The dining hall at camp is buzzing.  Students are playing with their cups or bottles (will bottle flipping ever end?), laughing, and catching up after the activities of the day when it’s announced the meal is ready.  You send a student to go get food and when she comes back with it actually looks edible!  As bowls, platters and plates are passed around you notice one of the girls letting almost everything pass by.  She finally takes six green beans and some shredded lettuce meant for the tacos.  You ask her what’s wrong.  She says she pigged out at free time and isn’t hungry.  It is at least 80 degrees in the hall and yet she is wearing a long sleeved t-shirt and a sweatshirt.  You shrug it off for the moment, but you know something isn’t right.

At another table something similar is being played out.  This student is piling food on her plate.  Not so much to be really obvious, but you saw her munching on nachos, fries and ice cream at free time and you can’t figure out how she could still be hungry.  You marvel at her metabolism because you have watched her eat for the past month and the girl never seems to gain a pound.  A little bit into the meal she excuses herself.  She is gone only a few minutes and when she comes back you notice her eyes are a little red (had she been crying?), her hair is a bit mussed and as she sits down you catch sight of her right hand.  The knuckles appear a little red and somewhat scarred.  What is going on?

Both students are showing signs of active eating disorders that may have been going on for some time.  When you see something like this, it is easy to look back and wonder why you hadn’t seen any of the signs earlier.  That is one of the “problems” with eating disorders:  they can be easy to hide.  They can even be easy to miss. “She is so popular.”  “He is such a fantastic athlete.”  “She is so honest and giving.”  “She is so smart; she would never do anything like that.”  In counseling and treatment centers and private practices you will find some of the most intelligent, beautiful, giving human beings sitting with therapists talking about how fat they are (while barely weighing 90 pounds), how not worthy they are of the good things that are going on in their lives, what awful people they, how they deserve the hell they live in, and related feelings.

What is a youth worker to do?

We strive to be there for students, help them through rough patches, and to at times try to solve some of the puzzles of their lives.  In cases like this, we are often helpless to do much but pray, connect families with resources, and be there when and if a student or volunteer wants to talk about it.  Most of the time a person with an eating disorder (ED) feels too needy and will isolate herself rather than talk about how she feels because of the shame tied to someone with an ED.

Watching a student not eat meals at events, at camp, or at lock-ins can be very frustrating.  At times you may want to take a student and tell her to “just eat already!”  For a bulimic student you may wish to follow her after every meal, after every pizza party, to make sure she isn’t purging her food.  We can’t be “Food Police.”  In truth, it makes the situation worse.  Unless a student has been 100% open and honest about the struggle, if she suspects you know something it can easily cause her to go to greater lengths to hide it.

What You Shouldn’t Say?

“You’re looking really (insert physical description here)”

The person with an ED already has low self esteem and statements like these do not help and continue to shame her.  There is nothing wrong with showing your concern in a loving way, but pointing out anything physical can backfire.

“Why don’t you EAT already?” or “Why can’t you stay out of the bathroom?” 

Families will use these statements more than a youth worker, but they will probably go through your mind at some point, too.  It is totally natural.  As someone without an ED it almost seems that “simple,” but it is not about food. These statements begin to make it sound as if it is only about the food and not the feelings she is trying to starve away or purge from her being.

“Why are you doing this to yourself?” or “You have everything going for you, why can’t you just be happy?” 

Those with an ED did not choose to do this to themselves even though it may appear that way.  But the ED is a coping mechanism, a means for dealing with depression, stress and self-hatred that has been built up over many years. These disorders are about the person suffering and how they feel about themselves inside.

“Just pray more…God will help you through this.”

Many with EDs don’t need more guilt piled onto them. Guilt plays a large part in the disease.  Guilt, real or imagined, for things done (or not done) to and for them, guilt and shame over the ED itself, and guilt over what they think God says about them.  They know He is there and yet they continue.  There is one Christian therapist who, before he began his degree program, used to tell friends that they needed to have more faith.  He now knows that those statements are toxic and hurtful and doesn’t use them in his practice.

What Can You Do As A Youth Worker?

• Set a time to talk. Set aside a time for a private, respectful meeting to discuss your concerns openly and honestly in a caring, supportive way. Make sure you will be some place away from other distractions.
• Communicate your concerns. Share your memories of specific times when you felt concerned eating or exercise behaviors. Explain that you think these things may indicate that there could be a problem that needs professional attention.
• Ask your student to explore these concerns with a counselor, doctor, nutritionist, or other health professional who is knowledgeable about eating issues. If you feel comfortable doing so, offer to help your student make an appointment or accompany her on her first visit.  This issue is not geared for youth workers.  You may wish to offer to sit down with the student and their parent/parents about the concerns and what can be done next.
• Avoid placing shame, blame, or guilt on your student regarding her actions or attitudes. Do not use accusatory “you” statements like, “You just need to eat,” or “You are acting irresponsibly.” Instead, use “I” statements. For example: “I’m concerned about you because you refuse to eat breakfast or lunch,” or “It makes me afraid to hear you vomiting.”
• Avoid giving simple solutions. For example, “If you’d just stop, then everything would be fine!”
• Express your continued support. Remind your student that you care and want them to be healthy and happy.

Refer, Refer, Refer!

Unless you are a licensed therapist, you need to refer families to therapists, credible treatment centers and programs, and other professional services.  What follows is by no means a comprehensive list.  You will want to do your own research, but this does give you a place to start.

Two of our awesome blog contributors (Carl Dodd and Nate Rice) wrote a fantastic help guide called 5 Tips To Referring Students To Professionals for more insight.