Eating disorder recovery
September 22, 2015 1:43 AM Subscribe
What is the line between being health conscious or anxious about body image/food consumption and having an eating disorder? If you are in recovery from an eating disorder, how do you know when you are lapsing? What would be the best way to offer support?
Almost eight years ago I discovered that my best friend had an eating disorder. I found her secret blog filled with model photos and other "fitspo" material. Her boyfriend and I sat her down at the time and told her what I had found. She was humiliated, started therapy and had seemingly recovered.
We are both in our early thirties now and I have seen behavior that leads me to believe that she is still struggling with an eating disorder. We were recently at a restaurant eating some very fried food and she excused herself to the bathroom. When she returned, she casually told me that she had felt nauseous and had just thrown up. She continued to drink her beer as if nothing had happened. I told her the next day that I didn't believe that she had just felt "nauseous," and that her behavior was not healthy. She completely denied it and said her eating disorder was a thing of the past. This has happened a handful of times in the past year -- this supposed "nausea" after eating a greasy meal -- and she continues to tell me about these experiences. I keep telling myself, well, if it was a part of an eating disorder, why would she be telling me about it in the first place?
I find other behaviors of hers, when it comes to food, "abnormal." I rarely see her sit down and eat a full meal. When I go to her house around dinner time, she will be eating crackers and say that she hasn't "eaten crackers for dinner in forever," or she will say that she's not hungry for dinner because she had a really big piece of cake at work. Sometimes I feel like she'll go overboard in telling me these things, trying to express to me how much she has eaten. We went on a road trip one time and afterward she had told me how anxiety-inducing all the eating out had been for her since she had no idea what was exactly in the food.
On top of this, she has taken up running. I am uncomfortable when she talks about how much she loves it because I feel that this is part of a larger problem of control surrounding her body.
I feel that these things are happening frequently enough to where I notice them, but then again, I don't feel like this is a "crisis." I find it very difficult to be around her when she tells me these stories about food. I feel like she wants me to play along that everything is fine.
My question is: What is the line between being health conscious or anxious about body image/food consumption and having an eating disorder?
If you are in recovery from an eating disorder over a period of several years, how do you know when you are lapsing? What would be the best way to offer support? Is this a scenario where somebody needs help?
I want to continue being her friend, but I do not know how to approach this issue with her, especially since she will likely deny any problem. (She has been in therapy off and on for years. She is currently off.)
Almost eight years ago I discovered that my best friend had an eating disorder. I found her secret blog filled with model photos and other "fitspo" material. Her boyfriend and I sat her down at the time and told her what I had found. She was humiliated, started therapy and had seemingly recovered.
We are both in our early thirties now and I have seen behavior that leads me to believe that she is still struggling with an eating disorder. We were recently at a restaurant eating some very fried food and she excused herself to the bathroom. When she returned, she casually told me that she had felt nauseous and had just thrown up. She continued to drink her beer as if nothing had happened. I told her the next day that I didn't believe that she had just felt "nauseous," and that her behavior was not healthy. She completely denied it and said her eating disorder was a thing of the past. This has happened a handful of times in the past year -- this supposed "nausea" after eating a greasy meal -- and she continues to tell me about these experiences. I keep telling myself, well, if it was a part of an eating disorder, why would she be telling me about it in the first place?
I find other behaviors of hers, when it comes to food, "abnormal." I rarely see her sit down and eat a full meal. When I go to her house around dinner time, she will be eating crackers and say that she hasn't "eaten crackers for dinner in forever," or she will say that she's not hungry for dinner because she had a really big piece of cake at work. Sometimes I feel like she'll go overboard in telling me these things, trying to express to me how much she has eaten. We went on a road trip one time and afterward she had told me how anxiety-inducing all the eating out had been for her since she had no idea what was exactly in the food.
On top of this, she has taken up running. I am uncomfortable when she talks about how much she loves it because I feel that this is part of a larger problem of control surrounding her body.
I feel that these things are happening frequently enough to where I notice them, but then again, I don't feel like this is a "crisis." I find it very difficult to be around her when she tells me these stories about food. I feel like she wants me to play along that everything is fine.
My question is: What is the line between being health conscious or anxious about body image/food consumption and having an eating disorder?
