What are the signs/symptoms of Anorexia
What are the signs/symptoms of Bulimia
What's the difference between dieting and an eating disorder
How do you talk to a friend who may have an eating disorder
Specific suggestions on helping a friend with an eating disorder

This article was written to help you identify the signs of an eating disorder and give you some guidance on how to help a friend who suffers from either anorexia or bulimia. Generally when we talk about eating disorders we are talking about either anorexia, a disorder where a person loses 15% of their body weight as a result of a highly restrictive diet and excessive exercise, or bulimia; a disorder of eating where the person uses purging, diuretics, or laxatives after having consumed large amounts of food. There are other forms of disordered eating but these are the ones that I’ll focus on because they are the ones that students most often come to us concerned about. It’s also true that an individual can have symptoms of both disorders.

What are the signs/symptoms of an eating disorder?

For anorexia-

• Preoccupation with food and weight loss (15% of normal body weight) that interferes with daily functioning, relationships and self-esteem.
• A person with anorexia becomes highly restrictive of the foods they will eat; there are good foods- low calorie and bad foods- high calorie. The list of good foods typically will shorten as they become more involved with their eating disorder.
• Someone with anorexia usually engages in excessive exercising as a way to control their weight and to compensate for eating what you and I might think of as an extremely small amount of food (a bagel for an entire day, a salad as their only meal for the day etc.)
• Because of excessive exercising, less time is spent doing other activities the person use to enjoy including spending time with friends.
• Eating habits can become regimented (e.g. eating one pea at a time, having to move food around their plate, eating food in a particular order)
• Situations that involve food can cause anxiety in the person with anorexia and they may avoid those situations altogether (stop going to dinner)
• The person with anorexia may "explain away" any concern others have about why they don’t eat or deny being hungry.
• Cognitive functioning can be effected by the undernourishment of anorexia. Thinking can become very black and white or concrete and perceptions can become restricted. A person with anorexia can become very focused on a part of their body and believe they are fat when really they are too thin
• Someone with anorexia may notice trivial weight fluctuations and exaggerate their importance (gaining 1/10 of a pound)
• There are other physical changes due to anorexia in addition to weight loss
• Loss of menses in females
• Development of soft peach like body hair on the arms
• Loss of hair
• Often feeling cold, the person with anorexia may wear layers of clothing which serves to keep her/him warm but may also prevent questioning about their weight.
• An unhealthy, sallow look to their skin

A person who is really involved in their anorexia will look undernourished, which they are, though they don’t see it.

In reading the symptoms of anorexia you can begin to see the emotional experience of a person with anorexia. Part of what drives someone who suffers from anorexia is a desire to obtain perfection. Anorexics can be high achievers and as a result they may look pretty successful and pretty "together" to others. The pursuit of perfection is also channeled into pursuing the perfect body, one without an ounce of fat. They become focused on losing weight, and other aspects of their lives are scarified in order to achieve thinness. Friendships become strained as the person avoids eating with others and is less available because they are spending significant amounts of time exercising. An aspect of having anorexia is that the person with the disorder doesn’t see what’s happening to them as others do. What they see is that they are losing weight but as anyone who is perfectionist they are never quite satisfied with what they’ve lost. That sense of not being satisfied with themselves coexists with a sense that they are in control- a feeling that comes from denying themselves food, denying their hunger and pushing themselves to exercise, sometimes to the point of exhaustion. Being anorexic means losing perspective on what they are trying to achieve in terms of weight loss and what lengths they will go to lose weight. As the eating disorder progresses the person may feel more desperate and become extreme in their efforts to control their weight. A person with anorexia can feel trapped between the pressure to be more restrictive in their eating in order to continue to lose weight and their fear of giving in to their hunger and becoming "fat".

Bulimia

• Consumption of a substantial number of calories over a short period of time followed by an attempt to rid themselves of the food they have just consumed either by self-induced vomiting or diuretic use or excessive exercise or fasting.
• As the person with bulimia become more involved with their eating disorder they will purge more frequently, sometimes several times a day and the vomiting may be induced almost at will, reflexively.
• Excessive exercising despite weather, fatigue, illness or injury.
• A person who is bulimic may appear distracted because they are thinking about food and when they will binge next
• They can appear "dazed" after having purged, a physiological response to the act of purging and from the emotional release of the tension that was building up prior to the binge/purging.
• Frequent trips to the bathroom after meals
• Signs and/or smells of vomiting
• Presence of wrappers or packages of laxative and diuretics
• Unusual swelling of the cheeks or jaw area
• Calluses on the back of the hands and knuckles
• Stained/discolored teeth
• Electrolyte imbalance which can lead to heart attacks (Karen Carpenter)

While people who suffer from anorexia are underweight most people who are bulimic are usually average or above average in weight. The person who suffers from bulimia is constantly thinking about food but from the perspective of wanting it and fighting off their desire for food until they give in-eat a lot-and then have to purge. Where a person with anorexia may have a feeling of being in control the person with bulimia often feels out of control because their eating is out of control .

