National Eating Disorders Association

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RachaelK
What do I say to my friend when she says this....

Hi there,

Here is a brief history of my friend Sarah and how I have come to worry about her.

Sarah is 41 years old, happily married and has two young daughters. Sarah got diagnosed with Bipolar 12 months ago and stayed in a psychiatric hospital at this time for approximately one month. She is doing a lot better in regards to her mood and her anxiety. She is back to working full time and has been socialising with friends again. When she began to deteriorate last year around the time of her diagnosis, she began to talk a lot about her weight. She has always been very self conscious about her looks but over this last year she has become obsessed. Sarah is very tall (over 6ft) and within the healthy BMI range (but as you would know, BMI’s are not the be all and end all). I also worry that because she IS in the ‘normal’ range, this adds to her justification of her weight loss.

I do remember two years ago shopping with Sarah and her getting size from a shelf that was much larger than what she would fit into because she honestly thought she needed that size. I remember thinking at the time how warped her perceptions were. Perhaps this was early indication of things to come.

Back to last year, when she was deteriorating, she became obsessed with her weight and believed she desperately needed to lose weight. She has never had a weight problem and she had no weight to lose. She also became very paranoid that the antipsychotic medications she was given for her bipolar disorder were going to make her put on weight. She did not voice these concerns to her doctors and instead took herself off the medication. She began to talk about food and weight loss CONSTANTLY. Every conversation she would have would be about just wanting to lose that ‘one more kilo’. She would also talk about how she would be happy when she got down to a certain weight. I asked her at the time if she would stop losing weight at this point and she said that was her magic number. She has now lost weight below that since then and so obviously this ‘magic number’ has changed. I feared this would happen. She is also obsessed with exercise. She cycles and does long distance running. She has increased her exercise dramatically in the last 12 months and if she goes out to lunch, she has often said that she ‘had to’ exercise beforehand to justify eating out. She’s also very careful with what she orders when we ARE out at lunch. She will always get something small. From what I know, she doesn’t starve herself or purge. She cooks separate meals for her husband and kids. Her meals are very small. If she has dessert or anything like that, she will talk about it for a long time afterward and talk about how guilty she feels.

She is very, very open about her weight and also her mental health issues. She however is NOT discussing her eating and weight loss behaviours with her psychiatrist or psychologist. I think she withholds this information from them because she KNOWS it’s unhealthy but she doesn’t want to get help for it. She is in denial in my opinion but as I mentioned before, I am not equipped to know how to handle this.

Her husband and girls are very concerned about her. We all are.

Our mutual friend thought it might be useful getting her to focus on another angle of keeping healthy. She thought it might help her to perhaps enrol in a fitness or nutrition course. I personally am not sure whether this is the right thing to do or whether this may in fact be detrimental. I would love advice on this. What do people think about this??

We are all very concerned about her and no matter how much advice we give, she is very much in denial and we fear it may get out of control. Besides which, these behaviours may be impacting on her children who are at very impressionable ages (12 and 15).

Should we be ignoring her cry outs for attention? For example, should we be telling her how awfully skinny she looks? Or do these sorts of comments only FEED her obsession? Does she LIKE hearing these types of comments? When she talks about how much she weighs, do we talk with her about it? Or do we ignore her? It seems she’s often attention seeking and wanting to talk about her weight and I don’t know how to reject this?

Any help or guidance would be so appreciated.

Thank you so much for reading this story,

Rachael

SongSolomon4_7
Hi Rachel -

Hi Rachel -

Thank you so much for sharing your friend's story. First and foremost, I would like to advise you to please not ignore what you refer to as your friend's cries for help. The very fact that you use this terminology and have come here looking for advise tells me that the situation warrants concern. It is also much better to err on the side of caution than to ignore her and regret it later. I know you mentioned that you asked her about her weightless prior to her reaching her *magic number* but have you voiced your concerns to Sarah at all since she lost more? Sometimes these conversations can be uncomfortable, but she will appreciate knowing that you care for her. If you are worried about how to approach this, NEDA has some resources for friends and families here:

http://www.nationaleatingdisorders.org/family-and-friends
There's a specific link on here titled "what should I say?" that you may find especially helpful.

As far as commenting on her weightless, I think it is best to avoid such compliments - as you mentioned, this may only encourage more weightless. It may be beneficial for you to help her find self-worth in other ways. If she is involved in work or other hobbies, compliment those areas of her life, or how great of a friend she is to you, or the best ways she is a mother to her children. Our society places so much value in our appearance, and complimenting someone's beauty or weight only reinforces the importance of such things. Rather, we should feel comfortable complimenting other aspects of each others' lives so we can learn that our value is based on so much more!

I hope this helped a little bit. Please continue to update us!

RachaelK
Hi SongSolomon4_7

Thank you so much for taking the time to reply to me.

I may not have made it clear but I definitely never disregard her 'cries for help'. What I meant to say however is that in the last email she sent me she mentioned how much she actually weighed - out of absolutely nowhere. And I chose not to respond to that particular part of the email. I am CONSTANTLY giving her advice and trying to help her with her mental health issues. I am a nurse and also have a passion for mental health so SOME things she discusses with me I feel equipped to deal with. This however, is very difficult.

May I ask, do you think it's wise if we encouraged her to start some sort of nutrition course or fitness course? Or is this a really bad idea for someone with an ED?

I love your advice about not commenting at all about her weighlessness but instead focusing on other things in her life. We do do this, but I like the idea of doing it more and putting a much bigger focus on it.

Do you think it's bad to tell someone that they look TOO skinny? Is that helpful or not?

Brooke125
Hey Rachel,

Hey Rachel,
I'm not a health care professional nor am I offering advice, but from personal experience suggesting a fitness plan or saying that someone looks too skinny can be very uncomfortable and triggering. The disorder doesn't allow many of us to believe we've ever reached our goal even when we may look too thin to others.

It's awesome that you care so much about your friend. This link says it's for parents but actually it's a tool kit for family and friends. Its goal is to help foster conversation about an eating disorder with your friend:

http://www.nationaleatingdisorders.org/parent-toolkit

Another great option for answers is to speak with a Navigator directly. Check out this link below for more information about who they are and what they do:
http://www.nationaleatingdisorders.org/neda-navigators

Finally, this page describes different parent, family and friend suppor systems:
http://www.nationaleatingdisorders.org/parent-family-friends-network

I hope these resources help you gain the tools you need to talk with your friend about what she's dealing with right now. She's very lucky to have a friend like you.

_admin_moderator
Rachael -

Rachael -

Your post has been edited due to its inclusion of triggering material, but the major content has been kept the same. Please be sure not to include specific numbers in your comments, and refer to the link below for other forum guidelines.

https://www.nationaleatingdisorders.org/community-guidelines

Thanks!

RachaelK
Oh I am so sorry for putting

Oh I am so sorry for putting inappropriate content in my post. It really does show how little I know about this subject - hence why I got in touch in the first place. My sincerest apologies.

kayleigh91
Just my advice, I am not a

Just my advice, I am not a professional, but I think a food course or physical education class could also be triggering. Maybe suggest a support group or seeing a dietitian instead. This way, it will be geared towards what she needs to do. I know, in my case, I just always felt like everyone else was trying to lose weight, and losing weight was a way for me to feel like i fit in and could relate to others. Just a thought.

KayLeigh