I'm not there to make her eat.
May 31, 2011 12:33 PM   Subscribe

What can/should I do to help a friend on the other side of the world who seems to be starving herself?

My friend has been teaching English in an Asian country for over a year now. A few months her boyfriend broke up with her and she hasn't been dealing with it well. In the last couple of weeks, she's been reaching out to friends in her home town (including me) indicating she is unhappy and feeling isolated.

Today she posted pictures of herself on Facebook looking skeletal. She's naturally thin at the best of times, but these pictures could be used as thinspiration on pro-ana sites. I saw her about three months ago looking healthy and at a normal weight. I've known her for years and so have other people and this is the thinnest we've ever seen her. She looks like someone who is dying. She doesn't have a history of eating disorders, though she has been a heavy drug user in the past.

Considering the number of us who frantically emailed one another after these photos went up, it's clear that it's not just me who is worried about her. We're uncertain how to proceed though. Should we mention her weight? Do we contact her parents (who, admittedly, are not entirely supportive individuals)? Do we tell her it's time to get on a plane and fly home? How do we deal with this without her becoming defensive and more self-destructive?

I'm afraid that she's going to be flooded with emails asking if she's ok and I don't know if that is a good thing. As another friend said, "When I was 13 and starving myself and people told me I looked too thin, I would become furious." But our friend is 30, not 13. What's the protocol here?

I'm really worried about my friend, but I don't know what I should be -- or can be -- doing to help.
posted by anonymous to Health & Fitness (8 answers total) 2 users marked this as a favorite
Don't mention the weight specifically. She already knows she's skinny. Don't be all "OMG you look horrible!" Ask her how she's dealing with the breakup and if there's anything you can do to help. Encourage her to take care of herself.
posted by desjardins at 12:50 PM on May 31, 2011 [1 favorite]

I don't know if she would be willing to fly home, but if she does, that would certainly make it easier for you to help her. These kinds of situations are tricky to judge, since I really know almost nothing about this woman, but I think that in your situation I would tell her that I really miss her and want to see her again, and so do her other friends that you have heard from, and ask if she will come home, if only for a visit. she needs to be made to feel loved, and to feel that her life is worth living.
posted by grizzled at 12:51 PM on May 31, 2011

It seems like you and your friends agree that there is cause for concern, but there is still some information missing in terms of what exactly she and you, by proxy, are facing. She is dealing with the fall out of a break-up in a distant place with little support. Depression can certainly affect appetite as can stress, which might be part of why she's looking so thin. Drug abuse can also affect appetite and eating habits to the point of looking anorexic. It's unusual for someone to develop an eating disorder for the first time in their 30's, but that is not to say it never happens. It could be a separate illness or it could be a combination of all of the above.

As a friend from far away, you are not in a position to do much other than listen, get more information and provide support. Some of that support may be helping her to contact people closer on the ground who can help her. I think it's perfectly fine to express concern that she is not looking well (if it is an eating disorder, you might want to tread lightly on talking about her being "thin" as that can be seen as a positive to the person). Ask about what's happening and really listen. Ask about what support she has near to her. Is she working for a company who could help locating appropriate medical/psychiatric resources for her? Are there friends there who could provide support? Has she been in touch with her family? Could she contact the embassy there for assistance with medical issues?

At worst, she'll react defensively or angrily (and this is entirely likely). It will feel bad, but you have communicated your concerns and opened lines of communication. She might need to hear that others are concered 5 or 10 or 20 times before she is ready to act, but you've given her the message at least once. At best, she'll accept your help. You and your friends can then work together to support her. You can listen, send care packages, and if need be you can contact her family for additional help.

Be sure you also have support, as it's stressful to try to support someone else through something like this. Remember that you cannot fix any of these issues. She needs to agree to work on them, and needs to have professional support on the ground there with her to do so.

Best of luck to you, and your friend is so fortunate to have you as part of her support.
posted by goggie at 12:58 PM on May 31, 2011 [2 favorites]

Yes, I seriously wonder if she's doing drugs again.

You may not be able to do this without her becoming more defensive and destructive--that is part of her "illness", her pain, which can happen at any age. But perhaps that is better than doing nothing at all.
posted by Melismata at 1:12 PM on May 31, 2011

If she's caught up in the midst of anorexia and doesn't want to change, there's not much you can do - regardless of her location. Best case scenario, you phone her often and offer your support through the emotions of the break-up. I would let her bring up the eating, but I would provide lots of opportunities for her to bring it up. Like ask how she's coping...how much she's sleeping...if she's "taking care of herself." See if she'll open up. Have your friends do the same.

HOWEVER...don't assume that it's her choosing not to eat purposefully. When I went through a stressful breakup in college, I lost almost 30 pounds in a very short space of time. I just couldn't keep food down and had no appetite. For me, the real culprit was not anorexia, but depression. Encourage her to see a doctor/therapist and follow their recommendations. It could be a combination of being in a overseas in a place that is unfamiliar and nothing like home, the break-up and its residual stress, and normal life stress that caused her to stop eating normally.