The distinctions between anorexia and bulimia that are being drawn here are for the purpose of highlighting the symptoms of both disorders and the differences in their emotional experiences. In actuality there is overlap in symptoms and emotional experience with both disorders and people do suffer from anorexia and bulimia at the same time.

What's the difference between dieting and an eating disorder

Some of what can be difficult about identifying an eating disorder in a friend is that, both anorexia an bulimia appear to be unhealthy ways of accomplishing what many people try to do; manage the amount of food they eat and lose weight. While dieting is an American obsession some of the difference between an eating disorder and the culturally driven obsession with dieting lies in the amount of a person’s preoccupation with food and the lengths they will go to control their weight and food consumption. To be anorexic is too lose about 15% of your body weight and to be consumed with thoughts about food and weight. People who are bulimic are taking active, unhealthy steps to rid themselves of the calories they have just ingested. There are also health risks and health related problems that result from both anorexia and bulimia that can be very serious in the short and long terms.

How do you talk to a friend who may have an eating disorder

General considerations when helping a friend with an eating disorder:

There is a lot of shame attached to having an eating disorder and as a result individuals with an eating disorder can be pretty defensive about their eating- just as weight and food consumption is a sensitive topic for many people. It takes sensitivity to the person’s feelings about their eating along with concern in order to help a friend with an eating disorder. It also takes an understanding of what an eating disorder is about to be most helpful.

While the person who has an eating disorder is thinking about food and weight you need to do what they can not- look beyond the food and weight issue and help them focus on what’s really going on. In the end, eating disorders aren’t as much about weight or how much or how little the person has eaten as it is about becoming trapped into relying on food and weight as the basis for how a person feels about themselves. Most people derive some of their feelings about themselves from their appearance but the person with an eating disorder relies too much on weight and food in their feelings about themselves-their self-esteem. Those feelings of self-esteem fluctuate with the tiniest of weight loss or gain or amount of food consumed. It can be an emotional roller coaster of feeling in and out of control and good and bad about themselves and one that is hard to get off. You can help your friend by helping them to focus not on their weight but how they are doing emotionally. The bad feelings someone with anorexia or bulimia has about themselves don’t begin with their eating disorder. An eating disorder often starts from an attempt by a person to feel better about themselves by controlling or using food.

Because of the control issues associated with eating disorders and the shame the person experiences, as much as you want the best for your friend, it’s not likely that they will get help as a result of one conversation. It usually takes repeated conversations and nonjudgmental listening for a person to feel safe enough to actually talk about what’s going on and then do something about it. Treatment for an eating disorder can be successful but it is hard won -sometimes with two steps forward and one step back. You’ll need to be supportive and encouraging to your friend over time as they struggle to overcome their eating disorder.

Specific suggestions on helping a friend with an eating disorder

• Talk to your friend; mention their eating habits but don’t focus on food or their appearance- they already worry too much about both- ("You spend less and less time with us and a lot more time exercising." "You seem to be eating less and less". "I notice you always leave the table after we eat and when I see you later you seem kind of dazed.")
• Focus on what is going on for your friend emotionally ("It seems like when you get really stressed you stop eating. What’s causing you to feel so stressed?)
• Encourage your friend to get help but don’t force them ("Maybe you should talk to someone about the things that are stressing you out... coping by not eating doesn’t seem like the best way to handle your stress - maybe they can help you find other ways to cope").
• Don’t try to get them to eat more or less –they’ll experience it as your trying to control them and it can cause them to feel out of control
• If your friend continues to have problems with food talk with someone about what else can be done to help them.

I hope the information above helps you to recognize the signs of an eating disorder and how to be helpful to a friend who suffers from one. If you’d like to know more about how to help a friend with a problem, we have another article on our web page that you can check out. Helping a Friend with a Problem

I’d like you to know that you’re not alone in trying to help your friend. Part of our advice is that if you feel like your friend’s problems aren’t changing or you feel that they are too big for you to handle –give us a call at the Counseling Center and we’ll talk with you about how to get help for your friend.