HELP ADVICE FOR FRIENDS

If you have observed behaviour in your friend or roommate that is suggestive of an eating disorder, you may be in a position to help.

Make a plan to approach the person in a private place when there is no immediate stress and there is time to talk.

Say in a caring but in a straightforward way what you have observed and what your concerns are. Tell him or her that you are worried and would like to help. People who are too angry with the person to talk quietly should not be present.

Give the person time to talk and encourage them to verbalise their feelings. Ask clarifying questions, like "perhaps you could explain what has happened to make your weight fall" or "we hear you being sick a lot these days, why might this be happening". Listen carefully and accept whatever is said in a non judgemental manner.

Do not argue about whether or not there is a problem or insist that someone has anorexia or bulimia. For example you could say "I know that people who are afraid of eating might be suffering from anorexia, or are at risk of developing anorexia." Power struggles are not helpful or getting into an argument about definitions. Perhaps you can say "I hear what you are saying and I hope you are right that this is not a problem. But I am still very worried about what I have seen and heard and that is not going to go away".

Provide information about resources for treatment. Offer to go with the person and wait while they have their first appointment with a counsellor or doctor or a nutritionist. Ask them to have just one appointment without having to commit to regular treatment.

If you think that the eating disorder is dangerous or life-threatening enlist the help of a doctor or counsellor, relative or friend of the person before you intervene. You will have to present a united front.

If the person denies the problem, or becomes angry or refuses treatment, understand that this is part of the illness. Besides, they have a right to refuse treatment unless their life is in acute danger. You will probably feel helpless angry and frustrated with them. You can say "I know you can refuse to go for help but this will not stop me from worrying. I will talk to you about this again". You must follow up on what you say.

Whether the person agrees to get help or not, do not be a hero or a rescuer, you will probably be resented. If help is rejected, stop, no matter how difficult it seems. Remind yourself that you have done what it is reasonable to do. Eating disorders are stubborn conditions and you may have planted the seed of future change.

You may need to see a counsellor to help you to deal with your own feelings and detach from the problem. In some cases this may mean withdrawing from the company of the sufferer. Hard as this may seem, when everyone is bending over backwards to get help for someone and they are not doing much to help themselves, the attention can keep the problem going.

Knowing when to do "tough love" requires expert advice from someone specialised in helping carers.

Eating disorders are rarely emergency situations, if a person collapses it may be the best thing to get them out of a situation of denial and into a program of help. However if you think that someone is suicidal get help immediately.

Don’t collude with the illness. If someone is caught out with the illness, and begs you to keep it a secret, it is too much of a burden for you to carry on your own. If you wish to be a true friend you might have to say that there are some secrets that cannot be kept and you will need to speak to someone you can trust.

With acknowledement to the Dartmouth College Health Service. This material is used for educational purposes only.