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There is a dangerous misconception about anorexia nervosa that suggests it only hits young people or some very specific demographics. The truth is that anorexia nervosa can affect men and women, young and old, rich and poor and the stigma about it is what makes it so dangerous. The inability to speak frankly about mental health can steal our happiness, our peace and in some cases our lives.
Suspecting that a loved one is suffering from anorexia nervosa is difficult to reckon with. You want to help but you don’t necessarily want to be presumptuous or invasive. Perhaps you’re afraid that your good effort at help will push them away or anger them, or further exacerbate their symptoms. There are many questions likely running through your mind when you’re concerned for their health and that’s completely normal. Our goal in compiling this guide is to give you the information to determine if:
- Your belief is grounded in the actual signs of anorexia nervosa
- How to ask questions that will help your loved one see you as someone with whom they can talk
- Ways you can help them yourself and ideally get them professional help as well
Using this information will prepare you to calmly bring up your concerns and express how willing you are to help in any way. Often, knowing that they have a non-judgmental person on their side is all anyone wants.
Determining if Your Loved One Might Have Anorexia Nervosa
The symptoms of anorexia nervosa are not often as clear as one might expect. A person who is losing weight without being vocal about trying to lose weight could have one of many physical or biological conditions causing the weight loss. Even anxiety and depression often cause fluctuations in weight without specifically disordered eating, so weight loss or thinness is not enough to diagnose anorexia nervosa.
There are, however, some questions you can ask yourself about the habits and emotional state of your loved one to get a better understanding of what is going on. If you’re able to answer yes to 3 or more of these questions, coupled with some outward physical signs of anorexia nervosa, then you should be concerned. External physical symptoms of anorexia nervosa are:
- Dizziness, fainting spells or general weakness
- Constant fatigue
- Of course dramatic weight loss but not always – a person who has anorexia nervosa might restrict and then binge, keeping their weight somewhat constant
- Dry, mottled blue skin on hands and feet
- Yellowing teeth with reduced enamel from vomiting
- Menstrual irregularities
These are only some of the symptoms to keep an eye out for, but again, just a few of these together could be something else entirely. These questions will give you context on which to base your concerns of anorexia nervosa.
1 – Does your loved one show anxiety around food choices?
This will go beyond simple pickiness as dinnertime. A person who is showing food anxiety will not want to eat around other people and might eat significantly less food, even those that they typically enjoy.
Often this food anxiety will be noticeably more prominent than generalized anxiety, even if your loved one has been diagnosed with both. Certainly, multiple psychological conditions can coexist, and more than one can cloud diagnosis of another one; in particular, the emotional symptoms of anorexia nervosa can be clouded by depression, anxiety or mood disorders. It’s critical to determine how much of their anxiety is directly centered around mealtimes, avoiding food or is food-related in a broad sense.
2 – Has your loved one lost more than 12-15 pounds in the last few months without outwardly actively seeking to do so?
This is the most common symptom of anorexia nervosa when viewed from the outside. The “hallmark” of the disease is that a person with it is very skinny but again, there are other psychological conditions that can manifest as weight loss. Orthorexia, which is a disease of pathologically over-exercising and obsessive food choice, can cause dramatic shifts in weight but will look very different from the outside than anorexia nervosa will. Though both disorders cause unhealthy weight loss and restriction, we tend to look at people who exercise constantly as dedicated or even discount them as zealots when they are suffering, too.
Anorexia nervosa can appear similar to orthorexia, but in general, it presents in total food avoidance rather than a strict preference for one particular food.
3 – Have you observed any external indications of malnutrition – cold hands or feet, extreme fatigue, chronic illness?
Chronic malnourishment will reduce one’s ability to warm up, causing cold extremities. Additionally, it will create an anemic state in the blood, reducing red blood cells that transport oxygen and create energy. This can also downturn white blood cells, making it difficult to fight disease, which leads to chronic illness.
General loss of muscle tone, cavities, weak or brittle hair, nails and bones, and confusion are all symptoms of malnutrition. If you are seeing these symptoms then it’s necessary for you to determine a plan of action to help as quickly as you can.
4 – Do they comment on their own appearance negatively and repetitively?
