Like all mental health issues, eating disorders like anorexia are complicated and do not have an identified cause. Even though the symptoms of eating disorders can seem to be all about food and body image, they are often more complicated than just wanting to look or eat a certain way, and there are underlying issues that can be addressed through treatment.

Many influences are involved in the development of eating disorders, such as biological, psychological, genetic and environmental factors. Here are some of these contributing risk factors or “triggers”:

• Low self-esteem or self-worth.
• Trauma (e.g. abuse, grief, etc.) or feeling a lack of control in life.
• Stress or deep emotional difficulties that are avoided or unresolved.
• History of other mental illnesses.
• Social pressure and idealization of thinness.
• Bullying.
• Dieting.
• Perfectionism.
• Early puberty.
• Family history of eating disorders or other mental illness.
• Chemical imbalances.

Anorexia is treatable. For eating disorders or any other mental health concern, if signs or symptoms are interfering with your life in any way, it’s time to seek help. Eating disorders are potentially life-threatening and have the highest mortality rate of any other group of mental illnesses.

If a person’s pattern of eating behaviours and feelings around food, exercise and/or body image are interfering with physical health or the ability to live a comfortable life, it’s time to talk to someone. That someone could be a friend you trust, a teacher, your family doctor, a crisis line, or counsellor.

If it is a friend you are concerned about, they may resist help or not even recognize that they need it. Someone who has anorexia may have a very distorted view of how they look, and an inability to realize how serious their illness is. They might need you to make the first step.

As always, if you feel like your friend might hurt him/herself or someone else, it’s time to call emergency services.

Visit the Help Section to find out how to get help for yourself or a friend.

Supporting someone with any type of serious illness can be challenging. Ways to help and support a friend or loved one who is living with an eating eisorder:

• Know the signs and symptoms of eating disorders.
• Encourage professional help for your friend when needed (see Help Section).
• If your friend is in the hospital, go and visit them if you are able. The hospital may be scary and overwhelming for them and a friendly face can help. Make sure to ask about visitor rules first.
• Many social situations centre around food. When you have a friend who has an eating disorder, it can be hard to know what to do when you’re planning a party or outing. Here are some tips that might help:

a)    Talk to them. Ask them how they are, reassure them that you want to include them in outings but are unsure of how that is making them feel at the moment. Listen. Check in regularly.

b)    Don’t make a “big deal” out of food. Include your friend in your dinner plans, but understand that going out to eat with people might be a very stressful situation for them. Don’t single them out if they don’t eat much, eat a lot, make a trip to the bathroom after a meal or if they seem uncomfortable. If you think something is wrong, quietly check in with them to see if they are ok.

c)    Certain conversations about food or dieting might make someone feel uncomfortable when they are struggling with an eating disorder. It’s probably not necessary to talk about how many calories were in the burger you just ate, or how you feel guilty for skipping the gym this week.

• Avoid making comments on people’s weight, eating behaviours or body shape. Even if you feel like the comment is positive (“You look so healthy!” or “It’s so great to see you eating!” or “your clothes fit you so much better now!”), a person struggling with an eating disorder may not be ready to hear these comments in a positive light.
• You’re probably worried about your friend, and the instinct might be to encourage them to eat. Telling someone who is struggling with an eating disorder to “just eat” is not helpful.
• If you worry that your friend is relapsing into unhealthy behaviours, let them know you are worried about them and encourage them to check in with their doctor or family. If you’re really worried about their health and safety, tell an adult you trust.
• Treatment is a process. Medications and therapy can take time to help. Be aware of this and try to be supportive as your friend adjusts.
• Be a sounding board. Listening without judgement and without trying to “fix” their problems can be incredibly helpful.
• Ask your friend how else you can help. It may be as easy as just providing a distraction, asking them to do simple, relaxing things with you (like hanging out, watching a movie, etc.).
• Stay calm and don’t take things personally. Sometimes eating disorders can really distort how someone perceives conversations or situations. How someone reacts or communicates when they have an eating disorder may be confusing, distressing or even hurtful at times. They may be feeling overwhelmed and acting out, and it’s probably not about you.
• Set some boundaries for yourself, and take care. You can’t help someone if you’re feeling overwhelmed yourself. Don’t be afraid to seek help if you need it.

See the Help Section for more info about helping a friend and self care.