You are out to lunch with your best friend and just happen to notice the amount of food on her plate still outweighs the amount of food she actually ate. Being she is your best friend and you share more meals with her than anyone, you also can’t help but notice that this is becoming a pattern. A small amount of fruit for breakfast, saying ‘no thank you’ to desserts, and stating she is ‘full’ are all things that have started raising your eyebrows.
But what’s the harm in dieting? Isn’t that healthy? Am I crazy for being concerned? What’s the difference between dieting and being healthy and the sign of a true blue, dare I say it, eating disorder? And most important of all, how do I even begin to talk to her about this?
According to ANAD (National Association of Anorexia Nervosa and Associated Disorders), 28.8 million Americans struggle with an eating disorder. Of this population, 26% attempt suicide, and less than 6% are medically underweight. While anyone can be vulnerable to an eating disorder, certain groups such as athletes, individuals with family members who also have an eating disorder, LGBTQ individuals, larger bodied individuals, and younger females are especially vulnerable. Eating disorders commonly co-occur with other diagnosis such as autism, ADHD, spectrum disorders, anxiety disorders, and even addictions. Access to a variety of forms of social media where body shaming and promotion of a ‘thin’ ideal also influences these behaviors. Family stressors also can greatly influence eating disorders, as the individual may feel it is the only element in their lives they have control over.
What are some warning signs to look for? How to I know for sure if my friend is just trying to be healthy or is overdoing it? Here are some key points:
- Have you noticed your friend becoming increasingly preoccupied with physical image, body size, or self-esteem? Has she been making more negative comments about her appearance or what she ‘wants’ to look like?
- Has your friend also been increasing their frequency of exercise?
- Have you noticed any changes in her mood or other behaviors?
- Have you noticed she also spends excessive time counting calories or being very careful about the types of food she eats? (Ex-eliminating all carbohydrates, all fats..)
- Have you noticed visible weight loss?
- Has she mentioned other health concerns such as feeling tired, losing hair, losing a period, or dizziness/fainting?
- Have you noticed a difference in her ability to function-for example missing school or work, appointments, neglecting responsibilities, etc.
But wait-can DBT be a helpful approach for someone with an eating disorder?
If I ask my friend about what I am noticing, I at least want to be able to offer her some advice as to where to turn.
The answer to this is absolutely! While specialized treatments for eating disorders are available and very helpful, DBT skills also target eating disorders by:
- Allowing the individual to fill out a modified eating disordered based diary card
- Teaching mindfulness skills to increase awareness of thoughts and emotions associated with ED behaviors
- Teaching mindful eating practices to bring awareness to these thoughts during eating time and how to sit with any discomfort that arises
- Teaching distress tolerance skills to increase distracted eating, as well as self-soothing skills to increase self-kindness and impulse control strategies
- Emotion regulation skills to target any underlying mood disorders that may contribute to the behavior itself
- Balanced thinking strategies using dialectics to target thoughts that contribute to ED behavior
- Behavior chain analysis for in depth look at any eating disordered moments to identify corrective replacement behaviors
So, if you have a concern about a friend, the kindest thing you can do is speak up! Sometimes someone just noticing is enough to have a person feel cared about enough to want to open up more and potentially have a discussion about seeking help. Let them know you are there for them every step of the way and that there certainly are healthy ways to take care of our bodies versus unhealthy ways. You and your friend have nothing to lose!
National Association of Anorexia Nervosa and Associated Disorders. “Eating Disorders Fact Sheet,” (2023), Retrieved on 3/1/2023 from: https://anad.org/eating-disorders-statistics/