Before anything else, I want to make this disclaimer abundantly clear: this is all my personal opinion, drawn from my own experiences, my own disorder, and the my own perspectives on what has worked (and what hasn’t) when people have reached out. These guidelines won’t work for everyone. Always take into account your friend’s personality, your level of closeness with them, and any other circumstances that may call for an adjustment of this advice.
1) Be aware.
If your friend (or classmate, roommate, coworker, etc.) behaves oddly or begins to form strange habits, take notice. Skipping meals, frequenting the bathroom (alone) after meals, extreme exercising, an obsession with nutrition contents, excessively talking about food or weight, secretive eating, and sudden weight loss or gain are some obvious indicators. Depending on the duration of the ED, know that they may have developed ways to hide such indicators — or, on the flip side, they may have become so used to behaving this way that they are oblivious to the fact that their behaviors aren’t normal.
There are many lesser-known warning signs of EDs to look out for as well. Isolation and avoiding group activities, low energy levels, frequent sickness or injury, hand tremors, excessive water or coffee drinking, wearing baggy clothes, marks on the knuckle joints, smoking, cold sensitivity, food rituals, seeming withdrawn or anxious in a group setting (especially if it involves a meal)… the list could go on and on.
None of these behaviors are requirements for having an ED, nor is this an exhaustive list. These are, though, some pretty common indications that something is off.
2) Take initiative.
Let’s approach this from two possible scenarios. In scenario A, you only suspect that someone has an ED. You’re probably not sure how to approach them, or if you even should in the first place. My answer to that quandary — in my personal opinion — is that you should always speak up.
What exactly you say will depend on your relationship. If you’re only a classmate, for example, it may be worth hanging back after class one day and asking how things are going, if they feel good in the class, or how their workload is looking. This conversation could give you an “in” to invite them to coffee, lunch, or a study break; if it does, know that your reaching out is probably much appreciated. EDs are so isolating and secretive that, in my experience, the most touching and effective expressions of concern have come from people who I only knew in passing.
If you’re a close friend or family member, you have more leeway in what you say. You may be close enough to feel comfortable saying something outright: “I’ve noticed you using [x] behaviors lately,” or, “I’ve seen some changes in your life and health and want to make sure you’re okay.” Be careful to use a tone that’s concerned and friendly rather than accusatory and entrapping. The most important thing is that your friend has a safe space to talk and share whatever they feel comfortable with. If they deny everything, don’t push it; they could be in denial, embarrassed, or actually not have an ED. Err on the side of caution and believe them. If you’re still concerned after the initial conversation, follow up while remaining gentle and approachable. It’s good to be informed about EDs, but rather than barraging them with scary facts and statistics, it’s much more effective to let them know that you’re concerned and available in specific ways. Offering to have meals with them, go with them to a chaplain or counselor, or plan a healthy social event are all good starts.
In scenario B, your friend has already admitted to having an ED. Believe it or not, your initiative is just as important here as it was in scenario A. In admitting to having this disease, your friend has essentially put the ball in your court. It may not always seem fair, but due to the nature of the illness, one of the best things you can do is remind them that they are not alone. Anxiety, depression, poor self-image, fatigue, and a whole host of other things are plaguing your friend. They are not always going to have the energy or feel worthy of reaching out to you. Take initiative to invite them to coffee, a party, a study break, or anything you would do with a “normal” friend. Even if they say no, knowing that their isolating condition has not caused their friends to forget them is a powerful thing.
3) Watch yourself.
I once had some sweet, beautiful, and very well-meaning friends who knew about my ED accompany me to dinner one night. I was terribly anxious about what I would eat, but happy for the distraction of being with others. As soon as we sat down to the table, though, the conversation turned to the weight of a well-known, curvy female celebrity. She was quickly deemed a “fatass” and lightheartedly bashed for her recent weight gain. I was mortified. I loved these women and was certainly glad that they weren’t walking on eggshells around me, but the whole situation was insanely triggering.
This particular story is just one of many — all too often, I’ve had friends talk openly about how fat they feel, how guilty they are about what they’re eating, or a whole host of similarly jarring things, all while knowing what I struggle with.
I’ve also had numerous experiences where I admit my ED to others and they sympathetically nod, saying that they feel for me because they too have felt fat or gone on a crash diet. While the compassion is appreciated, be aware that it’s kind of demeaning to compare your own struggles to someone else’s. If my friend had a brain tumor, I wouldn’t try to sympathize by bringing up my own migraines, no matter how bad those migraines may be. Instead, responses like “That must be really difficult,” “Do you feel comfortable sharing your story?,” or “What are your motivations for recovery?” are much more welcome.
