Advice: What-to-do, How-you-can-help

• What to do for yourself
• What you can do to help a friend
• DO's and DON'Ts
• Guides For Parents, Coaches and Professors

What to do for yourself:

No matter how you look at it, whether you have eating issues, distorted
eating behaviors, or an eating disorder—if you are bothered by ways that
your relationship with food may be harming you, then you should do
something about it. Find out the facts about eating disorders; find out who
you can talk to about your questions and concerns. Friends, family members,
an R.A. or a teacher may be a good place to start to draw support around
you, but you will probably get the most knowledgeable, objective and
accurate information by going to someone who has training and experience
helping students with eating disorders. This would include counselors and
psychotherapists, medical doctors, nurses and advanced nurse pracitioners, nutritionists and other specialists. Family and friends can be enormously helpful, but remember that they may not know how to help, and they may not at all understand why food and eating are such emotional, conflictual things for you. It can be easy for them unwittingly to say or do the wrong things, so the more you are able to
hold on to your own resolve about your concerns, the better you can guide
the people you turn to (and yourself) to some good solutions.

The hardest step to take for some people is that first time you voice to
someone else that something is not right with you and your eating. For
others, the hardest part is admitting and then accepting—deep down—that
something really is wrong and that you need help with it. For yet others, the
hardest part is giving up the unhealthy behaviors and attitudes about food and
eating: when you let go of your "symptoms", you may be scared you won't
be able to handle other parts of your life.

In fact, you will feel stronger and more in control to the extent you
decide to look after the welfare of your self and your health. This is not
easy, but will be easier if you have the help of some good allies along the way
and if you can remind yourself that what you want deep down is to feel good
about yourself and who you are in the world.

You say you have gone for help, tried these things, but it wasn't any
use? After all is said and done, there is no one solution to reverse and heal
an eating disorder, and some solutions that work for others may not work for
you. This is not your fault; neither should you lose faith in people or
approaches that still might help. When eating issues and eating disorders go
on for a long time, or when they are needed for some reason psychologically,
they can become firmly rooted in a person and it can take time and hard
work to extricate those roots.

Sometimes a variety of interventions or treatment approaches are
necessary, either simultaneously or over time. Medical exams,
counseling and nutritional guidance are the most common interventions a
person could need. Group therapy, self-help groups and medication also may
play a role in a person's recovery. In certain instances hospitalization in an
eating disorders program is necessary. Hospitalization may be medically
necessary, but it also can be extremely useful from a simple practical vantage
point: time in a specialized and comprehensive hospital program should have
a concentrated impact in altering the course of a person's eating disorder.

Remember that this will take time and tolerance and a belief in
yourself. With society and the media's constant messages, never mind the
reinforcement you get from friends, guys and others, that 'thin is better', you
are up against an awful lot. Keep heart and good luck.

For a friend:

You are worried about your friend, your roommate, your girlfriend; you think she (or he) may have an eating disorder. You don't know what to do, but you want to do something. Maybe you are afraid to confront your friend. Or maybe it is complicated because, on top of your worries for your friend, you are also feeling frustrated or disturbed at what you see happening, nervous about creating conflict, fed up, or just plain helpless about what can be done. It is normal to have any and all of these reactions to someone with an eating disorder, especially a person you care about, whom you want to see get well.

While eating disorders are growing unfortunately "common" among young women, and even young men, the behaviors that manifest themselves in an eating disorder are really quite unnatural. Human beings are not meant to starve themselves, or force themselves to vomit, or exercise their bodies to the risk of collapse or injury. To see someone you care about in the grips of something so unnatural, which clearly is hurting them in personal ways as well possibly as physical ways, can be quite awful. You see how caught up they are, out of control and unrealistic; yet how fiercely they are holding to their regimens and secrecy, how threatened they are to have these questioned or interfered with in any way. This is very difficult, and can cause quite uncomfortable tensions between you and the person whose behavior is troubling you. Find a way to talk to your friend!

