How Do I Talk to a Friend or Family Member With An Eating Disorder? (Or You Suspect They Do)

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This is 2017’s National Eating Disorders Awareness Week, and I’m excited to be writing a few posts based on requests.

My first post is how to talk to a friend or family member with an eating disorder or who might have one… from my perspective as someone in recovery. While I was struggling through the years, I heard from friends and family that they felt powerless. It was like watching a sinking ship and not knowing if they could do anything to stop its demise.

While it is impossible to cure another person, friends and family members are NOT powerless. I think about the camp counselor who talked about her own eating disorder openly without shame while I was symptomatic but not yet diagnosed; the friend who reached out to the school administration when she was concerned about me; my mom who spent countless hours trying to understand why I wouldn’t eat. I might have resented them at the time, but now I know that they planted seeds that would bear to fruition later. I didn’t enter recovery in their timing, but it did happen.

I will forever have memories of friends, family members, professors, and co-workers expressing their concern to me over the years. If you think that your words don’t make a difference or impact to someone deep within an eating disorder, you’re wrong.

I will give a cautionary note, however. For every good friend who expressed concern and gave me unconditional love during my journey, there was another who met me with insensitivity and stigma.

Talking to someone with an eating disorder can be a tricky endeavor. On the one hand, you want to express love and concern, but you don’t want to do so in a way that is off putting or hurtful.

In this blog post I will be outlining some “do’s and don’t’s” derived from years of experience of what has and hasn’t helped me.

  1. Do ask about it…

… but try not to probe or make assumptions.

Bringing up your concerns with someone you believe to be struggling can be anxiety provoking. It is a whole lot easier to pretend everything is okay. However, if you have a sinking feeling that something is wrong, and you are close enough to the person to broach the subject, by all means consider it.

Before you do so, consider these two things:

a) Don’t push it– If you bring it up and are met with defensiveness, it might not be the right time to talk. People with eating disorders can be highly secretive. In my deepest stages of denial and shame, I avoided all conversations about how I was doing. I remember how one time prior to admission to residential treatment, a teacher asked if I had an eating disorder. Taken aback, I mumbled something about having a rare digestive disorder. I wasn’t ready to admit how out of control or scared I was. Eight years later, I still remember that conversation as formative. She did not push the issue but expressed concern, and that meant a lot. Even though I wasn’t in a place to talk about it at the time, I respected her for bringing up the subject.

b) Check your assumptions– In society, we tend to associate eating disorders with “thinness” (whatever that means), but that’s just not accurate. Most people with eating disorders are not underweight. Anorexia is the most rare eating disorder, and bulimia and binge eating disorder are more common. People with eating disorders often fluctuate between periods of restriction, bingeing, and purging. I know some of my most symptomatic, out of control times were when I looked healthy. Don’t automatically assume that someone’s thinness is anorexia. It might as easily be a thyroid issue, an autoimmune disease, drug abuse, or simply body type. Similarly, don’t assume that someone doesn’t have an eating disorder because they appear to be healthy.

I have a “spidey sense” in my judgments about whether someone has an eating disorder, but I can be wrong. I am also careful about bringing up the subject of a possible eating disorder. Far before I bring that topic up, I make sure to talk about my own experience, normalize the reality of eating disorders, and check the facts.

. . .

2. Do seek consultation…

… but avoid gossip.

I can’t tell you how horrible it feels to know that people have been talking about you in the whispers you slightly overhear as you pass by and in hushed conversations you know have happened. I think by all means people learn more about eating disorders if they suspect a problem in a family member or friend. Education is important. Talking to a dietitian, therapist, or an organization like the National Eating Disorders Association can be a great move. HOWEVER, when that trickles into gossip and shaming, it stops being helpful.

Sometimes a family or friend group might need to get together to discuss how best to broach the subject with a loved one, but as soon as it turns into judgment and teasing, it can become toxic.

A note about consultation: It is strangely easy to read an article from BuzzFeed or some other reputable source (joke, but in full disclosure, I love BuzzFeed) and think you’re Dr. Phil or something. “Is it about control?” I’ve had people ask me in condescending tones. As if that comment is unique and your therapist hasn’t talked about control 900 times. Eating disorders *can* have an element of control, but it is ALWAYS much more complex. Eating disorders are associated with a cluster of things that may or may not be related: psychological factors, personality types, presence of past trauma, significant stressors, biological predisposition, family history, etc. A cursory look at a non-scientific article or watching a horrible Lifetime movie about anorexia cannot make anyone an expert.

. . .

3. Do express concern about eating habits…

… but don’t do so during meal time. 

Eating with someone you’re almost sure has an eating disorder is difficult and uncomfortable.

