when a friend has an eating disorder: what to do, what to say, how to help

source

 Eating disorders thrive in secrecy and lies. So what do you do when a friend or loved one is open about it, but not yet really committing to heal themselves? How can you possibly support someone while they destroy themselves? Because eating disorders, body image, and recovery are a few of my favorite things to talk about (along with sex, Smith College, and baby animals) and because I love breaking the secrecy and taboos that surround them, I get asked about this pretty frequently from lots of different people. Recently, a high school classmate sent me this:

This is a bit out of the blue, but I know from having read your blog and such that you have done an amazing job at overcoming an eating disorder. I could really use some advice. A close friend of mine has been bulimicfor  years. For awhile it stopped...or at least she stopped doing a lot. Recently it has gotten really bad. She is in therapy, but her bulimia seems to be coming second to other problems. So basically I need advice on what to say to her. She knows she has a problem, but says she can't stop. Recently she started telling me every time she throws up, so i know she is reaching out to help but I never know how to respond to her saying things like "my nail is really weak from all the stomach acid it touches" and "I've throw up all my food today." Advice?

My (slightly edited) response:

First of all, let me say your friend is clearly very lucky to have someone who cares a lot about her and is standing by even when things are rough. It can be really hard and scary to bear witness while someone you care about it participating in self destructive behaviors, so props on that.

That being said, it kinda sucks to be in your position in this scenario.

The best thing you can do (even though it feels helpless and is really hard!) is to listen openly and without judgment. Express your concern when appropriate ("Wow, your nails are really weak from stomach acid...that makes me worry about your health" except maybe said in a less cheesy and scripted way) and let her know that you support her in any efforts to get help and decrease/stop purging, but that it's also a behavior you hate. Bulimia is incredibly hard to stop once it's a regular behavior because it actually is physically addicting (the body releases endorphins after you puke), so I'm sure she genuinely does feel that she can't stop.

You should also be prepared for someone with an eating disorder to be lying to you at any moment about it, even if they've been honest in the past: for them, it's a very effective coping mechanism for the stresses of life/trauma/a million other things, and when a well-meaning someone threatens that coping strategy, they will most likely get defensive and lie to keep it protected, secret, and theirs. But be aware that it's not personal.

source

But damn if those awkward statements of ED nastiness don't suck. I know I used to say a lot of fucked up shit too, not necessarily for attention per se, but just to have someone acknowledge that I was indeed sick and deserved help. In the moment of awkward statements...You can tell her straight up that you want her to continue being honest with you, AND that comments about her habits and their effects make you tremendously uncomfortable because you're not sure how to support her...and then ask how she wants you to support her. Often times, people with ED/addictions/any problem know what they need and want from their loved ones but don't know how or when to say it, so by opening that space you're doing your friend a huge favor.

Be clear on what you're willing to do to help her handle her urges to purge or skip meals or exercise unhealthily (i.e., maybe you'd be willing to talk to her on the phone when she gets an urge anytime, or you'd come over and paint her nails [a great method for me when I was getting over bulimia because I couldn't make yourself vom with polish all over!], help her find a treatment center for ED, whatever), and then make good on it. Make sure that it is indeed something you can commit to helping with, because there's nothing worse than them reaching out to you and you being unable/unwilling to follow through. Just woman up and tell them what you can feasibly do to support them.

Of course, in general it helps to model positive body image/attitudes towards food/avoid negative commentary on anyone's body/take care of your own mental health needs, but all of that is just fluff when someone is really sick. But it certainly will help you keep yourself in a healthy place, regardless of whether or not they're positively impacted by it.

Have you ever struggled with a friend with an ED and how to talk to them about it, especially when they went out of their way to mention it? How did you deal?

Much love,
The Sheriff