How to Help Someone With an Eating Disorder
Nearly one in 25 American adults has serious mental illness, which means odds are someone in your life is coping with anxiety, depression, OCD, bipolar disorder or another debilitating condition. Still, shame about mental illness — likely a holdover from when people wrongly believed such conditions were character flaws or a mother’s fault — can make it hard to seek help or even know what to say to those who struggle. To shine a light on the daily realities of mental illness, Good Housekeeping and the National Alliance on Mental Illness (NAMI) surveyed more than 4,000 people, and found that over a third had a close friend or relative with mental illness. In our special package on how to support loved ones with mental illness, women who live with these widely misunderstood psychological issues share what it feels like, and how you can make a difference
Food is never simply fuel or sustenance or a pleasurable part of life for someone with an eating disorder — every bite involves rigid rules, supposed failures, and vows to be "better" when it comes to what you eat. “It’s like having another person in your brain who is constantly degrading you and berating you,” says Hollyn, 25, of Plano, TX, who has battled anorexia since she was 15. “The voice would tell me, ‘You can’t eat that,’ and I’d ask, ‘Why not?’ and it would reply, ‘Because you can’t.’ There was no rationale.”
Hollyn, who was chronically dehydrated through her teens and says she stumbled through high school in a daze because of her eating disorder, would often challenge herself to go as long as possible without eating or drinking. “When I did eat, I would make sure to eat very small portions. One of my rules was that I always had to leave something behind — I would never let myself finish a meal in its entirety, and I never allowed myself to be full.”
There are several types of eating disorders: The most common is binge-eating disorder, which involves emotionally distressing, out-of-control overeating (say, downing several pizzas and a box of cookies within two hours, and then feeling distraught about it). People who have bulimia nervosa also binge, but those episodes are followed by forced vomiting, overuse of laxatives, or excessive exercise to "purge" the calories. Anorexia nervosa is a disorder in which people restrict food so severely that it can lead to starvation, and they often have a distorted image of their body. Other restrictive eating disorders include orthorexia, an obsession with "healthy" or "pure" food that can lead to malnutrition, and ARFID (Avoidant Restrictive Food Intake Disorder), in which people avoid certain foods, not because of body-image or weight issues, but because they don’t like certain textures, have a fear of choking, or are just not interested in eating.
While there's a common myth that eating disorders are all about asserting control, there are usually multiple reasons why someone may develop one, says Deborah Glasofer, Ph.D., an associate professor of clinical medical psychology at the Columbia Center for Eating Disorders in New York. "Different risk factors include genetics, personality and temperament, peer influence, and social media exposure," she explains. "And there are some personality features that tend to track with particularly types of disorders, but we don't have a clear answer as to why someone would develop one eating disorder over another — or why they would develop an eating disorder at all."
If you or someone you know is battling an eating disorder, contact the National Eating Disorder Association's Live Helpline at 800-931-2237.
Hollyn, who is doing better after a recent round of treatment but says she still has some bad days, recalls how she would push herself to get through the day with as little nutrition as possible: She would skip breakfast, sit in the school hallway during lunch period, and eat very little at home — even throwing away or flushing the rest of her food so her family wouldn’t notice it hadn’t been eaten. “My excuse was always that I already ate, or I wasn’t hungry,” she says. “My eating disorder gave me something to focus on, something that I felt made me special.”
People with eating disorders often have a distorted image of their own body, believing they're overweight, when the opposite is true. Etsegenet, 40, from Inglewood, CA, developed an eating disorder in high school, a time she recalls as “the era of Calvin Klein models and body shaming. Anything more than 110 pounds felt like, ‘you’re gross.’” She gained a few pounds before starting high school, which set her on the road to exercising more and more and eating less and less. “I would throw up after dinner, but then my appetite changed, and there were times I don't remember eating at all,” she recalls. It wasn’t until after she graduated college and landed in the hospital that she was finally given a diagnosis of anorexia and bulimia (the two have overlapping symptoms; while many people with bulimia are of average weight, Estegenet was extremely underweight). That's when she began therapy and started to recover.
According the National Eating Disorders Association, around 20 million women and 10 million men will struggle with an eating disorder at some point in their lifetime. “Eating disorders are biologically based,” says Glasofer. “There are people who walk around in the world who are more vulnerable to it, and stressors such as puberty, moving to a new place, and trauma can set the stage for the disorder to develop.”
Whatever the trigger may be, the disordered eating then takes on a life of its own, she says. Because eating disorders can lead to severe health problems, including tooth decay, reflux, growth deficiencies, dehydration, infertility, organ failure, and even death, getting treatment early is crucial. “Cognitive behavioral therapy for adults and family-based therapy for adolescents are very effective,” says Glasofer, who says that patients may begin with outpatient therapy and nutritional counseling, but may require hospitalization or residential treatment if their disordered eating doesn’t improve within a month. One drug, Vyvanse, has been approved to treat binge-eating disorder, and since eating disorders are often intertwined with other conditions such as depression, anxiety, and bipolar disorder, antidepressants, antipsychotics, and mood stabilizers may also be prescribed.
If you know someone who is struggling with an eating disorder, it's crucial to lend support. Here's how you can be an ally:
If you see something, say something — gently: Rather than calling out your friend or family member on their eating habits in the middle of a meal, wait until you have a chance to talk privately, and use supportive language, says Glasofer: “Be specific about the changes you’ve seen in their health or mood.” Say something like: “Are you feeling all right? You look under the weather lately,” or “I notice the last few times we've had lunch together, you didn't eat much and seemed really uncomfortable. Is everything okay? Can I help you find someone to talk to about it?”
Be aware of and avoid "diet culture" or disordered talk: Although you may not have an eating disorder (and may be focused on health), when you talk to a friend with an eating disorder about how many steps you tracked today, or how thin an actress looks after having just given birth, it can set the other person down a path of obsession. You may not even realize how much daily conversation focuses on the gaining and losing of weight. Even if you're talking about yourself, “It really doesn’t help when people talk about their food and their body image and exercise and calories,” says Hollyn. “For me it’s triggering.”
Give healthy compliments: If you're trying to boost the confidence of someone with an eating disorder, talk about their achievements ("I'm so proud of you for sticking with your treatment") or their health in general ("You are absolutely glowing these days") rather than complimenting their weight gain or loss. "To this day, when my family tells me I look thin — even though I know they mean it as a compliment — it makes me feel scrutinized, that they prefer me that way, which adds pressure and makes start obsessing about my body," says Alex, 45, of New York City, who had bulimia as a teenager.
Work together as a family: During treatment for an eating disorder, the entire family often redefines how they eat meals together, says Glasofer. That may involve finding interesting topics for everyone to discuss that don't center on weight or food, while giving gentle and consistent reminders about finishing the meal, praising the person for their effort when they've eaten, or agreeing to sit together after the meal, when the person with the eating disorder would normally be compelled to throw up.
The COVID-19 crisis has made life more challenging for everyone — especially those who are struggling with a mental illness. Visit NAMI’s COVID-19 Resource and Information Guide for more advice. For more information on eating disorders, visit the National Eating Disorders Association.
Additional reporting by Lambeth Hochwald
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