Lifelines Foundation for Eating Disorders

Warning Signs:
People with eating disorders often display certain tendencies prior to developing these disorders. Some signs to be aware of in your friend or family member which may indicate that they have a high possibility of developing an eating disorder include: thinking of things in extremes (also known as black and white thinking), perfectionism, dieting, picky eating, becoming a vegetarian, avoiding sweets, avoiding or being reluctant to eat in front of others, wanting to exercise a lot but usually alone, talking about what calories or ingredients are in foods and the appearance of people, drinking a lot of water or diet soda, and involvement in certain sports such as gymnastics, dance, wrestling, etc.

Once an eating disorder begins to develop, you may notice your family member or friend beginning to spend a lot of time preparing meals for others but not eating a lot of them him/herself. The person will often continue to spend a lot of time involved in food related activities such as cooking, grocery shopping, menu planning, or reviewing the contents of certain foods. Be aware of habits such as mixing odd combinations of foods, chewing food and spitting it secretly into napkins, continuing to consume large amounts of low calorie liquids to feel full, and attempting to turn the focus to what others are eating. The person will often continue to try to exercise in a much more solitary manner and will continue to do so when sick or hurt. Money or food may be missing if someone who is bulimic or has binge eating disorder has experienced a binge-eating episode. Be attentive to disappearances after meals. These disappearing acts may occur for the person to vomit or to hide food that he/she has pretended to eat. However be aware that not all bulimic individuals vomit as their inappropriate compensatory mechanism so also look for periods of fasting, exercising, and the purchasing of laxatives, diuretics, or diet pills.
While these warning signs are largely behavioral, there may be other changes in your friend or family member that you may notice. He/she may become more withdrawn and less sociable, resisting doing things even with his/her closest friend. He/she may seem more moody. Some of the physical signs to be aware of include blood shot eyes, swollen glands, becoming tired easily, becoming cold easily, having slightly yellowish skin tone and bluish fingernails, and having soft fine hair grow on the body – particularly in the abdominal region. If you suspect someone has an eating disorder and they complain of chest pains or any type of heart beat irregularities, it is important to get them to an emergency room right away and be sure that the emergency room staff are aware that they may have an eating disorder since heart irregularities can be fatal.

Interventions
The first thing to remember when dealing with someone with an eating disorder is that you have no control over another person’s behavior. As frustrating as this fact can be when watching someone you love, it is important to remember that all you have power over is how you act in any given situation. When confronting your loved one about his/her eating disorder, choose a private place when you will have enough time to thoroughly discuss the situation. Be prepared with information about eating disorders so that you can talk about the facts and compare them to what you have observed behaviorally in the person that you care about. Be sure to speak with love and understanding and not sound judgmental and blaming. Remember the person that you are talking with is scared and believes that he/she needs the eating disorder to survive. Use “I statements” to express your concern and say things like “I’d like to help you find help.” Be prepared to provide information and resources about treatment. Be sure to have investigated what resources are available in your area so you can discuss them with your family member or friend. Denial is a large part of an eating disorder so be prepared to be rejected. Don’t get into an argument or power struggle with the person. A large part of eating disorders are about control. Continue to express how you feel and how you hope the person will get help.
Parents of minor children have the final say and can bring them to therapy, physician, and dietitian appointments. It is helpful to give people the “three strikes and you’re out rule.” You will go see someone three times – the first time they usually obtain a history, the second time, your loved one will begin to get to know them, by the third time, he/she should have a good feeling as to whether a working relationship will be able to be formed - if it can be great, if not ask for a referral to another professional. Be sure when getting help that you do not make promises to your friend/family member that you can’t keep. Eating disorders are potentially fatal – do NOT promise to keep them secret. If someone is under 18 their custodial parent must accompany them to at least the first session, so do not promise not to tell their parents. Instead offer to help the person tell his/her parents or offer to talk with the parents about getting the person help if he/she is too afraid to do it alone. Divorced or separated parents should not promise to keep an eating disorder a secret from the other parent as they will need to work together to help their child recover. If you are a friend of someone with an eating disorder and do not feel comfortable talking to his/her parents because your friend has asked you not to, talk to your parents or another trusted adult about it. Remember your friend needs help and this type of illness needs a lot of people’s support. Ultimately, if the person needs a formal intervention because he/she is too ill or is in too much denial, it is important to contact a professional who specializes in eating disorders and arrange the intervention in a professional’s office. Remember recovery from an eating disorder is possible, but it takes a lot of hard work and support, and can often take 4-7 years for a full recovery so be patient and supportive for your family member or friend and find support for yourself if necessary.