What to Do When Your Friend Has an Eating Disorder

February 26 to March 4 is National Eating Disorders Awareness Week 2017. We'll be sharing information about this important issue throughout the week, from what to do if you or a friend is suffering from an eating disorder to how to love your body just the way it is! Be sure to check out all of our past content about this week here.

If you’ve recently noticed that your friend’s eating patterns have been off and you think that she might have an eating disorder, you might feel powerless. This could be a difficult situation for both you and your friend, but with the correct information and the right tools, you’ll be well equipped to get her through it. Experts told us the telling signs that your friend’s relationship with food is unhealthy, and they explained what you can do to help.

How to tell if your friend has an eating disorder

With all the fitness and nutrition fads we see in college, it can sometimes be hard to tell if your friend is adopting wholesome habits or an unhealthy relationship with food. You might notice radical changes in her behavior straight away because you know her so well, but you could be missing more subtle indicators of anorexia, bulimia and other eating disorders.

Vanessa Richard, a registered dietitian and nutritionist at Louisiana State University’s student health center, recommends browsing the National Eating Disorder Association website for more information, but she lists the following as some of the most common warning signs:

Constant dieting
Avoidant eating or restrictive eating
Obsessive thinking about food, calories, fat grams or carbohydrates
Purging by vomiting, laxative use or exercise
Loss of control eating or binge eating
Inability to eat foods that others (or restaurants) have prepared
Poor body image or low self-esteem
Compulsive exercise
Low body weight

All of these symptoms could suggest that your friend has an eating disorder, whether she only displays one of them or a combination.

“My best friend had an eating disorder for about three years,” says Robin*, a senior at the University of Tampa. “When I noticed she was losing a lot of weight at first, I didn't know what to say to her. I didn't want to hurt her feelings or make her feel uncomfortable, so I chose not to say anything.”

Although telling your friend that you are worried about her is scary, you should gather up the courage to do it; you could really help her. For Mary Anne Knapp, a staff therapist at Pennsylvania State University’s Counseling and Psychological Services, “the most important things to do are to show you care in a supportive and non-judgmental way, know campus resources and offer to support your friend to get help.”

If she is getting progressively thinner, this could be a cause for concern. However, you should be aware that “someone with an eating disorder can look healthy, be in a normal weight range or even be overweight,” Richard says. “Someone experiencing anorexia may be underweight, but those struggling with binge eating and purging or disordered eating are likely not underweight.”

How to approach her if you think she has an eating disorder

If, like Robin, you feel powerless upon noticing your friend’s struggle, know that you do have the tools to support her. Paige*, a junior collegiette at the University of Texas at Austin who suffered from an eating disorder, says her friend was crucial to her recovery.

“Had my roommate—who also doubles as my best friend—not intervened, I definitely would not be where I am today,” Paige says. “The first extremely helpful thing she did was (strongly) suggest that I see a therapist. While I was highly against it and terrified of speaking to someone, she never stopped bringing it up.”

Richard agrees that you should “be armed with resources to help that person get to professional help on campus or in the community” and offer to accompany her, but warns that you should “be prepared for defensiveness or denial. [However,] doing something is better than doing nothing, even if your friendship is on the rocks.”

With this in mind, Richard recommends that you first show your friend that you are there for her. “Your goal is to say, ‘I love you,’ ‘It hurts me to see you suffer’ and, ‘I’m here to support you and help you get the help you need,’” Richard says. “Sit down with [your friend] privately at a neutral time and share your concerns with [her].”

Richard says you should talk to your friend in person and when the two of you are alone, except in the case of an emergency. “I suggest avoiding a high-stress time, such as right before a big test or project is due, unless you see your friend engaging in high-risk behaviors and you are concerned for your friend’s safety,” she says. “If you feel like someone is at risk to harm oneself or others, addressing the concern immediately or involving someone else who can help is always best.”

This is a difficult situation for both you and your friend: She could get very offended when you bring up the subject, and you might not know how to deal. The best way to approach her is to focus the conversation on your concern for her and never to make personal attacks or statements that she could interpret the wrong way.

“Address specific behaviors about what you have seen, not the person as a whole,” Richard says. “Use ‘I’ statements rather than ‘you’ statements. Avoid accusations and questions like, ‘Why are you doing this to yourself?’” Make sure she knows that you are worried about her and ready to help her in any way she needs.

Paige’s friend insisted that she talk to someone about her issues, and it was the best thing she could have done. “She knew that I needed help and that I was past the point of being able to help myself,” Paige says. “So, despite how embarrassed or scared I felt, I went. I didn’t know it then because I was so wrapped up in my problems, but, looking back, I desperately needed therapy. She, as someone I love and trust, made it her responsibility to get me there—and she did.”