If you are in recovery from an eating disorder over a period of several years, how do you know when you are lapsing? What would be the best way to offer support? Is this a scenario where somebody needs help?
I want to continue being her friend, but I do not know how to approach this issue with her, especially since she will likely deny any problem. (She has been in therapy off and on for years. She is currently off.)
To answer your first question: that line differs for everyone, and you will find that it can be blurry. It's mostly in how one frames eating, not what's being eaten. I can't really define it for anyone else, but for me the line is crossed once I start to get a "high" of sorts from restriction and also seek it out regularly. I've kind of accepted that I will never not enjoy restriction on some level or another. When I wasn't actively hiding or denying my ED, talking about only drinking coffee (black, unsweetened) for breakfast or skipping lunch was more of a source of pride, not shame. It could be what's happening with your friend, or it could be a cry for help, but it's really not my place to tell you which.
Despite this, I have not experienced a full relapse since college (a few years ago). My best friends have seen me start to relapse. The kindest thing that they could do for me is remind me that they loved me, and offer to help me in any way possible. It was nice to know that I could talk to them about the underlying issues that brought my ED just below the surface, and not just about food itself.
I would, in your position, try not to call explicit attention to what she's saying/doing. You don't want to start driving her underground or putting pressure on her if she is experiencing her ED like I did, because it will probably make it worse for her. My parents did not handle the discovery of my ED well, and I shame-spiraled whenever they started openly talking about it. I didn't really start working through my ED until I was happy to be in therapy and happy to be staring my issues in the face. She may not be there yet. Unfortunately, you can't drag her there, either.
So on one hand, continue to be there for her, because EDs are nasty business and harrowing to try to fend off. On the other hand, decide how much exposure to ED patterns you can handle before you need to step back. You may need to support her from a distance if you find yourself wanting to corral her into a come-to-Jesus talk or closely monitoring her eating habits, which she may notice and feel poorly about.
I would maybe start an exchange, like this one:
OP: Hey, how've you been feeling?
Friend: Great! Everything's fine!
OP: Good! But, hey, just so you know, if you need to talk about something heavy or you need help parsing through stuff, I'm here. I promise.
Friend: Oh, thanks! Don't worry about it, I'm good.
OP: I know! But just in case.
And then drop it for a while. It's not going to make her ED go away if she's relapsing, but if she needs your help and is ready to seek it, having that conversation will make it clear that you're trying to be a safe person to approach.
Oh and! This probably goes without saying, but part of making yourself a safe person also includes ensuring that you never snark or wax judgmental about other people's bodies, ever, around her. It'd probably be best to assume that even if she does all of those things or rags on people who aren't runners or whatever, agreeing with her isn't going to be helpful.
posted by Ashen at 5:54 AM on September 22, 2015 [3 favorites]
Despite this, I have not experienced a full relapse since college (a few years ago). My best friends have seen me start to relapse. The kindest thing that they could do for me is remind me that they loved me, and offer to help me in any way possible. It was nice to know that I could talk to them about the underlying issues that brought my ED just below the surface, and not just about food itself.
I would, in your position, try not to call explicit attention to what she's saying/doing. You don't want to start driving her underground or putting pressure on her if she is experiencing her ED like I did, because it will probably make it worse for her. My parents did not handle the discovery of my ED well, and I shame-spiraled whenever they started openly talking about it. I didn't really start working through my ED until I was happy to be in therapy and happy to be staring my issues in the face. She may not be there yet. Unfortunately, you can't drag her there, either.
So on one hand, continue to be there for her, because EDs are nasty business and harrowing to try to fend off. On the other hand, decide how much exposure to ED patterns you can handle before you need to step back. You may need to support her from a distance if you find yourself wanting to corral her into a come-to-Jesus talk or closely monitoring her eating habits, which she may notice and feel poorly about.
I would maybe start an exchange, like this one:
OP: Hey, how've you been feeling?
Friend: Great! Everything's fine!
OP: Good! But, hey, just so you know, if you need to talk about something heavy or you need help parsing through stuff, I'm here. I promise.
Friend: Oh, thanks! Don't worry about it, I'm good.
OP: I know! But just in case.
And then drop it for a while. It's not going to make her ED go away if she's relapsing, but if she needs your help and is ready to seek it, having that conversation will make it clear that you're trying to be a safe person to approach.
