Discussing Social Activity

If your child has an eating disorder, chances are she goes to great lengths to avoid eating socially; she probably shuns opportunities to be with friends even if the plans don’t include meals. The social withdrawal that often accompanies an eating disorder can gradually impact the individual’s life in ways she never imagined before her illness struck. Your efforts to paint a picture of talk therapy as a road to feeling more comfortable in social situations can help motivate your child, particularly if she previously found friendships rewarding. For a son or daughter who declines an invitation to a formerly enjoyable activity, try opening a dialogue with a comment such as “It must be so hard when something inside you holds you back.” The idea of initiating discussion about her social life (or lack thereof) is not to change or “cure” her, but rather to try to understand why these situations have become so difficult for her.

As it is, worries such as “I’ve eaten too much” or “I will eat too much” or “I’m gaining weight” might pummel a person with an eating disorder continually; on top of these feelings, the prospects of socializing tend to call forth a number of additional concerns.

Particularly challenging is the threat of embarrassment. For example, if your child is invited on a day outing with friends, she’s likely to worry about how she’ll finagle her way out of eating with them.

It is not unusual for an individual with anorexia to worry that others at the table will look at her plate to see what she has or has not eaten. Chances are she feels embarrassed going to a restaurant with friends but ordering nothing; if she shares a table with only one other person, she’s apt to fear that her own abstinence from food will make her companion uncomfortable.

If the individual with anorexia feels pressured to eat, she typically decides to fake it, often by pushing her food around on her plate or hiding some in a napkin. However, executing these maneuvers is stressful, and no matter how much she likes the people she’s “eating” with, her preoccupation with her no-eating strategy diminishes her ability to enjoy their company or concentrate on the conversation.

Reaching Out to Your Student
If you are a teacher, athletic coach, school nurse, or residence adviser, you can play a key role in helping students who are struggling with an eating disorder. Naomi, a residence adviser at a large university, has reached out to many kids. Several parents we’ve seen have credited Naomi’s nonjudgmental, calm manner not only for seeing them through a trying time, but also for mobilizing their children into treatment. The following is Naomi’s account of her journey with Sophie, who recently became our patient.

“It started with a brief message about ‘roommate problems’ on my telephone answering machine. Later that evening, I saw the student who had called me, and she expressed concern that Sophie had recently begun to gorge on food and then traipse straight to the bathroom. I never doubted this roommate’s good intentions. But sometimes a student who reports a friend’s behavior is also worried about her own, so I explored that possibility and ruled it out. When I asked the roommate whether she wanted our conversation about Sophie to remain confidential, she replied, ‘Yes, though I told her I was coming to you-and she’s really mad at me.’

“Like many with bulimia nervosa, Sophie looked healthy. But she seemed sullen. She was aware that her eating habits were problematic, and I approached her several times about seeing a doctor, but she wanted no part of it. Early in the course of my discussions with her, I made it clear that I would contact her parents if her condition worsened. Within the next few weeks, her mood went downhill and her eating problems continued. Much to Sophie’s dismay, I phoned her mom:

Naomi:  Hello, this is Naomi, the residence adviser in Sophie’s dorm. Have I caught you at a convenient time?
Mom:  Is Sophie okay?
Naomi:  Until recently, she seemed fine. She’s keeping up academically, but she’s been having difficulties with food, and she’s not her enthusiastic self. I explained to her that I’d be contacting you.
Mom:  She hasn’t mentioned anything about food.
Naomi:  Students with eating disorders often keep their problem a secret. Sophie seems to have a habit of binge eating and vomiting, and I’ve been encouraging her to see a doctor for evaluation, but she’s hesitant to do that.
Mom:  Of course she needs to see a doctor! Whew, this is all so unexpected.
Naomi:  I’m sorry. I can only imagine how overwhelming this news feels to you. It must seem very sudden. I’ve come to know Sophie as a very bright young woman with good friends, and I believe she can feel much better. The student health center right here on campus is equipped to help people with eating disorders, and as I’ve told Sophie, I’d be happy to go there with her. If she prefers to see a primary care physician she’s known in the past, that’s fine as well.
Mom:  I’ll start making some calls. Can I get back to you later today or tomorrow?
Naomi:  Of course. You can call me anytime. Please know that what you and I talk about will be confidential. Also, I can fax you some information on eating disorders if you wish.
Mom:  Yes, I’d like that information. Thank you, Naomi. We’ll talk soon.

“It didn’t surprise me that Sophie resented me for calling her mom,” said Naomi. “The message I tried to send her was ‘I care about you, and I did it for your safety.’ “

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