Difficulties Often Associated with an Eating Problem

Use this checklist to help you identify your concerns. The presence of one or more of those behaviors could indicate a problem.


Restricting calorie or food intake

Eating episodes during which the person seems out of control

Compulsive or excessive exercise


Drug use to control eating or weight gain

Rituals around food (e.g., not allowing food to touch lips; cutting food into small pieces)

Frequent weighing

Counting calories

Mood swings

Guilt about eating

Intense fear of fat

Low self-esteem

Emotional discomfort after eating


Shame about eating habits



Preoccupation with food

Rigid eating schedule

Alternate between being in control of eating and “letting go”


Frequently eating alone

Eating in secret

Avoiding friends

Avoiding situations where food is involved

Strained relationships because of food or eating

Difficulty being assertive


Amenorrhea (menstruation has stopped)

Throat problems

Frequent weight fluctuations

Puffy cheeks

Broken blood vessels in eyes



Hair loss

Now if you think that your friend might have a problem, you might be wondering what to do. Before you talk with your friend, ask yourself…

Is Your Relationship Ready?


Are you careful not to hurt each other when vulnerable? Does the relationship include support even if you disagree with each other? Can you trust each other to “stick with it” if there is a disagreement?

If you answer “yes” to most of these questions, you probably have a trusting relationship.


Do you make attempts in your friendship to try to talk about feelings even if it may be awkward at times? Do you talk with each other about vulnerable issues as well as strengths?

If you answer “yes” to these questions, you probably have a good foundation for intimacy.


Do you tend to be a caretaker? Do you feel desperate to “make” your friend change? Do you consistently put your friend’s needs above your own?

If you respond “no” to these questions, you probably have well-established boundaries.

If you’re unsure about your answers to any of these questions, you might consider consulting with a professional.

Carefrontation,” Not Confrontation

Approaching your loved one: What to do?

Remember: your motivation to approach stems from how much you care.

1. Create An Action Plan Read up on eating disorders. Write out ahead of time a list of specific behaviors that have you concerned. Consider whether to include anyone besides yourself, as well as where and when to have the “carefrontation.” Again consider consulting with a professional.

2. Approach With Compassion Be prepared to listen first! It will be easier for your friend to change his/her perspective if he/she first feels heard and understood. Be empathetic. Empathy means both trying to grasp a situation from your friend’s perspective and conveying that understanding in words. Empathy does NOT necessarily mean that you agree, but does allow you to disagree without imposing judgment or shame. Remember, you may view the eating disorder as a problem that needs to be “fixed,” but your friend may be protective of his/her eating disorder.

3. Remain Patient The recovery process is often slow and involves both progress and relapse. This is normal and is to be expected. Stay supportive and focused on how much you care about him/her, not on any setbacks that may occur.

4. Emphasize Specific Behaviors Focus on the specific behaviors that cause you concern and not on his/her personal characteristics. Be mindful of the checklist. Use “I” statements. These involve comments which convey your thoughts, feelings, and reactions (e.g., “I heard you throwing up last night and I am concerned” “I don’t want to continue pretending that nothing is wrong”). Using “you” statements tends to convey judgments about the other person, causing your friend to become defensive.

Self Care

Recognize the limits of your own power/responsibility.

You do not have the power to:

Make your friend change

Control how your friend will respond to you

You have the power to:

Be genuine and supportive

Be concerned about your friend

Determine how to express your caring and concern

Be honest with yourself about the amount of time and effort you can expend in helping your friend

Get support for yourself

Inform yourself about eating disorders and the recovery process

Be aware of your own needs and find ways of meeting them… e.g., seeking people who can give your emotional support

Maintain healthy boundaries


You could consult with professionals from a variety of fields (e.g., a psychologist, social worker, psychiatrist, physician, or nutritionist). Professionals can provide additional information, help you come up with a plan for whether and how to approach the person you’re concerned about, suggest resources available in your area, and help you take care of yourself in the process. Look for professionals who have past experience or explicit specialization in working with eating country.

Useful Terms

The term “eating disorder” has become a common label for a range of behaviors and feelings. It is very important to remember that all of us fall along a broad continuum of eating behaviors and attitudes:

Body Image Confidence is characterized by mostly positive feelings about your body shape and size. In this range, your body is seen as a good part of you that can help you enjoy life. For body confident people, all foods are seen as fitting into an overall healthy diet, without feeling that some foods are “good” and some are “bad.”

Preoccupation with body shape/size and eating involves frequently thinking about food, eating, and your body. In this range of the continuum, you may find yourself thinking about what you ate at your last meal and feeling that you’ll need to “make up for it.” You may be a little inflexible about what you “allow” yourself to eat. There may be moments when you feel guilty or bad for what you’ve eaten. In addition, you may not like the way certain parts of your body look or you may consistently feel that you could lose a few pounds. In general, however, these feelings do not interfere with enjoying life and engaging in situations involving food.

Eating Or Body Image Distress refers to a level where your preoccupation with eating and body size/shape does interfere with daily interactions and activities. You may find yourself thinking a great deal about food or your looks. In this range of the continuum, you may be fairly rigid in your eating patterns and you may work hard to change your body size/shape. In general, however there is not a great deal of compensating for eating (e.g., vomiting, fasting, extreme exercising) nor is there a significant amount of weight loss.

Eating Disorders most commonly refer to Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder.

Anorexia Nervosa involves a significant fear of gaining weight or becoming fat and a restriction of food intake to the point of significant weight loss. Women with Anorexia Nervosa stop menstruating. People who struggle with Anorexia Nervosa may or may not engage in compensating behaviors such as extreme exercising.

Bulimia Nervosa involves binge eating episodes during which the person eats large amounts of food and feels unable to control the eating. The person may also engage in behaviors (e.g., vomiting, use of laxatives, over exercising) to try to offset food eaten. Bulimia Nervosa describes a pattern where cycles of binge eating and compensating occur at least twice a week for three months. People struggling with Bulimia Nervosa often evaluate themselves extremely critically on the basis of their body shape and weight.

Binge Eating Disorder describes a pattern where binge eating occurs at least 2 days a week for a 6 month period, but without compensating behaviors.


Center for the Study of Anorexia and Bulimia

1841 Broadway 4th Floor

New York, NY 10023


National Association of Anorexia Nervosa and Associated Disorders (ANAD)



National Eating Disorders Association


Toll-Free Information & Referral Helpline 1-800-931-2237


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