What to avoid when someone you know is struggling with an eating disorder

I struggled with an eating disorder for half my life.

My issues with food started around age 10, and I only really began to recover in my mid-twenties. Despite being a writer and comedian, I’ve never publicly addressed my disorder; perhaps that's because I feel like no one wants to hear a thin, white(ish) girl discuss her self-inflicted “problems,” when there are people who struggle to get food on the table.

Despite all the stereotypes about eating disorders and their sufferers, they can happen to anyone. An eating disorder is—without question—an illness. In fact, of all mental illnesses, they have the highest mortality rate. And those who survive must continue dealing with the disorder's long-term effects, including a lifetime of health complications.

One of the primary characteristics of an eating disorder is secrecy, so it can be hard to tell if someone you know is struggling. And it can be even harder to know how to act or what to do after you find out. In my experience, many people tend to react in a way that makes the problem worse.

With that in mind, here are five behaviors to avoid when trying to support a loved one with an eating disorder (disclaimer: I am not, nor do I claim to be a medical professional):

While it’s true that a dramatic weight change is the most obvious sign of an eating disorder, it’s not a good idea to assume that just because someone looks “healthy,” they’re okay. Eating disorders are mental illnesses that happen to cause physical problems.

First off, not all eating disorders look alike. As a culture, we generally think of sufferers as being too thin, but that’s not always the case. People with binge-eating disorders, for example, are more likely to be overweight or obese. What's more, depending on how long someone has had the disorder, their physical symptoms may not be as obvious. Friends and family may assume that a sufferer is just “naturally thin” or “big boned" if they've been sick for a while.

One of the most psychologically trying times for someone with an eating disorder is during recovery. While they may start to look better on the outside, their mental state can be incredibly fragile, so be extra careful with your words and how you relate to them. One seemingly innocuous comment could trigger a relapse.

This may seem counterintuitive, but it’s in the sufferer's best interests if you refrain from complimenting their physical appearance.

People with eating disorders link their body to their self-worth in an unhealthy way. You may think you’re providing encouragement, but complimenting their physique reinforces the idea that they’re only as good as a number on a scale.

In the early stages of an eating disorder, such as anorexia—which manifests itself through an intense fear of gaining weight—telling someone they look good is like throwing gasoline on a fire. It can motivate the sufferer to continue on a path of self-destruction. Even if you have the best intentions, they may take your comment the wrong way.

When I was anorexic and someone told me, “You’re looking healthier,” I took that to mean I had gained weight and it showed. The comment would trigger a cascade of negative emotions, and make me want to recommit to my eating disorder even more.

Just like compliments, body-shaming is something you should avoid at all costs. People with eating disorders are experts in shaming themselves—they don’t need any outside help.

For those whose size is the result of an eating disorder, calling them fat or telling them they need to lose weight helps perpetuate a vicious cycle of self-loathing; this could then cause them to eat more as a coping mechanism.

Unfortunately, it’s more culturally acceptable to shame a thinner person. At the height of my anorexia, many people felt the need to tell me that I was getting too thin—as if I wasn’t already religiously keeping track of every pound I lost. Many eating-disorder sufferers also struggle with body dysmorphia, which means they fixate on real or perceived flaws in their appearance, so disparaging comments will only make them feel even more insecure.

I recently posted a photo to Facebook, and some of my friends thought it was appropriate to write comments that said I was too thin (in a much less tactful way, mind you). Although I'm fully recovered, the comments triggered some very dark memories for me, and could have derailed my recovery if I wasn't in such a great state of mind. So if you’re genuinely concerned about your friend's weight, tell them in private.

Recovery isn’t something anyone can be forced into—it’s a choice. People with eating disorders have to want to get better, and even then, setbacks and relapses happen.

That said, there are times where friends and family should intervene. If someone is playing Russian roulette with their health, loved ones sometimes have no choice but to take action. I know people who were forced to go to clinics and attend recovery programs, but these resources usually have no positive impact until the sufferer decides themselves that it’s time to get better.

While it’s admirable to want to aid in someone’s recovery and provide them with resources, understand that whether or not they “work” isn’t up to you.

While recovery is a choice, developing an eating disorder certainly is not.

Telling someone to eat or eat less is not only ineffective, it also completely ignores the disorder's root causes. Very few people have eating disorders out of pure vanity; they usually stem from other issues or trauma in the sufferer’s life.

Eating disorders have a lot in common with substance abuse and addiction. You can’t tell a heroin addict to simply stop doing heroin; the drug literally changes their brain chemistry in such a way that makes quitting not only harder, but dangerous. And the same largely goes for people with eating disorders.

In a recent study, researchers at the University of California, San Diego School of Medicine found that anorexics show a decreased response to rewards, like food, and that "hunger does not motivate them to eat."