For a person struggling with anorexia, bulimia or binge eating, certain compliments, comments or words of advice might cause more harm than good -- no matter how innocuous they seem.
Take recent college graduate Maya Guttman, who struggled with anorexia nervosa and exercise bulimia as a student yet was initially praised by peers for her dramatic weight loss. Then there's Andrea Bass, an eating disorder counselor in Florida who alternately purged and starved herself for years. Her friend, she says, advised her to keep bags of pretzels in her nightstand to encourage her to eat more.
"These kind of remarks usually come from a place of good intentions," says Claire Mysko, director of programs at the National Eating Disorders Association. But too often, she says, they come across as insensitive or triggering. And in even more dangerous cases, she says, they can normalize or downplay an eating disorder's severity.
Here's what not to say next time you talk with a friend, family member or acquaintance with an eating disorder:
Anything that focuses on weight or appearance. People with eating disorders often initially receive compliments when they lose weight. Such positive reinforcement can spur them to continue engaging in dangerous eating, purging or exercise patterns. You never know whether someone's shedding pounds through healthy or unhealthy means. Therefore, you shouldn't automatically celebrate their changing body or focus on their smaller size, says Adina Fradkin, a registered dietitian at the Renfrew Center, a residential eating disorder facility in Baltimore, Maryland. "Think twice about the praise that you're giving them, and think about whether you're praising an eating disorder as well," she says.
Even if you're only complaining about gaining a few pounds or noting how slender someone's outfit makes them look, these offhand comments can be upsetting or triggering to someone with an eating disorder. And telling someone in recovery how great she looks now that she's put on a few pounds is harmful, too.
Guttman's parents, for example, who were once alarmed by her diminishing frame, told her how "healthy" she looked after she sought help and started regaining weight.
"I thought it was good, but at the same time I was upset about gaining the weight back," she says. In her mind, "healthy" was synonymous with "fat."
"These type of remarks are meant to comment on how well a person is doing. But when you've been so fixated on weight loss, the idea of gaining weight back is terrifying, even though it's necessary for recovery," Mysko says. "If you're trying to support someone, it's really important to take the focus away from physical appearance." Instead, she says, concentrate on celebrating the person's inner qualities.
Anything that focuses on food. Too often, Mysko says, parents, spouses and siblings like to give their two cents about what a loved one with an eating disorder ought to be be putting into his or her mouth. That translates to "Oh, try to eat more" to someone with anorexia, or telling someone who binge eats or purges to simply exercise more self-control. But it's not that simple, Mysko says.
"There's a lot of compelling research to show that eating disorders have biological roots. And there are cultural connections to eating disorders as well," Mysko says."They are incredibly complex and not simply about food. So for someone who's struggling with an eating disorder, hearing 'Why don't you just eat?' minimizes the problems at the heart of these illnesses" -- complicated issues such as depression, anxiety, perfectionism and a need for control.
Plus, Fradkin points out, many patients with eating disorders are prescribed meal plans to help reach or maintain healthy weights. When people tell them to "eat more" or "eat less," it makes it difficult to follow the "doctor's orders" -- which could impede recovery.
In some instances, onlookers will alternately praise or punish people with eating disorders about what's on their plate. Bass recalls loading up on vegetables and other healthy offerings at a buffet; a friend complimented her on her "beautiful plate" of food -- an observation she found both awkward and off-putting.
And Sarah, a health analyst in New York who chose not to include her last name for privacy reasons, looks back on high school classmates who commented when they noticed she was hiding food. "It made me really uncomfortable, and it made me pull back from them," she says.
Drawing attention to people's eating habits -- or any rituals, peculiarities or tics they have around food -- makes them feel ashamed of their eating disorder, says Sharon Peterson, a therapist in Towson, Maryland, who specializes in treating eating disorders. That makes them less likely to open up about their struggles. If you know someone is in recovery and working with a doctor or family members to eat more, don't focus on unusual behaviors or obsess about what he is -- or isn't -- putting in his mouth.
Anything that stereotypes eating disorders. Too often, Sarah -- an African-American female -- says, society views eating disorders as an "upper-middle-class adolescent white female problem." In fact, eating disorders transcend gender, race, age and socioeconomic status. Telling someone he can't have anorexia because he's a man, or because she's a mid-career professional, is inaccurate. Not to mention, such generalizations stigmatize certain populations and shame them from seeking help.
Another misconception is that someone with an eating disorder must be thin, Peterson says. Many people with anorexia, bulimia or binge eating disorder are a normal weight. In fact, it's possible to be overweight and suffer from an eating disorder.
"They don't know what's balanced or healthy. They've really lost sight of that," Peterson says. "Even someone who is overweight and has binge eating disorder might actually be malnourished. That's what our society doesn't realize." Telling someone they don't have an eating disorder because they "look fine" isn't just misguided and lacking in empathy -- it's also potentially life threatening.
Anything that normalizes the disorder. "If someone is binge eating and you say, 'Oh, don't worry, I do that all the time," that's giving them a sense of comfort. You're making them think that what they're doing isn't disordered," Fradkin says.
Similarly, telling someone who's anorexic that you also skip meals -- say, you don't eat breakfast -- can be harmful as well. "It's reassurance that what they're doing is right, when in actuality, it's really dangerous," Fradkin says. Normalizing behavior that might be indicative of an eating disorder prevents people from getting treatment.
Anything that sounds like it's lifted out of a textbook. You've read the self-help books, poured over the medical journals and spoken with the doctors. Therefore, you now consider yourself to be a self-taught "expert" on your loved one's anorexia, bulimia or binge eating. But just because you understand the disease medically doesn't mean you understand it psychologically or emotionally, Peterson says.
She advises friends or family members to refrain from channeling their inner physician. It comes across as condescending, she says, and neglects the most important aspect of recovery -- the person's emotional well-being.
"Don't act like a professional and say you need to do this, and this and this -- for example, 'You should probably eat this,' or 'Don't do that,'" Peterson says. "Instead, let the person know you understand a little bit about eating disorders, but you don't totally understand how they feel. That's something that takes time for the person with the eating disorder to realize for themselves."
Anything that shows shock or disgust. "There's a lot of shame around binging or purging behavior," Mysko says. "People can sometimes be shocked and say, 'How can you do that?' or 'That's disgusting.'"
If someone you know has bulimia or binge eating disorder, she says, don't be judgmental. Instead, channel care and compassion, and let him or her know that help and recovery is possible.