It is SO tempting to reach across the table and critique a meal choice, or say something like, “Is that all you’re having?”, or, “Why aren’t you eating more?” In my experience, those conversations are never helpful. The person with an eating disorder, who is likely anxious from the experience eating out, is on guard and gets defensive fast.

I get it– meal time seems like the most logical time to express concern. After all, it is commonly thought that meal time is in fact the problem. When I was deep into my eating disorder, going out to eat was SO MUCH more than an hour at a restaurant. It was the fasting before and after; it was the fear of eating in front of people; it was planning a binge later in the night so I didn’t have to eat in front of people; it was looking up the menu online beforehand; it was counting calories hours before I stepped foot in the restaurant.

It is better to bring up the specific behaviors later in the day when meal time is over. Stick to the specifics about behavior and don’t make it personal. An example: “I noticed when you were at dinner tonight, you ordered a low calorie entree, and you kept putting parts of the meal in the napkin on your lap.” –> I know, easier said than done!! I’ve been the recipient of a lot of insensitive mealtime comments, but I’ve also given some insensitive mealtime comments to friends I knew were struggling. I get it: Frustration can mount in the moment at mealtime, but try to hold off until later. You’ll end up having a much better conversation.

. . .

4. Do focus on food…

… but look at the greater picture, which has a whole lot more to do than just food.

Someone I knew in graduate school said something to the extent of, “I don’t know why families don’t lock the family member with an eating disorder up and force the person to eat.”

While that is absurd, I have heard so many comments that are similarly invalidating and off base:

“Just eat.”

“It’s not that hard.”

“Don’t make this such a big deal.”

That approach doesn’t work.

Eating disorders are both about food and not about food. Of course, eating disorders are highly related to weight and food habits (that’s why they’re called eating disorders) but in some respects have little to do with food.

Restriction was my teenage coping mechanism to deal with a lot of internal chaos– undiagnosed generalized anxiety, crippling OCD, existential anxiety, depression, and feelings of hopelessness, and worthlessness.

In my years of being symptomatic, I was way more likely to talk about those things than my eating habits. I hated when people would make it seem like gaining weight or eating would solve all of my problems. My eating disorder served multiple functions in my life, and until I dealt with those, I didn’t get truly better.

On the other hand, eating disorders are necessarily about eating.

If someone is underweight or malnourished, it is impossible to look adequately at the big picture. Medical, nutritional recovery is a precursor to psychological recovery.

Sometimes in more psychoanalytic approaches to recovery, it is conceptualized that when a person deals fully with the psychological parts of the eating disorder, the symptoms will dissipate. That also doesn’t work.

If you are bringing the subject up with someone, consider the rather paradoxical statement that eating disorders are about eating, but they don’t give us the full picture of what’s going on.

. . .

5. Do take action if necessary

… but think it through first.

Eating disorders are dangerous.

Period.

It is well-known that anorexia has one of the highest mortality rates of all mental health issues, but it is definitely possible to die of bulimia or binge eating disorder too.

The first thing I tell people who haven’t gotten into treatment is: SEE A DOCTOR.

Eating disorders can be associated with some serious medical complications that can kill including (not an exhaustive list): potassium/ electrolyte imbalance, low heart rate, low blood pressure, and general heart abnormalities (that’s why people with eating disorders must have regular EKG’s).

I will reiterate here that someone of average weight, overweight, or obese can die of an eating disorder as well. All of the above medical problems can happen to a person at 70 pounds or 370 pounds.

That is why if you truly suspect a loved one or friend has an eating disorder, don’t stay silent.

In all three of my three major anorexia tail spins, the initial descent into the illness and two subsequent relapses, I needed intensive medical intervention to get back to normal. Two of those times, it was not of my own choosing. Friends, family, and even my school had to intervene on my precarious downward spirals, and thank God they did. Otherwise I might not be here right now.

With that said, if you are seriously concerned about someone who is NOT getting treatment for an eating disorder, there might be cases in which you should advocate for medical consultation or even hospitalization.

For someone with a SEVERE and UNTREATED eating disorder, it could be that lovingly suggesting a trip to the doctor or ER for a medical evaluation is what is needed in the moment. Or, perhaps looking up residential treatment options and calling the person’s insurance company for help.

** Now: Before you attempt this kind of conversation with someone, heed caution! Most people who are diagnosed with an eating disorder have a treatment team or are getting support of some kind. If that is the case, step back and offer support in other ways. Suggesting hospitalization or a doctor consultation additionally has a high likelihood of pissing off the person’s eating disorder, so be prepared that you will likely be met with resistance.

There are some cases when this kind of conversation happens more organically: For example, if a friend passes out or complains of heart palpitations.

. . .

