How to Help a Friend With Bulimia

Three Parts:Knowing the Signs of BulimiaTalking to Your FriendOffering Care and Support

Bulimia is a psychological condition in which someone overeats (binges) and then forces the evacuation of food through induced vomiting, use of laxatives, or fasting (purging). Even though it may seem to be about food, bulimia is based in someone's inability to handle emotional or stressful life situations. You can't force a friend with bulimia to change, but you can help support them. If you have a friend who you suspect might have bulimia, you can help by learning more about the condition, talking to your friend, and learning ways to provide support and care.

Part 1
Knowing the Signs of Bulimia

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    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.[1] The cause of bulimia is thought to be an inability to deal with painful or overwhelming emotions.[2]
    • Binging, or overeating, helps a bulimic person to calm herself. It may help her 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 her body. It may be the way that the person overcomes feelings of helplessness and self-loathing.
    • Bulimia is a cycle that is based in a person's emotional responses, rather than rational reactions. Simply knowing that the behavior is out of control isn't sufficient to change it.
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    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. She'll attempt to hide her overeating from others, often eating late at night or in a private spot where no one will see her eating.[3]
    • 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 her behavior.
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    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.[4]
    • 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.
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    Consider whether your friend is over-exercising. Excessive exercising, regardless of weather, injury, or illness, may be a method of purging.[5]
    • 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 her friends by her exercise, this might be a sign of using exercise to purge. She may skip work or school in order to exercise; prioritize working out over family, a social life, her own health and safety; feel guilt or anxiety when when she's not working out; and exercising alone to avoid attention or notice from others.[6]
    • If your friend shows these signs of compulsive exercise, she may also suffer from an exercise addiction.[7]
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    Notice if your friend appears obsessed with food. He may avoid eating in public completely, or he may appear overly focused on talking and thinking about food. He may be overly interested in counting calories, in special diets, or in managing his food intake.[8]
    • He may use excuses to avoid eating with others, such as saying that he's not hungry, that he already ate, or that he's not feeling well.
    • When he does eat, he may be very anxious about what people think of his food intake. He may become increasingly self-conscious.
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    Pay attention to changes in appearance. The person with bulimia may lose or gain a large amount of weight in a short time. He might become increasingly self-critical of his own appearance, developing a distorted perception of his body image. You may notice him wearing baggy clothes to hide his body from others.[9]
    • Someone with bulimia may see himself as being quite overweight even if he's not.
    • Look for yellowing teeth (a sign of purging) as stomach acid affects the tooth enamel.[10]
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    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.[11]
    • Physical signs that are less visible to the observer include anemia, muscle weakness, and muscle thinning. People with bulimia may also experience severe constipation.[12]
    • Osteopenia or osteoporosis (thinning of the bones) is commonly associated with bulimia.

Part 2
Talking to Your Friend

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    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 she has a problem. Talking to your friend requires that you be sensitive to your friend's feelings.[13]
    • 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 her problem right away.
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    Don't focus on you 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 her in your social group rather than accusing her of binging in private. Remind her that you care about her.[14]
    • Remind her that you're concerned about her 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.
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    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 you area and remind her that help is an option.[15]
    • Never force a friend to seek help. The decision must come from the person with the eating disorder.
    • 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.
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    Don't try to get a person with bulimia to stop binging and purging. If you try to get her to stop, she will perceive this as your attempting to control her, and resist. It may be difficult to allow the person to continue in this unsafe behavior, but trying to force her to stop will only result in more difficulties.[16]
    • Getting into power struggles over food is usually a bad outcome.
    • Focus on what your friend might be going through emotionally. Talk to her 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?"
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    Talk with someone who can help you. If your friend won't admit to a problem, you can't force him to. Each person must decide for himself whether to try to address bulimia. Talk with someone else about what can be done to support your friend.[17]
    • 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 her 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 himself.

Part 3
Offering Care and Support

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    Remind your friend that you care about her. Your concern is based in your friendship for her, not because she's wrong or bad. Don't demand immediate progress or change in her behavior.[18]
    • Your friend needs your hope, encouragement, and kindness. Provide these in abundance!
    • Remember that her eating disorder is not about you or your friendship.
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    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.[19][20]
    • 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 a to have a healthier relationship with food and ways to better address stress and adversity are all part of treatment for bulimia.
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    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.[21]
    • 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.


  • Hospitalization might be recommended if your friend is dangerously malnourished, severely depressed, or having suicidal thoughts.

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Categories: Eating Disorders