Deal With Anorexic Friends or Family

The eating disorder Anorexia Nervosa is a serious mental and physical condition that's one of the most common chronic illnesses in adolescence. The disease has a higher mortality rate than all other causes of death for females 15-24 years old. Additionally, although the majority of people who suffer from anorexia are female, 10-15% are male. If you are worried that someone you know has anorexia, act quickly to help her avoid serious consequences such as heart and kidney problems or even death. There are many different treatment options she can explore to improve her chances of recovery.

Steps

Helping Her Take Steps to Recovery

1. Have her see a doctor about diagnosis and treatment. Untreated anorexia nervosa can become a serious health issue, potentially causing kidney problems, heart problems, and even death. If she exhibits the following symptoms, ask her to see her primary care physician as soon as possible. If you are her parent, take her to see the doctor.
   • Eating very little and avoiding fatty foods.
   • Severe weight loss and dangerously low weight.
   • Fear of gaining weight.
   • In females, loss of period.
   • In males, body dissatisfaction and obsession with building a muscular physique.
   • Body image distortion, where the body is seen as larger or smaller than it actually is.
   • Weighing oneself excessively, also known as checking.
2. Be aware of the difference between healthy and unhealthy body types. Obviously there's nothing wrong with being in good shape. Regular exercise and healthy eating can result in being fit. There are differences however between healthy, fit bodies and unhealthy bodies.
   • In males, unhealthy bodies may be 15% lower in body fat than is normal for his age, height, and activity level. He may lift weights compulsively and be obsessed with toning his muscles. He may also take anabolic steroids in order to gain muscle mass.
   • In females, unhealthy bodies may have a consistently low weight, such as a 17.5 or less on the Body Mass Index, which she can calculate by clicking here. She may diet excessively and spend a lot of time on scales and in front of the mirror.
3. Talk to her about triggers. A trigger is a person, place, or thing that causes her to turn toward anorexic behaviors to cope. She can gain control over how she reacts in these situations by learning identify what triggers her, such as:
   • Interacting with someone who is judgmental of her body.
   • Specific foods that are difficult for her to eat or think about.
4. Help her set reasonable goals. Goals that are reasonable and realistic will help her make progress in her recovery. These are goals that can be achieved within a specific time-frame without causing problems in other areas of her life.
   • If she has trouble eating a typical amount of food three times a day, ask her to try once a day. After she has mastered this smaller step, she can continue to the bigger goal. This will help her feel accomplished and work at a realistic pace, so that she doesn't overwhelm herself.
5. Recommend that she keep a recovery journal. Journaling about her struggle with anorexia can help her express herself in a positive way. Although writing a journal is no replacement for a supportive community or professional help, it can be a powerful tool for her to share her feelings and reflect on what is happening in her life.
   • Have her try the Five-Minute Sprint approach by Kathleen Adams, founder of The Center for Journal Therapy. Give her these instructions: set a timer for five minutes, pick a topic that's been on your mind, and write. You don't need to put a lot of thought into this writing exercise; try to let your thoughts flow on to the page. Now read this draft back to yourself, and whenever something stands out to you, write: "Reading, I notice or feel _________." This will help her begin to process her emotions around these issues. It's a good idea to do this exercise with her to show solidarity.
6. Learn about intuitive eating together. Intuitive eating is a nutritional system designed by dietitian Evelyn Tribole and nutrition therapist Elyse Resch. It can help her learn to listen to her body's needs and develop a healthier relationship with food. Show her you care by learning about this system together. Intuitive eating can help her:
   • Listen to when her body is hungry or full.
   • Find ways of solving her emotional difficulties without using food.
   • Learn how to take pleasure in eating.