The one other big comment that’s a no-go is also the most common, even from medical professionals: “You look good.” EDs are not measured by how someone looks, and even if they were, voicing your opinion on someone with a disorder’s size only reinforces the idea that size is what matters. Whether the person looks good or not, NEVER bring up the way they look in conversation. It has so much potential to backfire and just isn’t a mess you want to impose.
But I thought friends aren’t supposed to walk on eggshells? You may be rightfully wondering. Since the above info may seem confusing at first, here are some bullet point tips to help:
– Make the conversation about your friend, not you.
– Choose wording that encourages honesty, not politeness. (Example: “I’m so sorry!” requires your friend to be polite and say “It’s okay,” even if it’s not; “That must be really difficult,” or “Thank you for telling me,” leaves your friend open to say whatever they want.)
– If you think a conversation topic may not be appropriate to use around someone with an ED, don’t use it. If you’re really friends, there are tons of other things to talk about anyway!
– Encouraging comments should be framed about the person as a whole, not their looks or how they’re handling their EDs.
4) Have patience.
This one is pretty self-explanatory. As I mentioned before, your friend will likely battle isolation, favoring their bed or secretive ED-related activities over any anxiety-producing social interaction.
Do not, do not — please, for the love of God, do not — let this drive you away.
Recognize that when they decline an invite they would normally accept, it’s the ED who declined, not them. Recognize that when they stop responding to your texts, it’s because their brains are in overdrive, not because they don’t value you. Recognize that you, as a fellow human being, are the most powerful weapon they have against so many of their battles, but they’re scared to use you.
Even at their worst, your friend is still there underneath it all. Whether it’s a few months of outpatient treatment or years of being in and out of hospitals and residential, recovery is possible, and you’re not going to want to miss getting to meet the friend that comes out on the other side.
5) Ask questions.
You’re curious. I know that; my blog wouldn’t get so many hits if it weren’t for pure curiosity. And guess what? That’s more than fine! I love it when people ask me about what EDs mean, how my life has been affected, or what treatment involves.
Not everyone is at a point where they’re ready to share that much, so use your best judgment when asking and always offer your friend a chance to decline the question.
Obviously, avoid talking numbers (weight, calories, BMI, etc.) or asking anything that implies wanting to know a number.
The more you ask, though — especially about treatment, recovery, and what your friend finds helpful — the more you know what to do.
6) Set boundaries.
When EDs control a person, they can act bizarrely. It can be anything — expecting a call every day, unloading seriously depressive thoughts onto you instead of their therapist, being unreasonably hurt if you’re not available when they need you — but no matter what it is, sometimes boundaries need to be set, especially if you’re prone to depression or anxiety yourself.
Judge for yourself how to approach this conversation with your friend. If you need a guideline, here’s what I usually do when a friend is overstepping boundaries:
– I first ask if they’ve spoken to their therapist.
– I honestly tell them that I wish there were something I could do to help them, but I’m not qualified.
– If it’s an issue like those mentioned above (a friend expecting too much of my time or emotional energy), I remind them that I have my own things I’m going through and am not equipped to help them while remaining in a healthy place myself. I then redirect them to whatever professionals would be of better help.
It could also help to set these boundaries ahead of time. If a friend tells you about their ED, giving them constructive feedback on what you’re available to do not only presents you as a good friend, but also conveys what you’re not able to take on. For example, if A were to tell B that he has an ED, B could respond by saying that she will eat dinner with him twice a week, always get back to his texts within the day, and study with him on weeknights if they’re both free. This way, A won’t feel bad asking these things of B if the need arises, but A also knows that B is not the one to call during a 3 AM breakdown.
7) Seek support.
Depending on your relationship and emotional investment in this friend and considering the severity and duration of the ED, there is strength in seeking support for yourself. Compassion fatigue is a real thing, and its consequences can be devastating. The best way you can be there for someone else is by being stable yourself. It is so important that you don’t leave your friend with the ED behind just because you can’t handle it, so seek support wherever you can find it, and seek it earlier than you may think you need it. I recommend counselors or chaplains instead of fellow friends as people to talk to, since you don’t want to venture into gossipy territory. For more resources, nationaleatingdisorders.org is a great place to start.
Dance. Don't Apologize. 