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how do i help a friend or loved one?

There are many ways in which you can help your friend or loved one if they have an eating disorder. The most important thing that you can do is offer your unconditional love and support. Remember, they are not to blame and it is not their fault that they have an eating disorder.

Another important point to remember is that recovery takes time. It is also possible that, just because your friend or loved one has confided in your about their eating disorder, they are not ready to start the recovery process and may simply want somebody to talk to.


What you can do to help

The most important thing that you can do is to offer your friend or loved one complete and unconditional support. Support is vital to all of us and even more important for someone with an eating disorder because they are likely to have low self-esteem and feelings of worthlessness. Remember, unconditional support means you are offering to be there for your loved one no matter what happens.


Perseverance

It is possible that you friend or loved one will, at times, try to push you away and reject your offers of support. Don’t take this personally – an important aspect of an eating disorder is the “negative voice” inside the individual that will try to resist all assistance. In a way, the “negative voice” is testing the resolve of all who come close and is looking for any excuse to be able to say, “See, I told you so, you’re not worth anybody’s time.”


Mood swings

One typical feature of an eating disorder is mood swings in the person concerned. This can be for both physical and psychological reasons. Physically, an eating disorder can lead to vitamin and mineral deficiencies and this can have an effect on the brain. If, as is often the case, depression accompanies the eating disorder, then low levels of serotonin may be a contributory factor.

Psychologically, the mindset of an eating disordered individual is usually negative, particularly if they have had an eating disorder for a long period of time. More than anything, they will have a negative opinion of themselves and may often put themselves down. They may take anything you say and try to use it against themselves. Accept that mood swings are likely, that it’s not your friend’s fault and that what is said during a period of depression doesn’t reflect how they really feel.


“If only I wasn’t so fat…”

It is best not to be drawn into an argument about how “fat” or “thin” your friend or loved one is. In reality, this is completely irrelevant because an eating disorder is not about weight. Your friend is likely to express her feelings through her weight, for example: “I feel so fat today.” Of course, this is not really the problem, but their eating disorder has become a method of coping, therefore even basic emotions can be expressed in terms of weight or food. Think of an eating disorder as being a filter between the person’s emotions and the outside world; all emotions must go through this filter before they are expressed.


Therapy and the recovery process

Whether your friend or loved one has confided in you about their eating disorder, or if you confronted them about it, it is always up to them to initiate the recovery process. Even if they are willing to talk about their eating disorder, it does not necessarily mean that they are prepared to “give it up” at this time. Things should be taken at their pace and, ultimately, the decision is always theirs.

Offer to help your friend or loved one seek help, but do not try to force them. There are many therapists who specialize in the treatment of eating disorders and finding one is often the first step towards the recovery process. In more serious instances, an eating disorders center may be appropriate, but that would be for a physician or therapist to decide. Again, it is up to your friend or loved one to want therapy; you should offer to support them in any way you can, including helping them to seek treatment. If they don’t want to seek treatment, you must accept this and tell them you are always there for them and will continue to be there regardless of whether they are in therapy or not.


What you cannot do

Just as there are many positive things you can do to help somebody with an eating disorder there are also many negative things which should be avoided.


Weight isn’t the issue

Don’t concentrate on your friend or loved one’s weight; it isn’t the issue, even if they insist that it is. Food and weight are really coping mechanisms that your friend is using to deal with and help take control of their life. Remember, your friend’s health IS your concern but is not your responsibility. By focusing on their weight, you are reinforcing the idea that it’s central to the problem, which of course it isn’t.

If you are a parent with an eating disordered child, then you do have a responsibility to intervene, particularly if you feel your child’s weight is dangerously low. You should always consult a doctor and, if necessary, go to the emergency room if you fear your child’s health has reached a critical point.


Emotional blackmail

Your friend or loved one will already have low self-esteem and this can be made worse if you try to make them feel guilty about their behavior(s). Don’t try to make them choose between their eating disorder and your wishes; the odds are high that they will choose the former. Comments which should be avoided include:
  • “Why are you doing this to me?”
    Your friend or loved one is not deliberately doing anything to hurt you. Their actions are not intended to cause pain to anybody else and accusing them of hurting you is likely to make them feel even more guilty than they already do.

  • “Why won’t you just eat?”
    Food is a coping mechanism for somebody with an eating disorder. It is used (and abused) to help cope with a variety of negative feelings. Statements like the one above are likely to have the opposite effect of the one you desire because you are threatening their control.

  • “If you don’t eat, I will…”
    Again, this is threatening your friend’s control over their life. You need to be a supportive influence, not a negative, domineering one. Cheap threats are never a good idea – even if you are prepared to carry out your threat, there is nothing positive or supportive about your actions and you are trying to take their control away.

  • “Why are you doing this to yourself? Can’t you see what you are doing?”
    Somebody with an eating disorder does not usually choose to live a life of starvation, binging or purging. Because it is not a conscious choice, they are not to blame for resorting to such a coping mechanism, albeit one which is physically damaging. Also, it should be remembered that the initial “aim” of an eating disorder is not normally ill health. Many eating disorders start off as just a “fad” or a “diet” which quickly spirals out of control.


