be prepared for the possibility that a discussion about her eating problems might not lead to any change in attitude or behavior on her part. Again, she may have very good reasons for not giving up the eating disorder since it's a "coping strategy." Though it may seem like your concerns are ignored, hearing concerns from different people over time can have a cumulative effect.
If she refuses to get help, tell her that you don't want to bug her, but that you are not going to stop being concerned either. This gives you a foot in the door witout being too threatening. Though frustrating, it is important to remember that only the person experiencing the difficulty can make the decision to get help and choose what kind of help they need and want.
Find Education and Support
Give your friend information about who can help her. You can help her make an appointment with a counselor, doctor or nutritionist or even offer to accompany her to the first appointment. It may take more than one discussion before she will agree to get help.
Whether she is getting help for her eating disorder or not, stay connected to her the same way you would with any friend. Call her, invite her to do things, hang out, and ask her for advice about your life.
Remember that you cannot force someone to seek help, change their habits, or adjust their attitudes. You are likely to gain her trust if you honestly share your concerns, provide caring and support, and know where to go for more information.
You may also want to consider getting support for yourself. It can be distressing to be around a friend who is dealing with a problem and yet is consistently denying the problem. Find a counselor, friend, or support group where you can receive support for what you are going through.
Remember to be patient, recovery takes time!
GET PROFESSIONAL HELP IMMEDIATELY
if your friend is fainting, suicidal,
or otherwise in serious danger
Tell your friend you don't care if she's mad at you. You care about her and you're concerned that she is in serious trouble. Do not try and handle the eating disorder on your own. Do not buy into keeping it a secret. Eating disorders are serious physical and psychological problems. Although they are usually not emergencies, if they become severe they can be life threatening. It's best to address the problem in the early stages.
Tell someone: - RESOURCES ON CAMPUS FOR YOU:
The student's Dean (confidential if you request it)
Her coach
Counseling - you can have a confidential consultation without sharing your friend's name
RESOURCES ON CAMPUS FOR YOUR FREIND:
Her Dean
Her coach
Counseling (confidential) X5141
Health Center (confidential) X5135
Nutritionist (confidential) X5141
Sources:
www.hedc.org www.raderprograms.com/famfmd.htm
www.medic.ca/guide.html
www.nationaleatingdisorders.org