Dealing with the Weirdness:

Suggestions for Family and

Friends in Talking to Loved
Ones with Eating Disorders

Contributed Article By Yong Lee, MD ~ Medical

Director of Remuda Ranch
Completing treatment is a beginning, not an end, to the long
road to recovery. For families, coming home is a time meant
for joy, with possible plans for festivities and socializing.
These are times meant for families to draw closer together
and to re-affirm love and support, a time to catch up on what
has been going on and share with one another hopes for the
future. To the individual suffering from an eating disorder, or
in the throes of recovery, these occasions can be
overwhelming and threatening. We want to be helpful and
supportive, but nothing seems to come out right. What do
we say? How can we let them know that we care and are
there for them, without being so awkward about it?
Those patients who are struggling are often at a loss during
homecoming. They, too, have expectations; and, oftentimes
being perfectionists, they dont want to let down their loved
ones who are worried about them. Not only do they have to
deal with the normal stresses of life and recovery, they worry
that they will faileither their families by engaging in their
eating disorder; or, conversely, their eating disorder by
losing control and gaining weight. Surely, everyone is
looking at them, wondering if they are eating enough, eating
the right things, getting enough rest. Surely, everyone
knows that they just got out of treatment and are talking
about them. They smile and put on a brave face. They
wonder if people are avoiding talking to them. Maybe its for
the best.
Some family members ask innocuously: How are you
doing? Well, they think, before they respond with an
obligatory, Fine, thanks, they feelpretty much like a

failure. Some of them have had to drop out of school, leave

jobs, see their friends move on with their lives as they stay
stuck. What happened to the person who was an honor
student, track star, the one voted most likely to succeed?
Youre at home with your parents? Thats great. Maybe you
can use this time to get closer together. Theres always a
silver lining to our struggles.
Even worse: Youre looking really good. You lookhealthy.
Great, they think, I look fat. This dress is making me look
fat. My face is all puffy. Everyone is talking about how fat I
am. Maybe I need to stop eating right now.
No wonder they sometimes hide in corners, avoiding eye
contact, during family get-togethers. Their body language is
closed, forbidding. Dont talk to me. Dont tell me that
things will get better. Dont ask me how Im doing or if Im
going back to school or if Im done with treatment. Dont ask
me anything.
The best approach is not to ignore the eating disorder
individuals presence, but to approach them with kindness
and sensitivity. Let them know you are glad to see them.
Instead of commenting on their clothing; praise their shoes,
jewelry or hairstyle if appropriate. Maybe you have a happy
memory that you want to share with them to let them know
that they are an important part of your life. Maybe you want
to share something interesting that happen to you to help
take the perceived focus off of them. To engage in
conversation is important and a positive optimistic twist such
as talking about their pets, new people in their lives, or
television shows will go a long way to diminish the
awkwardness. Getting together as friends and families are a
time to connecta time to let each one of us know that we
are not alone, that we are part of something greater than
ourselves, that we are part of a family. You can count on us.
Well be there for you.
Article Contributed by our Sponsor ~ Remuda Ranch
Treatment CenterPublished Date: January 10, 2013
Last reviewed: By Jacquelyn Ekern, MS, LPC on January 10,
2013

Page last updated: January 28, 2013

Published on EatingDisorderHope.com, Eating Disorders
Treatment Information

Approaching someone you care

about
There is no right or wrong way to talk to
someone with an eating disorder and
different approaches will work for different
people.
1. Be prepared
The most important thing you can do when approaching someone
about an eating disorder is to be prepared and educate yourself as
much as possible about eating disorders. The person you care about
may be experiencing high levels of anxiety, shame, embarrassment,
guilt or denial or may not recognise that they have an eating problem.
It is important to take this into consideration and be prepared to deal
with the person if they respond with anger or denial. Feeling angry or
denying that there is something wrong does not mean that the
problem does not exist.

2. Choose a caring environment

Any approach needs to be carried out in a caring manner, in an
environment that can support open and calm conversation. For
example, it can be beneficial to approach the person in an
environment where they feel most comfortable and safe, such as at
home. Avoid broaching the topic if you are around food or in
situations in which either of you are angry, tired or emotional.

3. Use the right language

If you are approaching someone with an eating disorder, you need to

take into account their fear of disclosing their behaviours or feelings.

