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Volume CXXXIII, Number 7 |
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Ask Dr. Jeff
JEFF BENSON, M.D.
STAFF WRITER
Dear Dr. Jeff: I'm worried that a friend of mine has
an eating disorder, but I'm not sure. When I brought this up with her,
she was angry and said she was fine. As a friend who cares about her,
what should I look for, and what should I do? T. F.
Dear T. F.: Your wondering and worrying about your friend's
well being is an important first step towards helping her.
Over 5 million Americans suffer from eating disorders. Among
them, women far outnumber men, although there are increasing numbers of
men affected. Studies estimate that up to half of female college students
consider themselves 'extremely worried' about body image, weight management,
or out-of-control eating. Overall, about 15 percent of young women struggle
with significantly disordered eating. About 1,000 of these women die each
year from complications of anorexia nervosa alone.
The most common eating disorders include anorexia nervosa
(food restriction) and bulimia (binging and purging). Most experts would
include compulsive exercising in this same family of disorders.
People with anorexia typically spend a lot of time thinking
about eating, food, weight, and body image. They count and recount the
calories in every meal, weigh themselves many times a day, and place themselves
on severely restricted diets. They often feel "fat" when their
weight is normal or even low, and complain of feeling uncomfortable after
eating a normal or small meal. They categorize foods as "good"
or "bad" and express judgments about themselves or others based
on what they eat, how much they eat, and how well they control what they
eat.
People with bulimia will eat large quantities of food at
once ("binging"), and then try to get rid of that food by vomiting
or using laxatives ("purging"). Their weight gains and losses
tend to be rapid. Their food intake varies greatly from one meal to the
next. Sometimes they take diuretics to lose fluid weight. They may rush
off to the bathroom immediately after each meal, or after a certain meal
each day. Some exercise excessively, often without a training goal. Like
anorexics, bulimics diet frequently, express fears of becoming fat, and
have unusual preoccupations with food.
To help a friend with a possible eating disorder, it's important
to remember that the disordered eating likely represents an attempted
solution to other problems. It may represent an effort to cope with other
struggles and to express the pain of those struggles. A friend might be
trying to manage the anxiety of low self-esteem, feelings of helplessness,
problems at school, or troubled relationships. Disordered eating and exercising
behaviors are intended to be self-protecting, but end up self-destructive
and potentially very dangerous.
When you speak to a friend about a possible eating disorder,
stay focused on how you feel about what's happening to him or her. Express
your concerns about specific changes you've noticed or observations you've
made about him or her as a person, not about the disordered eating itself.
Prepare yourself for the possibility that you'll make your friend defensive
and even angry. Hopefully, in showing support and concern, you'll be able
to open the door to talking more and to helping your friend get help.
Numerous resources may be helpful. You can contact the Counseling
Center, the Health Center, or W.A.R.R.I.O.R.S.. The Health and Counseling
Services have recently added to their websites a quick and confidential
on-line screening test for eating disorders, depression, and alcohol problems.
Both websites have information and links for further reading about eating
disorders. You can find more information from the American Anorexia and
Bulimia Association at www.aabainc.org, "Go Ask Alice" at www.goaskalice.columbia.edu,
"Something Fishy" at www.somethingfishy.org,
or "About Face" at www.about-face.org.
Our culture idealizes distorted body images and lifestyle
expectations. We all need to do our part to change this. This includes
reaching out to each other and trying to understand and support each other
in our struggles. That is the foundation many of us are seeking to build
a true sense of community at Bowdoin. The effects could be life changing
and life saving.
Jeff Benson, M.D.
Dudley Coe Health Center