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Volume CXXXII, Number 17 |
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Eating disorders' dangers
JEFF BENSON, M.D.
Dear Dr. Jeff: "I'm worried that a friend of mine has an eating disorder. As someone who cares about her, what should I do?" E.D.
Dear E.D.: Just wondering and worrying about your friend's well being is an important first step towards helping her.
The best advice suggests that you find some time when you are both feeling pretty calm, and have plenty of time to talk in privacy.
Express your concern about specific observations you've made (e.g. "You seem unhappy/preoccupied/distant/angry these days, and I'm worried about you") or about changes you've noticed (e.g. "You seem to be losing a lot of weight recently, and it worries me.") Talk about her, as a person you care about, and are worried about, not about her disordered eating or behaviors. Focus on how you feel about what's happening to her.
Keep in mind that your friend's disordered eating likely represents an attempted solution to other problems. It may represent an effort to cope with other struggles, and to communicate the pain of those struggles. Your friend might be trying to manage the anxiety of low self-esteem, feelings of helplessness, problems at school, or troubled relationships with family or others. Disordered eating and related behaviors are intended to be self-protecting, but end up becoming self-destructive.
You'll need to have realistic goals for your conversation. Obviously, you won't be able to "just change" her behavior. She might not even want to open up to you at all. Hopefully, you will at least be able to open the door to talking more, to show your support and concern, and to offer to help get help for her. No matter how indifferent she might seem, at some level she'll hear your concern, feel your support, and move at least one step closer to finding help herself.
You should prepare yourself for the very real possibility that you'll make her defensive and even angry. Remind yourself that you are trying to help, and consider finding help for yourself. Many students seek help for themselves, before and after they have these kinds of discussions with their friends.
There are many different resources available to help you and your friend. Come in to the Health Center, the Counseling Center, the Women's Resource Center, the Dean's Office or Res Life. Talk to a professor, a trainer or a coach, or contact a member of W.A.R.R.I.O.R.S. You can feel free to discuss your concerns confidentially, and to keep your friend anonymous, if that makes it easier. The important thing is to reach out-to your friend, and for yourself.
The Health and Counseling Services both have on their websites a quick and confidential on-line screening test for eating disorders, depression, and alcohol problems. Both websites also have information and links for further reading about eating disorders. Check out 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.
Two weeks ago, in a column about depression, I mentioned the fact that only 20 of the 166 college students who committed suicide last year, had ever been seen at their college counseling centers prior to their deaths. This is a very sobering statistic. A great deal of help, and effective help, is available for those who struggle with inner demons, but obviously that help has to be sought out.
We live in a culture, which idealizes, distorted body images and equally distorted lifestyle expectations. We all need to examine our roles in perpetuating this culture, and to do our part to start changing it. We must be willing to reach out to each other, to try to understand each other, to support each other in our struggles. Maybe this is the foundation many of us are seeking, here at Bowdoin, in trying to build a sense of true community. Maybe it is our obligation to each other -- and to ourselves -- part of a renewed "Community Honor Code."
Public health researchers like Ichiro Kawachi study the relationship between "social capital" and individual health. Social capital consists of those features of social organization that bring people together for mutual benefit. It includes everything from community associations and bowling leagues to levels of interpersonal trust and reciprocity. Kawachi has found that variations in these indicators of social capital correlate strongly with mortality rates. A 10% increase in a community's sense of mutual trust, for instance, is associated with a 9 percent lower level of overall mortality. People who live in societies rich in social capital, have a significantly greater life expectancy than those who don't, even if the latter are wealthier and spend far more money on their health care.
The more concern and care we show one another, and the more we are able to build a sense of trust and support amongst ourselves, then the greater will be our community's social capital, and the greater will be our own individual well-being.
The effects could be truly life-changing, and might well be life-saving.
Jeff Benson, M.D.
Dudley Coe Health Center
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