Supporting Someone with an Eating Disorder: A Guide for Family and Friends

What Are the Warning Signs of an Eating Disorder?

Warning signs of eating disorders include rapid weight loss, preoccupation with food and body image, avoiding meals, excessive exercise, mood changes, social withdrawal, and establishing rigid food rules. These signs can develop quickly or gradually, and the person often hides their struggles due to shame.

Eating disorders can develop rapidly or over an extended period, and they are often difficult to detect. It is common for the person with the eating disorder to hide their problems, partly because they feel ashamed and do not want to discuss their thoughts, and partly because eating disorders do not always have visible external signs. The person may insist that they are fine and have no problems, even while you sense something is deeply wrong. This is especially common with anorexia nervosa.

Understanding the warning signs is the first step toward being able to help. While these signs can occur in people without eating disorders, it is important to be alert to certain changes or new habits if you believe someone is at risk for developing an eating disorder. The key is noticing patterns of behavior that persist and intensify over time, particularly when multiple warning signs appear together.

Research shows that eating disorders affect approximately 9% of the global population at some point in their lives, making them among the most common mental health conditions. They can develop regardless of age, gender, ethnicity, or socioeconomic background, although they most commonly begin during adolescence and young adulthood.

Eating disorders can develop at any age

While it is most common for anorexia to develop during early adolescence, it can occur earlier or later. Bulimia nervosa and binge eating disorder typically develop later, from the early twenties and onward. However, eating disorders can develop regardless of age and gender, and healthcare providers are increasingly recognizing these conditions in older adults, children, and men.

The stereotype that eating disorders only affect teenage girls is both inaccurate and harmful. Men account for approximately 25% of eating disorder cases, though they often go undiagnosed because of stigma and the misconception that these are "female diseases." Similarly, eating disorders in older adults are frequently missed because symptoms may be attributed to other health conditions or aging.

Rapid weight changes

Often, an eating disorder can begin with significant and rapid weight loss. You may notice this change in your loved one and observe that they view it positively. The person may seem unusually cheerful and feel filled with energy despite eating very little. This initial "high" from restriction is a dangerous sign, as it often reinforces the disordered behavior.

The feeling that the low weight must be maintained can be intensified if people in their environment also express approval or admiration for the weight loss. Well-meaning comments like "You look great!" or "Have you lost weight?" can inadvertently fuel the disorder. This is why healthcare professionals recommend avoiding any comments about weight or appearance, whether positive or negative.

It is important to note that significant weight loss is not present in all eating disorders. People with bulimia nervosa often maintain a normal weight, and those with binge eating disorder may have a higher weight. Focusing only on visible weight changes can cause you to miss other important warning signs.

Excessive exercise

Exercising intensely and thinking excessively about eating healthily can also be signs that a person is developing an eating disorder. While regular exercise and healthy eating are generally positive, they become concerning when they become rigid, compulsive, and interfere with daily life.

A person who is dieting strictly or exercising excessively may become more irritable and easily upset than usual. They may also feel cold frequently and be more sensitive to temperature changes than normal – these are physical signs that the body is not receiving adequate nutrition. Other physical signs include fatigue, dizziness, difficulty concentrating, and sleep disturbances.

Exercise becomes problematic when the person feels compelled to exercise even when injured, sick, or exhausted; when they experience significant distress if they cannot exercise; when exercise takes priority over work, school, or relationships; or when exercise is used primarily to "compensate" for eating.

Changed eating habits

It can be helpful to ask about the reasons behind changed habits if you notice, for example, that the person has developed new eating patterns and is avoiding shared meals. Changes in eating behavior are often among the earliest and most noticeable signs of an eating disorder.

Starting to create rules around what one eats can also be a sign of excessive focus on weight. The person may, for example, eliminate fats and sugars, become vegetarian or vegan suddenly (not for ethical reasons), or establish strict "forbidden foods" lists. While dietary preferences are normal, using diet as a way to restrict overall intake or justify avoiding social eating situations is concerning.