Oh and! This probably goes without saying, but part of making yourself a safe person also includes ensuring that you never snark or wax judgmental about other people's bodies, ever, around her. It'd probably be best to assume that even if she does all of those things or rags on people who aren't runners or whatever, agreeing with her isn't going to be helpful.
posted by Ashen at 5:54 AM on September 22, 2015 [3 favorites]
The playing along thing is hard. If she is "participating in disordered behaviors", you definitely do not want to play along and allow her to use you to reassure herself that everything is fine. It seems like everything is not fine. I'm not diagnosing her with an eating disorder at all, but these do sound like some worrisome behaviors.
Your questions were: What is the line between ED and health consciousness? How do you know when you are relapsing? What would be the best way of offering support? Is this a scenario where someone needs help? and How to approach this issue?
As far as the "line" goes - it's different for everyone. My line is most often when I start obsessing about every calorie, restricting and eating in secret and I'm like Ashen, restricting will always be a problem for me. It's a control thing. At first I'm just making some changes in my food and within a couple of weeks I'm at 800 kcal a day. I'm in therapy with an ED specialist though, so that hasn't happened in a while (also, after 25 years of ED I haven't purged in 5 years, nor do I have a desire to anymore - so recovery is possible).
As far as whether or not your friend needs help, the answer is yes and no. Yes, she could probably use help, no, you cannot be the one to provide it. Eating disorders are sneaky little bastards and you could easily become the enemy very quickly. I think Ashen's advice of offering your ear in case she wants to talk about anything is really the best way to go about it. Also, backing off if the ED talk gets to be too difficult for you is important. You need to take care of yourself first. I have ended friendships entirely over this issue as, my health was dependent on it. I cannot talk about food and exercise as a normal casual conversation. It just triggers the living hell out of me. Therefore, if all you know to talk about is how many calories you've consumed today, how far you've run and what does and doesn't fit you anymore is all you have to contribute to a conversation, I cannot be around you. You may not have such lines.
Feel free to memail me. I'm around.
posted by Sophie1 at 9:04 AM on September 22, 2015 [2 favorites]
Your questions were: What is the line between ED and health consciousness? How do you know when you are relapsing? What would be the best way of offering support? Is this a scenario where someone needs help? and How to approach this issue?
As far as the "line" goes - it's different for everyone. My line is most often when I start obsessing about every calorie, restricting and eating in secret and I'm like Ashen, restricting will always be a problem for me. It's a control thing. At first I'm just making some changes in my food and within a couple of weeks I'm at 800 kcal a day. I'm in therapy with an ED specialist though, so that hasn't happened in a while (also, after 25 years of ED I haven't purged in 5 years, nor do I have a desire to anymore - so recovery is possible).
As far as whether or not your friend needs help, the answer is yes and no. Yes, she could probably use help, no, you cannot be the one to provide it. Eating disorders are sneaky little bastards and you could easily become the enemy very quickly. I think Ashen's advice of offering your ear in case she wants to talk about anything is really the best way to go about it. Also, backing off if the ED talk gets to be too difficult for you is important. You need to take care of yourself first. I have ended friendships entirely over this issue as, my health was dependent on it. I cannot talk about food and exercise as a normal casual conversation. It just triggers the living hell out of me. Therefore, if all you know to talk about is how many calories you've consumed today, how far you've run and what does and doesn't fit you anymore is all you have to contribute to a conversation, I cannot be around you. You may not have such lines.
Feel free to memail me. I'm around.
posted by Sophie1 at 9:04 AM on September 22, 2015 [2 favorites]
The level of anxiety she has about eating and lack of regularity is alarming, and relapse is common. But I agree w/ others that being food or behavior police isn't helpful and calling out the behavior might make her uncomfortable. She may be falling back into the ED mindset without wanting to acknowledge it yet and you can't really reason with an eating disorder.
