Helping Friends With Eating Disorders

Published: January 28, 2014

Recently it was reported that, Kesha (a female singer-songwriter known for hits such as the recent chart-topper “Timber”) entered rehab for an eating disorder. As a side note, eating disorder treatment is not typically referred to as rehab—a term usually reserved for drug and alcohol treatment. Perhaps all of the debate about whether eating disorders (and other behaviors) are a form of addiction has led to this change in language, or perhaps it’s just the press loosely applying a term frequently associated with celebrities in treatment. But, that’s not the point of this post – just something to be aware of…

Amongst the flurry of responses to Kesha’s announcement was an online post by MTV containing information on how to help a friend with an eating disorder.

It is common for people to seek advice from me when they find out I work in the field of eating disorders.  One of the most common questions I receive is, “I think my friend has an eating disorder. Should I say something? How do I help?” Luckily, students at UNC who are seeking answers to these questions have an excellent resource in Embody Carolina, a new student organization that aims to educate students about identifying and supporting someone struggling with an eating disorder. Embody Carolina offers four-hour, student-led training sessions to help “identify the signs of struggle, learn to approach friends with sensitivity and compassion, seek out professional help in the community, and serve as allies in the recovery process.”  I was fortunate to speak with Rachel Guerra, a UNC undergraduate who leads Embody training sessions, and is also a research trainee at the UNC CEED. Below is a summary (with my two cents added in) of the broader points Rachel emphasized to someone seeking to help a friend:

  • You can’t determine whether someone has an eating disorder based on weight or appearance alone. Low weight and changes in weight can be signs of an eating disorder. However, someone who “looks anorexic” may not have an eating disorder, whereas someone who “looks healthy” could be suffering immensely because of an eating disorder. It’s important to look for behavioral indicators that your friend has an eating disorder, such as: skipping meals, exercising excessively, or frequently disappearing into the bathroom immediately after eating.
  • If your friend does need help, encourage him or her to speak with a professional. Eating disorders specialists are best poised to help people suffering from both eating disorders and disordered eating. Don’t try to be your friend’s therapist. Doing so may alienate your friend and exhaust you, rendering you less able to help them. Avoid offering your own theories as to why your friend developed an eating disorder or giving suggestions on how to get better, even if you yourself have struggled with an eating disorder. Instead, encourage your friend to seek professional help. Do not wait until your friend’s eating disorder becomes very severe before talking to him or her. The sooner your friend seeks help, the better. Not only will your friend spend less time suffering, but eating disorders tend to respond better to early intervention.
  • If you’re going to talk to your friend, be respectful of where he is or she is in the recovery process. For someone who isn’t ready to even acknowledge that he or she has a problem, pushing the person to seek treatment can be counter-productive and may alienate them. Even though you may be fearful for your friend and his/her health, don’t let your sense of urgency drive you to push them towards something they’re not ready for. (Of course, if the situation really is urgent from a medical perspective—e.g., they are vomiting blood—it’s important to insist on calling for medical assistance) Never give ultimatums, such as, “I won’t be your friend if you don’t get help.” Instead, express your concern (“I’m really worried because I’ve noticed that you are skipping meals and have lost a lot of weight”) and be prepared to truly listen. Try to be as non-judgmental of them and their behaviors as possible.
  • Be patient. Even if your friend does have a problem, he or she may not be open to acknowledging it or seeking help right away.  Continue being a supportive friend, even if your friend isn’t ready for help. However, continuing to be the person’s friend does not mean you have to collude with the eating disorder. If your friend wants you to go on a long run with him/her and you don’t feel comfortable doing so, suggest an alternative activity. If your friend wants you to lie to help conceal the eating disorder, it’s okay to say no.
  • If your friend does seek professional help and begins treatment, he or she will need continued support from friends and family during and after treatment. This support can take many forms and does not need to involve talking about the eating disorder – your friend may welcome the chance to do something other than focus on eating disorders. Remember that treatment progress and decisions are between your friend and a medical provider. Of course, if your friend wants to talk about treatment and you are comfortable with listening, that’s fine as well.
  • Avoid making weight- and most appearance-related comments. Weight or appearance-related comments directed at your friend, even positive and well-intentioned ones (“You’re looking so much better”), can be very triggering, especially if his/her weight has changed during treatment. The same holds for making weight- or appearance-related comments about other people in front of your friend. Doing so reinforces the idea that people’s value derives from their weight.
  • Remember that your friend is a complex person who is more than the eating disorder. It’s important to continue to view and treat your friend as a whole person and to continue to have many interactions that have nothing to do with the eating disorder. One of the best ways to help a friend struggling with an eating disorder is simply to be a good friend in general.
  • Don’t beat yourself up if your friend is not receptive to your efforts to help. Despite your best efforts, your friend still may not be receptive to help. Ultimately, whether your friend seeks help is beyond your control. Most importantly, remember not to neglect your own needs – taking care of yourself puts you in the best position to provide support to your friend.

Members of the UNC community who want to learn more about how to support a friend with an eating disorder can register for training through the Embody Carolina website. For anyone outside UNC who would like to learn more, there are numerous online resources devoted to this topic; a quick Google search reveals a variety of webpages, many of them provided by mental health or eating disorder advocacy organization or college counseling services.  For example, the National Eating Disorders Association website has a number of helpful webpages, from, “How to Help a Friend with Eating and Body Image Issues,” to “What Should I Say,” to “What Can You Do To Help Prevent Eating Disorders?” If you suspect a friend has an eating disorder and want to help, learning more about eating disorders is a great place to start.

photo credit: cristianbernal via Creative Commons