I met my friend, “Maria,” (not her real name) in high school. She was beautiful, sweet, and I enjoyed spending time with her. One time the I didn’t see Maria, however, was at lunch time. She was very thin, and I always suspected that food was an issue for her.
My suspicions were confirmed when Maria disappeared for three months, to enter an inpatient program at the hospital. She was diagnosed with anorexia nervosa and felt very awkward about returning to school once she was discharged.
When she came back, she was still the same Maria that I had enjoyed spending time with. But there were some things that we both had to learn. I learned–through trial and error–how to be a good friend to someone with an eating disorder, and how to help Maria through her recovery.
Supporting someone with an eating disorder can be challenging, but it can make a huge difference in your loved one’s recovery. Here are some things to remember if you love a person with an eating disorder:
1. They may not be underweight.
According to this article in the Natural News, clinicians are beginning to notice a new eating disorder, called orthorexia, which is an obsession with eating the “right” foods. People with orthorexia do not necessarily eat less, so they may be a healthy weight or even overweight. So be understanding if a loved one has been diagnosed with an eating disorder, and do not assume that they are not telling the truth about their diagnosis, just because they are not underweight.
Maria said that the worst thing for her was when people would tell her that there was no way she had anorexia, because she was not that thin. This was when she was in recovery. She was gaining the weight back, but she still had a number of issues to work through. The weight comes back first, but there is still a lot for the person to work through once they have started gaining weight.
2. They tend to avoid gatherings that center around food.
According to this article in NY Mag, people with eating disorders tend to show up to parties after the meal has been served, claiming that they have already eaten. They may also suggest outings that do not involve food. This is because eating is stressful for them, even if they are in recovery. You can help by suggesting activities that do not involve food. People with eating disorders tend to isolate themselves, and providing an opportunity to socialize without the focus being on food can be quite helpful.
Maria avoided lunch for most of the time I knew her. Even when she was in recovery, she preferred to eat in a teacher’s classroom. I was respectful of this, and found a lot of fun, food-free activities for us to do after school.
3. They may be very sensitive to comments about their appearance.
The National Association of Anorexia and Associated Disorders (ANAD) states that even well-intended compliments, such as, “You look really healthy now,” may be misinterpreted as meaning “you look fat.” People with eating disorders are very self-conscious about their physical appearance, and many times when someone looks recovered, they still have a lot of recovery work to do.
Maria found it very triggering when people told her she didn’t “look” anorexic. She said that she often felt competitive with other people who had eating disorders, trying to be the “best” anorexic. These comments triggered those patterns of thinking and weren’t helpful to Maria in her recovery.
4. They don’t need you to be a therapist.
ANAD cautions friends of people with eating disorders not to try and be that person’s therapist. If your loved one has been diagnosed, they are likely working with a team of professionals to help them recover. Your job is to be a caring friend. Be supportive, but understand that your role is not to “solve” their problems.
This was something I learned through trial and error with Maria. It wasn’t my job to make sure she ate enough. We had an argument once, because I was asking her how much she was eating. My job was to be her friend, as I had always been.
5. They want you to know it’s about more than just food.
According to ANAD, eating disorders are about much more than just food, so telling your loved one to “just eat” is not going to solve the underlying issues. There are many complex issues involved in eating disorders, and recovery can be a time-consuming process. Be there for your friend, and be supportive and understanding. Ask your friend how their day is going, and how they are feeling. Don’t keep the conversation limited to food and eating.
This is why being Maria’s friend was so helpful. While our interactions were not centered on food, Maria did confide in me about a lot of her fears and doubts. Being able to have someone with a sympathetic ear there to listen to her helped her tremendously.
6. They may feel ashamed of their condition.
An article by Caltech states that people with eating disorders are often ashamed. This can lead them to be very defensive about their eating and find conversations about food consumption to be very upsetting. Understand this, and understand that they are working with professional to help them with their diet. The role they need you to play is that of a supportive friend.
Coming home from the hospital was very awkward for Maria. She was embarrassed that she had lacked to “willpower” to keep her condition under control. She was worried that seeking professional help meant she was “weak.” Of course none of these were true. Eating disorders are not about willpower, and it takes a great deal of strength and courage to seek help professionally.