For me restriction always starts again with this idea that I'll just lose a little weight, just cut a bit of food, then suddenly I'm not eating real meals and purging again. I definitely have periods where I get back into this idea that I don't need to eat like other people do and I'm getting off track and need to control what I eat again.
my boyfriend sometimes knows when I have been purging and it can be frustrating but also a good thing that after I go to the bathroom (sometimes before) he'll say something like, "are you okay?" Which some people would find annoying, but sometimes it keeps me from purging when I would have otherwise. When I tell him about not eating enough that day or feeling guilty about purging his response is usually "I'm sorry, what happened?" and then "let's work on getting through the next meal." That has helped me because I know he isn't going to berate me into recovery (which won't work), but is recovery-focused, and it helps me feel comfortable telling him things because I know he isn't going to guilt me.
That being said, he does have points where he really struggles to hear about how I'm doing and he says things that are insensitive, or I sense frustration, and I try to step back a bit. So setting a comfortable distance can be important.
posted by mmmleaf at 9:46 AM on September 22, 2015 [3 favorites]
For me restriction always starts again with this idea that I'll just lose a little weight, just cut a bit of food, then suddenly I'm not eating real meals and purging again. I definitely have periods where I get back into this idea that I don't need to eat like other people do and I'm getting off track and need to control what I eat again.
my boyfriend sometimes knows when I have been purging and it can be frustrating but also a good thing that after I go to the bathroom (sometimes before) he'll say something like, "are you okay?" Which some people would find annoying, but sometimes it keeps me from purging when I would have otherwise. When I tell him about not eating enough that day or feeling guilty about purging his response is usually "I'm sorry, what happened?" and then "let's work on getting through the next meal." That has helped me because I know he isn't going to berate me into recovery (which won't work), but is recovery-focused, and it helps me feel comfortable telling him things because I know he isn't going to guilt me.
That being said, he does have points where he really struggles to hear about how I'm doing and he says things that are insensitive, or I sense frustration, and I try to step back a bit. So setting a comfortable distance can be important.
posted by mmmleaf at 9:46 AM on September 22, 2015 [3 favorites]
To reiterate what Ashen and Sophie1 have already said, the line between "healthy"/"disordered" is one that is different for everyone and (even more frustratingly) can be different for the same person at different times in their recovery process. So, for example, what was an absolute sign of relapse for me four years ago, may now be something that I can engage in more-or-less "safely". Conversely, things that were never triggers for me before can become triggers/unsafe for me later on. ED is an asshole and works hard to find ways to keep his claws in you, and one of the ways it happens (for me, at least, and everyone is different) is that the "line" keeps moving.
Judging from the information in your post, it sounds to me like your friend is going through a period where she herself might not be sure where that "line" is, and is maybe struggling a bit with letting go of having the ED as part of her identity, and is therefore testing how far she can go with ED behaviors without going over the edge, and also how much she can bring out into the open without setting off alarms. I know that for me, there have been times where my eating behaviors are more-or-less normal, and I become very insecure about that, and begin to freak out, and start flirting with disordered behaviors more and more, and will "casually" drop into conversations with my boyfriend (who knows about my issues) little crumbs and clues to what's going on, or will be not-so-secretive about hiding behaviours. I guess it's my way of letting him know that I'm struggling, and that I need a little bit of extra sensitivity from him right then. It's not so much a cry for help (I'm not in crisis, I'm just working through some shit), as it is a marker of me feeling particularly vulnerable and prone to relapse, a sort of warning before the storm rather than the storm itself, you know? That's what your description of your friend's behavior sounds like to me..... but I'm a random stranger on the internet, so many grains of salt are required when taking this opinion.
As to how you can support your friend, that really depends on her. Some people respond to offers of support by retreating and hiding, some people respond by being needy and dependent in an unhealthy way, and some people respond somewhere in between. As others have said, you can't really be the one to "help" her, if she in fact needs help. It's not your job or your place. Just as a potential counterpoint to some of the suggestions above (which are absolutely good ones), I just wanted to offer that FOR ME, the most helpful thing my friends can do when I'm on the edge is to be there to listen if I approach them, sure, but even more importantly, is to NOT INDULGE in my fetishization of ED behaviors (me being obvious about purging, or drawing attention to how much/little I ate, valorizing exercise, etc.) These are (again, just my opinion based on my own personal history, which may or may not actually be applicable to your friend)all ways that I might be putting behaviors that I know to be borderline out in the open to see what kind of reaction I get, and in my case the most helpful/health-promoting reaction I can get is either no reaction at all, or a very blunt but kind "Dorinda, is this something that you might want to talk to your therapist about?" Whether or not that's appropriate in your friend's case is something I can't answer.
