How to Help a Friend With an Eating Disorder
Takeaway: It can be difficult to watch a friend struggle with an eating disorder, but it’s important to remember that there are ways to support them. In this post, we’ll share some tips on what to do (and what not to do) when you are concerned for a friend or family member. By following this advice, you can help support and encourage your friend in their recovery.
Unless you have past personal experience with disordered eating, there's a good chance all of this is unfamiliar and overwhelming. We’ll review some of the most common eating disorders to help you make sense of it all and better understand some of the warning signs.
Types of Eating Disorders
There are several different types of eating disorders recognized by the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM 5). You’ll notice that each type has its own unique symptoms. However, they are all psychological, medical, and nutritional disorders characterized by persistent disturbances in eating that cause significant distress or impairment to a person's health.
Anorexia nervosa is an eating disorder characterized by an intense fear of gaining weight. In order to avoid weight gain, individuals with anorexia nervosa significantly restrict what and/or how much they eat. They may perceive their body size, shape, or weight inaccurately, do not recognize the seriousness of their low weight, or significantly link their self-evaluation with their body size, shape, or weight. While most individuals with Anorexia nervosa are underweight, the National Eating Disorders Association (NEDA) notes that individuals in average-sized or larger bodies can have Anorexia nervosa.’
Bulimia nervosa is an eating disorder characterized by cycles of binge eating and compensatory behaviors. Binge eating includes eating a large amount of food in a distinct time period. The amount of food eaten is significantly larger than what most individuals would eat under similar circumstances. Compensatory behaviors, also know as purging, are used to prevent weight gain and may include self-induced vomiting, misuse of laxatives, or excessive exercise. Individuals with Bulimia nervosa often describe themselves as feeling out of control around food.
Initiating a conversation about eating disorders, or mental health in general, can be tricky. Oftentimes, people avoid commenting or having these difficult conversations because they worry their friend or loved one will not be receptive. They may also worry about saying the “wrong” thing, making the person angry, or getting it wrong altogether. However, not having these conversations could be fatal. So what do you do? In this post we’ll offer suggestions for navigating these challenging conversations and helping a friend with an eating disorder.
Understanding eating disorders
Binge-eating disorder is similar to Bulimia nervosa in that individuals engage in recurrent episodes of binge eating. Unlike Bulimia nervosa, those with Binge-eating disorder do not engage in compensatory behaviors.
Avoidant/restrictive food intake disorder (ARFID)
ARFID differs from the other eating disorders we’ve covered in that body image and weight do not play a role. Individuals with ARFID fail to meet nutritional requirements through oral food intake due to a lack of interest in eating, fear of choking or becoming ill, an aversion to the sensory qualities of food, or another factor. It should be noted that it is not related to the lack of availability of food.
Other specified feeding or eating disorder (OSFED)
OSFED includes all other feeding or eating disorders that cause significant distress or impairment but do not meet the strict diagnostic criteria for another disorder. While there are misconceptions about OSFED and some perceive it as less serious than other diagnoses, NEDA states it “is a serious, life-threatening, and treatable eating disorder.”
Warning signs to look out for
Sometimes it’s pretty obvious that a person is struggling, but more often than not, the eating disorder is hard to spot at first glance. We all have food related habits and preferences, but there are some warning signs to look out for. Here are three signs that it’s time to speak up.
Behavior and thinking changes
Eating disorders often start when people make well-intentioned changes to help them get healthier. What may start out as a desire to follow their doctor’s advice to lose weight and exercise more can end in a full-blown eating disorder. Pay attention to new behaviors related to your friend’s eating habits or when talking about body image, such as eating more or less than usual, rigid rules, counting calories, excessively exercising, self-inducing vomiting after eating, misusing laxatives, or weighing themselves more frequently. Also, be mindful of new thoughts. Behaviors and thoughts are closely linked. It’s likely a warning sign if your friend is talking a lot about food, obsessing over what or when to eat, comparing their body to others, or speaking negatively about their body.
Eating disorders affect an individual’s whole wellbeing. Keep an eye out for changes in your friend’s self-esteem, a decrease in interest in things your friend used to enjoy, avoidance of social situations (perhaps avoiding lunch time at school) , or irritability. It is not uncommon for people diagnosed with an eating disorder to be diagnosed with an additional mental health condition. Pay attention to things like low self esteem, self loathing, depression, anxiety, trauma, substance use or other self destructive habits.
Physical changes and medical concerns
It is common to assume people with eating disorders are emaciated. While this is one presentation, eating disorders come in all shapes and sizes. Weight loss and weight gain can be a warning sign. In children and adolescents, maintaining weight while growing in height can be concerning.
