How to Talk to a Loved One About an Eating Disorder
Feb 24, 2019 Cedars-Sinai Staff
Our relationships with our weight can be complicated—fad diets and unreasonable beauty standards can skew our concepts of what makes a healthy body.
For some, food obsession and anxiety hijack their entire sense of self-worth, indicating an eating disorder.
"Eating disorders have infiltrated every socioeconomic status, race, and ethnicity."
We asked psychiatrist Dr. Rebecca Hedrick about the long-term health consequences, the signs and symptoms of eating disorders that aren't necessarily obvious, and how to start a productive conversation with a loved one you suspect is suffering.
Eating disorders are general anxiety conditions that manifest in unhealthy relationships with food and body image. They fall into three major groups:
- Anorexia nervosa: A severe restriction of calories and obsessive need to lose weight, this condition can lead to osteoporosis and heart damage. Anorexia is generally treated with psychotherapy and nutritional intervention.
- Bulimia nervosa: An impulse-control disorder characterized by binge eating, purging by vomiting or with laxatives, and exercising too much, bulimia can destroy the kidneys and ruin teeth. Binge eating and bulimia can be treated with antidepressants and psychotherapy.
- Avoidant restrictive food intake disorder (ARFID): People with this condition usually have irrational fears about certain food groups and avoid them not for fear of weight gain, but due to fear of allergic reactions or choking. Effective treatment methods are still being researched for ARFID, a relatively new classification of eating disorder.
Though eating disorders don't discriminate, younger people—especially teen girls—are most at risk.
"Eating disorders have infiltrated every socioeconomic status, race, and ethnicity," Dr. Hedrick says. "Having said that, unfortunately for women, intelligence and success can be risk factors."
Late onset anorexia is more likely to be fatal: A 16-year-old who develops an eating disorder might live for decades without treatment, but a 40-year-old could die within 5 years.
Wrestlers and people who dance ballet, act, or model can be at risk for eating disorders, but the most predominant risk factor for anorexia is having overly controlling parents.
"In these cases, the only chance that a child has of establishing their own sense of self and autonomy, subconsciously, is restricting what they put in their body," she says.
Signs and symptoms
Anorexia is the easiest eating disorder to recognize since its sufferers tend to be thin. They may have outwardly apparent habits, like not eating very much, pushing food around and cutting it up, food hoarding, or a general preoccupation with food.
People with anorexia may have learned to publicly announce they need to gain more weight to convince others that they are eating regularly, Dr. Hedrick says.
"If they've been told by 50 different people they're too skinny, they won't tell their loved ones they want to lose more weight," Dr. Hedrick says.
"Anorexia is often intertwined with one's identity, which can make it harder to change."
Bulimia is often trickier to notice, because most patients are a normal weight or overweight.
Symptoms a friend or family member might notice are frequent trips to the bathroom, especially after eating, or running water while in the bathroom to disguise the sound of vomiting. People with bulimia might complain of constipation to gain access to laxatives.
Generally, people with bulimia are more motivated to get well than those with other eating disorders, Dr. Hedrick says.
"There is often a lot more room and space to talk to them about it, and they'll be more open."
Patients with ARFID might claim many food allergies or sensitives—their diet may be reduced to an unreasonably limited selection. They can present as "picky eaters," but will usually exhibit significant weight loss.
How to talk to a loved one
Before you initiate a conversation with a child, friend, or family member about a suspected eating disorder, educate yourself, Dr. Hedrick says. Come prepared to talk about the long-term health effects of eating disorders.
Start the conversation gently, in a safe environment, about how you and the person you love are feeling—don't focus on food or put a name to the suspected disorder. Instead, concentrate on behaviors and negative consequences of thinness.
"There is so much shame and guilt associated with these disorders that it's incredibly difficult for people to ask for help."
"Start with 'I' statements," Dr. Hedrick says. "Tell them you care about them and you're worried they're so thin and might develop osteoporosis or heart problems."
Avoid blame or manipulation, and explicitly note that you're not criticizing or judging them, but you want to be supportive.
"There is so much shame and guilt associated with these disorders that it's incredibly difficult for people to ask for help, and when approached, they'll quickly go into denial."
Eventually, your goal should be to help your loved one address the underlying anxiety that could be fueling the eating disorder.
"Find out from them what is it about their life in this moment they're not happy with," Dr. Hedrick says.
"It's not likely they'll tell you they're worried that they're anorexic. It's more likely they'll list their stressors, which could be an opening to bring up therapy."