Nobody likes confrontation, but that is exactly what you are going to need to do with your friend in order to broach your worries to him or her. There are some common rules of thumb that may help you to make this first direct talk go well (for both of you). They are as follows:

(Please note that the Do's & Don'ts below apply equally to women and men who have eating disorders. For the sake of simplicity and clarity, however, and because women with eating disorders outnumber men, we have used the feminine pronoun in our statements.)

DO's and DON'Ts:

DO

• Prepare yourself: think ahead about what you want to say and
  how you want to say it; check out in advance what resources
  you can recommend to your friend; get in touch with any
  feelings you are having that could get in the way of being helpful;
  educate yourself about eating disorders.
• Pick a time and a place to talk: where both of you are
  comfortable, where there is privacy, and when neither of you is
  distracted by other things.
• Approach your friend, above all, with an attitude and
  expression of caring, appreciation, and belief in her.
  Your friend will have confidence and trust in you, to the extent
  that she feels respected, treated with kindness, and accepted by
  you.
• Convey your worries or concerns: in terms that are objective
  and that describe specific behaviors, changes, emotions or
  mental states you have observed in your friend that have led to
  your concern. Use "I" language. Make clear that you accept
  and care for your friend, but that you do not accept or care for
  anything that hurts her.
• Encourage your friend to open up with you. She may have
  fears about going for help; anxiety about trying to change;
  shame about her out of control behavior; maybe even feelings of
  betrayal at your confronting the matter.
• You may be met with your friend's anger, defensiveness
  and denial. She may blast you with fury, and then turn away
  from you and avoid further contact. Or maybe what you say
  will be ignored or discarded. Be patient, don't take it
  personally and hang in there. Keep in mind that the volume
  of your friend's negative reaction is probably a signal of just how
  overpowering her feelings of vulnerability and threat are at that
  moment in time, and that the loud negative reaction probably
  has very little to do with you (even if it does get directed at
  you).
• Sometimes more than one conversation is needed. You
  don't have to accomplish all your goals for helpfully confronting
  your friend in one sitting. You can do it a bit at a time. And
  even if all your goals are accomplished in one conversation,
  your friend will still need your friendship and support over
  time—next it will be around the steps she takes to address her
  eating disorder.
• It is good to have in mind what you hope to accomplish in
  intervening with your friend: what is realistic to expect,
  and what not? What is your main priority? It may be
  enough of an accomplishment just to speak out loud to your
  friend the concern and worry you have about her. Other goals
  for helping your friend might include: informing her of resources
  you have found where she can find help; getting her to agree to
  make an appointment to see a counselor or other specialist who
  can assess what she might need psychologically and physically;
  or clarifying who else can be told about this who could offer
  additional support (for example, an R.A., parents or older
  siblings, other peers).
• Remember that your friend is more than just her eating
  disorder. She may be very low in self-confidence, self-esteem
  and a secure feeling of identity. If the eating disorder provided
  some reason for your friend to feel a sense of self-worth in the
  first place, you will want to help her to know and feel that there
  is much more of interest and value about her than that.

DON'T

• Although it probably goes without saying, don't approach
  your friend in anger, or on the attack. Your feelings are
  legitimate, but anger will probably not be conducive to a
  productive interaction.
• If you and several other friends or roommates make a
  joint intervention (this is a common and perfectly fine
  thing for peers to do), be especially sensitive: to how
  out-numbered your friend may feel; how bothered she may be
  to surmise that all of you have been talking behind her back;
  how ashamed she may feel at the public exposure of these
  evidently disturbing behaviors; or how unloved she could feel to
  be experienced as a problem for so many people. The group of
  you may want to balance what you each say, soften your
  words, and otherwise convey that this is about caring and
  concern—and not about condemning or dominating her.
• Don't get caught up in discussing how rational or
  "normal" or "healthy" your friend believes her eating
  behaviors to be.
• Also don't be persuaded by excuses for the behavior, such
  as "all the girls at the Plex do this", or "I have to avoid eating all
  week, because I eat and drink so much at parties on the
  week-end".
• Don't hound your friend. Don't feel you need to play
  detective or watch dog or coach. You cannot take
  responsibility for what your friend decides to do with her
  eating. Find ways to be present and supportive that respect her
  autonomy and independence.
• Don't guilt-trip your friend; and don't judge her.
  Although, she is responsible for her behaviors, it is an extremely
  tough challenge she is facing, and in all likelihood she is doing
  the very best she can.
• Don't talk loosely about your friend's troubles. When you
  need to talk, find someone who you know will be supportive of
  you while keeping what you reveal about your friend in
  confidence.
• Try to avoid focusing attention on your friend's size,
  weight or appearance. Likewise, don't focus on her
  achievements (grades, sports events, awards, etc.) Instead,
  focus on her inner qualities, strengths, character, interests and
  other pleasures. Try not to reinforce the importance to your
  friend of things that have to do with performance and
  measuring-up. These are traps for a person with an eating
  disorder.
• With all these "don'ts in mind, also don't feel you should
  know exactly what to say and do with your friend. It is ok
  to not know. You can even say to your friend; "I don't know
  how to help; what can I do?"
• Last of all, don't give up on your friend. Believe in her, and
  be open to the ways that you will be touched and your
  friendship changed because of this experience you share.