Let them know that you care about them and that you want to help
them face the problem and support them through every stage of the
healing process.
Below are some helpful tips when talking to someone you suspect
may have an eating disorder:
Try to use I statements; e.g. I care about you or Im worried about
you
Make the person feel comfortable and let them know it is safe to talk
to you
Encourage them to express how they feel; remember, it is important
to understand how they feel, rather than just state how you feel
Give your loved one time to talk about their feelings dont rush them
through the conversation
Listen respectfully to what your loved one has to say and let them
know that you wont judge or criticise them
Encourage them to seek help and explain that you will be there with
them each step of the way
When talking to someone you care about, there are also certain
things you should try to avoid:
Avoid putting the focus on food; instead, try talking about how the
person is feeling instead
Do not use language that implies blame or that the person is doing
something wrong; e.g. You are making me worried. Instead try, I am
worried about you
Try not to take on the role of a therapist or dominate the
conversation. You do not need to have all the answers; it is most
important to listen and create a space for the person to talk
Avoid manipulative statements; e.g. Think about what you are doing
to me or If you loved me you would eat properly. This can worsen
the eating disorder and may make it more difficult for the person to
admit to their problem
Do not use any threatening statements; e.g. If you dont eat right I
will punish you. This can be extremely harmful to the persons
emotions and behaviour and can exacerbate the eating problem
significantly
It can also be beneficial to talk to a medical professional or support
organisation before you approach someone about their eating
problems. Your local specialist or support organisation can help you
further understand the issue and may be able to provide you with

further advice about how to raise the topic with the person you care
about.

HELPINGAFRIENDWITHANEATING
DISORDER
Thisarticlewaswrittentohelpyouidentifythesignsofaneatingdisorder
andgiveyousomeguidanceonhowtohelpafriendwhosuffersfromeither
anorexiaorbulimia.Generallywhenwetalkabouteatingdisordersweare
talkingabouteitheranorexia,adisorderwhereapersonloses15%oftheir
bodyweightasaresultofahighlyrestrictivedietandexcessiveexercise,or
bulimia;adisorderofeatingwherethepersonusespurging,diuretics,or
laxativesafterhavingconsumedlargeamountsoffood.Thereareother
formsofdisorderedeatingbutthesearetheonesthatIllfocusonbecause
theyaretheonesthatstudentsmostoftencometousconcernedabout.Its
alsotruethatanindividualcanhavesymptomsofbothdisorders.

Whatarethesigns/symptomsofaneating
disorder?

ForAnorexia
Preoccupationwithfoodandweightloss(15%ofnormalbodyweight)that
interfereswithdailyfunctioning,relationshipsandselfesteem.
Apersonwithanorexiabecomeshighlyrestrictiveofthefoodstheywilleat;
therearegoodfoodslowcalorieandbadfoodshighcalorie.Thelistof
goodfoodstypicallywillshortenastheybecomemoreinvolvedwiththeir
eatingdisorder.
Someonewithanorexiausuallyengagesinexcessiveexercisingasawayto
controltheirweightandtocompensateforeatingwhatyouandImightthink
ofasanextremelysmallamountoffood(abagelforanentireday,asaladas
theironlymealforthedayetc.)
Becauseofexcessiveexercising,lesstimeisspentdoingotheractivitiesthe
personusetoenjoyincludingspendingtimewithfriends.
Eatinghabitscanbecomeregimented(e.g.eatingonepeaatatime,having
tomovefoodaroundtheirplate,eatingfoodinaparticularorder)
Situationsthatinvolvefoodcancauseanxietyinthepersonwithanorexia
andtheymayavoidthosesituationsaltogether(stopgoingtodinner)

