HOW TO HELP A FRIEND

If you are reading this handout, then chances are that you are concerned about the eating habits, weight, or body image of someone you care about. We understand that this can be a very difficult and scary time for you. Let us assure you that you are doing a great thing by looking for more information! The following information may not tell you everything you need to know about what to do in your specific situation, but it will give you some helpful general ideas on what to do to help your friend.

	Learn as much as you can about eating disorders. Read books, articles, and brochures.
	Know the differences between facts and myths about weight, nutrition, and exercise.     Knowing the facts will help you reason against any inaccurate ideas that your friend may     be using as excuses to maintain her disordered eating patterns.
	Be Honest. Talk openly and honestly about your concerns with the person who is     struggling with eating or body image problems. Avoiding it or ignoring it won't help!
	Be caring, but be firm. Caring about your friend does not mean being manipulated by her.     Your friend must be responsible for her actions and their consequences. Avoid making     "rules," promises, or expectations that you cannot or will not uphold.
	Tell someone. It may seem difficult to know when, if a t all, to tell someone else about     your concerns. Addressing body image or eating problems in their beginning stages     probably offers your friend the best chance for working through these issues and     becoming healthy again. Don't wait until the situation is so severe that your friend's life is     in danger. If you have already spoken with your friend and still feel like more steps need     to be taken to address these issues, consider telling her parents, a teacher, a doctor, a     counselor, a nutritionist, or any trusted adult. She needs as much support and     understanding as possible from the people in her life.

Remember: You cannot force someone to seek help, change their habits, or adjust their attitudes. You will make important progress in honestly sharing your concerns, providing support, and knowing where to go for more information! People struggling with anorexia, bulimia, or binge eating disorder do need professional help. There is help available, and there is hope!

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HOW TO HELP A FRIEND: THE IMAD APPROACH (Levine & Hill, 1991)

If you are worried that a friend may be excessively concerned with her eating, exercise, or body image it is a good idea to share your concerns and feelings openly and honestly with her. Instead of focusing on the number of calories she is eating or the number of pounds she has gained or lost, you may find it helpful to use the following approach to help you address your concerns with your friend.

Focus on the inefficiency, misery, alienation, and disturbance that your friend's eating disorder is causing in her life. IMAD stands for:

	Inefficiency - Is your friend suffering from physical and psychological lapses in strength,     energy, and concentration?
	Misery - Is your friend clearly suffering? Is she angry, depressed, anxious, obsessed, or     sad?
	Alienation - Is your friend's constant concern with and thoughts about eating, weight,     exercise, and body image cutting her off from you and her family and friends, and even     from herself?
	Disturbance - Is your friend doing things that are frightening, upsetting, or generally     disturbing to her and to others?

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WHAT TO SAY, STEP BY STEP

	Set a time to talk. Set aside a time for a private, respectful meeting with your friend to     discuss your concerns openly and honestly in a caring, supportive way. Make sure you     will be someplace away from other distractions.
	Communicate your concerns. Point out a few behavioral instances that indicate to you     that you should be concerned about your friend's health, happiness, and safety. Explain     that you think these things may indicate that there may be a problem that needs     professional attention.
	Ask your friend to explore these concerns with a counselor, doctor, nutritionist, or any     health professional she feels comfortable enough to see. If you feel comfortable doing so,     offer to accompany your friend on her first visit.
	Avoid conflicts or a battle of the wills with your friend. If your friend refuses to     acknowledge that there is a problem or any reason for you to be concerned, re-state your     feelings and the reasons for them and leave yourself open and available as a supportive     listener.
	Avoid placing shame, blame, or guilt on your friend for her actions or attitudes. Do not     use accusatory "you" statements like, "you just need to eat," or "you are acting     irresponsibly."
	Express your continued support for your friend. Let her know that you care about her and     that you want her to be healthy and happy with herself.
	After talking with your friend, if you are still concerned for her safety and health, find a     trusted adult or medical professional to talk to. This is probably a challenging and difficult     time for both of you. It could be helpful for you, as well as your friend, to discuss your     concerns and seek assistance and support from a professional.

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WHAT SHOULD I SAY?

If you are worried about your friend's eating behaviors or attitudes, then it is appropriate for you to express your concerns to her in a loving and supportive way. It is important to handle these issues with honesty and respect. It is also important to discuss your worries early on, rather than waiting until your friend has endured many of the damaging physical and emotional effects of eating disorders.

	In a calm and caring way, talk to your friend about the specific things you have seen or     felt that have made you worry.
	Share your memories of two or three specific times when you felt concerned, afraid, or     uneasy because of her eating rituals.
	Talk about the feelings you experienced as a result of these events.
	Try to do this in a very supportive, non-confrontational way. Here are three suggestions: Use "I" statements. For example: "I'm concerned about you because you refuse to     eat breakfast or lunch. It makes me afraid to hear you vomiting." Avoid accusing "You" statements. For example, don't say: "You have to eat     something! You must be crazy! You're out of control!" Avoid giving simple solutions. For example, don't say: "If you'd just stop,     everything would be fine!"
	If your friend has become obsessed with eating, exercising, or dieting, she probably     needs professional help. Your friend may be angry that you are calling her on her     attitudes and behaviors. Your friend may deny that there is a problem. If your friend won't     listen to you and your concerns, you may need to tell someone else--someone who can     help. Consider talking to your friend's parents, a teacher, a doctor, a counselor, a     nutritionist, or any trusted adult. Your friend needs as much support and understanding     as possible from the people in her life.