Once Heavy Friend Now Gaunt: Anorexia or Another Eating Disorder?

Reader’s Question

My friend is 27 years old and has lost a lot of weight within the past few months. She says that guys give her attention that she never received before when she was heavier. When we go out to eat, she’ll eat a little bit and then push around the rest of her food. Growing up, her mom would call her fat and now she’s back home living with her mom.

I tried once or twice to talk to her about her weight, telling her that I cared for her but didn’t want to see her hurt herself. But all she did was get defensive and claim that she just lost baby fat or that she’s just been exercising more. Her clothes hang off of her now and she looks gaunt in the face. Her hair is thin and dull. When I see her, she seems irritable and claims she is lonely. Still, she brags about her wonderful life and all of the male attention she now receives.

What is going on with her and how should I handle it?

Psychologist’s Reply

Some of the things you describe, including the current gauntness of your friend and the fact that she seems irritable and verbalizes loneliness raise some red flags about the possibility of an eating disorder such as Anorexia, as well as another, and frequently accompanying illness, Depression. The cardinal signs and symptoms of Anorexia Nervosa include:

  1. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected).
  2. Intense fear of gaining weight or becoming fat, even though underweight.
  3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
  4. In young women who have not yet gone through menopause, amenorrhea (the absence of at least three consecutive menstrual cycles).

Anorexia can occur in two principle forms: Restricting Type, in which the person has not regularly engaged in binge-eating or purging behavior during the course of the disorder, and Binge-Eating Type or Purging Type, in which the person has regularly engaged in binge-eating OR purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

An eating disorder can also be present even if a person does not meet all of the official diagnostic criteria.

If your friend meets the criteria, or if you still have serious concerns about her even in the absence of all the signs and symptoms, make clear to her your care, concern, and support, and encourage her to visit a mental health professional.

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