7. They will experience good days and bad days.
According to an article by NHS, recovery is a long and bumpy process. Part of your loved one wants to get better, while another part is afraid to let go of the old habits. Understand that not every day will be easy, and does not mean that your friend is not getting better or that they are backsliding. Be there for them through the ups and downs.
This was something that surprised me with Maria. Some days, she would seem very confident and even eat lunch with me. Then the next day, she would be absent from school because she felt so challenged. Recovery is a roller coaster, and being there for her and the good and bad days was very important.
8. They may at times come across as angry or aggressive.
NHS states that this is because people with eating disorders are often fearful and insecure. Learning to cope with and redefine these fears is a part of recovery, so be patient with your loved one. Understand that it is not about you, and take care not to take it personally.
Maria would sometimes become angry and lash out at me for no reason at all. Learning not to take this personally was an important lesson, and it helped me to be there for her when she calmed down and felt embarrassed about her outburst.
9. They still want to be included.
According to the Butterfly Foundation, people with eating disorders may feel isolated and alone. Even if they try to isolate themselves, continue to invite them to participate in the activities that they used to enjoy with you. This can help them a great deal in their recovery. Invite them, but don’t push it if they say “no.” Just keep inviting.
Anytime I went out with friends on the weekend, I invited Maria. Sometimes she came, and sometimes she did not. But later on she said that always being a part of the group and always having a place where she belonged was very helpful.
10. They need you to set boundaries for yourself.
The Butterfly Foundation states that it is necessary for you to set the boundaries, as far as being supportive of your friend. It is not possible for you to be on call 24/7, but when someone is lonely and struggling, it can be hard–if not impossible–for them to realize this. It is not only perfectly fine for you to set boundaries for when and how long you are available, it is also helpful to your friend in the long run. By taking care of yourself, you will be more able to be patient and understanding of your loved one.
11. They likely learned their habits as children.
According to Eating Disorders Online, children are especially at risk. One study conducted by the Agency for Healthcare Research and Quality found that hospitalizations for eating disorders in children under 12 increased 119 percent between 1999 and 2006.
My friend Maria went on her first diet at age 10, and had her first hospitalization at age 16. She said a lot of her misunderstandings were learned in childhood.
12. They want you to know that men can have eating disorders as well.
According to Eating Disorders Online, 20% of women and 10% of men will have an eating disorder in their lifetime. That means 1/3 of eating disorder sufferers are male.
Maria did meat a surprising number of men while in treatment, and she said they encountered a great deal of misunderstanding, because they were not skinny women.
13. They want you you to know that eating disorders kill.
Eating Disorders Online states that one in five people diagnosed with anorexia will die from the disorder. People with anorexia are 50% more likely to die by suicide than people without the condition.
Maria said that she did think of suicide, but she sought help right away. This is not always the case though. If your loved one seems depressed or talks about ending their own life, seek professional help immediately.
14. They want you to know that there is not a lot of funding for treatment.
According to Eating Disorders Online, the government allocates 93 cents in research funding per eating disorder patient, while the average autistic person is designated $88. So while it is getting more expensive to hospitalize an eating disorder patient, the money to pay for it is not there.
The important thing to remember from this is that your loved one might not be fully recovered when they are released from treatment. There is a great deal of red tape, and they will need your support as they work their way through it.
15. They want you to know that most people don’t get treatment.
Eating Disorders Online states that only one in ten people with eating disorders get treatment, due to insurance issues. This is because eating disorders are hard to diagnose but also because healthcare laws largely consider eating disorder coverage to be non-essential.
Maria was lucky in this respect, but she knows that things would not have gone so well for her, had her family not had adequate insurance coverage.
Maria is now a healthy woman in her 30’s, happily married and the mother of two beautiful children. She emphasizes that recovery is possible and that most people with eating disorders do eventually get better.
Eating disorders are challenging and often misunderstood. By better understanding your loved one’s struggles and challenges, you will be a much-appreciated source of support for them in their recovery!
Featured photo credit: BFF/Flickr Creative Commons via flickr.com