Since I've started writing and opening up about my history of disordered eating, I've had a lot of people approach me. Some of them want to share their issues with eating, others want to commend me on sharing. Many of them, though, see what I write and wonder if I can offer insight as to how they can approach or help someone they are worried has an eating disorder.
Usually it goes something like this:
"I think my friend/romantic partner/sibling/cousin has an eating disorder. How can I talk to him/her about it?".
It just about kills me, but I really don't have a good answer for this. And there's a reason I don't.
Talking to people about their possible eating issues is hard, because often, disordered eaters make themselves fairly unavailable to such conversations.
Over my storied career with disordered eating, various people tried to talk to me at different points. I have to say, I became awesome at avoidance.
Anything to get out of the conversation, I'd do it. And I was good at it.
I would evaluate the person inquiring. Acquaintance? I'd say that I didn't have a problem, and usually that was enough. Friend or family member? I'd get quiet, admit that I was struggling with it, but that I was "in a good place". Oh my god, I so wasn't. But it made the conversation end. My steel resolve to stick with my disease will was seemingly always stronger than the level of kind concern on offer. Yes, their concern was real, but they weren't ready for that level of commitment or to push--shove--me in the way I needed.
A friend of mine who also identifies as eating disordered put it really well:
"I don't think there is any way that my parents could have brought it up that would have been productive. Certainly, any direct comment about weight/food/amounts of food made me put an iron wall up immediately. I do remember that as a teenager my parents talked about having me see a therapist. I actually think that would have helped me and deep down I really wanted them to push that. But they didn't and I wasn't capable at the time of asking for it. "
This is to say: as much as you might want to help, as concerned as you might be...you're walking into a hornet's nest, my friend.
Ultimately, someone isn't going to respond to an offer for help until they are ready to admit that they have a problem and that they want to get better.
That having been said, I don't want to leave you without hope or scared to connect with someone with an eating disorder, because truthfully, connection is probably what they need most.
With that in mind, I have put together this post about common approaches that simply don't work, an explanation of why, and then the simple approach that I have found to work.
I don't know if I really need to remind you, but I am not a doctor. I'm not a psychiatrist or therapist. They might disagree with me here. But I know from my own experience and that of other eating disorder survivors that there is wisdom in what I say.
What not to say to someone you suspect has an eating disorder
This might be exactly what you want to say. It might feel really good to say it. For you. But think about the person you're saying it to. They are basically operating with a handicap, and you're telling them that they're not doing things right. What they hear is "your very existence is wrong, and I can't accept it, and furthermore, and I am asking you to do hard work right now."
For someone with an eating disorder, getting help can be difficult--financially, mentally, physically. So unless you are going to be right there with them, make a list of therapists and programs and call them on the person's behalf, please don't put the ball in their court with the "you need to get help" statement. It's truly not helpful.
Commenting on someone's weight is probably not going to have your desired effect. For me, when I got very skinny and people expressed concern about my low weight, it thrilled me. I had clearly gotten skinny enough to be recognized as skinny. My work was paying off.
Even if you notice an extreme change in someone's weight, please don't bring it up. If they bring it up, however, that is a door opening and you can take their lead. But please know that leading your conversation with weight concerns is probably going to make the disordered eater put up a wall.
A very well intentioned person told me about how, during high school, for an entire summer, she tried to diet, but it was unsuccessful and after she binged on an entire carton of ice cream, she never dieted again.
At the time, I was bingeing and purging several times a week, so this story of a single binge really didn't have an impact: my internal response was basically two words, and they weren't "Happy Birthday". I felt like this was downplaying my disorder, like it was something that I could easily "grow out of".
If you have never had an eating disorder, you don't know how they feel. That's the long and short of it. By downplaying an eating disorder, you can make it even more shameful for the person, as if they should be able to just get over it but have failed.
It might be so obvious to you that someone has an eating disorder. But--honest to goodness--they might not know. They might not even know that they have an eating disorder. If they don't realize that they have a problem, then they are going to deny having an eating disorder. And their denial will be genuine.
Many times, people just think that their relationship with food is simply the way it is in their life. If they aren't within the clinical diagnosis of bulimia or anorexia, they might not even be aware it's a problem, or might think it's not enough of a problem to warrant help.
Listen, it's hard to bring up eating disorders. But to offer a vague "hey, you're getting thin" or "are you eating enough?" is not going to be a good way to bring it up.
Personally, when people alluded to me being "so thin" or "not eating enough" I took it as a badge of pride that I was finally skinny. At no point did I think "hey, they're saying I'm too thin and maybe I'm not OK." I honestly took these comments as compliments.
Someone with anorexia will pretty much always tell you that they're eating enough. or "so much!". They don't have a good grip on what is enough and what is too much.
