This blog post can be applied to anyone who knows a loved one suffering from Bulimia Nervosa, Anorexia Nervosa, Binge Eating Disorder, Orthorexia, ARFID and/or OFSED.
When I first started opening up about Bulimia/Anorexia (I’ll call it ED – short for Eating Disorders) to some of my close friends I was surprised at the amount of people who responded by saying, “you know what, I’m going through a similar thing.”
Every. Single. Time. I was shocked at their confession.
You could say that being shocked was an ignorant response on my part. For me however, it was more of a shock as I did not expect those people to have EDs. They seemed like the life of a party, the most out-going, caring, sensitive people I knew. Not the extremely frail-looking that you usually expect to see when you hear about ED sufferers. But again, this is what I thought.
I was still considered to have a “normal” BMI (I do not like the BMI system but that’s for another post). A misconception that people have is that those with EDs should be severely emancipated and underweight. Yes, some sufferers do display such anatomical changes, but for a lot of them, they are often of a “normal” weight. This may explain why their illness may go under the radar for so long.
I once came across a friend (let’s call him Aly) who helped me through my ED and provided me with the moral support to carry on. I remember during a WhatsApp conversation Aly opened up to me and told me that he was using binge-purge behaviours to alleviate stress that he was dealing with due to a personal problem. This was the first time I was faced with a male who suffered from an ED. However, men suffering from ED is not an uncommon occurrence. Research has found that in 2013 0.3–0.7% of men in Europe reported to suffer from ED (1). The key word here is “reported” suggesting that there may be others suffering from ED also who may have not disclosed their illness.
Either way, men as well as women suffer from eating disorders, and that particular situation opened my eyes to this fact.
Let’s not get too side-tracked…
One of the hardest things to do as a friend of someone who is suffering from an eating disorder is to make them realise the extent to which their behaviour is harmful. A lot of them are so drawn in to their disorders that they cannot comprehend a life where they are free from it. A lot of them are afraid of gaining weight as a result of their recovery. I was. As a result, if you have a friend who is going through this it is your responsibility to make sure your friend feels safe and comfortable when disclosing any information to you so that they can come to terms with their illness.
Here are some helpful ideas:
“Ultimately, the binge-purge behaviour was like my comfort blanket.”
1. Enable them to come to the realisation that they have a problem and that it is harming them.
This sounds like a fairly simple one. As someone who has now recovered I cannot explain to you the amount of times I was in denial that I actually had a problem. I was convinced that what I was doing was not that harmful to me and that as long as I was losing weight and had a caloric deficit I was doing well. Ultimately, the binge-purge behaviour was like my “comfort” blanket. I was in self-destruct mode.
Getting your friend to understand and accept that they have a problem is the first step towards recovery. If they have come to you asking for advice then it shows that they are taking a step. Build on what they share with you. Let them know that what they are feeling is okay and that they will get better.
2. Patiently Help them Understand that they Will need to end the ED.
After speaking to a lot of ED sufferers who feel stuck, the last thing that they want to think about is the process of actual recovery. For them recovery is like going from one hurdle to another and they would prefer to remain in the hurdle that they are more comfortable and familiar with.
The fear of the unknown can be a scary prospect.
An ED can sometimes feel like a rope that you are holding onto if you have a chaotic life or if you are going through personal struggle. A lot of ED sufferers develop this as an unconscious way of re-gaining control in their lives, especially if they are going through a personal battle with something. Some of the reasons that some friends disclosed to me were of family conflict, IVF failures, body image and being bullied.
It is incredibly frightening to think about recovery, a lot of ED sufferers fear gaining weight or ‘losing’ themselves after a long period of controlled diet and exercise.
“The fear of the unknown can be a scary prospect.”
For most of the ED sufferers that I have spoken to, the realisation that they must get better comes from within. ED warriors (those who have recovered) have often likened recovery as the switch of a light going from “on” to “off”; like as if all of a sudden it hits them that they have to recover otherwise they will end up severely ill or institutionalised.