Thepersonwithanorexiamay"explainaway"anyconcernothershave
aboutwhytheydonteatordenybeinghungry.
Cognitivefunctioningcanbeeffectedbytheundernourishmentofanorexia.
Thinkingcanbecomeveryblackandwhiteorconcreteandperceptionscan
becomerestricted.Apersonwithanorexiacanbecomeveryfocusedona
partoftheirbodyandbelievetheyarefatwhenreallytheyaretoothin
Someonewithanorexiamaynoticetrivialweightfluctuationsand
exaggeratetheirimportance(gaining1/10ofapound)
Thereareotherphysicalchangesduetoanorexiainadditiontoweightloss
Lossofmensesinfemales
Developmentofsoftpeachlikebodyhaironthearms
Lossofhair
Oftenfeelingcold,thepersonwithanorexiamaywearlayersofclothing
whichservestokeepher/himwarmbutmayalsopreventquestioningabout
theirweight.
Anunhealthy,sallowlooktotheirskin
Apersonwhoisreallyinvolvedintheiranorexiawilllookundernourished,
whichtheyare,thoughtheydontseeit.
Inreadingthesymptomsofanorexiayoucanbegintoseetheemotional
experienceofapersonwithanorexia.Partofwhatdrivessomeonewho
suffersfromanorexiaisadesiretoobtainperfection.Anorexicscanbehigh
achieversandasaresulttheymaylookprettysuccessfulandpretty
"together"toothers.Thepursuitofperfectionisalsochanneledinto
pursuingtheperfectbody,onewithoutanounceoffat.Theybecome
focusedonlosingweight,andotheraspectsoftheirlivesarescarifiedin
ordertoachievethinness.Friendshipsbecomestrainedasthepersonavoids
eatingwithothersandislessavailablebecausetheyarespendingsignificant
amountsoftimeexercising.Anaspectofhavinganorexiaisthattheperson
withthedisorderdoesntseewhatshappeningtothemasothersdo.What
theyseeisthattheyarelosingweightbutasanyonewhoisperfectionist
theyareneverquitesatisfiedwithwhattheyvelost.Thatsenseofnotbeing
satisfiedwiththemselvescoexistswithasensethattheyareincontrola
feelingthatcomesfromdenyingthemselvesfood,denyingtheirhungerand
pushingthemselvestoexercise,sometimestothepointofexhaustion.Being
anorexicmeanslosingperspectiveonwhattheyaretryingtoachievein
termsofweightlossandwhatlengthstheywillgotoloseweight.Asthe
eatingdisorderprogressesthepersonmayfeelmoredesperateandbecome
extremeintheireffortstocontroltheirweight.Apersonwithanorexiacan

feeltrappedbetweenthepressuretobemorerestrictiveintheireatingin
ordertocontinuetoloseweightandtheirfearofgivingintotheirhunger
andbecoming"fat."
Clickhereformoreonthesigns/symptomsofAnorexia.
ForBulimia
Consumptionofasubstantialnumberofcaloriesoverashortperiodoftime
followedbyanattempttoridthemselvesofthefoodtheyhavejust
consumedeitherbyselfinducedvomitingordiureticuseorexcessive
exerciseorfasting.
Asthepersonwithbulimiabecomemoreinvolvedwiththeireatingdisorder
theywillpurgemorefrequently,sometimesseveraltimesadayandthe
vomitingmaybeinducedalmostatwill,reflexively.
Excessiveexercisingdespiteweather,fatigue,illnessorinjury.
Apersonwhoisbulimicmayappeardistractedbecausetheyarethinking
aboutfoodandwhentheywillbingenext
Theycanappear"dazed"afterhavingpurged,aphysiologicalresponseto
theactofpurgingandfromtheemotionalreleaseofthetensionthatwas
buildinguppriortothebinge/purging.
Frequenttripstothebathroomaftermeals
Signsand/orsmellsofvomiting
Presenceofwrappersorpackagesoflaxativeanddiuretics
Unusualswellingofthecheeksorjawarea
Callusesonthebackofthehandsandknuckles
Stained/discoloredteeth
Electrolyteimbalancewhichcanleadtoheartattacks(KarenCarpenter)
Whilepeoplewhosufferfromanorexiaareunderweightmostpeoplewho
arebulimicareusuallyaverageoraboveaverageinweight.Thepersonwho
suffersfrombulimiaisconstantlythinkingaboutfoodbutfromthe
perspectiveofwantingitandfightingofftheirdesireforfooduntiltheygive
ineatalotandthenhavetopurge.Whereapersonwithanorexiamayhave
afeelingofbeingincontrolthepersonwithbulimiaoftenfeelsoutof
controlbecausetheireatingisoutofcontrol.
Thedistinctionsbetweenanorexiaandbulimiathatarebeingdrawnhereare
forthepurposeofhighlightingthesymptomsofbothdisordersandthe
differencesintheiremotionalexperiences.Inactualitythereisoverlapin
symptomsandemotionalexperiencewithbothdisordersandpeopledo
sufferfromanorexiaandbulimiaatthesametime.
Whatisthedifferencebetweendietingandaneatingdisorder?

