What not to say to an eating disorder sufferer
Suffering from eating disorder can be a profoundly isolating experience. Most people with an ED suffer in silence, and in secret. You become an expert in hiding and lying: pretending to eat, purging in little-used campus bathrooms, downplaying how far you ran today.
The hunger, the lies, and the self-loathing combine to form a veil between you and the people in your life, through which it can be incredibly difficult to communicate. It can be very hard to "come out" to the people you love, and to tell them that you're unhappy enough to stop eating - or to binge and purge, or to compulsively over-exercise, all of which are disordered eating behaviours.
And when someone you love has an eating disorder, it can be equally hard to know what to say to them. But there are lots of things you shouldn't say.
But you don't look anorexic.
People with eating disorders, like healthy people, come in all shapes and sizes. True, to be officially diagnosed with anorexia nervosa, you have to engage in "persistent restriction of energy intake leading to significantly low body weight," a dramatic change that will often leave a person skeletally thin in the way we most often associate with an eating disorder.
But very often, people who have other diagnosed named eating disorders - bulimia nervosa, binge eating disorder - won't lose much weight at all, or will gain weight.
People with OSFED (Other Specified Feeding or Eating Disorder) or UFED (Unspecified Feeding or Eating Disorder) - which are more fluid, catch-all diagnoses for people who don't fit the rigid requirements of an anorexia, bulimia, binge eating disorder diagnosis - can be at a completely normal weight but still be really, really sick.
Certainly, dramatic weight loss or gain can be a sign that someone has an eating disorder, but absence of those things doesn't rule out the possibility that they're in serious trouble. If your friend was telling you that their leg was really hurting, you wouldn't say "but it doesn't look sore." You'd listen to what your friend was telling you about how they felt. The same applies here.
Why don't you just eat/just stop eating so much/just exercise less?
Because eating disorders aren't about food or exercise. They're about emotional and psychological distress; food and exercise are just the ways in which that distress is expressed.
They are, in fact, a form of self harm, and when someone is cutting themselves, you don't worry nearly as much about the cuts themselves as you do about why they're opening their veins.
True, part of recovering from an eating disorder is remaking your relationship with food and/or exercise, but that's part of a larger project of remaking your relationship with your body: you have to learn to eat to fuel yourself, not to starve or reward yourself, and you have to relearn how to exercise to feel good, not to lose weight or to atone for the "sin" of eating.
At their core, though, eating disorders aren't about food. So simply telling someone with an eating disorder or a compulsive exercise problem to just work out less is equivalent to telling someone one with Depression to just cheer up.
Well, exercise is good for you, so working out a lot isn't that big a deal.
Exercise is good for you. Self-harm isn't. When I was at my worst, I ran almost every day, rain or shine, no matter how sick or tired I felt, no matter how little I'd eaten that day. I took no pleasure in it, enjoyed no endorphin rush, and instead of feeling more connected and at home in my body, spent entire runs thinking of my body as the enemy: a machine to be driven as hard as possible, to be made as skinny as possible. It makes me shudder now to think of the things I told myself, the names I called myself, as I ran. Not all exercise is healthy, at least, not if you're taking a holistic view of health, one that includes mental and emotional health. If a family member tells you they're overexercising, or compulsively exercising, or exercising to purge, listen to them, even if their workouts don't sound that hard to you.
I wish I had that kind of self control.
Yeah, and I wish I had the kind of dreamy, wide-eyed pallor one gets from late-stage tuberculosis. But it's probably not worth the price you pay for it, and neither is the kind of "self-control" that people with eating disorders have.
This is the toughest one. Conversations about eating disorders are really difficult to have, for everyone involved. If you're a concerned friend, you might be afraid of saying the wrong thing: if you tell them that you've noticed how much weight they've lost, will they feel a sense of accomplishment and keep starving themselves? Will they feel humiliated that they've been found out, and turn that feeling back on themselves? Will they feel angry at themselves for being inadequately secretive, and redouble their efforts to hide from the world what they're doing to themselves? Will they feel angry at you and withdraw from you, making it even harder for you to help them?
All of the above are possible, and every person will react differently. But I can tell you that nothing anyone said to me while I was sick, no foot-in-mouth misstep or ill-informed remark, hurt me as much as the silence of the people I loved and tried to confide in.
Nothing made me feel more alone, or like my problem didn't matter, than my loved ones not noticing, or noticing and saying nothing. Nothing made me feel more let down than taking the risk of confiding in people, only to have them barely respond in the moment and never raise the issue with me again. Yes, these conversations are hard, but they're not impossible. There are lots of ways to go wrong, and in very select cases, the best solution will be to stay silent, but overwhelmingly, the best way to tell someone that you care about them, and that you're worried about them, is to tell them exactly that. And then to keep telling them, and telling them, and telling them. Eventually, hopefully, they'll hear you.
- For more information about how to help a friend or family member with an eating disorder or disordered eating, check out the National Eating Disorders Assocation's parental toolkit (Australian). Or phone 0800 2 EDANZ to speak to someone at the Eating Disorders Association Of NZ.