A friend of mine who recently recovered from Anorexia described how she sat alone in a room and started thinking about the pain in her chest. She went on to explain, “it felt like I had this heavy pain in my chest. My teeth were in pain, my bones were sinking into the chair I sat on digging into my skin. I was told I was going to die very soon if I carried on at this severely low weight of 6 stones. It hit me then that I had gone too far and I had to do something about it.”
This realisation has to come from within. As a friend there is only so much you can do. Do not force. Do listen as much as you can.
I remember someone saying to me several years ago “I really struggle with understanding why someone deals with mental illnesses. I can’t relate. Why can’t they just get over it?” This is quite an ignorant statement to make. However, a statement that many do hold. Studies have found that mental illnesses are more than just surface, they go deeper at a neurological level causing changes in brain function and often brain structure too (2). So no, it is not easy to “just get over it”. It takes time, and a lot of positive self-reassurance.
So as a friend you must be patient with your friend’s recovery. Check up on them from time to time.
Ask your friend to make a list of the reasons why they should recover and why they should not. Often writing down lists can help make situations seem a litter clearer.
3. Introduce the Idea of Therapy.
Attending therapy seems like a major taboo subject among many cultures. When I have mentioned my experiences of therapy with people I have always come across comments such as “I could never speak to a stranger about my issues,” or “you’re brave, I could never do that.”
I always struggled with these comments as yes, it can be extremely difficult to open up especially if you are someone who prefers to keep a lot of your issues to yourself. There is this pride that we hold within ourselves that we can solve our issues ourselves and do not need anyone’s help. However, those with EDs must come to know that it is extremely difficult to recover without the involvement of a trained therapist who is expert in helping you to change negative thoughts and behaviours such as those that are manifested in EDs.
If your friend is attending therapy sessions then try to help them out with the homework that they receive from it. Help them identify their triggers and help them understand their thoughts and behaviours.
4. Help Them Develop a Healthier Relationship with Food
Eating with others is something that really aided in my recovery. I had a friend in school who realised the behavioural patterns that I had at the peak of my Bulimia; eat, go to the loo, eat again, go to the loo and so on. She was able to sit me down and distract me with a funny online videos. Or we would go for a walk around the school talking about random teenager things. I really appreciated my time at school as is was a chance for me to never be alone with my thoughts. I felt free for a few hours of my day as I could eat and not think about purging or how uncomfortable the food felt inside me after eating it.
Eating with your friend will help normalise the routine of eating. Help them pace themselves and eat more consciously, being more mindful of how they are eating and what they are thinking as they are eating. This is something that improves with practice, but something you can do to help support them.
“…delete any apps to help them lose weight or track their food or caloric intake.”
As well as eating with them, you should also persuade them to delete any apps that help lose weight or track their food or caloric intake. This will again normalise their eating habits.
5. Take some Time out for Yourself too
Kudos to you for being a supportive friend. The fact that your friend is opening up to you shows that you are a great friend. Nonetheless, you must always remember to help yourself so that you can help others. It is important for you to keep a level head and remain supportive to your friend as they can be quite sensitive especially during their recovery.
Helping someone with an eating disorder does not mean that you must constantly be aware of their every move. Sometimes this can have the opposite effect and encourage resistance.
If you do feel like your friend is at risk to themselves or to others then you must tell a health professional whether it be at a school, college, university or in the workplace.
The most important thing you can do is to reassure them that the steps they take towards recovery will all be worth all the struggle that they are going through.
For more advice on supporting friend and ways to identify the signs of an ED, please visit the sites below:
- Smink, F. R., van Hoeken, D., & Hoek, H. W. (2013). Epidemiology, course, and outcome of eating disorders. Current opinion in psychiatry, 26(6), 543-548.
- Titova, O. E., Hjorth, O. C., Schiöth, H. B., & Brooks, S. J. (2013). Anorexia nervosa is linked to reduced brain structure in reward and somatosensory regions: a meta-analysis of VBM studies. BMC psychiatry, 13(1), 110.