A person with an eating disorder may begin to withdraw and avoid meeting friends to escape shared meals. The person may, for example, focus their attention on controlling portion sizes, monitoring how much is on their plate, watching how much others at the table are eating, and ensuring they do not eat themselves. They may also develop rituals around food, such as cutting food into tiny pieces, eating very slowly, or arranging food in particular patterns.

What Is It Like Being Close to Someone with an Eating Disorder?

Being close to someone with an eating disorder often brings feelings of worry, helplessness, frustration, and grief. It is common to feel angry, scared, and sad seeing someone you love harm themselves. These emotions are normal and do not mean you are a bad person or unsupportive.

It is natural to feel worried, concerned, and powerless as someone close to a person with an eating disorder. You may become both angry, afraid, and sad watching the person with the eating disorder suffer and treat their body in harmful ways. These complex emotions are a normal response to a difficult situation, and experiencing them does not make you a bad person or an inadequate caregiver.

It is common for the person with the eating disorder to completely deny their problems, or become angry if you ask about food or weight. These types of reactions are part of the eating disorder itself. The illness creates powerful defenses against intervention, and what may feel like rejection or hostility is often the disorder talking, not your loved one's true feelings toward you.

Many family members describe feeling like they are walking on eggshells, never knowing what might trigger an outburst or withdrawal. Mealtimes, which used to be pleasant family gatherings, may become tense and filled with conflict. The eating disorder can feel like an unwelcome guest that has taken over your home and relationships.

Parents do not cause eating disorders

Many parents experience guilt and blame themselves for their children's problems. There is no evidence that eating disorders are caused by what parents have done or not done to their children. This outdated and harmful myth has been definitively rejected by modern research.

Eating disorders are complex mental illnesses influenced by a combination of genetic, biological, psychological, and environmental factors. Studies of twins have shown a strong genetic component, and brain imaging research has revealed differences in how people with eating disorders process reward and emotion. While environmental stressors can trigger the onset of an eating disorder in someone who is genetically predisposed, parents are not to blame.

In fact, families are now recognized as essential allies in treatment. Family-Based Treatment (FBT), also known as the Maudsley Approach, actively involves parents in helping their child recover and is one of the most effective treatments for adolescent anorexia nervosa. Rather than being the cause of the problem, families are part of the solution.

How Can I Talk to Someone About Their Eating Disorder?

When talking to someone about an eating disorder, choose a private and calm moment, use "I" statements to express concern without accusation, focus on behaviors rather than weight or appearance, listen more than you speak, and avoid offering simple solutions. Be prepared for denial or anger – this is part of the illness.

There are things you can do as a loved one that mean a great deal to the person with an eating disorder. Your support, patience, and understanding can make a significant difference in their willingness to seek help and their eventual recovery. However, how you approach the conversation matters enormously.

Educate yourself about eating disorders

It is common to feel that you need more knowledge to know how to handle the situation. It can become easier for you to understand how to approach things if you know how eating disorders affect the person who has problems with food and eating. Understanding that eating disorders are brain-based illnesses, not choices, helps you respond with compassion rather than frustration.

Learning about the different types of eating disorders – anorexia nervosa, bulimia nervosa, binge eating disorder, ARFID, and others – helps you understand what your loved one may be experiencing. Each type has different characteristics and may require different approaches to support. Reading reputable sources, attending caregiver education programs, and connecting with other families who have gone through similar experiences can all be valuable.

Professional help is essential

Most often, the person with an eating disorder needs help from someone who specializes in this type of problem. Eating disorders are complex conditions that typically require professional treatment including medical monitoring, nutritional rehabilitation, and psychological therapy. You cannot cure an eating disorder through love and support alone, no matter how much you wish you could.

You can support your loved one by, for example, researching what help is available. Share information about treatment options. Ask if they want you to help in any other way. Offering to accompany them to appointments, helping them find a therapist, or assisting with insurance paperwork can all be meaningful forms of support.

Early intervention leads to better outcomes, so encouraging professional help sooner rather than later is important. However, be prepared for resistance – many people with eating disorders are ambivalent about treatment, especially if they do not yet recognize the severity of their condition.