Since this is such a sensitive subject, you will need to be very gentle, Richard says. For instance, “if you have heard your roommate purging after meals, you could say, ‘I have heard you throwing up after you eat, and I am worried that it is going to hurt you. Would you be willing to talk to someone about it to find a healthier way to lose weight and deal with stress?’” Richard says. Or, more generally, try using a variation of, “‘There are resources on campus and I am glad to go with you to an appointment.’” Your friend’s situation is difficult to understand, but you should always try to be as kind and supportive as you can.

As a close friend, you’re in the best position to notice her concerning habits and make her realize that she needs help. We promise that in time she will understand, even if she’s originally angry.

How to react if your friend tells you about her eating disorder

For many of us, understanding eating disorders is difficult. That’s why you should do everything you can to not judge your friend and to encourage her to talk to you about her illness if and when she wants to.

“It was really hard for me to put myself in [my friend’s] shoes, and it still is even to this day,” Robin says. “Since I'm a person who loves myself, food and life, it was so hard to try and understand what she was going through. My friend would always tell me, ‘I know you probably don't understand how I feel, but that's okay. Just be here for me.’” So Robin found it in herself to help her friend in every way possible, even though she couldn’t relate to what her friend was going through.

It’s important to acknowledge that “if a friend comes to you for help, she has probably been thinking about getting help for a long time, and it is a huge step,” Richard says. “Sit and listen. Tell your friend you are glad [she] shared [her] struggle with you and you are here to support her. Try not to problem-solve, but let her know that you will help her find the right help and be there along the way, that she is not in this alone. Make sure she knows you will respect her privacy.”

This situation is primarily about your friend, but don’t forget to look out for yourself as well, because you will be affected emotionally, too. “One of the things I've struggled the most with as the sister of someone with an eating disorder is realizing that it is not really a choice,” says Sophie*, a recent graduate from Boston University. “I see my emaciated sister and want to shake her and say, ‘Just eat something!’ but I have to remind myself that it is not that simple.”

Family and friends of eating disorder patients often suffer from seeing their loved one harm him or herself, so “it's important to monitor your own feelings as you try to help,” Knapp says. “Being patient with yourself and your friend can help you stay centered. It's normal to feel some frustration if you experience roadblocks. Your friend may come and go from therapy and have relapses under stress. It can be hard to witness these fluctuations in motivation and recovery.”

If you start to feel helpless, sad or angry, take a step back and remind yourself that these emotions are completely normal. Although your friend’s recovery can be a long process, it will be well worth it when you see your friend healthy again.

What resources should you and your friend turn to?

You, her other close friends and her family are your friend’s first resources. If she doesn’t feel ready to seek out therapy, you could see a counselor yourself, like Sophie. “My sister has struggled with anorexia for the past seven years—she’s been to treatment twice and continues to struggle with it today,” Sophie says. “The best advice I could give would be to see a professional yourself and ask how best you could help in the situation.”

As for finding professional help, “do some research about what resources are on campus and in the community,” Richard says. “Check to see if your campus has a counseling service or eating disorder treatment program. If there is not a campus treatment program, a counseling center can connect you to the right community resources.”

You have the ability to help your friend follow a counselor’s advice. “During my recovery time, there was a phrase my therapist wanted me to constantly reinforce in my head: ‘If you don’t love it, don’t eat it. If you love it, savor it,’” Paige says. “After sharing this with my roommate, she always made an effort to remind me of it. If she saw me hesitate about eating something she knew I really wanted, she would give me an encouraging look.”

If your friend doesn’t feel comfortable speaking to a counselor in person, “calling a hotline, such as the National Eating Disorder Association Helpline, can also be a tremendous resource,” Richard says.

Whether your friend trusted you with her disorder or you confronted her, don’t tell anyone else about it unless it’s absolutely necessary. “It is important to respect someone’s privacy,” Richard says. “However, if you suspect things are worse than the person is letting on, or if you see a problem worsening, talk to a family member of your friend, RA, campus counselor or someone from your campus care team. Let [your friend] know when you talk to someone else about it so they do not feel betrayed.”

Finally, you should be aware that your friend’s disorder could be extremely harmful to her health. “Unless the situation is life-threatening, you can't make someone enter treatment against their will,” Knapp says. “However, in a life-threatening emergency, you may need to act immediately to get your friend to a help center if they are suicidal or appear to be losing consciousness.” As long as you know that these very serious consequences are possible, you will know to keep an eye out for signs and react quickly if needed.

For extra information and support, you can turn to the following websites and helplines:

Unfortunately, eating disorders are all too common, with 25 percent of college-aged women reporting that they use bingeing and purging to manage their weight. For this reason, you might find yourself having to assist a close friend in her internal struggle with food. With these guidelines, you should have the tools necessary to support her and get her through this difficult time in her life.

*Names have been changed.