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Ask the Mental Health Expert Archives 2001-2004

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Eating Disorder

Q. My best friend, a 16-year-old female, weighs a total of 100 lbs and she is 5'8" tall. She is extremely thin and I think she might be anorexic. She constantly calls herself fat and tries to lose weight.

At times she drinks alcohol to get over her hunger. She will get headaches and take Advil, only later to drink some more alcohol. Is this bad for her? If she is anorexic, is there anything I can do to help her?

Please I need help. I hate watching her kill herself...but I don't want to lose her friendship, so most of the time I give her warnings but I won't nag. If she wanted more of a parental figure as a friend, she would confide in the many people that live with her. I am really scared about what will happen to her. Can you help me?

A. You are right to be concerned about your friend, whether or not she has the eating disorder, anorexia nervosa (AN). As you suggest, this is a disorder in which the individual has a severe distortion in her body-image, believing herself to be fat when, in fact, she has lost at least 15% of her expected body weight--usually due to extreme fasting, exercise, or self-induced vomiting and laxative abuse. But the mere fact that your friend is using alcohol inappropriately is worrisome enough.

Taking ibuprofen (Advil) along with alcohol also increases her risk for bleeding in her GI tract. Unfortunately, it's often extremely hard to persuade AN sufferers (if that truly describes your friend) that they even have a problem, much less that they should seek professional help--and that is probably what your friend needs.

Very often, AN individuals go to great lengths to keep their abnormal habits and rituals a secret from others--and become very defensive when confronted about these things. So, great tact and sensitivity are required in trying to help the person with AN or other eating disorders. (By the way, about 90% of AN sufferers are female). You might try saying something to your friend along these lines (let's call her "Beth"): "You know, Beth, I'm a little worried about you lately. All these headaches you get--and the alcohol you use when you get hungry--I'm just worried you're gonna do yourself some harm. Can I help you in any way to get out of this pattern?"

You can see how your friend reacts to this. If she begins to open up a little bit, and indicates some willingness to share her issues with you, that may give you an opening. You could suggest, for example, that she talk to her family doctor; a school psychologist (if she is in school); or a counselor. (This could be a psychiatrist, a psychologist, social worker, or a nurse clinician). Parents can sometimes be helpful, of course, but very often, there are major communication problems between AN sufferers and their parents.

It's quite possible that your friend will push you away, emotionally, or feel angry about your butting in to her life. You can respect that--but you might still try again after your friend has calmed down. Although getting professional help is really the best approach, if your friend absolutely refuses this, you might suggest that she check out a website called ED Recovery Online (http://www.edrecovery.com). Their toll-free number is 1-888-520-1700. This site provides support, information, and online help for those with eating disorders.

Another resource is the book, "The Body Image Workbook: An 8-Step Program for Learning to Like Your Looks" by Thomas F. Cash, PhD. You could buy it and casually leave it where your friend will be sure to see it. It might be better than nothing--but again, gently steering your friend toward professional help is the preferred course of action. Be patient, and don't give up!

August 2003

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