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Eating Disorders

A friend Has bulimia

04/23/2009

Question:

A friend of mine has recently told me that she is throwing up after meals; she also has a very intense work out that she does. It’s obvious that she is bulimic. She knows that she is conducting this behavior (mostly concerned about the vomiting) due to personal image issues.

What frightens me is that she feels that she is in control of how often she throws up, and that there is nothing wrong and that it will not get out of control. Her parents are very hard on her at times and her schedule is incredibly demanding for school. So not only is she bulimic to feel better about herself, but also to feel in control of SOMETHING.

I really don’t know what to do. She does not want any professional help, or for any parent-age persons to know. I have been honest with her, in that I am NOT ok with her behavior, but I’m not going to yell at her or pressure her to change. I realize that she has to make the decision herself to want to get better.

How can I get her to understand that it is not normal or safe to throw up after eating, it’s a disorder, and that while it makes her feel like she will be skinny with no consequences at the moment, it will have long term effects on her body and self-esteem?

Answer:

You have a right to be concerned about your friend.  Vomiting in the way you describe is very dangerous and at times deadly.  Each time she vomits repeatedly, she is adding strain to her heart and over a short period of time her heart can become weakened and could stop. 

While she may want to avoid the treatment issue, as a friend you have a right to hold to limits.  If your friend hurt her ankle and was limping after jogging, would you not say something in concern, like, "Why are you limping?  Are you in pain?  I can go with you to check this out."  And if she says no, but the next week she is still limping, would you not get more insistent as a friend to check it out?   The same is true, for self-induced vomiting and in the same voice tone of concern.  Saying something like, "I heard (or know) you made yourself vomit; I'd be willing to go with you to check this out."  

It may be better that your concern and insistence for action is annoying to her, but keeps her in a place where she may be healthier over time.

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Response by:

Laura  L Hill, PhD Laura L Hill, PhD
Clinical Assistant Professor of Psychiatry
College of Medicine
The Ohio State University