You cannot force somebody to eat

One of the main points of an eating disorder is that it is your friend or loved one’s “friend”; it is their control and not yours. Trying to force somebody to eat by pleading with them or using emotional blackmail is never a good idea. It goes without saying that any attempt at physical force-feeding is cruel and extremely unproductive and may also be illegal in many countries. By pleading with your friend to eat (or not binge or purge) you are piling on extra shame and humiliation, something they already have enough of. Once again, by concentrating on their diet, you are avoiding the main issue(s) and reinforcing the notion that using and abusing food is the best way to cope with life’s problems.


Methods of control

There are a number of methods that those with an eating disorder (particularly anorexia and bulimia) may employ to try to affect their weight. The most common of these methods are laxative and diuretic abuse and over-exercise. Whilst it may be tempting to take away your friend’s laxatives, they are only likely to go out and buy some more behind your back and your actions may cause more harm than good. However, it must be remembered that laxative and diuretic abuse can have extremely harmful side effects and you should encourage your friend to see a doctor, especially if they have been taking large quantities or have been abusing pills for a long period of time.

Again, if you have a child with an eating disorder, then your situation is different because you have a responsibility to your child. Specialist eating disorder centers and hospitals don’t allow patients to take drugs whilst in their care and this might be a consideration if your child is heavily abusing laxatives, diuretics or ipecac syrup. Tell me more about typical methods and their dangers.

Many people with an eating disorder are not prepared to seek help or treatment and it is often the case that it takes someone else to voice their concerns before they will talk about it. If you suspect that your friend or loved one has an eating disorder, you should approach them with an air of love and understanding. You want to be supportive, not critical, and this will help in the long-term as your friend starts to confide in you.


How to approach your friend or loved one

It is not easy to predict how the person you care about will react when you approach them to say you are concerned they might have an eating disorder. There are three main types of reaction: relief, admission of a problem and total denial.


Relief

This does not necessarily mean that your friend will openly admit to having an eating disorder. However, they will feel relieved that someone else is aware of the problem and is willing to help. They no longer have to pretend that everything is okay and come up with excuses for their various behaviors. Your friend or loved one may not actually express their relief until a later time, possibly many years after recovery.


Admission of a problem

It is possible that your friend or loved one will admit to having a problem and will want to do something about it. This varies from person to person and may depend on how far their eating disorder has progressed. It is also possible that, when you approach someone about their eating disorder, they are already in treatment and therefore aware of the problem.

Hopefully, if your friend or loved one openly admits to having a problem, it will make it easier to talk about, both for them and for you. Obviously, it’s much easier to have a conversation with somebody who actually wants to talk. Ask if they have considered getting help for their eating disorder, but don’t pressurize them – ultimately, it is their decision.

If your friend is interested in seeking treatment, you can use the treatment finder on this website to find suitable facilities/therapists nearby. There are also many other resources available, some of which you can find in our link database and treatment finder.

Link database

Treatment finder
Denial

It is very possible that the person you care about will deny having an eating disorder, even to the point where they will refuse to even consider what you are saying. They may tell you that nothing is wrong, that you are imagining things or they will refuse to take the problem seriously.

Be prepared for strenuous denials and accusations against yourself. As the best form of defense is attack, your friend may retort with comments like “Well, I’ve seen YOU do this…”, “It’s not like you never go on a diet” or “I know you count YOUR calories.” Don’t be drawn into a discussion about yourself – you are there to discuss your friend. Politely say that you are more than willing to talk about any problems your friend feels you have, but right now you want to talk about her problems and how you are concerned about her welfare.

If you are told that it’s none of your business, point out that you love/care about her and how it’s affecting you (e.g. she is using large quantities of food, spending long hours in the bathroom when you want to use it, etc.), and therefore it IS your business. If your friend could handle things herself, then she wouldn’t have given you cause to be concerned. This is why you feel you must intervene.


Getting a professional opinion

The next step should be to consult a professional for a consultation. That way, you can receive help both in terms of knowledge and advice on whether it seems likely your loved one has an eating disorder. You should tell your loved one that you are doing this because you care about them but you do not expect them to come with you to the consultation. Even if they refuse to come with you (which is not unlikely), you do not need their consent to get a professional’s opinion and you are only trying to get as much help as possible because you care about them.


Other possibilities

You should always bear in mind that the person you are approaching does not have an eating disorder. However, you have a right to voice your concerns when it comes to somebody you care about. There are a number of medical conditions which can result in a decreased appetite, weight gain or vomiting. Alternatively, you friend may have other problems that are troubling her. When approaching your friend or loved one, be prepared to admit that you know they may not have an eating disorder.


Eating disorders in the workplace

Being a friendly and approachable employer is always important, but it is even more so when a member of staff has an eating disorder. A key feature of management is taking an interest in the welfare of staff members in order for them to be able to achieve their potential.

Most people with an eating disorder are hard working and good at their jobs. They may stand out as striving for perfection or going to extreme lengths to achieve deadlines and get work finished. However, they may also isolate themselves from other team members in an effort to keep their eating disorder a secret.


