You hear the toilet *whoosh,* but you hope it isn't what you think. It is. She emerges from the bathroom 5 minutes later. She vaguely waves hello, then sweeps by you on her way out to class. Sigh. You will have to alert the sorority president. She's been making herself vomit again.

For those with eating disorders, it is a disease of secretive behaviors, shrouded in shame. The two most common eating disorders are anorexia nervosa and bulimia nervosa. Both involve the sufferer having a poor body image. However, those with anorexia severely limit what they eat, while those with bulimia binge on large quantities of food and do something to reduce their anxiety about weight gain. It can be behaviors like exercising until they faint, eating boxes of laxatives, or forcing themselves to vomit. Women are more likely than men to have eating disorders.

Some sufferers from eating disorders describe their diseases as if it was addictive. They get hooked on how controlling their bodies with food helps them to temporarily reduce anxiety about their low body image. But it always backfires because they feel ashamed of their behavior, and out of control because they feel like they cannot stop on their own. Sufferers go to great lengths to hide their behavior because of the shame they associate with it.

Therein lies the paradox: despite all their efforts to conceal their disease, it is often in plain sight to those around them. People with bulimia may not be able to cover their tracks in a sorority house, with its gossip and shared bathrooms. People with anorexia often become so thin that they look emaciated which is alarming to their sorority sisters.

And of course it is alarming: eating disorders, particularly anorexia, are very detrimental to physical and mental health. In extreme cases, both of these diseases can be lethal. In fact, anorexia is considered to be the one of the most lethal of all mental illnesses.

Sometimes sorority sisters attempt to confront their friend in an effort to help them. Usually the eating disordered person responds with an angry dismissal that a problem exists. After this first confrontation, the sisters start to feel helpless. They may feel unsure how to help their friend who is wasting away before their eyes.

There are constructive ways to talk to someone you suspect has an eating disorder. Before having that discussion, it is important to know that you should actually expect an angry dismissal because the eating disordered person feels embarrassed and ashamed that they have been "caught." Conversely, some people with eating disorders may not see it as a problem. They may feel happy about their weight loss and the ensuing compliments. Maybe they believe that they are just dieting and their friends are overreacting. Whatever the reason for their dismissal, try to remain calm. The calmer you stay, the more rational the conversation is likely to be.

When confronting someone you suspect has an eating disorder, it can be helpful to speak to her with a caring and concerned tone. It can also be useful to focus on physical health instead of weight or mental health. If we put these two ideas together, you might say about that care about the person, and that you are concerned and worried you are for their health. Instead of making vague accusations, try to point out specific behaviors that support your viewpoint. Maybe you would say that you saw her skip lunch and dinner every day this week. This is a more powerful argument than to simply state that she is not eating enough. Try to avoid comments that could be perceived as judgmental.

Pick a neutral place to have the discussion. The discussion should be when everyone is sober. Have a brochure for your college's counseling or health center ready for her. Offer to walk her over to make an appointment with a counselor. She may rebuff your every effort. However, you can leave the door open for further discussion. You might say to her that you understand that she is upset and that it can always be revisited at a later time.

If you think that someone is very seriously ill, tell someone and get help. Some indicators of severity in anorexia are severe emaciation, soft downy hair growing on their body, hair falling out on their head, fainting, and eating next to nothing. Some indicators of severity in bulimia are vomiting multiple times per day, tooth decay from stomach acid, calluses on hands from forcing vomiting and puffy face above the jaw line from swollen salivary glands. For both disorders, if it seems like the person can no longer function, then it is definitely time to get help. Some signs of low functioning are missing class or work, failing grades, problems in relationships and staying inside all day, every day.

There are many people you can talk to, including the person's parents, or the dean of their academic program. You can always consult with your college's counseling center on how to help your friend.

It can be very stressful and alarming to be friends with a person with an eating disorder. If you are reading this blog entry to learn more about helping your friend, you have already taken a positive step towards helping her. Remember to care for yourself as well; the stress of their disease can exact a toll on you. Seek support, limit the gossip, and keep trying to help her.

About the Author

Erica Berg, Psy.D.

Dr. Erica Berg is a licensed clinical psychologist and Asst. Director at Student Counseling Services at the Illinois Institute of Technology.

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