If You are Worried About Someone Else

Eating disorders are complex mental illnesses characterized by persistent disturbances in eating and eating-related behaviours that result in harm to one’s physical health, mental health, and/or psychosocial functioning. These behaviours often serve as ways of coping with distressing life circumstances, interpersonal difficulties, and/or negative emotions. Eating disorder behaviours may also be symptoms of malnourishment or starvation, and/or a response to a difficult, stressful, or traumatic situation. You can learn more about the different types of eating disorders under Eating Disorders & Treatment.

Behavioural warning signs:

• Eating less or avoiding certain types of food
• Rigid patterns around food
• Eating more than normal (when not hungry and/or not related to a developmental change like puberty or a change in activity)
• Disappearing into bathroom after meals
• Eating alone or in secret
• Preoccupation with weight, calories, dieting
• Frequent body checking
• Intense and ritualistic exercise habits
• Choosing clothing that is more concealing or revealing than usual
• Increased irritability or uncontrollable outbursts of emotion
• Social withdrawal or loss of interest in activities and experiences that used to bring joy

Physical warning signs:

• Abnormal weight fluctuation
• Lack of growth in height (for children and young persons)
• Feeling cold all the time
• Stomach aches and gastrointestinal issues
• Fatigue and dizziness or fainting
• Changes in sleep patterns
• Brittle nails and hair loss
• Constant dry mouth or bad breath
• Menstrual irregularities

Psychological warning signs:

• Preoccupation with food, body shape and weight
• Extreme body dissatisfaction
• Distorted body image
• Heightened anxiety around mealtimes
• Depression, anxiety, or irritability
• Low self-esteem
• Rigid ‘black and white’ thinking when it comes to food, such as labelling food ‘good’ or ‘bad’
  
  

As our society normalizes many disordered eating behaviours, such as worrying about calories or eating the 'right' way, it can be challenging for some people to recognize there is a problem. Additionally, shame and denial are common in the eating disorder experience which can make it hard for people to seek or accept help. There is no singular way to express concerns to someone with an eating disorder, and different approaches will work for different people at different times.

Be Patient. When you approach the individual for the first time, do not be surprised if they reject your expression of concern. They may react with anger or denial. For many folks, having an eating disorder corresponds with experiencing shame and pain. It's also important not to rush the person, and instead recognize that it will take time for the person to make changes.

Be Informed. It's important to understand that an eating disorder is a complex mental and physical illness and that the individual’s symptoms may be helping them cope with distress. Remember: eating disorders are not about food or vanity! Learning about eating disorders, the warning signs, symptoms, and resources available for their particular illness increases your ability to help them. It may be worthwhile to share what you have learnt with them. You can also call the helpline or chat with us online for support and direction to relevant resources in your area. It is up to the individual to decide what to do with the information.

Be Compassionate. Eating disorders are complicated illnesses, and the food, weight, and body image issues are symptoms of deeply-experienced distress. Try to recognize that the individual would prefer to have healthier coping mechanisms; however, they are doing the best they can at the moment. Show compassion for the pain that they are experiencing.

Be Encouraging. Foster their confidence in their ability to recover. Affirm their qualities and abilities that are unrelated to food or physical appearance, and remind them that they are more than their eating disorder. Acknowledge and celebrate any healthy changes in thinking or behaviour. 

Be Non-Judgemental. It's important to express your own needs in your relationship with the individual without blaming or shaming them. Many individuals hide their eating disorder to avoid being stigmatized or as a protective response due to past negative experiences. Creating an environment free of judgement will help them feel more secure and better able to acknowledge and deal with the eating disorder.

Focus on feelings and relationships, not on weight and food.

• Tell them you are concerned about their health while respecting their privacy.
• Do not comment on how they look. The person is already very aware of their body and how it compares to others’. Such remarks, even if intended to be complimentary, will validate unhelpful beliefs they may have about physical appearance being a reflection of a person’s worth.
• Try to point out behaviours not related to eating and weight, as those may be easier for the person to see and accept. For example, you could highlight changes related to their social and mental well-being (e.g. social withdrawal, increased moodiness/dissociation, decreased laughter, etc.)
• Try to be positive and supportive. Find neutral, comfortable places and times to discuss the issues.
• Use “I” statements. It’s easy to sound accusatory when we use “you” statements (e.g., “You’re not eating! You’re exercising too much!”). To minimize the risk of raising defensiveness or perpetuating existing feelings of guilt or shame within the individual, focus on explaining behaviours you have personally observed (e.g., “I noticed that you aren’t eating dinner with us anymore,” or “I am worried about how frequently you are going to the gym.”)
  
  

Example One:

• Instead of saying, "Why are you doing this to me?"
• Say, "I am concerned about you. How can I help?”
  
  

Example Two:

• Instead of saying, "You could stop this if you wanted to."
• Say, "I know how hard it is for you. Let's talk about how we can try to make things better."
  
  

Find ways to keep calm, focused, and respectful during difficult conversations.

• Set caring and reasonable limits. Be firm and consistent. For example, know how you will respond if the affected person wants to skip meals or eat alone, or if they get angry if someone eats their "special" food.
• Avoid power struggles about eating. Do not demand that they change. Do not criticize their eating habits. Trying to trick or force them to eat can make things worse and be damaging to relationships.
• Examine your own attitudes about food, weight, body image, and body size. Think about the way you personally are affected by body-image pressures, and be mindful of the ways you discuss your body and food in front of the affected person.
• Make sure you do not convey fat prejudice, or reinforce their desire to be thin. If they say they feel fat or want to lose weight, don't say "You're not fat." Instead, suggest they explore their fears about being fat, and what they think they can achieve by being thin. Encourage them to reflect on how people are pressured to look a certain way, and how this makes us feel bad about ourselves.
• Acknowledge the affected person's rights and feelings.
  
