Her scale... ugh.

I’m facing a bit of a dilemma. I suspect my best friend might be struggling with an eating disorder. It doesn’t necessarily look like typical anorexia or bulimia, but I’ve noticed some concerning patterns. She eats incredibly slowly and seems to struggle through meals—though she prefers to say it just makes her "more comfortable." She eats very little and seems terrified of actually feeling full.
She has this persistent perception that everyone else is smaller than she is and that she’s overweight. To give you some context, she’s about 5'8" and weighs 119 pounds. Even when I point out that she’s actually much thinner than people who weigh significantly more, she still insists she’s large. She even confessed recently that she’s terrified of gaining weight and feels she needs to lose more just to reach some ideal standard.
Hmm... I’m honestly at a loss for words. Back in high school, she would almost entirely avoid food—maybe one ice cream a day—and I just brushed it off as a passing phase of puberty since her weight never dropped to a dangerous level back then. But clearly, these habits have resurfaced now that she's a young adult. Now, she’s aiming to drop down to 110 pounds and tells me she’s genuinely afraid of eating. I don't know how to approach this without her getting defensive or feeling like I'm forcing her to eat. If anyone has any advice on how to handle this delicately, I'd appreciate it.🤷

This is serious and dangerous. They need to see a psychiatrist who specializes in eating disorders.

I’ve already suggested she go see a doctor, but she thinks it’s a waste of time. Her logic is that since her weight seems fine and she hasn't experienced any significant drops in the past, there isn't much to report. She keeps insisting that people have much more serious issues than she does and claims I'm just making a big deal out of nothing.🙄

Aaron Castillo9 said:I’ve already suggested she go see a doctor, but she thinks it’s a waste of time. Her logic is that since her weight seems fine and she hasn't experienced any significant drops in the past, there isn't much to report. She keeps insisting that people have much more serious issues than she does and claims I'm just making a big deal out of nothing.🙄

I’m about 5'8", just a couple of pounds heavier than her. I eat totally normal meals, honestly. And frankly, constantly overthinking everything I eat? It’s just exhausting.
Look, it’s not even about the number on the scale. That doesn't matter right now. It only becomes a real issue when she ends up hooked up to an IV drip in a hospital bed. The actual problem here? It's her relationship with food.
Trying to actually get an appointment with a specialist around here? Honestly, it feels like a mission impossible.
She genuinely sees herself as overweight—it’s like her body image is totally warped. Honestly, she's heading straight toward an eating disorder.
She’s genuinely sick. Like, seriously unwell. She needs professional help—real medical intervention—but she just doesn't get it. In her head, everything is perfectly fine.

I agree—it all comes down to her mindset. From an outsider's perspective, she doesn't look ill, even though people constantly tell her she needs to gain weight. She doesn't seem bothered by those comments at all.
She insists she has her weight under control, but living that way seems incredibly taxing. I worry that things could spiral out of control quite suddenly; it’s really just a matter of when.
I was thinking that maybe her boyfriend could eventually convince her to sit down with a professional...

Aaron Castillo9 said:I agree—it all comes down to her mindset. From an outsider's perspective, she doesn't look ill, even though people constantly tell her she needs to gain weight. She doesn't seem bothered by those comments at all.
She insists she has her weight under control, but living that way seems incredibly taxing. I worry that things could spiral out of control quite suddenly; it’s really just a matter of when.
I was thinking that maybe her boyfriend could eventually convince her to sit down with a professional...

Yeah, that's a smart move. Honestly, the person she lives with probably has the biggest influence on her.
Take my cousin, for example. She stayed with me for about a month, and let me tell you, it was brutal. She struggles with anorexia—she’s about 5'6" and weighed barely 108 pounds.
It was constant math with her food. She’d barely eat anything, maybe an egg or a banana once a day, and the second she did consume something, she’d bolt to the gym and grind away for hours. Every single day. There were times I’d make this really nice, light meal, and she’d just sit there moving food around her plate with a fork. Watching her do that actually made *me* lose my appetite. I tried telling her, "Look, you have a problem," but nothing worked.
Of course, she ended up in the ER a few times because she’d just collapse from starvation, and even now, she deals with some pretty serious health complications.

P.S. People like that are always the hardest to convince that anything is actually wrong. At the end of the day, recovering from an eating disorder takes years of work. And you're looking at long-term treatment with a psychiatrist to make it stick.

