How can I best support friends struggling with disordered eating?

July 19, 2019 9:57 AM

I have a relatively new group of friends at work where two people in it struggle with eating. I don't have experience with these issues but want to learn how best to support them. They are both smart people and are able to navigate the nuances of the accessing NHS services. But what can I do to help, and avoid doing that would cause more problems?

One friend A has had these issues for a long timer but has a solid and stable support structure. I am less worried about her right now.

The other friend B is has the early signs of bulimia. She is starting to talk about it and reach out, but I can tell that it is really hard for her to talk about it. B actions can have a serious triggering affect for A and so it's important for me to be sensitive of this. We are becoming close friends and I feel as though I am in a good position to help them tackle their issues. We work together and often eat lunch together.

I would like to read something about the experiences of having an eating disorder, particularly bulimia. I am also looking for guidance on how best to support someone who is showing the early signs rather than waiting for a full crisis. If location is relevant to your answer I am based in the UK.

Finally, any tips that might help me talk to them about their issues without doing more harm would be welcome. I don't want to avoid the topic.

Thanks!

posted by anonymous to Health & Fitness (8 answers total)

When speaking with your friends, maintain a non-judgmental attitude and try to create a safe space for them to talk about their food patterns. Keep in mind that it is not truly your business or your job to help them, so avoid giving unsolicited advice and take cues for any helping behaviour from them. I don't think you need to avoid the topic, but I think your role should be more to ask questions and listen if they bring it up/want to discuss it. Support them 100% with any positive steps they make. If there are any things you can do as a friend to help with their mental health and wellbeing in general, do those things- eating issues aren't usually really about food. If your friends are not in therapy you could gently ask each if she thinks this would be helpful for her, but only do this if it seems natural in the conversation (I.e., she is sharing that she is really struggling). Don't push them on therapy or anything related specifically to their eating, because this is often very shaming and harmful and might damage your friendship as well.
posted by DTMFA at 10:19 AM on July 19, 2019 [2 favorites]

Just to clarify because my answer sounds extremely hands-off: asking questions can involve asking them if they are looking for any help or to change their eating patterns. It can also include asking them what they are getting out of their eating pattern, and talking about whether they can get this another way. I would just orient towards asking and listening rather than telling them what to do (unsolicited) or passing judgement, as this tends to be much more harmful than helpful.
posted by DTMFA at 10:30 AM on July 19, 2019 [1 favorite]

I have a very close friend who also has struggled with ED (I have too), here is how we talk to and support each other:

ED: i hate everything and feel especially bad in my body today

listener: uh oh. what is your brain telling you is bad? has something changed?

ED: i ate BAD things and now [body part] is [bad] and my pants are too tight and i am now without value and cannot go on

listener: THEN FUCK THOSE PANTS!! IT IS THEIR FAULT! i'm sorry your brain is doing this to you. you look as fabulous as ever. how can we get revenge on your traitorous brain, do you want to keep talking or go get distracted outside or something

ED: do I look different and terrible? can you see all these BAD things??

listener: i cannot. i do not doubt that you feel bad though. put on different pants and let's get out of here!



note: the only way i have been convinced to get therapy was by a friend telling me how effective HER therapy was for her. then i got her therapists number. then i went and it was super great!! and i talked about how much it was helping me to my ED friend as part of standard life sharing conversation (it was about me feeling happy it was helping, not about me wanting her to go), and now my ED friend goes to a therapist too. help is often just listening and being consistently available, not judging, and sharing your own vulnerability and struggle and then progress. i did not want to feel like a pitiful person in need of help, i wanted to feel normal and like i was in the trenches with others fighting their own battles with a squad who would lift me up.
posted by skrozidile at 11:07 AM on July 19, 2019 [4 favorites]

It’s tough to be supportive of someone with an eating disorder because there’s usually a lot of distortion - a common example is that “you look great!” can be interpreted as “you’ve gained weight / you’re fat / you’re not really sick / you’re faking it”. There can also be a lot of validation seeking and it’s not always helpful to give that validation. There’s also a big difference between supporting someone who is in treatment and actively trying to recover from an eating disorder vs. someone who is not actively trying to recover and kind of in the depths of it.

That said, some generally good rules are -
- No comments on body shape, body size, or changes in size/shape, or desire to change size/shape. That applies to the friend’s body, your own body, and the bodies of those around you
- No comments about food, especially the food the person with the eating disorder is eating or not eating. “Would you like to go to XYZ for lunch with me today?” is fine, but “you’re just having a side salad for lunch?” or “I can’t stop eating those cupcakes in the breakroom” is not.

If one of your friends brings up one of these topics, just actively listen without engaging in the talk. So your friend might say, “I ate too much last night and I feel so gross today” - you could respond, “Ugh, that’s so hard. I’m sorry you’re feeling like that!”

And definitely encourage them to seek help from professionals who are experienced with eating disorders; in my experience professionals (therapists, dieticians, etc) who don’t have eating disorder specific training or experience can do more harm than good, unfortunately.
posted by insectosaurus at 11:40 AM on July 19, 2019 [4 favorites]

A big new study looks like revolutionizing the field, really:

A global study, led by researchers at King's College London and University of North Carolina at Chapel Hill, suggests that anorexia nervosa is at least partly a metabolic disorder, and not purely psychiatric as previously thought. The research was published in Nature Genetics today.

The large-scale genome-wide association study, undertaken by over 100 academics worldwide, identified eight genetic variants linked to anorexia nervosa. The results suggest that the genetic origins of the disorder are both metabolic and psychiatric.

Anorexia nervosa is a serious and potentially life-threatening illness. Symptoms of anorexia can include a dangerously low body weight, an intense fear of gaining weight, and a distorted body image. Anorexia nervosa affects between 1-2% of women and 0.2-0.4% of men and has the highest mortality rate of any psychiatric illness.

Knowing that factors they cannot possibly be blamed for predispose them to these problems (and confirming how serious they are) may make it easier for them to seek help, but it's still going to take awhile for doctors and therapists to catch up.
posted by jamjam at 11:46 AM on July 19, 2019 [1 favorite]

ED person here! I would say the main thing is to not mention their bodies, ever. General compliments are fine ("Your hair looks great!" "I love that dress!") but no mention of body size or shape ever ever ever.

No comments about other people's bodies either.

(I think these first two suggestions should be ironclad social norms, but in my experience they are not.)

No comments on the food they're eating or not eating. Be super casual about offers of food or drinks. No pressure.

The conversation skrozidile models would work great for me as well.
posted by missrachael at 11:54 AM on July 19, 2019 [3 favorites]

Yes, I would agree with these points:
No food talk
No diet talk
No talk about bodies, ANY BODIES, yours or theirs or celebrities
No talk about any clothes fitting or not fitting, how hard it is to shop

If you invite someone to sit together for lunch or go out to lunch and they say no or waffle, leave it at that. Don't try to persuade them.

If they bring up one of these things, then sure, you can talk about it. But honestly, as a person in recovery from ED, I do not want to even navigate not talking about these topics on a bad ED day.
posted by fiercecupcake at 12:32 PM on July 19, 2019 [2 favorites]

I just listened to a great episode of the Therapist Uncensored Podcast that talks about this exactly. It gave me a lot of new insight into how a person with an eating disorder thinks and feels, and why reassurances ("You look great!" "You're too thin!") are counterproductive and can be harmful. But it was about a whole lot more than that. It was fascinating, and I bet you'd learn a lot.
posted by bluedaisy at 12:48 PM on July 19, 2019