I believe that eating disorders are a very sensitive subject in general. To actually have a friend suffering from one can be very intimidating. Placing myself in this situation brought about serious thought on what I could actually do for a person that I love. Before I could even think about possibilities, I found great importance in doing a little bit of research so I would know exactly what I would be going up against. I believe that knowledge can be powerful, and I have found that, in past experiences, the more you know about a certain subject, the more likely a person is to listen and respect what you have to say.
That being said, I simply went to Google and typed in, Helping a friend with an eating disorder. After examining a couple of websites, I came across one that proved to be very useful. At some point in each of our individual lives, we will provide some form of counsel to someone we know or love. Most of us are not professionals, nor are we prepared to provide it. In this instance, I have found that the counseling center at the California Institute of Technology has provided some very excellent advice for a friend who finds herself in a situation with a friend suffering from an eating disorder.
The counselor begins by examining the two most common forms of eating disorders, anorexia and bulimia. Knowing the physical and psychological symptoms will help me identify exactly what my friend may be dealing with. Pairing these symptoms with the realization that my friend is most likely suffering from an underlying cause, will better help me approach her. Along with detailed information on the signs and symptoms affecting an individual with an eating disorder, Caltech offers a few general considerations when helping a friend. These include recognizing the shame involved in part of the individual suffering, which can produce a defensive attitude. As a friend, I must realize the importance of approach, all the while, maintaining a certain level of sensitivity. Also, as a friend, I need to attempt to step outside of the situation, outside of the box, so to speak, so that I may recognize any negative attitudes and feelings that could have caused this disease to develop and progress. All of this must be done with the knowledge that these situations must be approached with time and patience for healing does not occur overnight.
Along with their general considerations Caltech has helpfully provided the following specific advice on their website...
Specific Examples 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 itme 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 liek the best way to handle your stress - maybe they can help you find other ways to help you 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. (Caltech Counseling Center.Helping a friend with an Eating Disorder. para. 11)
As a friend trying to help a friend, I found all of this to be very sound and realistic advice. I want to say that, in general, we can't always know what kind of impact we can have in an individual's life, but we will never know unless we try.
You can access the article referenced above at...
http://www.counseling.caltech.edu/articles/helpfriendwitheatingdisorder.html
I also want to include the following article, because we are talking about the realm of mental disorders and I was very impressed with the advice included in this as well.
Helping a Friend with a Problem
Two very positive aspects of Caltech are that it’s a small school and people care about one another. Students often say that it’s their friendships that help them get through Caltech, especially during the tough times. Friends are there to support one another when one of them is stressed out because classes are too much, or is depressed over a break-up or when a friend has had too much to drink. Friends help one another here.
Sometimes though the help you give to a friend may not be enough to solve their problems. No matter how much listening you do or support you give, the person still feels depressed or does harmful things to themselves. There are also times when helping a friend can take too much from you personally, whether it’s too much time and your classes suffer or too much emotional energy and you end up feeling stressed out. Some people would say, that’s just what friends do for one another and that’s true to a point. There are, however, some problems and some situations when you should look beyond what you alone can do, in order to be of most help to your friend. This article is meant to give you ideas on how to help a friend with a problem. It is also meant to help you recognize when a friend’s problem is too big or too serious to handle on your own.
How do you know if a friend’s problem is too big or serious for you to be dealing with alone? One thing to consider is whether the help you give to your friend actually results in a change in the situation for them. Some problems like; depression, low self esteem, eating disorders, or substance abuse problems don’t usually change as a result of a friend’s support alone. What can happen is that the friend will try to help, but over time they can begin to feel over-extended or burned out from helping. They can feel overwhelmed and out of control themselves because their work is suffering, or they begin to feel helpless because nothing they seem to say or do makes a difference. They can also end up wanting to avoid their friend because their friend needs so much from them and resenting the time they do spend with them. Does this sound familiar to you? There’s nothing about this situation that says you are a bad friend or that the person with the problems is bad themselves. What it means is that the problems the friend has requires more than friendship alone can provide.
