Information and Education


  • Weight-loss or weight fluctuation
  • Loss of menses (females)
  • Bone loss
  • Cardiac complications
  • Lanugo (fine hair on arms and back)
  • Electrolyte imbalance
  • Gastrointestinal problems
  • Obesity
  • Eating in the middle of the night
  • Purging (usually vomiting)
  • Dental problems
  • Laxative abuse/dependence
  • Swollen salivary glands (“chipmunk cheeks”)
  • Diet pill abuse/dependence



  • Attractive - extremely thin to overweight
  • Distorted body image - uncomfortable with compliments
    • e.g. “You look nice”.  “No I don’t.  I’m fat”.
  • Dichotomous thinking - everything is good or bad; difficulty seeing choices
  • Affective disorder - affect (expression of feelings) is lacking or exaggerated
  • Obsessed with food, weight, body image, calories
  • Avoidance/disdain of fat, protein, and dairy products
  • Attempts to stop have failed
  • Individual tells you they have an eating disorder






It is important to be thoughtful and compassionate when you speak with someone about an eating disorder.  They feel a great deal of shame about their eating disorder, and they do not need judgment.  If you are angry at the person, of if you do not know them well, you probably do not need to be the one to approach them.


The following guidelines may be helpful:

  • Learn more about eating disorders before talking with them.
  • Be passionate and be able to show them that you care.
  • Set aside time for a private discussion in a setting where the individual is comfortable.
  • Do not discuss weight, calories, or eating habits. Instead, focus on how they might be feeling.
  • Avoid comments about appearance.  In the case of anorexia, concern about weight loss may be heard as a compliment and comments about weight gain may be interpreted as criticism.
  • Do not get into a power struggle.  You cannot force anyone to eat or to stop throwing up.
  • Offer support.  Ultimately the decision to recover rests with the individual with the eating disorder. 
  • Give encouragement.  Tell them “I have faith in your ability to fight this.”  Your confidence
    • In their ability to change will mean a great deal.
  • Do not expect instant results from treatment. People develop eating disorders over many months or years, and they cannot change these behaviors overnight. Patients who seek
  • Outpatient treatment may initially worsen as they become aware of the issues that led
  • To their eating disorder.  Your continued support during this time will mean a great deal.





While eating disorders may seem bizarre, they are extremely painful to those who suffer from them.  Food is just a symptom.  Driving forces are our cultural obsession with thinness, the individual’s ability to handle stress, and family dynamics.  Individuals with eating disorders may feel out of control. Their behavior may be a desperate attempt to control their lives.  Although families do not cause eating disorders, they can be instrumental in the healing process. 


Due to the isolation and shame experienced by individuals with eating disorders, these illnesses are often misunderstood.  Eating disorders have complex, multiple causes.  An eating disorder is a coping mechanism.  Telling a person to just eat or to stop throwing up does not work because it does not address the cause of the problem.  Patients do not improve until they replace the eating problem with a healthier coping mechanism.  


Eating disorders are often compared to other addictions, a comparison that is not accurate.  Since the body does not require alcohol, an alcoholic can, with great effort, stop drinking, lock the tiger in a cage and throw away the key.  People with eating disorders must learn to face food.  They must eat, taking the tiger for an uneventful walk at least three times a day.


If you know someone with an eating disorder, your thoughtful approach may be invaluable.  Emphasize how much you care and give them time to decide they are ready for help.  Here is what you can do:


  • Educate yourself about eating disorders.
  • Tell her/him you are concerned.  Suggest seeking professional help.
  • Do not discuss weight, calories, or eating habits.  Instead, discuss feelings.
  • Avoid comments about appearance.  Concern about weight may be interpreted as criticism.  Comments about weight gain may be heard as criticism.
  • Do not get into a power struggle.  You cannot force anyone to eat or stop throwing up.
  • Offer support.  Ultimately the responsibility to get help rests with the individual.
  • Understand the recovery process is slow.
  • Offer hope.  Individuals with eating disorders are usually discouraged.


People can and do recover from eating disorders.  The non-profit groups that provide education related to eating disorders need help changing public opinion about eating disorders and letting insurance companies know that inadequate treatment of eating disorders is unacceptable.  These groups also need financial support to fulfill their missions.  The individuals described at the beginning of this article all recovered and now lead full, productive lives.  With everyone’s help, more people could recover from eating disorders.






Authorities disagree on definitions of eating disorders, and these definitions may range from disordered eating practiced by many people to eating behavior that is extremely troublesome.  The following definitions are offered as general guidelines:


Anorexia nervosa

Is characterized by a refusal to maintain a minimally normal body weight and an intense fear of gaining weight.  In women, this is also accompanied by amenorrhea, or loss of the menstrual cycle.  Two subtypes of anorexia are restricting type and the binge-eating/purging type.
Bulimia nervosa

Is characterized by binge eating and inappropriate compensatory methods to prevent weight gain.  The binge eating and inappropriate compensatory behaviors occur, on average, at least twice a week for 3 months.


Binge eating disorder

Refers to recurrent episodes of binge eating without the inappropriate compensatory behaviors characteristic of bulimia.


Eating Disorder Not Specified

Refers to disordered eating that does not fit the criteria for the specific eating disorders listed above.  For example, a female whose body weight is below normal who still has a menstrual period.  An individual can meet criterion for bulimia except for the binge/purge frequency.






  • Hall, L. & Cohn, L.  (1999).  Bulimia: A guide to recovery.  Carlsbad, CA: Gurze Books.
  • Schaefer, J. & Rudledge, T. (2004).  Life without Ed: How One woman declared independence from her eating disorder and how you can too.  New York, NY: McGraw.
  • Tribole, E. & Resch, E. (1995).  Intuitive eating.  New York, NY: St Martin’s Press.






  • Chrysalis Education Foundation;; 940.382.5688
  • Eating Disorder Referral and Information Center;; 202.543.9570
  • The Elisa Project;; 214.369.5222
  • National Eating Disorders Association - NEDA;; Helpline:800.931.2237






Dr. Annetta Ramsay is available for speaking engagements.  She is a Ph.D. trained, Licensed Professional Counselor Supervisor in Texas and a Nationally Certified Counselor who speaks and teaches on topics related to eating disorders.  She specializes in eating disorder recovery for women and men ages 14 and up struggling with anorexia, bulimia, and binge eating disorder.  Dr. Ramsay also directs Chrysalis, a 24 week intensive group treatment program for eating disorders.  Treatment is offered in a warm, encouraging environment in an old historic home in the college town and is based on a non-abstinence model of recovery that encourages clients to learn and grow as they are ready.  Please contact Dr. Ramsay for more information on presentation topics and availability. 


Dr. Annetta Ramsay, Ph.D., LPC, NCC
722 W. Oak St
Denton, Texas 76201