She says she’s at a loss for words when it comes to explaining her situation to the doctor, especially since her appetite hasn't changed at all.
Is it feasible, for instance, to have her boyfriend accompany her to the appointment to lay everything out for the physician? I feel like that might be the most realistic way to portray the situation, given that he’s the person closest to her.

Aaron Castillo9 said:She says she’s at a loss for words when it comes to explaining her situation to the doctor, especially since her appetite hasn't changed at all.
Is it feasible, for instance, to have her boyfriend accompany her to the appointment to lay everything out for the physician? I feel like that might be the most realistic way to portray the situation, given that he’s the person closest to her.

See, there it is. She thinks everything's normal... he can tag along if he wants, but it won't do much good if she isn't willing to cooperate. Honestly, just have him—or you—tell her straight up that being terrified of food isn't exactly "normal." If she could just start there, it wouldn't be such a mess.

Aaron Castillo9 said:I agree—it all comes down to her mindset. From an outsider's perspective, she doesn't look ill, even though people constantly tell her she needs to gain weight. She doesn't seem bothered by those comments at all.
She insists she has her weight under control, but living that way seems incredibly taxing. I worry that things could spiral out of control quite suddenly; it’s really just a matter of when.
I was thinking that maybe her boyfriend could eventually convince her to sit down with a professional...

NO!! That is hands down the dumbest move you can make here. In her head, that just sounds like "you're overweight," and it only fuels a warped body image.

What you described is how the downward spiral starts. You need to deal with this right now. Find a way to motivate her to actually seek help. Telling her she's too thin or looks bad basically translates to "you're fat and need to lose weight" to someone in that state. Try... I don't know... maybe suggest it could be parasites, or anemia, or whatever else—it varies from person to person—but NEVER use "you're too thin" as an argument.

How old is she and what does she do? She might be able to skip the GP and go straight to a psychologist if she has the means... obviously, you have to find someone who actually knows what they're doing.

First thing is to tell everyone to shut up about her being skinny. Her perception is totally busted and those comments just make it worse. If she's a minor, you might even have to look into involuntary treatment... showing her what a nasogastric tube looks like sometimes snaps them back to reality so they'll finally talk to a professional. Once that happens, things get easier.

Amanda Stewart7 said:See, there it is. She thinks everything's normal... he can tag along if he wants, but it won't do much good if she isn't willing to cooperate. Honestly, just have him—or you—tell her straight up that being terrified of food isn't exactly "normal." If she could just start there, it wouldn't be such a mess.

That’s another huge mistake right there. Saying "It's not normal to be afraid of food" basically translates to: "Just eat, you're already fat anyway; It's not like you'll lose weight; Being overweight is fine; You're ugly regardless, so who cares if you're heavy..." That's exactly how someone in that headspace hears it.

redharbor9 said:That’s another huge mistake right there. Saying "It's not normal to be afraid of food" basically translates to: "Just eat, you're already fat anyway; It's not like you'll lose weight; Being overweight is fine; You're ugly regardless, so who cares if you're heavy..." That's exactly how someone in that headspace hears it.

Don't take things so literally. Look, she’ll start by saying she’s afraid to eat—because that’s exactly what she told me, I'm talking about a friend here. And since she’s self-aware about it, that gives some "distinguished psychologist" the perfect opening. They’ll go straight for the thing they KNOW is going to sting.

redharbor9 said:NO!! That is hands down the dumbest move you can make here. In her head, that just sounds like "you're overweight," and it only fuels a warped body image.

What you described is how the downward spiral starts. You need to deal with this right now. Find a way to motivate her to actually seek help. Telling her she's too thin or looks bad basically translates to "you're fat and need to lose weight" to someone in that state. Try... I don't know... maybe suggest it could be parasites, or anemia, or whatever else—it varies from person to person—but NEVER use "you're too thin" as an argument.

How old is she and what does she do? She might be able to skip the GP and go straight to a psychologist if she has the means... obviously, you have to find someone who actually knows what they're doing.

First thing is to tell everyone to shut up about her being skinny. Her perception is totally busted and those comments just make it worse. If she's a minor, you might even have to look into involuntary treatment... showing her what a nasogastric tube looks like sometimes snaps them back to reality so they'll finally talk to a professional. Once that happens, things get easier.

