Knowing the Signs of Bulimia
Realize that bulimia is a mental condition. While it's most commonly found in teenage and young adult women, both men and women can be bulimic, at any age. The cause of bulimia is thought to be an inability to deal with painful or overwhelming emotions. Binging, or overeating, helps a bulimic person to calm themselves. It may help them feel less angry, unhappy, or lonely. When binging, the person may consume thousands of calories. Purging helps a bulimic person to feel more in control of their body. It may be the way that the person overcomes feelings of helplessness and self-loathing. Bulimia is a cycle that is based on a person's emotional responses, rather than rational reactions. Simply knowing that the behavior is out of control isn't sufficient to change it.
Look for signs of binging. Binging often happens in secret, when the person is alone. Someone with bulimia often knows that their behavior is abnormal. They will attempt to hide their overeating from others, often eating late at night or in a private spot where no one will see them eating. Signs of binging include finding piles of empty high-caloric food wrappers, having food disappear from shelves and refrigerators, and hidden stashes of junk food or sweets. Some people who binge may eat normally when around others. They may even appear to eat somewhat less, or say that they're dieting. Abnormal eating behaviors may not be easy to notice if the person with bulimia is hiding their behavior.
Know the signs of purging. Purging often takes place immediately following a meal or a binge. If the person seems to be visiting the bathroom more frequently than usual, or if you notice any signs of vomit, these may be signs of purging. The person with bulimia may use mouthwash, breath mints, or cologne to hide the smell of vomit. Running the sink may be used to cover the sound of vomiting. You may also notice packages of diuretics or laxatives. These are both used for purging.
Consider whether your friend is over-exercising. Excessive exercising, regardless of weather, injury, or illness, may be a method of purging. Because exercise is usually considered "good" and healthy, this may be difficult to understand as a sign of bulimia. However, over-exercising in this way can be as damaging to a person's health as any other method of purging. If a person is increasingly socially isolated from their friends by their exercise, this might be a sign of using exercise to purge. They may skip work or school in order to exercise; prioritize working out over family, a social life, their own health and safety; feel guilt or anxiety when they're not working out; and exercising alone to avoid attention or notice from others. If your friend shows these signs of compulsive exercise, they may also suffer from an exercise addiction.
Notice if your friend appears obsessed with food. They may avoid eating in public completely, or appear overly focused on talking and thinking about food. They may be overly interested in counting calories, in special diets, or in managing their food intake. They may use excuses to avoid eating with others, such as saying that they're not hungry, have already eaten, or that they're not feeling well. When they do eat, they may be very anxious about what people think of their food intake. They may become increasingly self-conscious.
Pay attention to changes in appearance. The person with bulimia may lose or gain a large amount of weight in a short time. They might become increasingly self-critical of their own appearance, developing a distorted perception of his body image. You may notice them wearing baggy clothes to hide their body from others. Someone with bulimia may see themselves as being quite overweight even if they're not. Look for yellowing teeth (a sign of purging) as stomach acid affects the tooth enamel.
Look for other physical changes. The National Institute of Mental Health (NIMH) lists the following among the physical manifestations of bulimia: brittle nails and hair; slowed breathing and pulse; dry, yellowish skin; fine hair growth all over the body; feeling cold all the time; feeling tired all the time. Physical signs that are less visible to the observer include anemia, muscle weakness, and muscle thinning. People with bulimia may also experience severe constipation. Osteopenia or osteoporosis (thinning of the bones) is commonly associated with bulimia.
Talking to Your Friend
Find a quiet, private time alone together. People with eating disorders often have a lot of shame. Your friend may be defensive, or deny that they have a problem. Talking to your friend requires that you be sensitive to your friend's feelings. Share your memories of specific incidents that resulted in your concern. Present your concerns in a nonjudgmental tone, and listen to anything your friend may say with openness and respect. Prepare to have multiple conversations. Because there is so much shame associated with eating disorders, it's unlikely that your friend will admit their problem right away.
Don't focus on your friend's appearance or eating. Talk instead about your friendship and your relationship. If you've noticed your friend spending more time alone, for instance, talk about the way you've missed them in your social group rather than accusing them of binging in private. Remind them that you care about them. Remind them that you're concerned about their health. Avoid giving compliments or criticism about the person's appearance. No matter how well-intentioned, this only triggers negative responses in a person who has an eating disorder. Do your best to spend time together with your friend and listen to their struggles, without actually offering judgment or advice.
Encourage your friend to seek help. Let your friend know that there are support groups, professional counselors and other emotional care providers who may be able to help. Come prepared with a list of counselors in your area and remind them that help is an option. Never force a friend to seek help. The decision must come from the person with the eating disorder. Your role is only to encourage them. Remember that bulimia is essentially a person's emotional response to feeling out of control. If your friend doesn't want to seek help, ask if she'll consider getting a regular physical just to rule out immediate medical concerns. Let them know that a dietitian or counselor trained in eating disorders can be a really good support to help them navigate the medical system and start getting professional help.
Don't try to get a person with bulimia to stop binging and purging. If you try to get them to stop, they will perceive this as your attempting to control them, and resist. It may be difficult to allow the person to continue in this unsafe behavior, but trying to force them to stop will only result in more difficulties. Getting into power struggles over food is usually a bad outcome. Focus on what your friend might be going through emotionally. Talk to them about the connection between eating and stress, for example. You might say, "I notice that you seem to spend more time alone when you're stressed. What's causing you to feel stressed?"
Talk with someone who can help you. If your friend won't admit to a problem, you can't force them to. Each person must decide for themselves whether to try to address bulimia. Talk with someone else about what can be done to support your friend. If there is a support group for friends and family of people with eating disorders, see if it helps you. Talking with someone who has recovered from their own eating disorder might help you learn more about the condition. A counselor may be able to help you better understand what you can do to help your friend, and what your friend must do for themselves.
Offering Care and Support
Remind your friend that you care about them. Your concern is based on your friendship for them, not because they're wrong or bad. Don't demand immediate progress or change in their behavior. Your friend needs your hope, encouragement, and kindness. Provide these in abundance! Remember that their eating disorder is not about you or your friendship.
Help your friend learn about treatment for bulimia. Treatment options include therapy, nutritional counseling, support groups and residential treatment. The best treatment for any individual person will vary, but it is usually a combination of several treatments. For example, a person might have bi-weekly therapy sessions paired with weekly nutritional counseling and support groups. Or the person may benefit from residential treatment if there are medical concerns. Family therapy is also recommended in order to address the impact the eating disorder may have on the whole family. The goal of treatment for bulimia is to address the physical as well as the psychological aspects of the condition. Learning to have a healthier relationship with food and ways to better address stress and adversity are all part of treatment for bulimia.
Be patient. Treatment for eating disorders takes time. You'll need to learn how to take care of your own needs, even while you're trying to help your friend. Don't become so involved with taking care of a friend that you don't take care of yourself. Find time in your day for relaxation, meditation, and doing things you enjoy. If you aren't able to take care of yourself, you won't be of use to your friend. If you find that you're having difficulty managing to care for yourself, consider taking some time apart.
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