I think the reason many people don’t express concern to a friend or family member about what they’re seeing is out of fear. I get it– it’s scary. People don’t inherently know how to bring it up or what to say.

You are brave and caring to consider having a conversation that might save a life. Sometimes simple comments can go a long way, things like:

“I love you, and I’m concerned about you.”

“It seems like you’ve been struggling lately, and I want to help.”

“If you ever want to talk more about what’s  been going on for you, I’m here for you.”

For more information or to take a free screening, check out NEDA’s website.

In keeping with the National Eating Disorders Awareness Week slogan for this year, I’ll finish with this: “It’s time to talk about it.”

Eating Disorders Kill, But Relationships Heal

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Fall 2009

Charlotte: Five years ago, the story was much different. Numbness and deprivation had drained my body of life, and vacancy replaced life in my eyes. Every night, I would pray that my heart would keep beating another night. I was spiraling into darkness, snowballing so fast that I wondered when and where I would crash. I eventually did crash, and landed on a ranch in Arizona, of all places. I had no hope but also nothing to lose by giving hope a try at residential treatment.

Janine: For over twenty years, anorexia had been the albatross around my neck. I had attended a long list of hospitals and treatment programs that seemed like one failure after another. As a last chance to evade death, I exchanged the towering evergreens of the Canadian west coast for the Arizona desert. My thoughts were jumbled in a fog of starvation and self-hatred. Anorexia had promised me everything, yet it had left me barely existing.

***

It sounds like the beginning of a bad, if not odd, joke. So this Canadian and Michigander walk into a ranch in Arizona… We, the writers, Janine and Charlotte, would never have met outside the confounds of one specific time and place: residential treatment for our eating disorders in 2009-2010. While our backgrounds were very different, in nationality, interests, and phases of life, we did share the same desperation for something better than living in the torture of anorexia. So we, along with others in our program, embarked on a journey that involved nourishing ourselves spiritually, emotionally, and physically. We cried with one another but also laughed and read books for pleasure. We ate pie on Thanksgiving and talked about identity and God. It wasn’t easy, or remotely close to easy even, but we healed together. We could see the tangible changes in ourselves. We could feel that we were no longer lifeless bodies anymore. Leaving treatment, we had hope again.

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Christmas at treatment 2009

Five Years Later:

Janine and Charlotte remain best friends. In many ways, our lives are so different now, now that we are less marred by our eating disorder scars. We are no longer treatment friends: we are just friends. We enjoy having adventures together. We have gone ziplining in Whistler, British Columbia (much to Charlotte’s terror/ chagrin) and to Disneyland (twice). While 1000+ miles separate us right now, we are intentional in maintaining our relationship through the wonderful development of Skype. Our eating disorders left us hopeless and incapacitated, but slowly, sometimes at a snail-pace, we have found freedom. In our respective ways, we want to help others out of their struggles within our spheres of influence. We would never have chosen to meet how we did or have anyone suffer in the ways we have, but we would never have changed the fact that out of the living hell of an eating disorder, an amazing friendship blossomed.

janine and i recovery

Charlotte: Treatment was a beginning of a new life chapter for me; not one filled with rainbows, unicorns, popsicles, and the end of all struggling forevermore, but one filled with real emotions, thawing, pain, and joy. In treatment, I felt unconditionally accepted and loved during one of the worst points of my life. I never believed that anyone could love all of me, even the ugliest parts. The abundant love and grace I received helped me emerge out of deep shame so I could deal with the factors that had led to my eating disorder in the first place. In the last five years, I moved across the country and then back to the Midwest and somehow earned two master’s degrees in the meantime. Although I still struggle with eating disorder behaviors at times, I believe there will be a day when that won’t be the case. I am so blessed by loving friends (such as Janine!) and a therapist who deserves an honor. I couldn’t be on this journey without them. Relationships don’t inherently heal eating disorders, but support is an integral part of recovery. While I wouldn’t wish my wild, roller coaster journey onto anyone, it is my story, and I am thankful for the beautifully chaotic mess. It is my story to own and love.

Janine: I catch myself once in a while realizing how different my life is now. A moment during work when I can’t believe I’m back doing what I love. I’m able to bring energy and enthusiasm to my job working with children that I couldn’t possibly have done when my eating disorder ruled my mind. I don’t think twice about eating cupcakes with my little nieces or laughing with friends over dinner. I am no longer numb and terrified all the time. I’m able to feel the amazing and wonderful parts of life and no longer attempt to dissolve into oblivion when the guaranteed challenges arise. Recovery has not made life perfect for me, but I am able to make plans for my life that I never thought possible. Nothing about recovery has been easy but I know it has been made easier by my unexpected and unlikely friendships.