Talking to Her About Professional Help

1. Discuss in-patient treatment. Anorexia is a condition that can threaten both her emotional and physical health. Because the condition involves different areas, discuss in-patient treatment options with her, such as a dedicated eating disorder facility. These sites will be able to address all of the problems anorexia brings up, so that her body and mind are both taken care of.
   • This is especially important if she is severely underweight or malnourished. Doctors at these facilities can help her maintain her body's health, while psychologists can address the mental part of the condition.
2. Help her find a good therapist. Therapy can help her deal with the emotional difficulties underlying anorexia. A good therapist will help her change the way she feels about her body and food.
   • Cognitive behavioral therapy. CBT is the most researched method of therapy for eating disorders. It can help her change her thoughts and behavior so that she doesn't fall into the same old irrational beliefs about her weight and food.
   • Interpersonal therapy. IPT focuses on improving the relationships in her life so that the symptoms of anorexia will go away on their own, as her social sphere becomes healthier and more supportive.
   • Search for a therapist by clicking here.
3. Recommend getting help for additional problems like depression and anxiety. Research shows that people who have an eating disorder are more likely to have depression and anxiety as well. These complex issues can make recovery more difficult, so it's a good idea for her to seek out help for any other major difficulties she is having as well, such as obsessive-compulsive disorder or depression.
   • Obsessive-compulsive disorder is the most common anxiety disorder that shows up at the same time as eating disorders. If she mentions having repeating thoughts about things she can't control, like germs or intruders in her home, she may want to ask her doctor about OCD.
   • Depression can lead to eating disorders and also be caused by them. If she seems to have persistent sad moods, constant tiredness, or difficulty feeling any pleasure, have her ask her doctor about major depression.
4. Suggest a registered dietitian. People with anorexia frequently have deficiencies in nutrition. Contacting a registered dietitian will help her get her body back in balance. A dietitian can assist with gaining weight as well as replenishing whatever her body may be lacking, such as electrolytes. Research suggests that it may actually be necessary to address food and weight concerns before recovery can take place.
   • Look for a dietitian who specializes in eating disorders. You can find one local to her by clicking here.
5. Ask her doctor about medication. There are no medications specifically for eating disorders, but things like anti-depressants or medication for anxiety can be helpful in treating the psychological symptoms of anorexia, which is often a necessary step in recovering from the disorder. If you are her parent, you can ask the doctor directly. If you are a friend or sibling, you may want to talk with her about it first.

Providing a Supportive Environment

1. Educate yourself and other friends/family about anorexia. The first step is to cultivate awareness around her disorder so that you and other people will understand what she is going through. You can ask a doctor or view a resource like the National Eating Disorders Association's toolkit for parents.
   • Click here for the toolkit.
2. Encourage her to ask for support. There are most likely things you and others can do, or not do, to help her recover from anorexia. Let her know that you are there for her whenever she needs help. Research shows that recovery from an eating disorder has a lot to do with how connected the person feels to other people. The kind of supportive care she gets from friends and family is essential to her well-being, so do your best to let her know that you care and are willing to help in any way possible.
   • For example, if her doctor or dietitian puts her on a specific diet, ask if she wants help managing this new routine.
3. Participate in therapy with her. One promising method of treatment for anorexia is family therapy, which involves other members of her family undergoing therapy with her. This kind of therapy enlists her family members as allies to help her recover from the condition. Some research actually suggests that family therapy is more effective than individual therapy.
   • The therapist will teach you and other family members how to be supportive and increase her chances for recovery. He may even observe your family eating together in order to make suggestions for healthy ways to encourage a better relationship with food.
4. Eat together as a family. If she is still living with parents, it's a good idea for her to have at least three meals with them each week. Research shows that people who have regular meals with family are less likely to have an eating disorder. This time together can be a healthy way of getting her back on track, especially if combined with family therapy, so that her family members know how to best support her while she is struggling with food issues.
5. Help her avoid isolating herself. Isolation is one of the worst things she can experience if she is already struggling with anorexia. It may seem like a good idea to hide away from the world while she tries to manage her weight, but isolating herself will only make the situation worse. Talk to her about letting her friends and family into her life so that they can be there for her. Relying on the people who care about her and want to see her recover is a key to success.

Tips

• When you talk to her, focus on her feelings and relationships. This will help you avoid bringing up feelings of shame about her relationship with food or her weight.
• Promote her self-esteem. Stay positive when you interact. Focus on what you appreciate about her.

Warnings

• Don't blame yourself if you're a parent. Eating disorders are complex. You didn't cause anything. If you feel like you made mistakes that contributed to her condition, try to apologize and act differently.
• Respect her boundaries. Be available, but don't pry or act in an overbearing way. Boundary violations such as food policing can contribute to an eating disorder.

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Sources and Citations

See also

• Eat Less During a Meal
• Find Help For a Suspected Eating Disorder
• Recover from Anorexia
• Fight Against Eating Disorders
• Convince an Anorexic to Start Eating
• Treat a Child Who Can't Keep Food Down
• Overcome Binge Eating Disorder
• Cope if You Want to Become Anorexic
• Stop Feeling Nervous About Eating Around Other People
• Tell if Someone Is Anorexic

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