Someofwhatcanbedifficultaboutidentifyinganeatingdisorderinafriend
isthat,bothanorexiaanbulimiaappeartobeunhealthywaysof
accomplishingwhatmanypeopletrytodo;managetheamountoffoodthey
eatandloseweight.WhiledietingisanAmericanobsessionsomeofthe
differencebetweenaneatingdisorderandtheculturallydrivenobsession
withdietingliesintheamountofapersonspreoccupationwithfoodandthe
lengthstheywillgotocontroltheirweightandfoodconsumption.Tobe
anorexicistooloseabout15%ofyourbodyweightandtobeconsumed
withthoughtsaboutfoodandweight.Peoplewhoarebulimicaretaking
active,unhealthystepstoridthemselvesofthecaloriestheyhavejust
ingested.Therearealsohealthrisksandhealthrelatedproblemsthatresult
frombothanorexiaandbulimiathatcanbeveryseriousintheshortandlong
terms.
Howdoyoutalktoafriendwhomayhaveaneatingdisorder?
Generalconsiderationswhenhelpingafriendwithaneatingdisorder:
Thereisalotofshameattachedtohavinganeatingdisorderandasaresult
individualswithaneatingdisordercanbeprettydefensiveabouttheir
eatingjustasweightandfoodconsumptionisasensitivetopicformany
people.Ittakessensitivitytothepersonsfeelingsabouttheireatingalong
withconcerninordertohelpafriendwithaneatingdisorder.Italsotakesan
understandingofwhataneatingdisorderisabouttobemosthelpful.
Whilethepersonwhohasaneatingdisorderisthinkingaboutfoodand
weightyouneedtodowhattheycannotlookbeyondthefoodandweight
issueandhelpthemfocusonwhatsreallygoingon.Intheend,eating
disordersarentasmuchaboutweightorhowmuchorhowlittletheperson
haseatenasitisaboutbecomingtrappedintorelyingonfoodandweightas
thebasisforhowapersonfeelsaboutthemselves.Mostpeoplederivesome
oftheirfeelingsaboutthemselvesfromtheirappearancebutthepersonwith
aneatingdisorderreliestoomuchonweightandfoodintheirfeelingsabout
themselvestheirselfesteem.Thosefeelingsofselfesteemfluctuatewith
thetiniestofweightlossorgainoramountoffoodconsumed.Itcanbean
emotionalrollercoasteroffeelinginandoutofcontrolandgoodandbad
aboutthemselvesandonethatishardtogetoff.Youcanhelpyourfriendby
helpingthemtofocusnotontheirweightbuthowtheyaredoing
emotionally.Thebadfeelingssomeonewithanorexiaorbulimiahasabout
themselvesdontbeginwiththeireatingdisorder.Aneatingdisorderoften
startsfromanattemptbyapersontofeelbetteraboutthemselvesby
controllingorusingfood.

Becauseofthecontrolissuesassociatedwitheatingdisordersandtheshame
thepersonexperiences,asmuchasyouwantthebestforyourfriend,itsnot
likelythattheywillgethelpasaresultofoneconversation.Itusuallytakes
repeatedconversationsandnonjudgmentallisteningforapersontofeelsafe
enoughtoactuallytalkaboutwhatsgoingonandthendosomethingabout
it.Treatmentforaneatingdisordercanbesuccessfulbutitishardwon
sometimeswithtwostepsforwardandonestepback.Youllneedtobe
supportiveandencouragingtoyourfriendovertimeastheystruggleto
overcometheireatingdisorder.
Specificsuggestionsforhelpingafriendwithaneatingdisorder:
Talktoyourfriend;mentiontheireatinghabitsbutdontfocusonfoodor
theirappearancetheyalreadyworrytoomuchaboutboth("Youspendless
andlesstimewithusandalotmoretimeexercising.""Youseemtobe
eatinglessandless"."Inoticeyoualwaysleavethetableafterweeatand
whenIseeyoulateryouseemkindofdazed.")
Focusonwhatisgoingonforyourfriendemotionally("Itseemslikewhen
yougetreallystressedyoustopeating.Whatscausingyoutofeelso
stressed?)
Encourageyourfriendtogethelpbutdontforcethem("Maybeyoushould
talktosomeoneaboutthethingsthatarestressingyouout...copingbynot
eatingdoesntseemlikethebestwaytohandleyourstressmaybetheycan
helpyoufindotherwaystocope").
Donttrytogetthemtoeatmoreorlesstheyllexperienceitasyourtrying
tocontrolthemanditcancausethemtofeeloutofcontrol
Ifyourfriendcontinuestohaveproblemswithfoodtalkwithsomeoneabout
whatelsecanbedonetohelpthem.