Support People

How do I know if someone has an eating disorder???

There is no way to know unless you ask, and even then, many people deny or hide the fact that they are struggling.  The following are some signs and symptoms that may be present.  

Mental:

• Distorted body image
• Preoccupation with appearance or weight
• Low self-esteem
• Feelings of worthlessness
• Perfectionistic
• Mood swings
• Depression, feelings of hopelessness
• Poor concentration
• Anxiety

Physical:

• Marked weight fluctuations
• Hair loss
• Dizziness, headaches or fainting
• Frequent sore throats and/or swollen glands
• Irregular or absent menstrual cycle
• Fatigue or weakness
• Frequently cold
• Insomnia, poor sleep, or sleeping all the time
• Layer of light hair all over the body
• Callused or bruised knuckles
• Dental issues
• Yellow or grey hue to the skin
• Poor healing

 Behaviors:

• Inordinate amounts of exercise
• Isolating
• Wearing baggy clothes
• Isolating
• Avoiding social activities when food is around
• Reading about weight loss, dieting, nutrition, exercise or eating disorders
• Preoccupation with recipes
• Cooking for others but not eating the food
• Going to the bathroom after eating
• Running a faucet while in the bathroom to cover up the noise of purging
• Constantly moving, never sitting, shaking legs 
• Body-checking behaviors such as feeling for bones, measuring body parts, or staring at reflections in mirrors and windows

Eating Behaviors:

• Restricting calorie intake
• Checking nutrition labels
• Binge eating
• Eating in secrecy
• Unusual food rituals
• Cutting food into tiny pieces
• Purging
• Shifting food around the plate to make it look like it has been eaten
• Chewing and spitting food without swallowing
• Hiding food to eat or throw it out later
• Vague eating patterns
• Drinking excessive amounts of water
• Rigid rules around food
• Eating very slowly
• Drinking excessive amounts of caffeine
• Chewing an excessive amount of gum 
• Limited variety of food
• Changes eating preferences (for example, becoming a vegetarian or saying they no longer enjoy sweets)

***Please remember that each eating disorder is very unique and show up differently for each person.  Just because a person does not exhibit any of the following signs of an eating disorder does NOT mean that the person is not suffering.***

 

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I think my [friend, mom, child, co-worker, peer, etc.] has an eating disorder.  Now what???

Approaching someone about having an eating disorder can be an incredibly sensitive subject.  I believe that it is always better to say something than to stay silent.  You are showing that you care.  Below are some helpful suggestions about how to talk to someone about your concerns.

• Speak from a place of concern and love. 
• Remain open and non-judgmental.
• Use "I statements," such as, "I'm worried about you because it seems like you've been struggling lately."
• Remember that your conversation will not go perfectly.
• Ask questions to get a better understanding of what the person is going through.
• Remember that eating disorders are about more than food and bodies.  People who are struggling are usually experiencing difficulties in other areas of their life, and the eating disorder is often their coping mechanism.  Ask questions about the other areas of struggle.
• Choose an appropriate time and place to talk.
• Encourage the person to seek professional support, and offer to help the person reach out.  This could include providing phone numbers or websites, calling a doctor, therapist or treatment provider for or with the person, or even going to the first appointment with the person.
• Validate that their feelings are real for them, and can sometimes feel scary or overwhelming.
• Continue to share your concerns - don't give up!  Eating disorders thrive in secrecy, and it is often difficult for people to admit they are struggling.  Continue to express your concern and your willingness to support them.

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"Do's and Don'ts" for support people:

Support people often wonder, "What can I do to help?"  In my opinion, the most helpful way you can  support someone is by offering unconditional love and concern.  Unconditional support means that you let go of judgment.  It means that you seek to understand each person as an individual.  Unconditional support means that you remember that everyone is doing the best they can, even if it doesn't appear that way to you.

Eating disorders can be incredibly confusing to understand.  Every eating disorder is unique, and every person who struggles with an eating disorder has different needs.  Ask people directly what would be most helpful for them, and remain open to the idea that needs are constantly changing.  Remember that you, too, are doing the best you can, and that it is okay to make mistakes.  Be patient and give yourself grace.  

It is okay to be confused and to express that confusion.  Sometimes the most helpful thing to say is simply, "I don't understand this disease.  It doesn't make sense, and I know that's okay.  I'm still here for you."

Although everyone is unique, there are some general "do's and don'ts" that apply to many people with eating disorders.  You can use the following as a general guideline, but remember to ask people what they find most helpful. 

DO:

• Use "I" statements.
• Remind them that you love them.
• Encourage them to accept support.
• Remind them to use their coping skills.
• Listen.
• Validate their feelings.
• Gently express concerns when you notice them.
• Act as a healthy role model to them.
• Set healthy boundaries.
• Learn about eating disorders.
• Ask questions about what their experience is like.
• Take care of your own needs.
• Talk to them about everyday things outside of the eating disorder.
• Spend time with them doing enjoyable activities.
• Remind them that they are more than an eating disorder, that you will love them and pay attention to them even (and maybe especially) when they are healthy.
• Provide positive feedback when you notice effective and healthy behaviors.
• Forgive them when they make mistakes.
• Accept your limitations that you cannot "cure" them.
• Work on your own thoughts, beliefs and behaviors and seek help if appropriate.
• Remind them of their personal goals.
• Express hope for them.
• Make meal time enjoyable by providing conversation or other distractions.
• Ask them for feedback about the support you are providing them.
• Educate yourself about eating disorders.
• Be patient and remember that eating disorder recovery is a very long process.
• Encourage them to seek professional help, and offer to call or go with them to their first appointment.
• Provide reality checks to help them counter irrational beliefs.  For example, if they say, "I know that everyone hates me," you can respond by saying, "Wow, that must feel pretty awful to think that.  I hear that's what you're thinking, but I want you to know that I genuinely care about you."
• Realize that people will not change until they want to.
• Validate that recovery is difficult, and remind them that others have done it.
• Remember that people are separate from their eating disorders.
• Remind them that your love and acceptance for them does not depend on their weight, size, shape or appearance.

DON'T:

• Blame them.
• Threaten them.
• Comment on their food, eating habits, body, weight or appearance.
• Make negative remarks about your own or others' eating habits, body, weight or appearance. 
• Make assumptions about what is or is not helpful.
• Be the food/bathroom/gym police.
• Minimize their feelings.
• "Should" on them.  For example, tell them that they "should" be able to eat, "should not" need to go back to treatment, or "should" tell their therapist something.
• Talk about diets or food.
• Force them to eat.
• Punish them for engaging in eating disorder behaviors.
• Give up on them.
• Ignore or deny the problem.
• Make assumptions.
• Force them to get help.
• Dismiss their feelings or fears, even if they seem irrational to you.
• Get in a power struggle with their eating disorder.
• Hide your own feelings.  If you are feeling sad, cry.  If you are feeling angry, express it in an appropriate way.
• Let the person's eating disorder take control of your relationship with the person.  For example, if you used to get together with the person once a week to watch a movie, continue that ritual.
• Offer advice or support that is beyond your level of comfort or expertise.
• Share personal information about the person's struggles with others.
• Lie to them or hide the truth.