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What are some ways to start a discussion with someone who might have bulimia nervosa?
"My mother could not acknowledge or accept that I was having a problem. Because I was living on my own and already in treatment, she only knew about my behavior after the fact while I was trying to recover. She didn't understand when I would ask not to have large portions or more servings, or when I did not want to come to dinner. Even with I tried to talk with her, she was not able to express anything. She had this blank look on her face like it didn't register or didn't concern her. Then two minutes later when I was ready to leave [her house], she' ask if I wanted to take home some food."

The following guidance presumes that the situation is serious, but not immediately life threatening and does not require emergency medical care or a call to 911.
  1. First, learn all you can about eating disorders by reading this guide and referencing www.bulimiaguide.org, as well as Web sites listed in "Additional Resources." List the resources that you can offer if asked by your loved one. Remember that even though you are informed about bulimia nervosa, only a professional trained in diagnosing eating disorders can make a diagnosis. Avoid using your knowledge to nag or scare the person into treatment. The goal of a discussion should be to express your concerns about what you've observed and persuade, but not force, the person to seek help.
  2. Plan a private, uninterrupted time and place to start a discussion. Be calm, caring, and non-judgmental. Directly express, in a caring way, your observations and concerns about the person's behavior. Use a formula like "I am concerned about you and what's going on for you when I see you [fill in the blank]." Cite specific days/times, situations, and behaviors that raised your concern. Share your wonder about whether the behavior might indicate an eating disorder that requires treatment. Avoid discussing appearance or weight, but discuss what you've observed about the person's mood, depression, health, addiction recovery, or relationships.

    Avoid words and body language that could imply blame. Explain the reasons for your concerns. The person may deny the situation because of overwhelming feelings, such as shame and guilt. Avoid expressing frustration with the person. Stay calm. Be gently persistent as you go on expressing your concerns. Ask, "Are you willing to consider the possibility that something is wrong?" Be prepared with resources to offer if the person seems to be listening—or just leave a list of resources behind for the person to look at on his or her own time. Expressing your concerns may be awkward at first, but such efforts can provide the bridge to help for the person. Even if the person does not acknowledge a problem during your discussion, you have raised awareness that you are paying attention, are concerned, and want to be a support.

    Ask the person if s/he is willing to explore these concerns with a healthcare professional who understands eating disorders. Remember that only appropriately trained professionals can offer appropriate options and guide treatment. Your job is to express concern and offer support.

    Ask the person to describe the feelings they get from the behavior you've observed. Does it provide a sense of control, relief from depression, anxiety, short-term feelings of satisfaction or pleasure, other feelings? Let the person know there are other ways to feel better that don't take such a physical and emotional toll. Explain some of the advantages of a life without binge eating and purging or other compensating behaviors. Remind this person that many people have successfully recovered from bulimia nervosa. Offer to help find a treatment center or accompany him or her to a therapist or doctor. Encourage and support the person, but, understand that ultimately, recovery is up to the individual.

    Avoid suggesting overly simple solutions like "Just stop overeating and you won't have to purge." That's like telling a smoker to just quit smoking. Avoid power struggles over food and eating behavior. Leave those issues for the therapist to handle. Avoid talking about weight and looks. Comments like "You're putting on weight" or "You look thinner," may be perceived as encouraging disordered eating.

  3. Take a break if the person continues to deny the problem. Revisit the subject again soon, but not in a confrontational way. It's frustrating to see someone you care about suffering and be unable to do much about it. Remember that control is often a big issue, and you can not successfully control another person's behavior—he or she does. Many patients and families interviewed for this guide discussed "control" as a key issue they had to come to terms with. If the person with bulimia nervosa is older than 18, treatment cannot be forced or discussed with any health professional without written permission from the patient. Even if the affected person is younger than age 18 years, s/he must be willing to acknowledge the problem and want to participate in treatment. In some cases, enlisting the support of others that the person likes and respects may help—like a teacher, coach, guidance counselor, or other mentor who can shares your concerns. Tips for teachers who suspect a student has an eating disorder are listed here.
  4. Lastly, being a good support means that you also have to take good care of yourself and the stresses you may feel from the situation. This is important not only for your well-being, but also serves as a model of healthy behavior for the person you are trying to support. Don't let your loved one's eating disorder completely disrupt and rule your life.

Is planned "intervention" ever a viable option?

Intervention is when a group of friends and family members confronts their loved one about destructive behavior, the need to acknowledge that behavior, and its impact on the person and others. Intervention has been used to confront people practicing substance abuse and also to confront people with bulimia nervosa. Sometimes, this technique can be successful in convincing a person with bulimia nervosa to start therapy, but it can also backfire and alienate the person from those closest to him or her. If you are considering intervention, the best chance of success is to work closely with a qualified profession who can help plan, organize, and facilitate it.

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Bulimia nervosa is an eating disorder in which a person engages in binge eating (eating a lot of food in a short time) followed by some type of behavior to prevent weight gain from the food that was eaten. This behavior can take two forms: self-induced vomiting, misuse of enemas, laxatives, diet pills (called purging) and excessive exercise, fasting, or diabetic omission of insulin (called non-purging). Some people with bulimia nervosa may also starve themselves for periods of time before binge eating again. Bulimia nervosa has important mental, emotional, and physical aspects that require consideration during treatment.

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