Another consideration in determining if a friend’s problem is too big or too serious is if there is potential for the friend to harm themselves. Examples would be; someone who is harming themselves intentionally by cutting or other means of self injury, someone out of control with their drinking or drug use, or someone who is suicidal.
What can you do to help a friend with their problems? Starting from the beginning-when you first become aware of a friend’s problems-the most important thing any friend can do is listen. People underestimate the power of just listening without giving judgment or advice. Showing the person that you’ve heard what they have said is important too. Sometimes people change the subject or don’t say anything in response to a friend talking about their problems because they don’t know what to say. Even simple things like, "that seems really hard", "I’m sorry you are having to go through this" lets the other person know that you care about them. You don’t have to solve their problem, they may just need to know you understand and care.
What can you do when your friend’s problems continue?. For example, the person who has really low self-esteem. This is sometimes a person who needs other people’s support and reassurance but when it’s given it doesn’t seem to satisfy their need to be reassured. A person who remains depressed for more then two weeks or repeatedly becomes depressed over time is another example of a problem that can continue. Probably the most important thing you can do is to be honest with a friend whose problems feel like too much for you or whose problems continue even with your best efforts. After having tried to help them by listening and giving advice, if things don’t change, you should point that out to them. Saying something like " You know, even though we talk and you try to shake off your feelings of depression you still seem depressed". People worry that they would be offending their friend by saying something like this. This won’t be news to your friend. They know full well that things aren’t changing for them and they probably feel helpless themselves and maybe guilty for taking up your time.
The next step is to say the obvious thing " Have you thought about talking to the RA or someone at the Counseling Center?" Again this isn’t something that is likely to insult your friend, as if you are saying they’re really messed up. They probably have thought about talking to someone but may be too scared to do it. Your raising the issue may help them get past their own reluctance to get help. They may also have a specific reason for not getting help. Maybe they’ve had a bad experience in the past with a counselor or they’re afraid it means they are really weak. If you raise the issue of their talking to someone you can then address the reason that’s keeping the person from getting the help they need. You can say to them, something like, " I don’t think it means you’re weak for talking to someone, I think it’s a good idea, maybe it will help" or " even though you had a bad experience with a counselor during high school you could have a different experience with someone here, maybe it could help now". If your friend is from a culture where seeking help really does mean that the person is very disturbed then it may be harder but still important to make the suggestion. You can say something like" I don’t know if talking to someone at the Counseling Center seems really extreme to you but to me it just means talking about what’s going on with someone who is there to help". Obviously you’d find your own words and own way of saying these things but the point is to be direct and caring about your concerns.
It’s rare that a friend tells another friend to seek help too soon. More typically the friend keeps trying until its painfully clear that all of their support isn’t making a difference and their friend has been struggling with their problem longer then they needed to. It’s often the case too that it takes more then one time of encouraging a friend to talk to someone for them to actually do it. It can help to suggest that they go one time and see how it goes. It also helps to offer to go with the person.
In situations where there is risk of harm to your friend. Situations where a friend runs the risk of harming themselves increases the level of concern and responsibility for helping that friend. These situations require a person to take more initiative in talking to the friend about their problems. As with any time you talk to a friend you are concerned about, be caring but direct. You could say something like, " you’re telling me that you get so down you think of suicide and that has me really scared for you." Or "I understand that cutting yourself makes you feel better temporarily but I hate to see you have to hurt yourself to feel better".
The next step is to talk to your friend about getting help. Sometimes people worry if they push their friends to get help they will push them away and they won’t talk to them any more. The idea isn’t to push your friend into getting help but being clear that you want them to get help, especially in the case of someone who is suicidal. Be honest with your friend about your concern and that you want them to get help. You could say something like "this has me really worried for you and I want us to talk to the RA about what we can do for you" Your friend may not like the idea but if your friend is talking about suicide it’s important to make sure someone is evaluating the risk of suicide and arranging for help. Your friend may be mad at first but if you explain the position you’re in they may understand. You could say something like" This feels very serious to me -I want to talk to the RA now so I can be sure I’m doing everything I can for you." Or " I know you’re not happy with this but I can’t just walk away from you knowing you’re thinking of taking your life and not knowing if you are going to be ok". It may be hard to do something that would make your friend angry with you but it’s really important to make sure they are safe and getting help. It’s also true that your friend may feel relieved that you are helping them to do what they can’t bring themselves to do-get help.