  

Guide for Friends (PDF)

Guide for Family (PDF)

The Guide for Family is available in additional languages:

     Arabic:  دليلك إلى معرفة إذا كان أحد أفراد العائلة يعاني من اضطرابات تناول الطعام

     Chinese:  家庭成員患有飲食失調時的指南      

     French:  Guide en cas de trouble alimentaire d’un membre de la famille

     Inuktitut:  ᖃᐅᔨᒪᓕᑕᖅ ᐃᓚᒌᓐᓄᑦ ᐃᓚᒋᔭᐅᔪᖅ ᐊᑲᐅᓈᖅᓯᒪᖃᑦᑕᖏᑉᐸᑦ ᓂᕆᖃᑦᑕᕐᓂᖓ

     Punjabi:  ਨੂੰ ਜਦੋੋਂ ਪਰਿਵਾਰ ਦੇ ਕਿਸੇ ਮੈੈਂਬਰ ਖਾਣ ਦੀਆਂ ਆਦਤਾਾਂ ਦਾ ਵਿ ਗਾੜ ਹੋਵੇ, ਉਸ ਸੰਬੰਧੀ ਗਾਈਡ

     Spanish:  Guía para saber qué hacer cuando un familiar tiene un trastorno alimenticio

     Tagalog:  Ano ang dapat gawin kapag may kapamilyang may eating disorder

Anger and denial are common responses. Sometimes people don’t realize they are ill – this can be a result of various factors, such as: the psychological effects of starvation; living with symptoms for such a length of time that these have become the norm for them; or experiencing benefits as a result of the effects of their eating disorder (e.g., positive comments about their eating, exercise, or body). They may have fears around how change might look or not having support for their healing. Continuing to have open and honest conversations about your concerns and using “I” statements can be helpful. 

• While difficult, try not to get angry or upset in response. Expressing these emotions can feel like an attack, rather than indicate you’re their ally. It may also inadvertently amplify feelings of guilt and shame the individual may already have.
  • Take a moment to consider whether you need to use any coping strategies to de-escalate your own feelings (e.g., taking a deep breath). If needed, give yourselves a break before coming back to the conversation (e.g., stepping away  to grab some water and collect yourself).
    
    
• Explain that you’ve brought up the conversation because you are concerned and you care about them, not because you are critical of them. You can be gentle with your language, but firm with your explanation.
  • E.g., “I’m not blaming or criticizing you and I’m not angry at you. I’m just really worried about the things I’ve noticed and wanted to have an honest conversation about it. I care about you and don’t want to make any assumptions or make you feel like you can’t lean on me for support.”
    
    
• Giving them time may help. It can be a lot to process as change – both good and bad – can be scary, and the initial step forwards can be the most difficult. Keep letting them know that you are available to listen to them and encouraging them to share about what they’re experiencing to the extent that they are comfortable. However, if you don’t feel the conversation can continue productively and safely, don’t force it.
  
  
• As you continue trying to get them to open up and/or seek support, think about your past interactions with them. Was there anything specific that the person found upsetting? Could you approach it differently?
  
  
• They simply might not be ready to chat about their difficulties with you or anyone in their life. It could be helpful to let them know about resources such as NEDIC’s helpline and live chat – the anonymity and confidentiality can often serve as a buffer if they are feeling vulnerable with sharing personal details.

If you’re feeling overwhelmed or scared – that’s normal. Know that you’re not alone. Eating disorders are treatable, and full recovery is possible. The fact that someone has opened up to you and asked for help indicates that there’s a part of them that really would like to get better and that they really trust you!

Accessing support and treatment as early as possible increases the chance of their recovery and minimizes the risk of needing more complex care. Have an open conversation with them to see if they already have any next steps and other people they want to inform in mind, and offer to support them in taking those steps if you can. If they don’t know what to do next and you’re unsure about how to help, you can still offer supportive listening and assure them you’ll be learning along with them. 

If you didn’t notice anything was wrong, try not to blame yourself. Getting stuck in feelings of guilt won’t help the person; what will help is taking their concerns seriously. Ask what you can do to be supportive and help them get better.

Reading more about eating disorders and what the person affected may be experiencing can be a great starting point. You can connect with us through our helpline or live chat to learn more about where to start and how you can help.

If the person you’re supporting finds their treatment ineffective, you could invite them to discuss the ways in which it could better meet their needs. Encourage them to be open about these concerns with their treatment team. You could offer to help them prepare for that conversation (e.g., role play, make notes) or even accompany them to help with talking through their options. 

Sometimes the hesitation and feeling of being stuck is not necessarily an issue with the type of treatment they’re receiving, but rather a broader struggle with the idea and process of recovery. For many people, disordered eating serves a purpose in their life and often provides some sort of comfort, safety, or familiarity, which is why treatment and intentionally challenging the eating disorder mindset can evoke fear and grief. Recovery isn’t linear, and it’s normal to have conflicting thoughts and feelings throughout one’s experience. Read more about the stages of change here. 

Unpacking some of the underlying reasons as to why they’re feeling stuck may help with identifying and reaffirming their motivations to recover. Encourage them to keep speaking up and communicate what they’re experiencing. They don’t deserve to carry this all on their own, and perspectives from supportive people in their lives can help.