But you can't force her to do anything, and if you get too forceful, she might cut off contact altogether, and therefore intensify the problem. Be a friend to her as best you can. Don't approve of her eating (or lack thereof), but also don't attack her.

It's tough, and I wish you luck. Thank you for caring about your friend enough to try. I wish I had people to help me through my break-up all those years ago as you're helping her.
posted by guster4lovers at 1:51 PM on May 31, 2011 [1 favorite]

I can't speak to how you should address the issue, nor am I saying not to worry about it either because if someone is unhealthily thin (not just naturally super thin) it's a problem regardless of the underlying cause.

However, I wouldn't assume she's anorexic for much the same reasons as guster4lovers has suggested. Having no appetite or being unable to keep things down or not having the energy or desire to take care of yourself all cause weight loss, and are all symptoms of depression. Myself and a friend both lost weight after terrible break-ups just from lack of appetite and lack of motivation to do anything. Another friend with anxiety and a finnicky stomach in the best of times lost a lot of weight during a particularly stressful time because she couldn't keep anything down; once the stress passed she could eat normally and her weight went back to normal. I'm sure the fact that your friend is currently in a different country makes her feel even more isolated than she would otherwise, and it wouldn't surprise me at all if she barely had the motivation just to get through teaching.

But yes, she could have an eating disorder. Sometimes when people go through break-ups they pick apart their appearance as a possible culprit, or as some factor they can control or change, or for other reasons. It's also possible she's doing drugs again. It's hard to know.

As I said, I'm not sure how you ought to approach this, but it seems best to avoid saying something that indicates you think she has an eating disorder -- either because she might not and hearing she looks like she has an eating disorder when she's already depressed will probably make her feel worse, or if she does have an eating disorder it might anger or encourage her or not change anything. I would try to help her cope emotionally at the very least, make sure she doesn't feel alone, be an outlet for her to talk to, and hopefully her outward symptoms will improve as his mental state improves.
posted by Nattie at 12:47 AM on June 1, 2011

I don't get it - why not just email her and say she looks too thin and that you're worried about her? Contacting her not-that-great parents without even discussing the problem with her first = no, no, no way.
posted by hazyjane at 4:46 AM on June 1, 2011

When I was majorly into my yoga practice (injuries got me backed off just now) AND was riding my bike everywhere in summer (in Texas) I lost a lot of weight. A lot. I was told -- by many people -- that I looked too thin, what was I eating, what was troubling me, blah blah blah. Nothing was troubling me, I loved being that thin, my doctor and my cardiologist and my mentor -- and I trust all of these people, a lot -- they all told me all was well. I was wearing clothing I could have worn in high school, I loved it. So I went on and did what I was doing, blew everybody off, went on my way.

And yeah, I knew for a fact that I'd changed my body considerably, clothing no longer fitting me, or, in some cases, fitting better. I don't own nor want a scale, I can't care about how many pounds, what's that matter, I only knew my weight from doctors visits. Clothing told me the tale, I never saw any difference in my mirror, I just can't see myself accurately. But I can see pants that were tight needing to be cinched with a belt etc.

It is possible, perhaps likely, that I have this orthorexia thing going on sometimes, where I eat nothing but real healthy food and exercise and do yoga and ride bikes etc and etc, and even though my health is fine I am using it as a way to deal with whatever I deal with. Like your friend, I've a history of addiction(s) and I'd never rule it out, I'd never say that I'm not doing that. I absolutely have used overeating and/or eating garbage to deal. An addict is an addict is an addict, it just shows up in different ways.

Here's the news: It bothered the fuck out of me to have people bring it up, at least in the way that many of them did. It was very. annoying. Extraordinarily rude, outlandishly rude. People felt they had/have every right to say "Oh, boy, you're sure skinny, do you have polio or what?!" when I lost weight who wouldn't *dream* of saying a goddamn word if I gained weight -- "Holy smokes, you sure have turned into a big fat tub of goo!" It's really, really rude, or it can be.

A lot of the people who had those 'concerns' were not exactly the thinnest people on the planet, if you catch my drift. Not saying that's the case with you and/or your friends but it was absolutely true in what happened to me.

Oh, and when I've gone through breaks I've gotten to where I just can't eat, same as others in this thread have mentioned, and sometimes puked when I did eat. Lived on coffee and tears as I've staggered through, sometimes I know that I'm getting better when I can enjoy a meal, same as when I can finally enjoy a nights sleep.

So I'd say it depends upon how close you are to this friend. If you're not her doctor or her mentor and/or if she hasn't asked you or brought it up, it's quite easy to step over a line of privacy, and deeply into the land of rude. If you are real close, then you maybe have the right to say something and/or ask something, whatever. Otherwise, you don't. That's my take on it, anyways.
posted by dancestoblue at 7:42 AM on June 1, 2011 [1 favorite]

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