Feel you need additional help?

When in doubt about how to intervene for a friend who you believe has an eating disorder, get advice for yourself. On campus, there are many people who could give you guidance: try the Counseling Services, your R.A., the Women's Resource Center or the Health Services (see the Campus Resources section of this web-site for a comprehensive list). These people could help you with your questions about what to do about your friend. Additionally, there are a great many resources off-campus (see the Off-Campus Resources section of this web-site), some of which provide in-person advising and some of which you can access through the Internet.

Remember that this will take time. Your friend needs to go through her
own process of recovery, and it may not always go the way you think it ought to. Recognize the limits of what you can do: you can't change your friend; she has to change herself. Likewise, accept your own limits as a friend: you may need distance or support at times; you may not be able to step in in certain ways you wish you could. Tensions could surface between the two of you; conflict could ease or escalate, or ease again over time. The bottom line is that you care and that you are doing your best. In the future your friend will remember this and be grateful.

Guides For Parents, Coaches and Professors

How Can A Professor or Supervisor Help?
A professor or supervisor is in a delicate position due to the nature of being in a role with the student that is of a superior, with a circumscribed range of interaction that is usually task-focused. Unlike a parent, coach, or friend, boundaries are usually more rigid and personal communication more limited. A professor or supervisor's role in intervening with a student with eating-related problems is best designed as that of a caring resource. In this vein, the most useful intervention is to provide initial concern, validation and support, while clearly directing the student to people on campus who are in a better position to intervene professionally. Students seem to respect the authority and advice of their faculty and bosses, granting them more legitimacy than they do the advice and concern coming from other people in their lives. This puts you in a rare and opportune position.

Members of the Counseling Services staff frequently provide consultation to B.C. faculty and staff who would like advice on how to "read" and how to respond to a perceived problem with a student. Do not hesitate to call on us (617-552-3310). The more informed you are, the more at ease you will feel in understanding your role and how to be most helpful with the student.

How Can A Parent Help?
The best way for a parent to prepare to be helpful is to become informed. Talking with or reading written material by experts is probably the best place to start. It is easy to assume that as a concerned parent your instincts and experience would adequately address most issues. However, eating issues are highly specialized and usually complex, often requiring professional consultation. It is important to understand at what stage or phase your child is at with regard to eating issues, so as to develop some perspective of your own. There may be a great deal of difference between someone who is trying different diets or exercise routines and someone who is obsessed with food and/or thinness to the detriment of their physical or psychological health.

Eating issues often begin with the wish to lose weight and maintain an ideal body image. Eating becomes a disorder when the primary reason to eat or not eat is no longer physical. It is usually not possible to get someone to stop their eating disorder by simply telling them to stop or by educating them on proper eating habits. They are usually far from ignorant about what would be seen as "proper eating habits". The problem is that there are reasons "behind" the eating disorder that are personal, private, and probably not very well understood by your offspring. The eating disorder is your daughter/son's best effort at a solution to some other problem. Hence, any questioning, disagreement, opinion or confrontation from you is likely to be met with resistance, denial and avoidance. They're not going to want to give up their solution. Clearly you are going to need to call upon your greatest sensitivity, tact and patience as you approach your daughter or son about this.