Anorexia nervosa sufferers are using the restriction of food as a measure of control. It can be an extension of how they feel internally about a disordered view of how other people see them externally. This can manifest as a sudden disinterest in dressing up, wearing baggy clothing or not wearing makeup when it was standard before. They may make remarks about their appearance when they see themselves in a mirror or just in general that go beyond “normal” complaints about body size or shape, and these remarks will be repetitive.
5 – Have they become withdrawn, anxious, depressed or otherwise psychologically different?
Again, context is critical here because a person who expresses withdrawal or social anxiety can have any number of other psychological conditions. A person with anorexia nervosa will be particularly avoidant of gatherings where food is a key factor. They might also be extremely anxious about scenarios where clothing is likely to be more revealing, like pools or situations where the weather would necessitate more revealing clothing.
Coupled with the physical health symptoms above, these questions will help you determine if your loved one is suffering from an eating disorder or if it’s something else. Intervention is critical in anorexia nervosa, particularly when malnourishment becomes obvious as the health impact is serious and can be life-threatening.
How to Approach a Loved One You Suspect Has Anorexia Nervosa
If you’ve determined that your loved one is likely dealing with anorexia nervosa, these next few questions will help you move forward in assisting their recovery. There are some things to be mindful of when broaching this topic with them:
- Do not bring up how their struggle is affecting you; blame and guilt are only going to fuel their condition
- Never mention food, either how much they are eating or how little as this can be triggering
- Further expounding on the first point, don’t express negative emotion about their condition from a sad or anxious standpoint, either. This can also lead to guilt, making their symptoms worse. You need to prepare yourself to be as impartial and calm as possible before you speak to them about your concerns.
1 – How have you been feeling lately, particularly emotionally?
Anorexia nervosa is very rarely if ever actually about food and so one of the first places to look for answers is what might be bothering your loved one. Trouble at work, at school or in personal relationships can strip a feeling of control away from them, which can produce or heighten mental health problems.
2 – What are your feelings about (list a few of the troubling symptoms without bombarding them)?
Rather than acting as if their symptoms are something in their control, ask how they feel about them. Bring up the weight loss, social withdrawal, affected mood and so on, and see how they view it. A person with anorexia nervosa might not feel that their behavior is disordered, at least in the beginning, and if it’s not brought up early, it can progress unchecked.
3 – Has anything in particular been bothering you lately?
The purpose of this would be to understand the root cause of the behavior, as anorexia nervosa is rarely about food rather than control or response to an antagonizing external force.
This is like the first question but more pointed. The goal of these questions is to specifically get answers without being intrusive or overwhelming. If your loved one feels bombarded with questions or feels accused they are less likely to be open to change or further discussion.
4 – Is there anything I can do or change that would help?
This is probably the most useful question when a person is suffering from any mental health condition. Making it obvious that you are there for them, to help them recover or to simply help them live day to day is critical in improving their emotional state. It’s also highly relevant to their ability to effectively seek treatment. Many times people don’t look for help with mental health disorders because they’re afraid of being labeled or attacked by friends and family. Being available is the best help you can provide.
5 – When do you feel most calm and comfortable?
Finding out what creates a sense of calm for your loved one is a big step in finding a place where you can work through your problems. Think of it as sub-clinical counseling; you’re not attempting to be a therapist, but if you can get them into a place where they are at ease, you can turn the conversation towards professional help. It also helps you determine where they’re at in their emotional state; if they don’t feel comfortable anywhere, then their daily life is a constant struggle to function.
Helping, Listening and Moving Towards Recovery
No matter how distressed your loved one is with their anorexia nervosa, your ability to listen and help is their greatest tool for success. Dealing with mental health issues isn’t talked about nearly enough but there should be no embarrassment or shame in speaking frankly about illness, be it mind or body.
You need to first determine if they are suffering from anorexia nervosa, or at least determine if it’s likely. Next, find a calm, safe space for you two to talk alone. Be frank, but never accusatory or aggressive, and never make it about how their disorder affects you. Find out how they feel daily, what types of things cause them stress and what helps them function. Calmly move the discussion towards finding a group or therapist that can help people with anorexia nervosa move forward and recover from their illness.
Investing time and love into a person with any mental health disorder is one of the best predictors of recovery. Using these questions, you can plot a course of action to effectively help you and your loved one move past their illness.