Yeah, I get it now—she told me, "Why does everyone tell me I'm getting thinner, while everyone else who looks like me doesn't? It's like they think I used to be fat or something..."
She's 23 and a college student (an arts major, by the way).

..And honestly, she’s never been overweight by any stretch. In my eyes, she’s genuinely beautiful, and I know others see her that way too. But she has this strange, insecure side to her that I don't fully grasp, since I can't truly be inside her head... I just know there are moments when she worries she isn't smart enough, and hearing that is honestly the hardest part for me.

Amanda Stewart7 said:Don't take things so literally. Look, she’ll start by saying she’s afraid to eat—because that’s exactly what she told me, I'm talking about a friend here. And since she’s self-aware about it, that gives some "distinguished psychologist" the perfect opening. They’ll go straight for the thing they KNOW is going to sting.

So, you think she should lead with that? It doesn't sound like a bad idea...🙂 You have to start somewhere, after all.

A college student? Then she should hit up the campus counseling center. Most big universities have specialists on staff who deal with this exact stuff all the time...

Look, the winning move here is finding that one specific "hook" in her own logic—that tiny part of her that knows deep down things aren't right. Use that to nudge her toward getting help. But remember, you’re the one who actually knows her best... so whatever you do, don't just call her skinny. You gotta be direct about the issue without being preachy. Let her reach the conclusion herself. That's how it sticks.

In her head, everything works differently. It doesn't matter how much everyone around her tries to lay out the facts; she’s going to process and hear it through a completely different lens. Trying to argue with her reality is just a fast track to making things worse...

Bottom line: find an angle that gives you leverage to get her into professional help. Don't get hung up on labeling it "anorexia" or obsessing over weight or body shape. Just follow her lead on what *she* thinks is wrong. Maybe it's her weight, maybe it's self-esteem, or whatever else she's fixated on...

Aaron Castillo9 said:So, you think she should lead with that? It doesn't sound like a bad idea...🙂 You have to start somewhere, after all.

Yeah, that’s probably for the best. But just a heads-up—these things aren't always black and white nowadays. You see a lot of "mixed" cases. For example, someone might struggle with both bulimia and anorexia. People like your friend can be incredibly sneaky; they can practically run circles around a doctor. They'll come up with an excuse in a heartbeat—saying they already ate out, or their stomach is acting up, or they need to stick to a strict diet. They'll claim they can't handle "heavy" food—which really just means regular meals. They dodge group dinners, spend fifteen minutes meticulously cutting up a salad with a knife, and then the second you turn your back, the whole plate ends up in the trash while they sigh about having overeaten.

By "mixed," I mean there isn't always a clear line between bulimia and anorexia. If someone barely eats for five days and then goes on a binge on the sixth, followed by purging, and then cycles back to not eating... it's all connected. You really have to pay attention to the tiny details of how they eat and where they're "cheating" just to avoid eating anything they deem "wrong."
It’s definitely a brutal job.
The thing is, with bulimia, a person can look perfectly "normal" on the outside. It’s nearly impossible to catch them purging after a meal. With anorexia, though, the weight loss is usually obvious—you can see the bones. Bulimic patients don't always show that; they can maintain a totally "ideal" weight and look completely healthy and fine.

Look, when it comes to those "mixed" states, they usually don't last forever because people dealing with bulimia often try to transition into anorexia. It’s like anorexia has a higher status—it's seen as this more advanced stage of the disorder...

And besides, purging isn't even a requirement for a bulimia diagnosis...

redharbor9 said:Look, when it comes to those "mixed" states, they usually don't last forever because people dealing with bulimia often try to transition into anorexia. It’s like anorexia has a higher status—it's seen as this more advanced stage of the disorder...

And besides, purging isn't even a requirement for a bulimia diagnosis...

And honestly? They usually do.

redharbor9 said:Look, when it comes to those "mixed" states, they usually don't last forever because people dealing with bulimia often try to transition into anorexia. It’s like anorexia has a higher status—it's seen as this more advanced stage of the disorder...

And besides, purging isn't even a requirement for a bulimia diagnosis...

Sure, maybe not, but then you’ve got people slamming down at least 5,000 calories during a binge phase—sometimes way more—and they end up gaining massive amounts of weight. It's pretty obvious something is seriously wrong there.
So yeah, we're talking 5,000 calories, sometimes even higher...