50 Shades of Disordered Eating

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Marya Hornbacher writes, “I look back on my life the way one watches a badly scripted action flick, sitting at the edge of the seat, bursting out, ‘No, no, don’t open that door! The bad guy is in there and he’ll grab you and put his hand over your mouth and tie you up and then you’ll miss the train and everything will fall apart!’ Except there is no bad guy in this tale. The person who jumped through the door and grabbed me and tied me up was, unfortunately, me. My double image, the evil skinny chick who hisses, Don’t eat, I’m not going to let you eat. I’ll let you go as soon as you’re thin, I swear I will. Everything will be okay when you’re thin. Liar.”

This week marks the National Eating Disorder Association’s annual awareness week, and the theme this year is, “I Had No Idea.” Fourteen years ago, I didn’t know anything about eating disorders. I was creating dances to Five for Fighting songs, eating Mackinac Island fudge (it’s a Michigan thing), and reeling from loneliness alone in my room.

I knew that I was miserable, that I needed middle school to end. I knew that there was a void that hours of studying a day and my endless quest to be good enough would not fill. There was a hole in my heart, and I believed that if I could fend off my age-appropriate weight gain, maybe I would feel better inside.

What I did not know is that starting on a seemingly harmless diet would turn into a rabbit hole of misery that would continue into my late 20s. I did not know that my personality traits, perfectly suited to anorexia’s grip, genetics, and my social context would culminate into the perfect storm that would change me so much, so fast, that I barely would recognize myself.

I have a picture of myself on a Florida beach on my 13th birthday, my eyes squinting at the sun. I am rocking a one piece turquoise suit, and I look… happy. I wonder if I could talk to that 13 year old now, what I would say. I wish I could hold her hand and tell her that she doesn’t have to worry about overeating at the breakfast buffet the next day. And that middle school is horrible for a lot of people. Far too many raging hormones and mean girls.

Just 2 months later after I turned 13, I have another picture of myself in a state of complete starvation. I still thought I was “fine” at that point, but my eyes tell another story. They are vacant and lifeless. My life had changed drastically as well. My Saturday morning choreography sessions had shifted to compulsively reading cookbooks and taking naps from starvation fatigue that zapped away all my energy. I was drifting farther and farther from reality.

Over a decade has passed since my eating disorder’s initial onset. I have been through more than 50 phases of restricting, bingeing, and overexercising. Here is the difficult part– I am extremely hesitant to mention the specific behaviors that I’ve done and the abuse I’ve put my body through, because I don’t want to have anything be a “how to” or trigger.

I’ll let’s put it this way: my eating and exercise over the last decade and a half has been a play in the theater of the absurd. I’ve done figure 8’s with my cyclical behaviors and manipulated people and reeled in physical pain. There have been compulsivity, vegetables, and bizarre safety foods. Revelation of the remaining 47 shades can be left to one’s imagination, or preferably, dismissed entirely. The details are irrelevant, really.

The end result has been pain for me and others… financially, relationally, physically, spiritually.

I wouldn’t have put the last 14 years onto anyone, even my worst enemy.

Sadly, I did not receive adequate early intervention for my eating disorder. Instead of hearing about eating disorders in my health class, I learned about nutrition from my liposuction, weight-loss obsessed nutrition teacher. In gym class, instead of hearing a single thing about eating disorders, I was subjected to public weigh-in’s (can we just all agree that those are shaming?).

When my eating disorder was in its infancy, I saw a therapist who stared at me for the majority of our sessions… awkward for both of us, I’m sure, and definitely not therapeutic. I lied outright to my first (okay, first few) dietitians. My doctor told me I would be sick for the rest of my life.

That is why NEDAW’s 2015 theme of early intervention is near and dear to my heart (take a free screening for ED’s here).

I implore you: take this week to educate yourself about eating disorders. You never know who you know who will thank you for the information you have. And I’m not just talking about learning only about anorexia and bulimia… read about binge eating disorder as well! It was only just “officially” recognized in the DSM-V, but it still lacks recognition but is more prevalent than anorexia and bulimia, and it can be very dangerous.

The bottom line is this:

Eating disorders are not sexy, enviable escapades. My stomach hates me (despite my profuse apologies to it), I have paid hundreds of thousands of dollars just to be here and alive writing to you today, I am constantly at risk of relapse, and I can no longer remember a time when I was completely normal about food because I’ve lived longer with an eating disorder than without it.

Early intervention and education are so important. I wonder still if I were 13 right now reading these words, taking an online screening, and hearing about eating disorders in health class instead of liposuction… would things have been different? Would I have had fewer years of suffering?

I don’t know. But I will do anything I can to prevent others from going down that road.

Nobody wants 50 shades of disordered eating. I mean how much more horrible (and less sexy) of a movie would that be? I would not see that movie. I have lived that movie. And it sucks.