Dear Alice,

I am writing in hopes that your answer to this question will help other readers. A few years ago, when I was in college, I discovered that my college roommate was bulimic. My boyfriend and I found evidence in the mornings that she had been vomiting on a daily basis; she also developed weird eating habits (at 6 A.M., she would wake up and buy two pints of ice cream and eat it all, and then not eat for the rest of the day). We didn't know how to address the problem, and were afraid of hurting her. When we called the Health Service, they took the "my best friend is bulimic" line to suggest that I was bulimic instead! I didn't want to become the food "hall monitor" — are you eating? What did you eat today? etc. — but we tried to include her in healthy meals.

Eventually, some other stress factors in her life calmed down and her binge/purge behavior seemed to subside. However, I've always regretted that I couldn't attack this situation head-on. Do you have any advice for people that might be in a similar situation?

Signed,

For future reference

Dear For future reference,

Living with someone who eats in disordered ways can be really stressful, and you’re not alone in wondering how to best support someone who may have a harmful relationship with food. Disordered eating affects people of all ages, genders, races, ethnic backgrounds, sexual orientations, abilities, and any other identity that they hold near and dear. Given the prevalence of eating disorders, it isn’t uncommon to notice potentially problematic eating patterns among friends, loved ones, roommates, partners, etc. that turn out to be signs of eating disorders. How you choose to provide support may depend on whether or not the person you’re worried about is in a life-threatening situation. There are a number of resources you could turn to that may provide more information and support. Read on for some effective strategies for how to support a loved one with disordered eating patterns.

How you choose to provide support may depend on whether or not the person you’re worried about is in a life-threatening situation. For instance, if the individual is blacking out, losing significant amounts of weight, sleeping all day, or expressing suicidal thoughts or attempts, it’s recommended to speak to someone who can help intervene right away. If you’re living on a college campus, you may consider contacting your resident advisor or resident hall advisor for support. If in immediate crisis, contacting the local emergency service (e.g., calling 911) or public safety may be an option, too. Whether you live on or off-campus, calling your campus medical or mental health services directly for support may also be helpful. Lastly, if student resources aren’t available to you or the person you’re trying to help, you can try calling the National Eating Disorders Association (NEDA) Helpline (800-931-2237) for additional support, as well as information regarding signs of eating disorders, treatment options, and how to help. NEDA also has a chat function on their website and a crisis text line that offer the same resources.

If you determine the person you’re worried about isn’t in a life-threatening situation, it’s possible that, based on your relationship, you may be in an effective position to express concern and motivate them to seek help. In terms of how to help, you may decide to speak with your roommate directly or to provide support in a way that’s less direct. Examples of less direct support include placing pamphlets about eating disorders around the common living areas, and attending seminars or workshops on eating disorders, body image, or healthy eating alone or with your roommate. Modeling a balanced relationship with food and physical activity, as well as avoiding discussions about body weight, diets, and other topics related to unhealthy body image may also be helpful. To speak to a loved one directly about your concerns, you may consider if any of these approaches to the conversation work for you:

  • Before the conversation, it may be worthwhile to set up an appointment with a mental health professional to discuss ways to help, and to educate yourself on eating disorders, harmful relationships with food, and what your roommate may be going through. You may find it helpful to check out Eating disorder vs. non-disordered eating for more information on common types of disordered eating behaviors and potential signs that may be cause for concern.
  • Pick a time to talk when you’re feeling calm and you’re both available. Choose a time and private place where you won’t be interrupted so that you can be focused on actively listening and be present in what may be a vulnerable space for them.
  • Start off by sharing how much you care about them. Make sure they know you value them and highlight the qualities you appreciate.
  • Focus on expressing your concern by conveying your observations about their health or behaviors. You don't need to diagnose what you’re seeing, but simply describe the behaviors you’re seeing that feel concerning to you. If they change the subject, ask when would be a better time to talk.
  • Use "I" statements to express your feelings. For example, "I'm worried because I've noticed that you don't eat meals with us anymore," or "I’ve noticed that you eat ice cream in the morning, and then I don’t see you eat anything for the rest of the day.” This helps keep it from your perspective and avoids putting the blame on another person.
  • Avoid making promises you may not be able to keep. For example, saying “I won’t tell anyone” may prove difficult if you’re seriously concerned about your friend’s health.
  • In an effort to reduce stigma, assure the person that many people struggle with their relationship with food and there is support available, and that they aren’t alone.
  • Your goal is just to express concern over what you're seeing and support them. Ask for their input, such as what they’re thinking and feeling in the course of the conversation, and actively listen. They may agree with your observations, but they may also feel differently. Ultimately, it's up to them as to whether or not they want to seek support; they need to be the one taking any actions.
  • Ask the person if they want help, and if so, what you can do. Potential examples may include assisting them in finding specific resources or simply being available to talk.
  • If they're open to support, encourage them to seek professional help from a mental health professional or health care provider. Here, you may choose to also offer up suggestions for who to contact, and help them brainstorm any next steps.

Note that it’s possible that the person you’re worried about may have a negative reaction to the conversation. This is common, and, if you get a negative response, you could try stating your concerns, naming how much you care, and that you’ll leave the door open for having this conversation in the future. Also, it’s good to remember that if either you or the person you’re speaking to become upset, you may choose to continue the conversation at another time! After this type of conversation, it may also be helpful to take a bit of time to take care of yourself, as these types of conversations can be stressful for the person providing support, too. 

Recovering from harmful relationships with food and disordered eating behaviors can be challenging and may require patience. If anything, having this conversation with a loved one may help them develop more self-awareness, and motivate them to eventually seek professional help down the line. Your friends and family are lucky to have you looking out for them.

Alice!

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