When You're Worried a Friend Has an Eating Disorder, It's Time to Make Some Hard Calls

Here's how to decide if you should say something.

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Sep 12 2018, 10:43pm

Alex Holyoake / Unsplash; Illustration by Lia Kantrowitz

For lots of people, the freedom that comes with college induces elation. No supervision, no curfew, no family obligations—the list of “nos” goes on, and that’s seen as a good thing, a rite of passage. But for some people with eating disorders, the independence can cause anxiety.

“Being in a new environment means losing a lot of consistency, predictability, and structure,” says Rachel Davis, medical director of Student Mental Health at the University of Colorado Anschutz Medical Campus. More than ever, food might seem like the one constant in their lives. And without well-meaning parents standing by to nag, they may find it’s easier to hide their disordered behaviors in plain sight.

College is likely the first time that people live with roommates, and these people are often strangers. For those with eating disorders, that might mean it’s the first time that non-family members will see or sense their disordered behaviors. Experts tell us if, when, and how you can talk to a friend who you suspect needs help.

What are some signs of an eating disorder?

Scrap the image in your head of what someone with an eating disorder looks like: Binge-eating disorder, anorexia nervosa, bulimia, and orthorexia all fall under the umbrella, and people who live with these conditions come in all shapes and sizes.

That said, there are some habits to look out for, including a preoccupation with food, weight, calorie-counting, and/or exercise; avoiding or making excuses to miss social events where food will be present; or skipping meals and hoarding food, says Rachel Goldman, a licensed psychologist and clinical assistant professor of psychiatry at the NYU School of Medicine.

The experts I spoke to for this story say other signs of distress include staring at other people’s plates during meals, cutting food into tiny pieces, and eating extremely slowly. Other causes for concern: Your friend regularly rushes to the bathroom post-meal, a sign of purging; works out compulsively, a sign of exercise bulimia; wears overly baggy clothes, not as a fashion statement but to hide how thin they are; or has loads of empty junk-food wrappers hidden in their room, which could signal a recent binge.

“But honestly, the biggest concern is if you never see them eat with other people,” says Stephanie Zerwas, associate professor at the University of North Carolina Center of Excellence in Community Mental Health and therapist at Flourish Chapel Hill. “Eating disorders are incredibly isolating; if your friend almost always eats alone, that’s a red flag.”


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How do I decide whether I should say anything?

College is probably the first time you’re living with people besides family, so make sure you’re not making assumptions just because someone eats differently than you do. Likewise, if you notice a friend skipped dinner last Tuesday or you find a single empty pint of Ben & Jerry’s in your shared trash can, bite your tongue. You have to observe several of these behaviors more than once to support your hunch, Goldman says.

Here are some specific questions she suggests you ask yourself:

*Am I concerned they’re unsafe?
*Do I have concrete reasons for saying something?
*If they deny it, do I know how to respond?
*Am I concerned enough that I need to ask for help from someone else, like a resident assistant (RA) or a parent?

If you answered yes to most or all of these questions, it might be time to sit down with your friend.

OK, but what should I say?

Let’s start with when to say something: Don’t bring it up during a meal or when there’s food around, Goldman says. Instead, find a safe, non-threatening time (like a low-key night in) and place (like your dorm room) to chat.

Now, on to what to say: It’s best to use “I” statements that are rooted in habits you’ve observed (like “I’m worried because I see you [insert concerning behavior here]”) rather than dumping the burden on your friend with “you” statements, says Joel Yager, a professor of psychiatry at the University of Colorado at Denver who conducts research on eating disorders. “Never accuse, judge, or blame,” he adds.

You can also point out the ways that the eating disorder is interfering with your friend’s life, like if it’s causing them to miss out on group dinners or stay in every night, Zerwas says. The National Eating Disorders Association (NEDA) has a list of helpful conversation-starters here.

No matter how prepared you feel, she suggests practicing your opener or role-playing with a trusted family member beforehand. And if you have your own experience with mental illness, consider opening up about it, which signals that this is a stigma-free conversation. “This can show you’re less likely to be judgmental or critical,” Davis says.

Talking about the eating disorder can help your friend feel less alone, but you should also encourage them to seek medical help. If they're resistant, ask them to think about where that hesitation is coming from (like embarrassment, denial, or worry about the cost of treatment), Davis says. "Ask if there are scenarios under which they would consider getting help and if they can commit to it if those scenarios play out," she adds. "Make it about your own concern for their safety, rather than about them having done something wrong or bad."

Is there anything I definitely should not say?

Lots of things—so glad you asked. Avoid commenting on their looks, size, or weight—even if it’s to say your friend looks healthy or strong. “For someone struggling with an eating disorder, those words can get twisted and feel like daggers,” Zerwas says. And mentioning how thin they seem is just as harmful. “The eating disorder part of their brain will be really pleased to hear that they look smaller or like they’ve lost weight.”

Don’t tell them how weird or abnormal their behaviors are, complain about your own weight, or try to convince them that they look fine. “Eating disorders are not logical illnesses,” Davis points out. “You can’t reason someone out of one.”

If they shut me down, how should I respond?

That’s a real possibility. Your friend might feel ashamed or humiliated that you're calling their bluff that everything's fine, Yager says. You can support and advocate for them, but it’s not your responsibility to come up with an easy fix. “It’s ultimately their decision to get better, so you have to have your own limits and boundaries,” Davis explains.

If they deny that anything’s wrong, repeat your concerns and leave the conversation open-ended so your friend knows they can talk to you when they’re ready. (And if you’ve noticed dangerous medical complications like passing out or confusion, it’s okay to ask an RA, parent, or other resource to step in, Davis says.)

What can I do if they’re open to getting help?

You can find out which counseling or health services are available on campus. Have the NEDA Helpline (1-800-931-2237) handy and help them find a therapist who specializes in eating disorders if the on-campus support is underwhelming.

Remember: Your friend might feel vulnerable, ashamed, and alone. One of the most supportive things you can do is offer to walk or drive them to their first session, then hang out until the appointment is over. “Having that extra nudge can make all the difference in starting someone on a path toward recovery,” Zerwas says.

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