This works the other way around, too. Commenting that someone is eating "so much" is really not going to make them want to open up to you about their binge eating issues, I promise. It's just going to make them eat in secret, away from you and your prying eyes.
I hit up Tina Klaus, who writes the amazing website Don't Live Small, about her thoughts on what is and is not helpful regarding talking about eating disorders. She had this to say:
"I was often told that I didn't look sick aka not thin enough to have an eating disorder. I was of normal weight so my struggle and suffering was brushed aside and not taken seriously and thought of as some sort of phase I was going through. I often was told if I wanted to lose weight so badly then I should stop eating. I was also an athlete, muscular and strong . Coaches constantly critiqued and focused in on my body. Those around me thought my ED was about my vanity and wanting to be pretty. I also think those around me at the time were ignorant to what an eating disorder was and out of fear most chose to look the other way."
Eating disorders come in all shapes and sizes. By downplaying the struggle because someone doesn't look sick enough, you may be pushing them deeper into the disease.
Eating disorders are shameful. People suffering from eating disorders tend to be secretive and avoidant. Don't create drama and anticipation by making a bold statement like "we need to talk" and then leaving them hanging. I can tell you that just hearing those words would make me want to A) hide from you, and B) run to the comfort of my disorder, be it making a list of how many calories I'd eaten, buying a cheesecake, or whatever the symptoms happened to be at the time.
How you can help someone who may have an eating disorder.
I don't mean to discourage you with all of the above "what not to say" entries. I simply want to help you direct your good intentions in a productive way, and to avoid non-productive avenues of conversation.
The fact is that all of the above things are in fact important to discuss. But when someone has an eating disorder, it's unlikely that they will just let you in that easily. That is why it is important to make a connection (having nothing to do with eating disorders) with someone before you discuss any of the above.
I know this sounds weird, but it is my deep belief that the best way to get to talking about eating disorders is to not talk about the eating disorder. I'm not talking about skirting the subject--if someone brings it up and wants to talk, then please, by all means, talk to them.
But to ease into that conversation with someone in a way that is safe, this is the method I suggest.
The very best way to help someone with an eating disorder is to connect with them on a personal level.
As Tina Klaus of Don't Live Small wrote me,
"I think the most powerful and helpful thing that has ever been said to me was from my therapist, Dr. Michael Maley, who said, 'Tina, you are perfect the way you are'. It has stuck with me and felt for the first time I had been authentically seen."
Eating disorders thrive in darkness and in secret. The best way to combat them is by making true and deep personal connections.
I'll give you some examples. Several years ago, when I started to be open about my eating disorder, I would talk about it. To basically everybody. I wouldn't share with any expectation of them sharing in return, but to my surprise, they did.
Some people would respond with their own confessions of eating disorders.
Others would respond with other confessions: that they were unhappy with their marriage. Or their job. Or they wished they'd never had kids. Or that they'd gotten really drunk and done something regrettable last night.
Opening yourself up to someone on a very real level allows them to do the same.
So think about it: how could you connect with this person who you think may have an eating disorder?
1: Spend time with them
Spend time with that person, as much as possible in NON FOOD SETTINGS. Take a walk. Go shopping. Ask them to help you with a garden project.
2: Don't involve food.
As noted above: NON FOOD SETTINGS. As much as you can, don't involve food in your socializing with the suspected disordered eater, or make food optional. I mean seriously, if you've taken enough time to read this, please tell me that you're not going to try to to meet for lunch at the Olive Garden to connect with the person you think has an eating disorder.
And it probably goes without saying, but don't use your time with this person to talk about weight or diet--yours, theirs, or anyone else's.
3: Be persistent
The disordered eater is going to flake out on you. Especially if they think food might be involved in a social setting. A lot of disordered eaters I know are scared of intimacy, and they're scared that you don't actually want to spend time with the real them.
I had a friend who I knew had an eating disorder, and every time we had plans to hang out she figured out some way to flake out. Finally I started responding "I'm coming over" and then hanging up before she could respond. She kept on flaking but every time I persisted she thanked me for it and said she felt better.
Be persistent. Be persistent. Be persistent.
4: Open up
This part isn't easy, because it makes you vulnerable, too. You might not be able to say to someone "I had an eating disorder", but chances are, there is something you can open up about with this person.
Opening yourself up is a good way to let others have a space to come in. You might just find it's a cathartic experience for you, too.
5: Keep on connecting.
Keep on doing all of the above. Know how I said "be persistent" above? Well, keep it going: be consistent. Be consistent. Be consistent. Don't let it go, don't start flaking out on your time with that person. Keep on connecting.
6: Know that these things take time.
Even after connecting with someone, they still might not be ready to admit that they have an eating disorder. It might not be your place to take further action. Maybe they aren't ready.
Unfortunately, it is not your place to make it happen sooner. But by being there, and letting them know you are there, you might be able to help make a difference.