Research shows that an estimated eight million Americans suffer from an eating disorder, with the majority being women. Of those eight million, men account for one million. Bulimia appears to be the most common disorder, with anorexia right behind it. While an eating disorder is characterized by many physical behaviors, it is considered a mental illness by the psychology community. Yet, of the many mental illnesses that exist, it has one of the highest mortality rates, due to the nature of the disease. Over half of Americans know someone with an eating disorder, and with it being National Eating Disorder Awareness Week, we felt this was an appropriate time to discuss the signs that someone you know may have an eating disorder, and how you can be a support system.
While roughly 50 percent of Americans say they know someone with an eating disorder, keep in mind that only encompasses those who recognize the signs, or who have a friend or loved one who has confessed to having the illness. It’s very possible to know someone with a disorder and simply not realize that the issue exists. Individuals who suffer from eating disorders often hide their condition, so unless they want you to know what’s happening, you may not spot it. Of course, many people with eating disorders may want to open up about their condition but are afraid to start the conversation. Having a friend who initiates that dialogue can go a long way. To demonstrate just how powerful it is for those suffering from eating disorders to discuss their problem, studies show cognitive behavioral therapy is one of the most effective treatments for bulimia. That requires the help of a mental health professional, but the study nods to the benefit of being open about these conditions. Maybe you have a friend whom you suspect may have an eating disorder, but before saying something, you’d like to be more sure. Here are some signs.
New and strict rules around eating
Individuals with eating disorders might develop strict rules surrounding eating and exercising, and might be unwilling to compromise on these. Perhaps a friend refuses to eat before or after a certain hour, and will not budge on this to accommodate your schedule even when you have a very good reason to need to push the meal just 15 minutes outside the friend’s comfort zone. In that case, she says she’ll just eat alone. She may have certain restaurants she will not go near, for reasons that seem vague or irrational. She might feel a compulsion to exercise a certain length of time each day, at specific times, and again will not compromise on this no matter what. Socializing with this friend means scheduling around these immovable new rules.
Obsession with or fear of one’s appearance
Your friend can either have a new fascination with viewing her appearance, or a new fear of it. You may catch her looking over her own body often. Even when sitting at a table, she might look over her arms, grab at her skin, or look at her thighs and pinch the skin. She might look at her reflection more than usual, finding reflective surfaces everywhere she can. This can be a compulsion to confirm that she hasn’t gained weight since the last time she looked at herself. On the flip side, in some cases, the affected individual might become afraid of her own image. If there is some body dysmorphia occurring, she may believe she looks different than she does and will go to extreme lengths not to look at herself.
Flakiness and periods of going MIA
If a friend who was usually reliable has started demonstrating the other behaviors on this list and becomes quite unreliable, she may have an eating disorder. After periods of binge-eating, your friend might want to hide away from others and could cancel on your plans at the last minute. Or, for fear of eating foods she wants to restrict, she may cancel plans that revolve around meals. The mood swings associated with her perceived “failures” (like failing to restrict food) might cause her to not want to be around others. She may also fail to answer her phone or respond to texts for long periods of time.
Rapid weight fluctuation and denial
Rapid weight fluctuation is an obvious indicator, but that alone isn’t always a sign of an eating disorder. If your friend’s perception of the weight change doesn’t seem grounded in reality, then that can be a sign of an eating disorder. So, for example, if she has become incredibly thin but speaks of having to still lose weight. Or if binge-eating has caused her to put on a tremendous amount of weight, but she blames her inability to fit into clothes on other elements like the dryer shrinking them, or all of her favorite clothing brands making their clothes smaller. If she perceives herself very differently than others, struggling to grasp reality, there may be an eating disorder occurring.
Fixation on the topic of bodies
A friend might develop a new fixation with speaking about bodies. She might redirect most conversations back to this topic. This can look like wanting to know exactly what other women eat and how much they eat, or how often others exercise and how they exercise. It can include wanting to know the exact clothing size of other women. Even if another individual with an eating disorder comes up in conversation, this friend might express heightened interest, wanting to know exact details about what you’ve observed in that person. Overall, there is a new and extreme obsession with topics like calories, clothing sizes, and exercise.
Be patient with scheduling
When I was anorexic, I took a lot of comfort in being around my friends. In fact, being around happy, healthy people was important for my healing. But the only way I got to be around healthy, happy people was by having friends who were patient with my rigid rules around scheduling meals. A few friends stand out as having accommodated my specific guidelines and I’ll be forever grateful to them. Try to be patient with a friend who insists you eat lunch at a certain time or at a specific place if you suspect she has an eating disorder. Though it’s inconvenient, she needs your company, and if this is the way she can have it, just be accommodating. You offer her more help by simply being there than by pressuring her to change her rules.
Redirect the conversation
When your friend wants to talk about her body, redirect the conversation. She may want to chat extensively about how proud she is that her clothes now fit loosely, or how she’s been asked to model for a petite clothing brand, and similar topics. Move the conversation away from her appearance. Refocus it on her personality and character-related attributes. If her eating disorder is linked to a belief that her body is all she has to offer, it’s important that you remind her of everything else she has to give. And if she seems to be terrified about seeing her body or discussing it, don’t pressure her. Don’t force her to look in a mirror. You can compliment her, but don’t force her to compliment or confront herself.
Understand that she’s going through something
Having a friend who constantly cancels on you, goes MIA, and flakes at the very last minute can be frustrating. In general, being reliable may be a quality you prioritize in friends, so this behavior could drive you to end the friendship. But try to treat this friend as if she is going through some tremendous grief. How would you treat someone who just lost a loved one or was going through a divorce? You’d understand that this is not a time to pressure them to keep plans or be the best version of themselves. You’d understand they will have mood swings and periods of darkness when they don’t want to talk to anyone. But you’d also understand that it is temporary, and these are extenuating circumstances, so you wouldn’t end the friendship over it. Treat your friend with an eating disorder the same way. Some of my most cherished friends today are those who stuck by me during my eating disorder. And today, I make a point to be someone they can rely on because I was able to rely on them when I needed that most.
Share your healthy habits
During my struggles, there were some individuals who tried to pressure me to eat more. Some tried to use scare tactics by telling me that my appearance had become frightening. I did not personally respond well to that. What I did respond well to was simply being around women who had healthy relationships with their bodies and with food, and who led by example. I remember one day having lunch with a friend who laughed at herself for putting on a few pounds on vacation. Then she ordered a cheeseburger. I said (and I shouldn’t have – but I was in that headspace), “You don’t want to get a salad after what you just told me?” And she said, confidently, “No. I’m not going to torture myself just because I had a good time on vacation.” That really stuck with me. Eating “poorly” one day didn’t have to mean punishing oneself the next.
Don’t shame the topic, but change it
When I was obsessed with talking about bodies, calories, clothing sizes, and the like, I remember some friends who tried to shame me for that. “We shouldn’t talk about this. This is just really typical that women would obsess about this stuff that doesn’t matter.” I felt embarrassed because the person was saying that what interested me “didn’t matter.” I know she was trying to help, but it made me shut down. The friends who handled it well, I recall, would make a small comment in response to what I’d said pertaining to those topics, and then gently change the subject. But they didn’t criticize me for wanting to talk about bodies. They did, however, do the smart thing of taking my mind off of that.