Your friend's weight is unhealthy for her height. Also, she has lost 28% of her usual body weight. Considering her weight loss, refusal to nourish herself, not eating in front of others and abuse of laxatives, I would say that she has anorexia.

You mentioned that she called you from a fast food restaurant . Most anorexics do not seek out restaurants even when with friends. Remember what you said about her excusing herself when friends ate together? Do you think that your friend is also bingeing on food and vomiting? If so, she could be in real trouble as an anorexic bulimic and her sodium and potassium levels could drop below normal. Depending on how many laxatives she took today, her potassium could be dangerously low. Yes she needs help.

The bruises on her hips and ribs are not necessarily from being thin, but she may be bruising easily from a lack of vitamin C in her body. It would be wise for her doctor to find the cause of the bruises. Body fat does help pad the bones and internal organs though and at 43.5 kg your friend certainly doesn't have much bodyfat.

I would suggest that you tell your friend that she looks unhealthy and needs to talk to someone about her health. Offer to accompany her to see a psychologist who is knowledgeable about eating disorders. Anorexics are not logical or reasonable in thinking about their weight. Your friend will continue to lower her acceptable ie "perfect" weight goal.

If she is an adult (over 18) then legally (in the U.S.) you don't have to notify her parents. You will have to make the choice of whether or not to tell her parents, but haven't they noticed that she is very thin for a person of her height? If her family hasn't seen her for a while, then they may not be aware of her behaviors and might be able to get through to your friend. You will have to make the choice to contact her family or not given your knowledge of her relationship to her family. What you have to lose is her friendship, but anorexics aren't thinking clearly when they are thin and she will probably thank you after she starts gaining weight back and getting healthier.

Thanks for your feedback.

I understand that you are having a difficult time understanding your girlfriend's behavior, even though you are studying to be a clinical psychologist. This is understandable since eating disorders are very complex. If you, yourself have never experienced or studied about them, you may not realize how much pain, both physically and mentally, your girlfriend is going through. It will take a lot of time and understanding from both of you if she is to overcome this long healing process.

It sounds to me that she knows that you recognize her symptoms. You should not ignore her behavior by any means, but try to talk about it to her in a supportive manner while expressing your concern about her health. Mentioning her weight will only provide a point to argue about. If she will talk to you, listen carefully and try to make her aware of available treatment. Show your concern and offer treatment options, but do not push. Understanding how much you support her may motivate her to get help.

If your girlfriend is having difficulty eating, then she probably has anorexia. If she is also bingeing and purging, then she also has bulimia. Eating disorders requires a team approach. This is one reason why you may not understand her treatment protocol, which demands a two-fold approach. Psychotherapy is necessary to help her become aware of the underlying reasons for her behaviors. Nutritional counseling will help her understand she needs to nourish her body and help her develop more normal eating patterns. With both of these treatments working together and the earlier treatment is sought, the more likely she will reduce anorexic behavior.

I do understand that you have a background in psychology, but it may be better if she seeks the help of psychologist or psychiatrist with experience and success in treating eating disorders, as well as a Registered Dietitian. Your emotional connection to her may interfere with your ability to work with her on a professional level. You are still an important piece of the picture, as she will definitely need your support and understanding during this difficult time.

First you should set a healthy and realistic weight goal. Have you tried the Healthy Body Calculator?

A realistic weight goal would be 148 to 163 pounds. Purging and starving yourself are not effective ways to lose weight and they can lead to serious health problems. Starving yourself can lead to a decrease in heart rate and body temperature, fainting, fatigue, weakness, nutrient deficiencies, dry and scaly skin and increased risk of infection due to a decrease in white blood cells.

I encourage you to develop a healthy eating plan for life along with physical activity, behavior and attitude changes. I recommend a healthy diet based on the Food Guide Pyramid, keeping in mind variety, balance and moderation. It is important to choose a variety of foods from all food groups to receive the nutrients your body needs. To achieve balance in your diet, eat foods from the 5 major food groups every day (milk, yogurt, cheese group, meat, poultry, fish, eggs, nuts, dry beans group, fruit group, vegetable group, bread, cereal, rice and pasta group). Eat foods in moderation, rather than eliminate certain foods. For example, if you have a high fat lunch from a fast food restaurant, choose a low fat supper.

Your construction job helps burn calories, but I encourage you to continue to exercise to balance out the difference between your winter and summer activities. Physical activity does not have to be high impact. Regular exercise is more effective in managing weight than short bursts of hard exercise. Ideas for other low impact exercise includes, walking, low impact aerobics, water aerobics and swimming laps. Keep in mind that people who combine exercise and a healthy diet are more likely to lose more fat and less likely to regain the weight back.

Lastly, your perceptions and attitudes about your body are unhealthy. I would recommend you make an appointment to see a therapist trained in eating disorders because based your symptoms above, you did have real anorexia and bulimia.