Being sensitive to and compassionate about the fact that she's struggling is fantastic, and there are many ways you can signal that (offering an ear to listen if she needs it, and not just for ED stuff; being cognizant of how you're interacting with and discussing food and bodies in her presence; not drawing attention to the behaviors she's exhibiting when they do show up; etc). What doesn't work, at least for me, is a friend attempting to talk with me specifically about my disorder. If I initiate the conversation, that's one thing, and in that case I am always so, so grateful for a compassionate ear of someone I trust. But I need to be the one to seek that person out. Otherwise, if they come to me, or if they bring the issue up unbidden, that just starts me on a spiral where I begin to equate my worth/interestingness/value to that person with my degree of disorder (I told you ED is fucked up), and it just feeds that part of my brain that associates thinness/sickness/neediness with people loving me. This might not be the case with your friend, but it's something to keep in mind as you attempt to navigate this really fraught territory.
You're a good friend, OP. Best of luck to you and your friend!
posted by Dorinda at 11:19 AM on September 22, 2015 [4 favorites]
Judging from the information in your post, it sounds to me like your friend is going through a period where she herself might not be sure where that "line" is, and is maybe struggling a bit with letting go of having the ED as part of her identity, and is therefore testing how far she can go with ED behaviors without going over the edge, and also how much she can bring out into the open without setting off alarms. I know that for me, there have been times where my eating behaviors are more-or-less normal, and I become very insecure about that, and begin to freak out, and start flirting with disordered behaviors more and more, and will "casually" drop into conversations with my boyfriend (who knows about my issues) little crumbs and clues to what's going on, or will be not-so-secretive about hiding behaviours. I guess it's my way of letting him know that I'm struggling, and that I need a little bit of extra sensitivity from him right then. It's not so much a cry for help (I'm not in crisis, I'm just working through some shit), as it is a marker of me feeling particularly vulnerable and prone to relapse, a sort of warning before the storm rather than the storm itself, you know? That's what your description of your friend's behavior sounds like to me..... but I'm a random stranger on the internet, so many grains of salt are required when taking this opinion.
As to how you can support your friend, that really depends on her. Some people respond to offers of support by retreating and hiding, some people respond by being needy and dependent in an unhealthy way, and some people respond somewhere in between. As others have said, you can't really be the one to "help" her, if she in fact needs help. It's not your job or your place. Just as a potential counterpoint to some of the suggestions above (which are absolutely good ones), I just wanted to offer that FOR ME, the most helpful thing my friends can do when I'm on the edge is to be there to listen if I approach them, sure, but even more importantly, is to NOT INDULGE in my fetishization of ED behaviors (me being obvious about purging, or drawing attention to how much/little I ate, valorizing exercise, etc.) These are (again, just my opinion based on my own personal history, which may or may not actually be applicable to your friend)all ways that I might be putting behaviors that I know to be borderline out in the open to see what kind of reaction I get, and in my case the most helpful/health-promoting reaction I can get is either no reaction at all, or a very blunt but kind "Dorinda, is this something that you might want to talk to your therapist about?" Whether or not that's appropriate in your friend's case is something I can't answer.
Being sensitive to and compassionate about the fact that she's struggling is fantastic, and there are many ways you can signal that (offering an ear to listen if she needs it, and not just for ED stuff; being cognizant of how you're interacting with and discussing food and bodies in her presence; not drawing attention to the behaviors she's exhibiting when they do show up; etc). What doesn't work, at least for me, is a friend attempting to talk with me specifically about my disorder. If I initiate the conversation, that's one thing, and in that case I am always so, so grateful for a compassionate ear of someone I trust. But I need to be the one to seek that person out. Otherwise, if they come to me, or if they bring the issue up unbidden, that just starts me on a spiral where I begin to equate my worth/interestingness/value to that person with my degree of disorder (I told you ED is fucked up), and it just feeds that part of my brain that associates thinness/sickness/neediness with people loving me. This might not be the case with your friend, but it's something to keep in mind as you attempt to navigate this really fraught territory.
You're a good friend, OP. Best of luck to you and your friend!
posted by Dorinda at 11:19 AM on September 22, 2015 [4 favorites]
What would be the best way to offer support?
