Q.I had an outstanding first year in college. My concern isn’t about me, but about a good friend I made at school. I’m afraid she’s bulimic. After I read your column last week about anorexia, I began to worry. My friend eats a lot at a time, and then disappears into the bathroom, comes back, and eats more. She never gains weight. Actually, she’s losing weight. Could she be bulimic? And if she is, what is my responsibility as a friend? We’ve shared a lot this year since this was our first time away from home. I really think her health is in danger.
Mary Jo’s response: You raise a delicate question: When should a friend get involved in a person’s life?
Ideally, two friends would discuss the possibility of intervention when times are calm and problems are few. As I grow older, I become more and more committed to the idea of communicating one’s needs to those who are dear to us. I believe in living wills; I love the concept of preparing for adversity. How radical would it be if good friends discussed the parameters of their relationship? For example, many young people ask me how far they should go to help a friend in a potentially abusive relationship. That type of intervention is complicated. Your situation is more straightforward. If your friend’s health is in danger, your responsibility is higher.
Ultimately, respect is key. It is not your job to “diagnose” your friend; you are not a professional counselor. However, you are in a position to notice behavior her family may not be see.
I think your first step is a discussion with your friend. Select a time when stress is low for both of you. Find a private spot to have coffee and talk. Share your concerns gently and without judgment. Be empathic. How would you want to her to speak with you if the situation was reversed? Please don’t talk about her with others. Keep your conversation confidential. Let her know you’re concerned.
Bulimia, like anorexia, is an eating disorder. A person with bulimia eats a lot of food over a short period of time (called binging), then tries to remove the food by throwing up or taking laxatives (called purging). A person with bulimia may not feel control over how much is eaten, but is obsessed with weight gain. Extreme exercise, overuse of diet pills, or eating very little are all components of bulimia.
Unlike anorexia, a person with bulimia may have a normal body weight. Like individuals with anorexia, however, a person with bulimia fears gaining weight, wants desperately to lose weight and is unhappy with body image, size and shape.
Remember, you’re not a counselor or therapist. Before talking with your friend, I recommend you research support systems she might be able to access. Your college may have a clinic or a resource list. A person with bulimia can be helped, but there is no quick fix. Typically, treatment for bulimia involves:
• A health-care team of doctors, nutritionists and therapists
• Nutritional therapy
• Psychotherapy, usually CBT (cognitive behavioral therapy). CBT has been shown to be effective in treating bulimia in changing binging and purging behavior while assisting the person to develop positive eating habits.
• Long-term support.
Your role as a friend will be to provide a portion of that long-term support. Stress your commitment to her health; you won’t go away and you won’t judge her when she experiences ups and downs.
Once more, I’d like to remind you how delicate your involvement is. If she doesn’t respond to your intervention and you genuinely feel she is in danger, you will need to decide if/how to involve her family.
Friendship is a two-way pact where people choose to share aspects of their lives. I applaud your efforts at supporting your friend and wish both of you a positive future.
Peer Educator response
Yes, you are responsible. You’re her friend, and you need to be there for her, even if she gets angry. You would do the same thing if your friend was drinking too much or using drugs. If a friend reacts badly to your involvement, you may lose the friendship. It’s still important to try.