There's a lot to consider when a friend is struggling with an eating disorder: How can you support them in a meaningful way? What can you say that will actually make a difference? What should you absolutely never say? In recognition of National Eating Disorders Awareness Week (February 25 - March 3), we're bringing you some advice from the experts on how you can help a friend coping with an eating disorder.
This might seem like the most obvious advice on the planet, but it's actually more complicated than it sounds. It can be hard to hear someone talk about their deep pain, but part of supporting your loved one means listening to them when they initiate the topic. "Listen without trying to fix or soothe," says Liz O'Carroll, a holistic health coach who struggled with disordered eating for over two decades. "Disordered eating leads to hypersensitivity around body image and food and usually distorts perceptions around both to the extreme. As a result, just listening without offering reassurance (which may or may not be triggering in some way) is the safest route."
Karen R. Koenig, a licensed psychotherapist, recommends being prepared for the fact that your friend may not want to talk about what they're going through. People coping with eating disorders have shame around their behavior and around food, so while you might be prepared for them to process out loud, leave room for the fact that they might want to talk about everything but. "Do what you can to help and neither give up on your friend nor expect that it’s your job to fix him or her," Koenig advises.
A person with an eating disorder may have a tendency to isolate––out of shame, avoidance, or a desire to hide their behavior. You can respect their personal space and reach out at the same time. "You can offer to go to a doctor or clinic with them. You can have a phone number of a hotline or a community resource ready to share if they agree to seek help," says Sal Raichbach, PsyD, of the Ambrosia Treatment Center. Remind them that you're in their corner, and ask what you can do for them. Suggest that you hang out in a context that doesn't revolve around food, like going on a walk. Whatever you do, don't give them an ultimatum. "You should also never threaten to avoid them or try to pressure them or guilt-trip them into getting help," says Raichbach."These actions will only risk making the situation worse."
"Learn as much as possible about your friend’s eating disorder," says Dr. Kristen Fuller of the Center for Discovery, a treatment center for adults and teens dealing with eating disorders, mental health issues, and substance abuse. "What can you expect from treatment? What causes these eating disorders? What are the commonly misguided myths associated with these eating disorders?"
There are tons of great resources available about eating disorders (National Eating Disorders Association, National Association of Anorexia Nervosa and Associated Disorders, Eating Disorder Hope, and Binge Eating Disorder Association, among others). While your loved one might want to talk about what they're going through, it's not their job to teach you about their experience, or to speak for all people with eating disorders. Therefore, it's vital to acquaint yourself with how eating disorders work, while keeping in mind that every person is different.
Avoid talking about diet, weight, and appearance
You might think you're engaging in casual chatter when you talk about diet, weight, or eating, but, says Sunny Yingling, a registered dietitian specializing in eating disorders based in Fresno, California, one of the most important things you can do for a friend with an eating disorder is to straight up avoid all of that. "Eating disorder patients are often ‘triggered’ by these topics, leading to urges to engage in eating disorder behaviors."
The same goes for commenting on appearances (yours, theirs, a stranger's) — just don't do it. "You look thin" might seem like a compliment to you, but it could further reinforce destructive behavior for your friend. It's important to get in touch with your own ideas about food, weight, diet, and appearance, and be aware of how you might be projecting those. "If you feel like you are in a negative mood, it may be safe to stay away from your friend for the time being as negative energy can be a trigger for them," advises Dr. Kristen Fuller.
Recognize your limitations
The truth is that unless you've gone through an eating disorder yourself, it's impossible to genuinely understand what your friend is going through. That said, listening can go a long way, and so will the knowledge that recovery for your friend is ongoing and will likely be a bumpy road.
Jessica Mehta is a self-described anorexic/bulimic who was diagnosed in 2012 and a PhD student studying the intersection of eating disorders and poetry. "Many people in the eating disorder community liken eating disorder to alcoholism, in the idea that there is no ‘cure,’" she says. "An eating disorder can certainly be managed for life, but since it is a mental disorder there is no way to ‘fix' an eating disorder. It's something a person will have for life."
"Relapse is common. You can't control lapses or prevent them from happening but make sure the conversation is kept open and don't get complacent with prioritizing self-care and compassion," says Emmy Brunner, a psychotherapist, spiritual recovery coach and the founder of The Recover Clinic, the UK's leading Eating Disorders and Body Dysmorphia Disorder outpatient service. "Often when people start to feel better, they think they don't need to take as good care of themselves and they can hit the deck quite quickly. Dealing with eating disorders is a process; recognition and awareness are key to helping someone/yourself along the road to recovery. Over time, you become more prepared to recognize the signs and deal with them in the moment.”
The odds are that you clicked on this piece and read it because you're invested in helping your friend feel the best that they possibly can. That's amazing, and you are an excellent friend. And don't forget to take care of yourself while you're taking care of them.