When a Friend Has an Eating Disorder
If you have a friend with an eating disorder, you are not alone. Some estimates are that as many as 1 in 3 college women have struggled with disordered eating while in college. Chances are, if you are a female college student, you have experienced your own struggles with weight, food, and body image - whether or not you have had bulimia, anorexia or compulsive overeating. Certainly, among your friends and acquaintances there are women and men who have an eating disorder.
Perhaps you have become aware of your friend's problem because you have observed her weight changes, or you feel uncomfortable with her preoccupation with dietary restriction, or you have become aware that she abuses laxatives or vomits to purge herself of what she eats. You feel concerned and wonder how to bring up the subject with her. You worry that she will feel "accused" or "diagnosed" and that she will be angry with you. You do risk introducing negative feelings into a relationship when you discuss such difficult topics, but not doing so risks straining a relationship through not being open and honest with one another. Also, hearing honest concern from others helps break denial and often is the first step on the path to acknowledgement of the problem and getting help.
What Can You Say?
First of all, you can make sure your friend knows you care and are interested. You might say:
"I'm here for you if you need me. I know you're struggling with a lot of stress lately. Let me know how I can help."
You may want to go further and share with her/him what you have observed and speak of your concerns about that more directly. For example:
"I've noticed you've lost so much weight, John, and that you're still dieting and losing. I'm worried about your health."
"It seems like we're always talking about weight and food and exercise. You seem so worried about it and so unhappy with the way you look. It bothers me. I'm starting to think that maybe you don't feel very good about yourself and that maybe you're depressed."
"Jane, I heard you vomiting 3 times last week. I know when that happened before you said you had the flu. I'm really worried that it's more than that. I'm scared something will happen to you."
What to Expect
Your friend may deny or minimize, or she may say she "used to have a problem" and is better now, or she may acknowledge the difficulty and want to talk about it. If she denies it and wants to avoid it, you may have to be satisfied to have expressed your concerns directly to her and let it be, for now, letting her know that you are still her friend and are there to talk if she wants to. If her constant discussion of her weight and what she eats interferes with your relationship, you may have to put some limits on that behavior. Those topics can be declared off-limits in your conversations with each other. If you are disturbed by her restrictive eating, you may not be able to have meals with her.
If you are concerned that your friend may be in some medical jeopardy and feel you must do more than just express your concerns to her directly, you may want to approach a dorm counselor, a dean, Counseling and Psychological Services (CAPS), Health Services or Health Education staff for more advice.
If They will Talk about It
If your friend is willing to talk and be open about the problem, of course it helps if you can listen empathically and without judgement. Admittedly, it is hard to understand why someone who is attractive, appealing, and well-liked would think they are "fat and ugly," or why someone would feel they needed to vomit if thay had been "bad" and had a chocolate chip cookie. It is so tempting to try to use logic, reality, and reason to talk someone out of these "irrational" ideas. One of the most helpful things you can do is facilitate the person's accessing professional help. At Brown, this is where Health Education, Health Services, and CAPS come in. At Health Education, a registered nutritionist is available to see students individually to help evaluate their nutritional status and eating patterns. Health Services professionals provide medical evaluations, and CAPS professionals evaluate the overall eating disorder in the context of the person's current and past life, providing treatment recommendations.
What is Not Helpful
One thing is almost NEVER helpful: monitoring what someone eats. To be told what to eat and/or how much to eat, or to be watched while eating, would create a problem with food for any of us. Resist the pull to comment or advise your friend about his/her eating.
Change the World, Too
There is something else we can do to help friends who are suffering from eating disorders; something that can enhance our well being and that of the community at large. We need to do all we can to eradicate "fatism". It is a form of prejudice and discrimination just like racism or sexism. It is based on the assumption that there is only one "right" or acceptable way to look. It equates thinness with attractiveness, intelligence, ambition, success, and worthiness. There is no room for variety, for difference, for valuing how we REALLY look instead of how we're "supposed" to look. What a wonderful world it would be if we focused on how we all feel instead of how we all look. What if there were other ways to know that we are ok deep inside, aside from how much we weigh, or how small our waist is, or how big our biceps are? It will take a lot of effort on all of our parts to change the way we think. Let's start now. We can create an environment where our self-doubt and unfulfilled longings don't have to be expressed in a war against our bodies. For more information about body image and eating concerns, visit the Brown Health Education Patient Education Page.