You’ve noticed that your typically up-for-anything friend has suddenly become more reserved. Instead of joining you and your other friends for your weekly group dinner, they’ve started making excuses about being too busy and needing to work out more. Maybe you’ve noticed that they often skip meals when they used to be your go-to for trying out a new food or restaurant. You’ve also heard your friend talking more and more about how they “hate” their body because they’re “too fat” and “ugly.” It hurts you to hear your friend talk that way and you wish they wouldn’t. You’re starting to wonder if these distorted beliefs about their body image and their weight is more than just a phase. Do they have an eating disorder?
Here are two helpful things to do if you suspect your friend might have an eating disorder: educate yourself about eating disorders, and support your friend seeking treatment for this harmful and potentially deadly disorder.
Eating disorders affect more women than men, and involve more than just dieting or a desire to be thin. Instead, eating disorders are often caused by a combination of genetic, biological, behavioral, psychological, and social factors that can often have incredibly harmful long-term effects. In fact, one type of eating disorder, anorexia nervosa, has the highest mortality rate of any mental disorder.
There are three main types of eating disorders: anorexia nervosa, bulimia nervosa, and binge-eating disorder (the most common type). While you don’t need to be an expert on these different types, knowing the primary signs and symptoms of each can help you discern whether or not you need to express your concerns to your friend.
If your friend is struggling with anorexia nervosa, she may believe that she is grossly overweight, even if she is average or even underweight. She likely has a distorted view of her body, believing that she is much more overweight than she actually is. She may restrict the amount of food she eats, count calories obsessively, exercise excessively, take laxatives or induce vomiting, verbalize an intense fear of gaining weight, talk constantly about her desire to be thin, and weigh herself constantly. This disorder can lead to long-term impacts to her health — from damage to the heart or brain to infertility and organ failure.
Other symptoms of anorexia nervosa that you may notice in your friend could include:
- Brittle hair and nails;
- Dry or yellowish skin;
- Growth of fine hair on body;
- Lethargic and feeling tired;
- Feeling cold all of the time.
If your friend is struggling with bulimia nervosa, he might exhibit a pattern of binge-eating followed by purging behavior. For example, he may eat an abnormally large amount of food (whole containers of food that would typically make someone feel sick) followed by behaviors meant to “compensate” for the amount of food eaten, such as forcing vomiting, taking laxatives, exercising excessively, or fasting. Some of the effects of purging behaviors can lead to a stroke or heart attack.
Other symptoms of bulimia nervosa that your friend might exhibit include:
- Chronic sore throat;
- Swollen salivary glands;
- Worn tooth enamel and decaying teeth (from stomach acid);
- Acid reflux;
- Gastrointestinal problems;
- Electrolyte imbalance.
Binge-eating is one of the most common eating disorders in the U.S. If your friend is experiencing this disorder, he may go through periods of eating unusually large amounts of food — similar to bulimia nervosa — but he will not engage in any purging behaviors. Your friend might talk about eating even when he is already full, eating really quickly, eating until uncomfortably full, or frequently dieting without losing any weight. Some symptoms might be difficult to notice — individuals often binge in secret because they are embarrassed or feel guilty due to their behavior.
An eating disorder isn’t typically something that someone can just “get over” without professional help because so many factors (psychological, social, biological, behavioral, etc.) are at play. Fortunately, there are many options for treatment to help your friend heal and recover from their disorder.
Because of the potential medical complications, your friend may need to see a doctor to address any physical side effects of their eating disorder. Cognitive behavioral therapy with a mental health professional has been shown to be an effective form of treatment to help individuals with eating disorders to correct unhealthy thoughts and behaviors related to food and body image. Working with a nutritionist can also be helpful, especially to establish healthy eating patterns and gain a better understanding of what a balanced diet looks like. And, some individuals benefit from an inpatient hospital program that provides comprehensive and intensive treatment.
How to help
If you suspect your friend has one of these eating disorders, it is important that you express your concern to them in a sensitive and compassionate matter. Because eating disorders come with an increased risk for suicide and medical complications, it is critical that your friend get treatment as soon as possible.
When raising your concerns to your friend, pick a time when the two of you are able to meet alone and in a private area. Let them know that you’ve noticed some changes in them lately and that you are concerned about their health. For example, you could say something like, “I’ve noticed that you seem to be skipping lunch a lot lately to hit the gym. While it seems like you’ve lost a great deal of weight, you are always talking about how obese you are. I care about you and am really worried. How have you been feeling lately?”
Gently bringing up your concerns without sounding accusatory is key. You also want to be sure to verbalize your care for them. And finally, let your friend know that they’re never alone.
Remember, it takes a great deal of courage for someone to acknowledge that they have an eating disorder. Getting help can seem like a daunting process for your friend. If you feel comfortable, offer to help them find a therapist who specializes in eating disorders and encourage them to schedule an appointment with their physician.