When you see a close friend or loved one struggling with an eating disorder, the obvious impulse is to help. But knowing the right steps to take can be difficult.
In the U.S., an estimated 20 million women and 10 million men will suffer from an eating disorder during their lifetime. And disordered eating behavior can be deadly -- not only are there more deaths from eating disorders than any other mental illness, but they can also cause heart failure, electrolyte imbalances and gastric ruptures. Being armed with this knowledge is one thing, but when you hear your roommate throwing up after meals, or notice that a friend is over-exercising or making drastic dietary changes, what can you actually do about it?
We spoke to a number of eating disorder experts and psychologists to determine the best way to help a struggling friend, all of whom agreed that it starts with a conversation.
Here's what you can do:
Understand why you feel compelled to step in. Psychologist and wellness coach Ann Kearney-Cooke told The Huffington Post that it's often frustrating when a friend bails on plans to hide their disordered behavior, won't order anything when you're out to dinner, or talks incessantly about hating their body -- but that any intervention has to come from a place of compassion. "Otherwise, it just won't work." Kearney-Cooke told HuffPost. "[He or] she will feel bad and probably withdraw from you."
Speak to them one-on-one. Find a quiet, comfortable place to have a talk with your friend when you're not distracted by other things or rushing around to various obligations. Don't have the conversation over a meal -- try having a cup of coffee or going for a walk. If your friend is struggling with food, mealtimes may already be a source of extreme stress for them, so try to avoid adding to that.
State what you've seen. Present the factual basis for your worries -- mood changes, lack of appetite, situations where he or she has avoided food or has binge eaten. Be as specific as possible without sounding accusatory, for example saying: "It seems like you often throw up after we eat together" or "your diet has become very restricted."
State exactly what you feel. Explain why you are worried, and how your friend's behavior affects you. Judith Brisman, a psychoanalyst, Director of the Eating Disorder Resource Center and author of Surviving An Eating Disorder: Strategies For Family And Friends, recommends using "I" phrases like, "As your friend, I feel like you might be in trouble," "I feel like I'm losing you" and "I would love for you to talk to me." These avoid putting blame on your friend while helping them understand your concerns.
Talk about what you'd like your friend to do. Bring up a variety of options such as speaking to a therapist, seeing a nutritionist or entering a treatment program. Come prepared with a list of treatment options in the area (the National Eating Disorder Association website offers numerous resources) and offer to accompany your friend to his or her first appointment.
Be open about your own experiences and vulnerability. Many people struggling with eating disorders are unable or unwilling to admit that they have a problem. Knowing that they're not alone in worrying about their bodies or having control over their lives can be a source of comfort. Dr. Brisman recommends comparing stories about body image and self-esteem, giving your friend a chance to open up.
Don't force labels. Many people struggle with disordered eating, but don't fit the diagnosis for specific diseases like anorexia or bulimia, leading them to believe that they don't have a problem. This is especially true for men. Even though the number of men suffering from eating disorders is on the rise, people are less likely to notice disordered eating behavior in their male friends and loved ones.
"Men suffering from eating disorders often don't realize they have one," eating disorder survivor and activist Matt Wetsel told The Huffington Post. "In recovery culture, the focus really is on women." Try to avoid putting labels on your friend -- instead, stress that you're concerned about certain behaviors he or she is engaging in.
Be hopeful about your friend's recovery. It's important for someone struggling with disordered eating to hear that you know how hard it is and realize that recovery takes time, but that you're certain they will overcome this. "It sounds really simple, but it can be really profound," Dr. Kearney-Cooke says.
Recognize that if your friend is not ready to seek help, he or she may deny having a problem or lash out at you. "Don't feel like you've made a mistake when the person blows up at you," Dr. Brisman advises. "It might be inevitable... you're talking to the part of them that doesn't have a voice." End the conversation by letting the person know he or she can reach out to you at any time for help, and raising the topic again in a few weeks' time if you see the disordered eating behavior continue.
If things get really dire, consider expressing your concerns to someone else. While no one wants to feel like they're "tattling" on a friend, there are times when it's appropriate to bring in another party. Dr. Kearney-Cooke recommends raising your concerns with the friend a final time before asking for help, saying something like: "I really care about you and your health, so i'm going to contact your sister/ boyfriend/ roommate."
Once your friend is in treatment, there are still ways to help him or her get well. Eating disorder recovery is an extremely individualized process, so how you can assist depends on what your friend wants and needs during this incredibly difficult time...
Listen. Ask "how can I support you?" -- and really hear what your friend has to say. Know how much or how little the person recovering wants you involved in the process.
Find out what your friend's goals are. Knowing what he or she is working towards will help you be a better friend and supporter along the way.
If your friend is in an inpatient program, ask if he or she would like you to visit."The best stories I have heard have been when friends have visited friends in treatment centers," Dr. Brisman told HuffPost. "They go out for walks and my patients report that it is the only time they are at the treatment center that they are not thinking about food or bodies. It reminds them that there is more to them than just their eating disorder."
Educate yourself about what he or she is going through. The NEDA website has a specific section for family and friends of sufferers. Available resources include facts about disordered eating, ways to talk to a struggling friend about his or her problem, recovery stories and confidential discussion forums.
Be mindful of your own behaviors around your friend. Fat-talk or extreme dieting in front of a friend in recovery is counterproductive -- instead, speak openly and without judgment about food and dieting. Dr. Brisman recalls one patient of hers who was relieved when her friends didn't tiptoe around those subjects:
It was moving and helpful to her that her friends actually were straightforward and down-to-earth about food-- they asked her what she wanted for dinner, what they should buy. Their openness made my patient feel comfortable and stopped her from feeling like she had to be secretive or ashamed.
Know that this isn't all on you. As much as you care for the people around you, their health is never in your hands. If you are struggling to support a friend, don't be ashamed to reach out for help for yourself, too.
Need help? Call the National Eating Disorder Association hotline at 1-800-931-2237.