Hi monkcarter, thank you for posting. We’re sorry to hear about this difficult situation. You mentioned some medical symptoms your family member has experienced. The following are just some of the signs of a serious problem that demands immediate medical attention:

• accidentally or deliberately caused themselves a physical injury
• become suicidal
• confused thinking and is not making any sense
• delusions (false beliefs) or hallucinations (experiencing things that aren’t there)
• disoriented; doesn’t know what day it is, where they are or who they are
• vomiting several times a day or has uncontrollable vomiting or diarrhea
• experiencing dizziness or fainting spells
• too weak to walk or collapses
• painful muscle spasms
• experience pain in the lower legs
• complaining of chest pain or having trouble breathing
• blood in their bowel movements, urine or vomit
• body mass index (BMI) of less than 16
• an irregular heartbeat, and fast heartbeat, or very low heart beat (less than 50 beats per minute)
• cold or clammy skin indicating a low body temperature or has a body temperature of less than 35 degrees Celsius/95 degrees Fahrenheit
• experience dizziness, nausea, fever
• wounds/cuts heal slowly
• feel tingling in the hands or feet
• blurred vision

Seek medical help soon on an outpatient basis if she experiences the following:

• have significant heartburn and/or a burning sensation after eating
• have other gastrointestinal concerns
• have high blood pressure
• struggle with significant joint or muscle pain
• have difficulty sleeping (falling and/or remaining asleep)
• struggle with fatigue, sudden weight gain, and/or hair loss
• have frequent urination or unquenchable thirst
• have gained and lost significant weight repeatedly
• have gained significant weight in a short period of time
• struggle with chronic diarrhea or constipation

 We recommend that she receive medical attention as soon as possible. The NEDA Helpline phone line can be reached for help finding resources at 1-800-931-2237 (Monday-Thursday 11:00am-9:00pm, Friday 11:00am-5:00pm EST). Helpline chat hours are Monday-Thursday from 9AM to 9PM ET and Friday 9AM to 5PM ET. Please take care, and we wish you the best.

Yep, it's good to see a list of what the person *should* do, and what sort of things *should* alarm them, but when the whole set-up seems to be based on denial, as you said, it's hard to know how we can help.

So I guess I would ask how totally she has shut you out. Do you think she reads any of the things that you send her ? If she does, then there may be some ways to help, although they may not always serve to convince her to do the things that you wish she would do.

What I mean is….it's unlikely that she doesn't know she's in trouble. Not too many people in her position honestly believe that everything's fine. This doesn't mean they are anxious to quit though. Often they want to keep losing instead. So perhaps you can imagine the sort of dilemma it puts them in. And then she has to deal with her parents, who sound like they have some issues of their own.

So rather than pointing out the ways in which she's endangering herself (which she may already be aware of) instead you might want to say something like "I imagine it might be difficult to be dealing with how things are going on the home front."

Her response to which might be "Thank God someone finally gets it about that."

Is this sort of approach going to help her quit having an ED ? Probably not. But it can help her feel less emotionally alone with her situation. And that is something that can make a difference.