Show that you care

You cannot solve your loved one's problems, but you can support and help by being there for the person who is ill. Being willing to listen can be a very good way to show that you care. Active, non-judgmental listening is one of the most powerful things you can offer.

The person who has an eating disorder may feel very alone. Having someone who is curious about how they are feeling and who tries to listen and understand means a great deal. It can make it easier for the person to engage in treatment and overcome the eating disorder. Knowing that someone believes in their ability to recover and will support them through the process provides hope during difficult times.

You can, for example, accompany them to appointments and be a support both before, during, and after treatment. Recovery from an eating disorder is rarely linear – there will be setbacks and difficult periods. Consistent, patient support through the ups and downs demonstrates that your care is unconditional.

Try to understand the context

There are different reasons why a person develops an eating disorder. It may, for example, involve how the person handles difficult emotions and thoughts. An eating disorder can prevent the person from finding other ways to manage emotions and solve problems. In this case, it can be helpful to talk about it. Ask questions and show that you care and have time to listen to the answers.

It may be that the person does not themselves know what has caused the problems. You may need to think together. Is there something specific creating stress in their life? Has something special happened? What do relationships with friends and family look like? Do they feel lonely or vulnerable in some way? It may involve, for example, high expectations, conflicts, or bullying.

You can express that you see the problems and that you care about what is happening. Even if you do not get answers to the questions you ask, the concern can help the person feel better. Simply knowing that someone notices and cares can be meaningful, even if they are not ready to open up.

Tips for talking with someone who has an eating disorder

Here are some specific guidelines for having a supportive conversation:

• Say that you have noticed changes and that you know the behaviors are not good for their body. Try to be direct but not angry, confrontational, or guilt-inducing. This can increase feelings of shame and guilt. Show that you are worried but also curious and want to understand the person's thoughts and feelings. Do not forget to listen to their responses and reactions to what you say.
• Ask how the person is feeling. Let them talk about their emotions. Try to just listen, even if you might not agree – for example, if they express thoughts about being inferior to others. You can acknowledge that you have heard them, and for example say: "Okay, so you have a lot of self-critical thoughts?"
• Try not to offer advice and solutions immediately. You do not need to fix everything. The important thing is that you are there. Wait for the person's own thoughts and give them space to process.
• Try not to talk about food, weight, and appearance. This can be triggering for the person, especially during meal situations. Instead, focus on their emotional wellbeing and non-food-related aspects of their life.
• Try to make meals a calm and pleasant time when you talk about other topics that are not so charged. Reducing tension around food can help make eating less anxiety-provoking.
• Do not accuse or threaten. Do not see the eating disorder as a way for the person to manipulate people around them. It usually does not help the person who is ill. The eating disorder is an illness, not a choice or manipulation tactic.
• Try to show that you understand that it is difficult for the person to change their behavior and that they need help managing their difficulties. Recovery takes time and involves setbacks.
• Show that you want to understand and want to be a support for the person to feel better. Ask if they want your help and what you can do. Respect their autonomy while maintaining appropriate boundaries.

When and Where Should You Seek Professional Help?

Seek professional help as soon as you suspect an eating disorder – early intervention leads to better outcomes. For children and adolescents, always seek assessment regardless of symptom severity. Seek immediate medical attention for severe weight loss, fainting, heart palpitations, or any mention of self-harm or suicide.

The earlier the person with an eating disorder receives help, the easier it is to address the problem. Do not wait to talk to the person about seeking help if you feel it is needed. Research consistently shows that early intervention significantly improves recovery rates and reduces the risk of the eating disorder becoming chronic.

Seeking help for children and adolescents

If you are close to someone under 18 who has an eating disorder, you should seek help for the person, regardless of how much or how long they have had the eating disorder. It is always good to get an initial assessment of the situation and what help is needed. Eating disorders can progress rapidly in young people, and what seems like "just a diet" can quickly become a serious illness.