Well you are healthier in that you have gained weight. But, I doubt that all the weight you gained was fat. Since you did not provide your height, I can generally comment that your BMI is probably healthy if you are over 19 and more than 5 feet tall. Try out the Healthy Body Calculator to check on your BMI and healthy weight range.

A weight of 120 pounds for a person even 5 feet tall is not overfat. Your efforts to eat healthy can stabilize your weight and exercise can change the composition of your body from more fat to more muscle. Remember though that you do need some body fat to make hormones and if your body fat gets too low, you may not menstruate on a regular basis.

Exercise will increase your metabolism for up to 15 hours afterwards. If you start losing weight again, your metabolism will slow down as your body thinks a famine (like anorexia) is starting.

You do not fit the criteria for weight loss pills and your issue still seems to be your weight. I would suggest you get back in touch with your doctor or psychologist before things get out of control.

First I would ask that you read my anorexia and bulimia topics for these answers since this is a school assignment and the majority of your answers can be found in what I have already written. Then, tell me what you didn't find the answers for and I would be happy to respond.

Answers for readers,

1. It has not been proven that eating disorders can be spread genetically. However, one could not rule out the possibility of eating disorders spreading because of similar family / lifestyle issues. The issue in eating disorders is psychological. Food is a symptom not the cause.

2. A psychologist or psychiatrist using specific diagnostic criteria first should assess eating disorders. Treatment may occur at home or in the hospital. Which depends on several factors. If the person's weight or blood electrolytes (sodium and potassium in particular) are life threatening, a person may be hospitalized and given an intravenous fluids to correct blood abnormalities. Then, a treatment plan including moderate weight gain goals for anorexics and reduction in binge / vomiting by bulimics is started. The person's family should be involved in treatment. A Registered Dietitian should be involved to advise and direct the appropriate medical nutrition therapy to achieve the weight or eating pattern goals.

3. Treatment length depends on how long the anorexic / bulimic has had abnormal eating patterns. Generally, the longer an eating disorder has existed, the longer the treatment. It would not be unusual for treatment to last 6 to 12 months.

4. There is no known prevention to eating disorders. Symptoms such as not eating in front of anyone else, getting sick a lot, obsessing with their weight, compulsive exercising or looking very underweight should trigger family / friends to express their health concern and be supportive of seeking treatment. The best you can say to a person with anorexia is "You don't look healthy. If you want, I will go with you to see a doctor."

5. A person can have anorexia or bulimia or anorexia / bulimia. Some consider persons obsessed with food or extremely overweight to have a type of eating disorder.

6. Anorexics are typically more than 10% under their healthy body weight. For instance if you should weigh 120 pounds and you weight less than 108 pounds, you are at an unhealthy weight. Bulimics on the other hand are usually normal weight to slightly overweight. You may notice puffiness in their cheeks if they are vomiting frequently which also erodes the enamel on their teeth.

7. Anorexics in particular carry on their daily routine with almost regimented regularity. They may wear layers of clothes due to low body fat and these extra layers of clothes help hide their low weight. Bulimics spend a great deal of their day thinking about food i.e. how to get it, how to eat it or vomit without anyone watching. Bulimics don't have time for much else. An eating disorder takes a lot of one's time thinking about food, which can be disruptive to a healthy daily, routine. While you need to eat to live, there is more to life than thinking about food.

Here is a fact for you to consider. Weight loss and dehydration can decrease your performance by 30%. Laxative and diuretic use can result in dehydration. Since your goal is doing well in track this year, laxative use will not help you reach your goal.

Currently your weight is proportionate to your height. Actually you could weight up to 110 pounds and still be appropriate weight for height. Why not focus on increasing your muscle mass, which will carry you much better over the track hurdles? After all, at 95 pounds, you would have 3 less pounds of muscles to compete. Take a look at some female Olympic track stars. They have large, muscular legs for competing. Why lose weight? You should be focusing on gaining muscle, even if you stayed around 100 pounds. For this you need to work with an athletic trainer or exercise physiologist.

I would suggest you talk to a school counselor or better yet a psychologist about your obsessions with body weight and working out which are superficial issues. These are symptoms of other issues that you need to deal with. Deal with this now or it could get out of control. You already have some of the symptoms of anorexia.

Have you read my anorexia and bulimia topics? If not that is a good place to start as I have some background information on eating disorders.

Wow, that's interesting, but not surprising. Are all your friends females? If so, they may be modeling your anorexic friend's unhealthy eating behaviors.

Is it a call for attention? Well losing weight usually does get a person attention (as does gaining weight or other changes in a person's physical appearance). As to whether this goes beyond temporary dieting or becomes a preoccupation with thinness, food restricting and a distorted body image, that remains to be seen as you continue to eat together. Your lunch friends may make up the calorie difference at other meals or when other persons are not present. However, if these friends start looking too thin, they probably are and will need professional help like your anorexic friend.