Having an eating disorder means you are already spending 99% of your time on your illness. What you are going to eat, how you are going to deal with eating in public at this one event, when you are going to get to exercise on day that looks like there is no room for exercise, what you ate today, what you can do to fix what you've eaten, what you are going to try to get better, what you are going to do today vs tomorrow, what are people thinking about you and your symptoms, do you want people to notice or do you want to hide it, do you look right (no), do you look sick, do you want to look sick, do you want to be better, how many calories are in this, and on and on and on and on and on. It is CONSTANT evaluation of the same rotating cast of worries, compulsively, until you either get better or you don't.
So if your friend is struggling with this, which I agree with you it sounds like she is, she does not need someone to figure it out and try to help her see that she has crossed a line. She knows! You sound like you have the best of intentions, so I'm going to tell you straight up that helping your friend shouldn't have anything to do with policing the line for her.
You know that thing where sometimes you want to vent without immediately having the listener go into problem solving mode? If not - PLEASE BELIEVE ME that a lot of people do. People want to share and have their feelings acknowledged without immediately getting hit with "solutions". If people want solutions or a brainstorming session on how to solve things then they say things like "I need your help". Usually.
Therefore the thing that I think would be most helpful is active listening and then following up with "how do you feel about x" type questions.
Examples:
She talks about her exercise routine - "How do you feel about maintaining the routine? Is it totally fine, or does it stress you at all? It would be too hard for me!"
She says she feels sick and threw up - "that sounds rough. are you otherwise ill? anything wrong?"
She comments on weirdness of her just crackers meal - "Eh whatever. Do what you have to do. I eat weird when I'm stressed sometimes, anything bothering you?"
This applies to every example: If she doesn't want to open up, leave it alone. I don't know if I buy the idea that you can force or intervention someone into wellness. You certainly don't have to support behaviors that you don't agree with, so no need to like... go with her on zillion miles runs or limit your eating around her or whatever. I hope you are able to feel better about this, I know it can be stressful to watch someone you care about suffer. Good luck!
posted by skrozidile at 12:08 PM on September 22, 2015 [2 favorites]
Having an eating disorder means you are already spending 99% of your time on your illness. What you are going to eat, how you are going to deal with eating in public at this one event, when you are going to get to exercise on day that looks like there is no room for exercise, what you ate today, what you can do to fix what you've eaten, what you are going to try to get better, what you are going to do today vs tomorrow, what are people thinking about you and your symptoms, do you want people to notice or do you want to hide it, do you look right (no), do you look sick, do you want to look sick, do you want to be better, how many calories are in this, and on and on and on and on and on. It is CONSTANT evaluation of the same rotating cast of worries, compulsively, until you either get better or you don't.
So if your friend is struggling with this, which I agree with you it sounds like she is, she does not need someone to figure it out and try to help her see that she has crossed a line. She knows! You sound like you have the best of intentions, so I'm going to tell you straight up that helping your friend shouldn't have anything to do with policing the line for her.
You know that thing where sometimes you want to vent without immediately having the listener go into problem solving mode? If not - PLEASE BELIEVE ME that a lot of people do. People want to share and have their feelings acknowledged without immediately getting hit with "solutions". If people want solutions or a brainstorming session on how to solve things then they say things like "I need your help". Usually.
Therefore the thing that I think would be most helpful is active listening and then following up with "how do you feel about x" type questions.
Examples:
She talks about her exercise routine - "How do you feel about maintaining the routine? Is it totally fine, or does it stress you at all? It would be too hard for me!"
She says she feels sick and threw up - "that sounds rough. are you otherwise ill? anything wrong?"
She comments on weirdness of her just crackers meal - "Eh whatever. Do what you have to do. I eat weird when I'm stressed sometimes, anything bothering you?"
This applies to every example: If she doesn't want to open up, leave it alone. I don't know if I buy the idea that you can force or intervention someone into wellness. You certainly don't have to support behaviors that you don't agree with, so no need to like... go with her on zillion miles runs or limit your eating around her or whatever. I hope you are able to feel better about this, I know it can be stressful to watch someone you care about suffer. Good luck!
posted by skrozidile at 12:08 PM on September 22, 2015 [2 favorites]
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posted by mermayd at 4:46 AM on September 22, 2015