The level of your daughter/son's acknowledgement and acceptance of an eating problem, will determine how difficult it will be to be helpful. Some simple suggestions: before raising any concerns, make sure it is a good time to talk; don't raise these concerns in the heat of an argument or at a time that is impinged on by any other stressful focus or emotion. Talk privately, without siblings or distractions at-hand. Present your concerns in a non-judgmental manner and with a calm but serious tone. If talking with you is too difficult for your daughter or son, you might facilitate their talking to another adult. You may need to insist on this and ultimately insist on your daughter or son seeing an objective professional for assessment and treatment. Many people who have recovered from an eating disorder say that it was consistent caring voices that made the difference. Try to hold yourself in that position, even if it is painful and fraught with conflict.

Common pitfalls for parents exist. Watch out for your own denial of a problem. Don't let yourself get into the business of diagnosing your offspring's problems: you do in fact know your daughter or son better than a doctor would, but you probably do not know eating disorders better than a doctor does, and hence cannot know exactly how serious certain signs may be. Many parents have trouble working out conflict with their children. Of course this is part of the territory with late-adolescents anyhow, but with the college-age it can be all the more complicated for you to attempt to assert caring authority at the same time you are generally endeavoring to relinquish your authority to the autonomy of your now-adult child. On top of this, for many parents, as well as their offspring, anger can be experienced as a very threatening emotion that can tempt you to avoid or give into matters that really need your sustained attention and concern.

Eating issues are unfortunate and sometimes put a person at risk for developing an eating disorder. Eating disorders are very serious. The physical health and mental health ramifications can be severe. The longer a person engages in symptoms, the more entrenched the problem will be and the more distorted their whole functioning will become. The earlier intervention and treatment can be made, the more likely that a young person will be able to leave their eating problems behind and move on with life. The longer the problem persists, or the more serious it has become, the longer and more serious will be the treatment you should expect your daughter or son will need. In most cases a "team" of professionals should be involved (a psychologist or psychiatrist, a physician and a nutritionist), coordinating with each other what they do, preferably all of them expert and practiced with eating disorders.

How Can A Coach Help?
Coaches are in important positions of influence and should cautiously respond to weight and eating issues as they relate to athletic performance. Weight in some athletic sports is a necessary factor in establishing fair competition among athletes. However, other than in those cases where athletes must fit in necessary weight categories, coaches should minimize their focus on student-athlete's weight and appearance.

If you have a concern about an athlete who you think has an eating or weight issue, think carefully about what the problem is and what the appropriate kind of response would be for you to make, given your responsibilities and who you are to the student. Is your concern primarily about the student's athletic performance; or are you concerned primarily about the student's physical and mental health? Coaches are in a tough spot when they face the possibility that changing an athlete's eating or weight could diminish the student's athletic performance. It may help to keep in mind that, sooner or later, disordered eating will definitely compromise an athlete's performance.

Approach the student with your concerns privately and in a non-judgmental manner. Stick to focusing just on your concern for the health of the athlete and your concern about effects on his/her athletic performance. Allow time for the athlete to talk about the issue in her/his own words. Remember your intervention is not a disciplinary measure; empathetic statements are the only helpful responses. A heavy hand will not be productive. If the athlete does talk to you, be a good listener and focus on reflecting back what you have heard. If the athlete wants your opinion, be open about the limits of your own knowledge or experience with these matters, but do convey the seriousness of your concern. You are in a prime position to steer a student to professionals who can make medical, psychological and nutritional assessments of the situation and contribute what they have to offer with your own efforts.

You yourself as the student's coach may want to consult with a psychological or medical professional so as to get a greater understanding of the particular problem you are seeing, and also for advice on the best course of action with the given student. If you believe that as a result of an eating issue a medical problem exists, then it is absolutely necessary to have the athlete evaluated medically before they compete further. Eating disorders cause invisible damage that can be quite life-threatening if not attended.