It is also good to seek an assessment if any of the following applies to the child or young person:

• They have been depressed for an extended period
• They become irritable or aggressive more often than before
• They have more uneven moods than previously
• They often seem worried or anxious

Other things to be aware of include whether functioning is declining at school, at home, or during leisure activities. It may also be relevant if they are sleeping poorly or if they no longer see meaning in things that used to be enjoyable. Also be alert if the person is isolating themselves and has lost interest in things they previously enjoyed.

For adolescents, consider reaching out to child and adolescent mental health services, school counselors or psychologists, adolescent medicine specialists, or your primary care provider who can provide referrals. A teenager can also independently contact these services if they are ready to seek help. Even people under 18 should participate in decisions about their own treatment. Assessment and treatment usually work better when parents or loved ones are involved in care.

Assessment and treatment

The person with an eating disorder can receive different types of help. What help they receive depends on how severe and how long they have had the eating disorder, and whether they have any other problems. They may receive treatment for other issues if needed, as eating disorders frequently co-occur with depression, anxiety, trauma, and other conditions.

Sometimes an initial assessment is done over the phone, which is common when seeking care through mental health services. Sometimes the assessment is done at the first appointment. After that, you will find out whether the clinic will continue with further evaluation or treatment. The process may feel slow and frustrating, but thorough assessment ensures the right treatment approach.

Effective treatments for eating disorders include Family-Based Treatment (FBT) for adolescents, which involves parents taking an active role in helping their child restore weight and establish healthy eating patterns. Cognitive Behavioral Therapy (CBT) helps address the thoughts and behaviors that maintain the eating disorder. Other approaches include Dialectical Behavior Therapy (DBT), particularly for those who struggle with emotion regulation, and specialized nutritional counseling.

The therapeutic relationship matters

It is important that the person receiving help feels trust in the treatment provider they meet, for the help to be effective. Ask to meet someone else if it does not feel right. A good therapeutic fit significantly improves treatment outcomes, and it is appropriate to request a different provider if the relationship is not working.

It is a right to receive information in a way that is understandable. The person receiving help can ask questions to the treatment provider if there is something they do not understand. Ask to have information written down or translated so it can be read calmly at home.

What If the Person Does Not Want Help?

If someone with an eating disorder refuses help, continue showing you care, listen without judgment, and periodically bring up the topic of treatment in a non-pressuring way. You cannot force recovery, but your persistent support matters. In cases where there is immediate danger to life, involuntary treatment may be considered as a last resort.

It means a great deal that you as a loved one are there for the person who is struggling. That you listen, have patience, show that you care, and offer to help is important for them to feel better. But if the person themselves does not want to accept treatment, you probably cannot make them do so.

This applies to people under 18 as well. It can be a very difficult and painful situation for you. Try to respect the person's wishes while maintaining appropriate concern. What you can do is continue to talk about how they are feeling. Bring up the question of help again and again, but in a non-demanding way. Keep the door open without creating constant pressure.

Understanding why someone might refuse help can make this easier. The person may be in denial about the severity of their condition. They may be terrified of weight gain or losing control. They may have had negative experiences with treatment in the past. Or the eating disorder may be serving a function for them – perhaps helping them cope with overwhelming emotions – and they fear what will happen without it.

Your role is to remain a consistent, caring presence. Let them know you will be there when they are ready. Share information about treatment options without pressure. Celebrate small steps in the right direction. And take care of yourself so you can continue to be supportive over the long term.

When involuntary treatment may be considered

A fundamental principle in healthcare is that no one should be treated against their will or without giving consent. This applies to people under 18 as well. Autonomy and the right to make decisions about one's own body are important values.

However, there are laws that allow a person to be compelled to receive care in certain situations where there is danger to life. This may be the case if someone is harming or starving themselves to a life-threatening degree. Criteria for involuntary treatment typically include imminent danger to the person's life, inability to make informed decisions due to the mental illness, and refusal of voluntary treatment.

Involuntary treatment is always a last resort and involves careful legal and ethical processes. It is typically used only when someone's life is in immediate danger and they are unable to recognize this due to the severity of their illness. If you believe your loved one may be at this point, consult with healthcare providers about the options in your area.