Your girlfriend should see her doctor and then a psychologist who specializes in eating disorders. She may or may not have anorexia and a professional should determine that. Many teenage girls are concerned about their weight because of societal pressure and sometimes don't eat right. Anorexia is characterized by a preoccupation with thinness, excessive exercising, restricting food intake and a distorted body image. The issue may not be food. Encourage your girlfriend to check it out.

Her healthy body weight is 90 to 100 pounds. If she is a vegetarian, what does she eat? See vegetarian topic for more information about foods and meal patterns. Soybeans are a complete protein and would be good to include in a vegetarian diet. Green foods are usually from a vegetable source and any would be fine to eat as well.

The best thing you can do is being positive and supportive. Your feedback could include that what you feel she is doing - not eating - is unhealthy. Any nagging you do about her food intake or body will probably make her more resistant.

Anorexia is characterized by self-imposed starvation, a loss of 15 to 25 percent of usual body weight, an intense fear of becoming overweight, a distorted perception of body image and an absence of a menstrual cycle. The majority of people with anorexia are white women from middle to upper class family, ranging in age from 12 to 18 years.

Bulimia is characterized by bingeing on large quantities of food followed by self-induced vomiting or abuse of laxatives. The bulimic behavior usually starts with an incident of overeating followed by guilt.

Yes, a person can have both and is at risk for electrolyte imbalance, which is when the minerals (sodium, potassium, calcium, magnesium) in your blood can become dangerously low. An anorectic-bulimic can become seriously ill quickly because of vomiting, diarrhea from laxatives and starvation.

Our culture today stresses that women be thin. At times, thinness is related to ability to succeed. This subtle message is frankly evident in advertising of diet pop, status foods like yogurt and women's products including makeup. The message is that you should look like the model in the ad and if you use the product the model is using, you will look like her. The irony of this comparison is that, photos are often airbrushed to remove imperfections. This technique can be used to greatly change a person's shape and "perfect" it.

Most anorectics start out by dieting to lose a few pounds. The dieting gets out of control and the few pounds leads to many pounds. Soon, the "dieter" looks like she has been in a prisoner of war camp. You could recognize an anorectic from her/his physical appearance. Friends and family express concern about the anorectic's low weight. This attention to weight is interpreted by the anorectic as, "everyone wants me to be fat". This soon evolves into a power struggle between the anorectic and her family. The anorectic's attitude is "I am the one in control and I will show everyone I can lose weight".

Initially, the anorectic starts out by eliminating high calorie foods like desserts and most starchy foods like bread and potatoes. Then as more weight loss is desired, other foods such as milk, meat and fruit are eliminated. Most anorectics' diets contain only raw vegetables and salads without dressing. An occasional egg, tuna fish, cottage cheese or yogurt may be eaten. It is a highly restricted diet with only a few "safe" foods and all other foods are forbidden. As an anorectic's weight drops to below 100 pounds, weight loss stops even when very little food is eaten. This frustrates the anorectic and they learn other behaviors to rid themselves of weight. Other anorectic behaviors can include: fanatical exercise routines; vomiting; abusing laxatives.

If the person is under age 18, a parent can bring the teen in for treatment. However, if the person is over age 18, you should encourage them to seek help. Tell them they look unhealthy or sick, not thin, because thinness is their goal for controlling their food intake. If an anorectic friend you know has threatened suicide, bring that person in for mental health treatment immediately. You can offer to accompany the anorectic to the appointment with a psychologist to be supportive, but don't get dragged into solving your friends problems for her. You can't.

Treatment for an anorectic must be intense and may last for several months or even years. Hospitalization may be required in the beginning or during a relapse of strict dieting and weight loss.

Seek out trained professionals who work with anorectics and their families. Look in the phone book for local eating disorder clinics. Call them now for help with an anorexic. It won't go away with time, it only worsens. Don't try to treat an anorectic yourself as the food issues are just a symptom, not the real issues.

Your friend meets three of the criteria for anorexia. Her appropriate weight is 110 pounds. Anyone who has lost 25 percent of her or his normal weight has one symptom of anorexia.

She also does have an inaccurate perception of her body. A person weighing 86 pounds probably does not have much fat on her stomach at all. Anorectics strive for body perfection and a fanatical control of their weight. The "fat pinch" they grab is skin with little underlying tissue, not fat.

Candy is a common binge food and I would imagine your friend might also have some bulimic behavior. Though, I am surprised that she would eat candy in front of you. Typically, bulimics don't eat binge foods in front of other persons. They usually don't eat much at all in front of others.

I would suggest you encourage her to seek professional help. Be supportive and offer to accompany her to a mental health appointment. Tell her that she looks sick, not thin. If she denies that she needs help, continue to tell her that she doesn't look healthy and to seek treatment.