How to start a discussion with someone you think might have bulimia nervosa

When the situation is serious, but not immediately life threatening, there are some important things to understand before you broach the subject with the person so you can know how to be as supportive as possible—and what to say or do and not say or do. The guidance provided here presumes that the situation does not require emergency medical care or a call to 911.

1. Do your homework first.

Learn all you can about bulimia nervosa and eating disorders by reading information on this website, such as Myths About Bulimia, and looking at Additional Resources links. Then, remember that even though you have learned about bulimia nervosa, only a professional trained in diagnosing eating disorders can make a diagnosis and provide or refer for appropriate treatment.

2. Choose a time to talk that will be private and uninterrupted and that is in a pleasant, safe physical environment for you both.

Schedule time in advance. Don’t surprise the person you want to talk with by pulling them unexpectedly into a heavy conversation. Let the person know you have something important on your mind that you want to talk with him/her about and suggest a time and place to get together that you know will be perceived as safe and pleasant and where you will not be interrupted.

3. Be calm and caring in your tone. Use “I” statements. Most important, be nonjudgmental.

The discussion should focus on explaining your concerns using “I” statements and listening to the person you are trying to help. Share, in small doses, what worries you about what you have observed. For example, use a formula like “I’m concerned about you and wondering what’s going on for you when I see you [fill in the blank].”

Be specific about days, times, situations, and behaviors that raised your concerns. Share your wonder about whether the behaviors might indicate a need for help from a healthcare professional. Avoid discussing appearance or weight. Rather, talk about what you’ve observed or experienced about the person’s mood, such as depression or anxiety, their health, and relationships with others.

Avoid a tone, words, or body language that could imply blame or shame. Calmly explain the reasons for your concerns. Don’t be surprised if the person denies the situation—he/she may be experiencing overwhelming feelings, such as shame, guilt, and fear.

If you feel frustrated with the person, stay calm and don’t show it. Be gently persistent as you express your concerns. Ask, “Do you think it’s possible that something is wrong?” Be prepared with resources to offer if the person seems to be listening—share the “Additional Resources” list from this site for the person to explore on their own.

Expressing your concerns may feel awkward at first, but your effort may be the bridge to recovery needed by the person to take that first step and seek help. Even if the person does not acknowledge any problem during your chat, let them know you care, are paying attention, and want to be supportive.

If the time seems right, ask the person whether he or she is open to explore the concerns you raised with a healthcare professional who understands eating disorders. Remember, only appropriately trained professionals can diagnose, offer appropriate treatment referrals, and guide treatment. Your job is to express concern and offer support.

If the person seems open to hearing more, offer a listening ear. Ask them to describe feelings he or she has after the behavior you’ve observed. “I’ve noticed [describe behavior]. Can you describe the feelings you have after that happens?” If the person can describe the feelings, notice whether those feelings seem to pertain to a desire for controlling a situation, to seeking relief from depression, anxiety, or to seeking immediate satisfaction or pleasure, or other positive feelings. Explain that the appropriate professionals can help the person find other ways to feel better that take much less of a physical and emotional toll. Remind this person that many people have successfully recovered.

Ask the person if they would like help finding a treatment center or want company to get to a therapist or doctor appointment (not to be in the appointment, but to be present). Encourage and support the person, but understand that, ultimately, recovery is up to the individual.

4. Don’t do or say these things.

• • Avoid suggestions like “Just stop overeating and you won’t have to purge.” That’s like telling a smoker to just quit smoking.
  • Avoid power struggles over food and eating behavior. Leave those issues for professionals to handle.
  • Avoid talking about weight, looks, or food. Comments like, “You’re putting on weight,” or “You look thinner,” may encourage disordered eating.

5. If things get too intense, take a break

If the person continues to deny your observations, conclude the talk. Thank the person for listening to your concerns. It’s frustrating to see someone you care about suffering and be unable to do much about it. Remember that control is often a big issue, and you cannot successfully control another person’s behavior. Getting into a power struggle can end up making the situation much worse. Many patients and families interviewed to develop the resources on this website mentioned “control” as a key issue they had to come to terms with. If the person with bulimia is 18 years or older, you cannot force treatment or discuss it with any health professional without written permission from the affected person. Even if the affected person is younger than 18, he/she must be willing to acknowledge the problem and want to participate in treatment. In some cases, enlisting the support of others the person likes and respects can help—such as a teacher, coach, guidance counselor, or mentor who shares your concerns.

6. Never try to plan and conduct an “intervention” yourself. Consult a qualified professional first.

Intervention is when a group of friends and family members confronts a person they care about regarding destructive behavior, the need to acknowledge the behavior, and its impact on the person and others. Professionals trained in intervention have sometimes used this approach to confront people practicing substance abuse and to confront people with an eating disorder, such as bulimia nervosa. Sometimes, this technique can be successful in convincing a person with bulimia nervosa to start therapy, but it can also backfire and alienate the person from those closest to him or her. If you are considering an intervention, the best chance of success is to work closely with a qualified professional who can help plan, organize, and facilitate it.

7. Being a good support means taking good care of yourself, too.

The stresses from the situation can feel overwhelming at times. Taking care of your own health is important not only for your well-being, but also serves as a model of healthy behavior for the person you are trying to support. Don’t let your loved one’s eating disorder completely disrupt and rule your life.