How Can You Take Care of Yourself as a Caregiver?

Caregiver self-care is essential, not selfish. Seek your own support through counseling or support groups. Set healthy boundaries. Maintain activities you enjoy. Take care of your physical health. Remember that you cannot force recovery – you can only provide support while protecting your own wellbeing.

You as a loved one may also need support. Being close to someone who has an eating disorder can feel heavy and evoke many emotions in you. It is natural to feel inadequate or powerless. That you show you care means a great deal. You are doing the best you can, and that is enough.

Caregiver burnout is a real phenomenon. The constant worry, the tension around meals, the emotional ups and downs, and the feeling of helplessness can take a significant toll on your mental and physical health. Taking care of yourself is not a luxury or a sign of selfishness – it is necessary for you to be able to continue supporting your loved one over the long term.

It can be difficult to be a support for someone else if you yourself are very worried, scared, or sad. Therefore, it is good to get help yourself. Reaching out for support is a sign of strength, not weakness, and models healthy coping for your loved one.

Talk to others

You can start by talking to someone you know, like a friend or acquaintance. You can also talk to school staff if the person attends school, or student health services if they are studying at a college or university. Having someone to confide in who understands what you are going through can provide enormous relief.

You can also contact someone who works with parental support within social services or child and adolescent mental health services. In some areas, there are support groups or educational programs for people who are relatives of someone with an eating disorder. These groups provide a space to share experiences, learn from others who have been through similar situations, and feel less alone.

Consider also seeking professional support for yourself through individual therapy or counseling. A therapist can help you process your emotions, develop coping strategies, and navigate the complex dynamics that eating disorders create in families.

Your emotions may change over time

It is not uncommon for you as a loved one to eventually start feeling irritation and frustration. You may also feel sad all the time. Perhaps it feels like you cannot bring yourself to care anymore. This can happen if you have been overwhelmed by difficult and painful emotions for an extended period.

Eventually, you might shut off those feelings in order to manage the rest of life – school, work, friends, and other things you must do. Feeling angry and wanting to shut down can be an attempt to escape your grief, fear, and worry. It does not necessarily mean you have stopped caring. These are normal protective responses to an overwhelming situation.

If you notice yourself becoming numb, cynical, or constantly exhausted, these may be signs of caregiver burnout. Take them seriously and increase your self-care efforts. You may need to step back temporarily and let others share the caregiving burden.

Practical self-care strategies

Do not forget yourself. Focus also on things that make you feel good and do activities you enjoy. Meet people you like spending time with. Maintaining your own life and identity outside of the caregiving role is important for your wellbeing and prevents your entire existence from being consumed by the eating disorder.

Make sure to eat and sleep well and to move your body. You need this to have the energy to be a good support. Basic physical self-care – adequate sleep, regular meals, and some physical activity – provides the foundation for emotional resilience. It is hard to be patient and compassionate when you are exhausted and running on empty.

Set boundaries to protect your mental health. You cannot be available 24/7 without burning out. It is okay to take breaks, to say no sometimes, and to have times when you focus on your own needs. Healthy boundaries actually make you a more effective support person in the long run.

Seek professional help if needed

Contact a healthcare provider if you are struggling significantly. You can meet with a counselor or psychologist and receive talk therapy support. Do not wait until you are in crisis – seeking help early can prevent more serious problems from developing.

If you need guidance on where to seek care, contact your primary care provider or look for mental health services in your area. Many therapists now offer telehealth appointments, making access easier. Some areas also have specific services for caregivers of people with mental health conditions.

Seek support from others who understand

Sometimes it can be valuable to talk to someone who has similar experiences. Most patient and family organizations have meetings where you can meet other loved ones. Hearing from others who have walked this path can provide hope, practical tips, and validation that you are not alone.

There are organizations that provide support to people with eating disorders and their loved ones through helplines, online communities, and in-person support groups. These resources can be invaluable for connecting with others who truly understand what you are going through.