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What to do When Someone You Know has an Eating Disorder

By: Lynne Smiley, PhD

Who needs to talk?

  • Friends and Roommates - If you have a friend or a roommate who you think has an eating disorder, then it is best if you talk to her or him first before going to professionals or to her or his family. Several friends can also get together and discuss the problem with this person. In this case, identify a spokesperson to initiate the discussion, so that there will be less likelihood of the person feeling attacked by everyone at once.
  • Family/Siblings - You may want to speak to her or him privately or pull in other family members. Again, identify one person to initiate the discussion. This will decrease the chance that this person will feel like they are being attacked.
When to talk?
Choose a time when you can be calm. Please do not bring this up when you are angry, hurt or upset. You need to stay focused on your concerns with this person and why you think she or he needs help. Getting angry or confrontational, using pleas or threats will shut down communication and he or she will end up being defensive about their behaviors.

What to say?
The more familiar you are with what you want to say, the more comfortable and less anxious you will be. Consider writing down what you want to say ahead of time. Practice with someone, or with other people who will be there. You need to address the following topics in your initial discussion.

What is worrying you?
Be specific with the person's behaviors about eating, purging, exercising, starving, etc. Be as direct as possible: "I hear you vomiting after dinner." If you are indirect, you are conveying the message that you don't want to talk about it. You're being open and up front about their behaviors encourages them to be open and direct.

Use "I statements".

"I statements" help to minimize the feeling of being attacked. Use "I statements" that also reflect your concerns: "I've been worried about you. It hurts me to see you so thin."

Changes in the relationship
If there are any changes that have occurred that have affected your relationship with that person, bring them up. Focus on being supportive -- this is her or his problem, not yours. Oftentimes, the person will try to sidetrack the issue and bring up other issues. Tell the person that you will take the time to discuss those issues at a later date. But, for now, you need to discuss why you think she or he has an eating disorder.

Do not expect the person to stop binging, starving or purging.

Bringing the problem out in the open is only the first step toward recovery. Your job is to support and encourage her or him to talk about their eating disorder. If the discussion is getting out of control, if you start getting upset or angry, then stop the discussion. You can continue at another time.

If you are worried that there is an emergency, and that you need a professional to assess the situation, tell the person you are going to call a professional for advice.

Responses to the discussion
Relief - Many people express relief that their problem is out in the open and they can now talk about it.

Admission - Some will admit that they have a problem and appreciate your support.

Denial - The person may deny there is a problem. She or he may attack you, get angry and tell you to mind your own business. She or he may tell you that you are wrong and there is not a problem or will try to minimize it. Stand your ground and refer back to your own observations. Be willing to admit it is a possibility you could be wrong, but stick to your observations. Remember, eating disorders can occur at all levels and intensities.

When they refuse help
Recovery from eating disorders requires intensive professional treatment and substantial time and energy on the part of the eating disorder person and their family and friends. Whereas the person may refuse help, you have established that you see a problem. It may take the fifteenth time someone says that person has a problem before they will seek help.

If you are concerned that the person is experiencing medically threatening problems from starvation, anorexia, ipecac syrup or medication abuse, please contact professional help at once.

For more information, check out "Surviving an Eating Disorder: Strategies for Family and Friends" by Siegel, Brisman and Weinshel, Harper Perennial.

If you want more information on eating disorders, check out these websites:

Anorexia Nervosa,  
Eating Disorder Awareness and Prevention,  
Gurze Books  
Academy for Eating Disorders