If you have a friend who exhibits any of the following signs of a problem:
- Withdrawal from people
- Loss of interest in activities
- Can’t concentrate
- Significant change in their weight
- Feeling helpless
- Talk about death or suicide
- Problems with eating/sleeping
- Unusual mood swings
- Chronic low self esteem
- Excessive video game playing
- Harmful use of alcohol or other drugs
- Self-harm
- Preoccupation with food or exercise
- Overly restrictive or unusual eating habits
- Acts in a bizarre or paranoid manner
- Talking incoherently or about very odd things, such as having special powers
Or if you feel any of the following:
- Feeling responsible for the other person
- Feeling over-extended/burned out
- Feeling pressure to solve his/her problems
- Feeling that the problem is too much for you to handle
- You notice that the problem keeps coming back
- You avoid this person or feel nervous around them
Be a friend and help them to get help. If they just won’t get help, come talk to us yourself and we can help you think through what you can do next. We also have a website that has information that might be helpful to you and your friend. http://www.counseling.caltech.edu.. Finally, some of the Counseling Center staff will be doing a series of programs in the Houses this term on "Helping a friend", watch for an announcement in your house and consider attending.
Things You Can Do To Help A Friend
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Listen. People underestimate the power of just listening without giving judgment or advice. Don't rush to offer solutions or to "fix" the problem.
- Understand. Reflect back what you heard the person say so they know that they are understood. Acknowledge that the situation must be stressful/hard.
- Help the person get moving. If there is something that your friend can do to change the situation, encourage them to address the problem now- before things get worse. (E.g. talk to the person they are mad at; get some tutoring, talk to their TA, etc.)
- If things don’t change for your friend-help them to get help. Point out how all of their best efforts and yours haven’t resulted in things changing for them (e.g. they are still depressed) and it’s time to try something different.
- Ask them if they have considered talking to someone (e.g. the RA or someone at the Counseling Center). If they have thought about talking to someone but haven’t, ask why they haven’t? They probably have a specific reason (e.g. feel they would be weak, had a bad experience with a counselor before) and you can help them get past their own reservations about getting help (Reassure them: it’s not weak to talk to a counselor, even though they had a bad experience before they could have a good one now, it’s worth a try).
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Encourage them to talk to someone at least once. This may help them get past the sense of starting something too big.
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Offer to go with them to talk to the RA or someone at the Counseling Center. This can help the person get past their own inertia or feelings of being scared.
- After they have talked to someone, ask them how things went. This lets your friend know you are still interested in them and it’s still ok to talk about how things are going for them.
- Respect their need for privacy. Your friend may want to share a lot or only a little about how things went.
- Be encouraging. It took some time for the person to get to the place they are at, it will take some time to have things change. Help them focus on the positive- how did they feel about talking? How did they feel about the person they spoke with? Be encouraging of their continuing to seek help.
- Keep in touch with your friend over time. Just because they are getting help doesn’t mean they don’t still need you-as a friend.
- If your friend continues to have problems. Check in with them over time on how things are going. Be honest with them if you remain concerned. The most important thing is to have the kind of relationship where you can talk with one another about what is going on. Don’t be critical, judgmental or apply too much pressure-just let your friend know if you remain concerned or become more concerned.
- If your friend won’t get help. Talk to your R.A. or someone at the Counseling Center (8331) about what you can do to help your friend.
- Check out the Counseling Center's Website for information on specific kinds of problems your friend may be experiencing.
Kevin P. Austin
Ph.D. Director, Counseling Center