Disordered eating comes with a long list of medical complications and concerns. They affect every organ system in the body. Gastrointestinal symptoms are common, including bloating, nausea, constipation, and abdominal pain. Cardiovascular symptoms are likely, including low blood pressure, electrolyte imbalances, and chest pain. Endocrine problems are prevalent for both men and women. Without the energy needed to make hormones, individuals are more at risk for bone loss. Women may have irregular menstrual cycles or stop having them altogether. Neurological symptoms are common, including difficulty concentrating, difficulty falling and staying asleep, and dizziness and fainting. Other symptoms can include hair loss, feeling cold, anemia, low energy, and kidney problems just to name a few. It’s important to keep in mind that laboratory test can be normal even when the eating disorder is severe.
I think my friend has an eating disorder. What should I do?
Eating disorders are serious, life-threatening, and take a significant toll on a person's emotional and physical health. They rank as the second most lethal mental health condition, with opioid overdose as number one (Arcelus, Jon et al., 2011). According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), 28.8 million Americans will struggle with an eating disorder at some point throughout their life. However, this statistic might actually be higher. Research suggests that certain populations are significantly less likely to be screened for eating disorders, which prevents some people from receiving the diagnosis and treatment they need. This is why it is crucial to have those difficult conversations when you notice something is wrong. We’ll review three dos and don’ts to help you get started.
What to do when your friend has an eating disorder
While there is no perfect way to navigate the situation, these three things that may be more helpful than others.
Educate yourself about eating disorders, treatment, support services and the recovery process. Being better informed will not only help your friend, but it will help manage your own fears and anxiety about the situation. There are many wonderful organizations with free information about eating disorders, including the National Alliance for Eating Disorders and the National Eating Disorders Association. Additionally, listen and learn about your friend’s experience. Ask open-ended questions, like “Tell me what it’s like for you” and “How can I support you?”
Talk privately and effectively
Talking to a friend about an eating disorder is challenging enough on its own, for both you and the friend. Having the conversation privately can help reduce anxiety, ensure confidentiality, and highlight the seriousness of the issue. Speak about your experience using “I” statements, including, for example “I noticed you’ve been eating alone in your room every day” and “I’m concerned about how often you’re weighing yourself.” Sarting a sentence with “I” instead of “you” is less threatening. Communicate honestly and compassionately. Don’t avoid or minimize what you want to share just because it is uncomfortable. Use a gentle tone, acknowledge the difficulty of the conversation, validate your friend’s feelings, and say what needs to be said.
Emphasize the need for professional help
In a perfect world, your friend would thank you for confronting them and immediately start their recovery journey. As you can imagine, that’s probably not going to happen. It’s normal for someone with an eating disorder to be unaware that they have one. Even if they are aware, they may not fully understand the seriousness of the situation or seek treatment themselves. They may underestimate how much support they will need while recovering and believe they can make changes on their own. Strongly encourage them to seek help from a professional. Eating disorders are complex, and there are special considerations to be mindful of when treating them. Working with a treatment team or treatment center with specialized knowledge of eating disorders is critical. If you’re unsure how to find someone, click here.
It can be tempting to search for what is to blame for the eating disorder. You may want to blame your friend because they continue to engage in harmful behaviors even when in treatment. You may want to blame yourself because you wish you would have said something sooner. You may want to blame social media because it’s filled unhelpful messages about food and appearance. However, there is not one thing to blame for eating disorders. Eating disorders occur when a combination of biological, psychological, and social factors come together to create a perfect storm. Blaming only creates anger, resentment, and shame.
What to avoid if your friend has an eating disorder
Don’t talk about food, bodies, or appearance
Talking about food, bodies, and appearance is normal in our society. However, it can be extremely unhelpful for someone with an eating disorder. Commenting about “good” and “bad” food or “healthy” and “unhealthy” food further reinforces the eating disorder’s rules. Talking about your body or other people’s bodies can send unintentional messages about how to look. Even complementing someone’s appearance can be unhelpful.
As mentioned previously, eating disorders are complex. For all, the recovery process will be filled with ups and downs. This is normal. You may want to seek individual therapy a join a support group to help you during this difficult time. Keep fighting, especially when it’s not easy.
Don’t give up
Eating disorder treatment options
Helping a friend or loved one seek treatment for an eating disorder can be overwhelming. You may not know where to start or which treatment options are the best fit. This is where we can help! Our team of expert clinicians, including both mental health professionals and registered dietitians, have extensive education and training in treating eating disorders of all kinds. When you reach out, our Care Coordination team will ask questions to help determine how we can best offer support and which treatment option is best. If we are not the right fit, our team will offer referrals to the right treatment team.