Certain jobs tend to attract eating disordered people

It is not uncommon for someone with an eating disorder to work in vocations that may be triggering or potentially have other eating disordered employees. Some typical job types include:
  • Food industry such as catering
  • The caring professions such as nursing, social services, health and dietetics
  • Work in fitness and sport, dance and theater
  • Modeling, jobs in the fashion industry and in PR and publicity

An individual working in the food industry may surround him or herself with food in order to keep an element of control about their working life. With vocations such as modeling, competition is everywhere and sometimes those without an eating disorder are considered abnormal.

Please bear in mind that the examples of jobs given above is only a guideline and that there are many eating disordered people in completely different working environments (e.g. office/desk jobs). All employers should be concerned about the welfare of their staff, but those in the industries above should be especially vigilant.


Finding out about a staff member’s eating disorder

Generally speaking, there are three main ways an employer will find out about a member of staff’s eating disorder:

The individual confides in their employer, for reasons which could include having to reveal information for a medical, an explanation for not wanting to attend staff lunches, or simply needing somebody to talk to about their problems.

Another member of staff raises their concerns with management. In this instance, it may be helpful to have a confidential chat with the individual to let them know you have been approached and you are willing to help in any way you can. Of course, the employer should always be aware that the member of staff in question may NOT have an eating disorder, however it is still important to offer support.

Management notice changes in an employee’s behavior, attitude or performance. This may be accompanied by physical signs, such as frequent trips to the bathroom (particularly after eating), avoiding staff events where food will be present, or persistent talk of weight loss and dieting.


How can I help a staff member who has an eating disorder?

People with an eating disorder have the same needs as other members of staff. They need to feel valued, accepted and that they are making a positive contribution to the company/organization. It is not necessary to treat an eating disorder differently to any other health concerns being experienced by staff members.

If you are an employer, it might be helpful to let the person know what is required from them in the workplace. Of course, they will not expect preferential treatment, but clear guidelines and managerial feedback can be beneficial.

The member of staff may require sick leave to attend hospital appointments, therapy or group sessions. Again, the nature of their illness is largely irrelevant; all employees should expect the same treatment if they need to go to medical appointments.

Some important points to remember:

An eating disorder is not an attention-seeking tactic. On the contrary, most eating disordered people would prefer that others NOT know about their illness.

It is up to the employee whether or not they want information disclosed to their work colleagues. It might be helpful to come to an arrangement about what answers should be given by management if other staff members make enquiries about the individual concerned.

An eating disorder is not a barrier to success. Indeed, people with an eating disorder are probably some of the most effective, hard working and loyal members of a workforce.


Recognizing emergency situations

Although in general you should not interfere with the behavior of a person with an eating disorder, there are occasions where you should act immediately to prevent physical harm or even death. This is even more imperative if you have a child with an eating disorder because you have a responsibility to them that is a little different to that of a friend.


Fainting or collapsing

A lack of nutrients in the body can lead to dizziness and fainting. You may feel that it is not serious and merely a classic symptom of an eating disorder, but this is not always the case. Fainting can be a sign of dehydration or an electrolyte imbalance. An electrolyte imbalance (having a low level of potassium in the blood) can lead to heart failure and death. Therefore, you should always consider it an emergency if your friend or loved one passes out.


Rupture of the esophagus

The digestive system can be permanently damaged by repeated (or even occasional) vomiting. It is possible for the esophagus to rupture or burst apart and this can be life threatening. There is no way to tell when a person’s body has reached the point where their esophagus could rupture from the pressure and acidity of vomiting. In some, in takes only a short time, where it may take longer in others.

Don’t make the mistake of thinking it couldn’t happen to you or your friend/loved one. If a person’s vomit has blood in it, it can be a sign that the esophagus is wearing down. In this case, you should always consult a doctor or healthcare professional because delays can be fatal.


Suicide attempts

Since depression often goes hand-in-hand with an eating disorder, suicide attempts are not uncommon. If your loved one is regularly threatening suicide, in can create a situation in which you are held hostage. Each threat may not carry any significance other than being a cry for help, but you should not evaluate this on your own. A professional opinion is vital in such circumstances, even if your friend or loved one refuses to attend any appointments or consultations.

Statistically, suicide attempts are more common among bulimics than anorectics. This is because bulimia is a more impulsive illness than anorexia, where the sufferer’s wish to get rid of pain can result in the wish to end their own life. If your friend or loved one makes suicidal gestures (such as toying with a razor blade over their wrist or taking large, but not fatal, amounts of painkillers) or even tells you they are thinking about suicide, you should consider the situation to be an emergency. Don’t delay in calling for help, even if your loved one protests – there will be time for tears and tantrums later and you only have their best interests at heart.


Dealing with resistance

Once you or a healthcare professional has identified an emergency situation, it may be necessary to take your friend or loved one into hospital. This is likely to be met with resistance, particularly if they are not currently in treatment for their eating disorder. They are unlikely to want help and will be frightened that their way of coping will be taken away from them. Assure your friend that you are only acting in her best interests and, although you are prepared to talk about it, you are determined to take her in for medical treatment.