updated 10/26/2004 6:50:05 PM ET 2004-10-26T22:50:05

They became fast friends in college, sharing rides home and going to parties. Then, month by month, year by year, Lisa Roy noticed her friend getting thinner, alarmingly so.

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“Like skin and bones,” Roy recalled. The image haunted her so much that she mustered the courage during a semester abroad to write to her friend. “I apologize if I’m wrong,” she wrote, but she hoped her friend would seek help for her problem.

“That letter just woke me up,” said the friend, an anorexic who wants to remain anonymous.

The young woman did seek professional help. Six years later, she still keeps the letter.

Thousands of Americans notice friends or daughters going beyond skinny to skeletal, and the urge to confront loved ones showing signs of anorexia — “Will you please just eat?!” — can be powerful.

But mental health professionals counsel gentle persuasion over hard lobbying. Friends and family need to realize that an anorexic looking in the mirror does not see the same emaciated figure they do.

“You want to avoid getting into a full frontal assault because that almost always ends badly,” said Dr. Doug Bunnell, a clinical psychologist and board president of the National Eating Disorders Association.

Anorexia nervosa is a psychological disorder in which the sufferer becomes exceedingly thin and still believes he or she is overweight. Some exercise obsessively; others use laxatives or force themselves to vomit.

Mental health officials have estimated that 0.5 percent to 3.7 percent of females will suffer from the potentially life-threatening disorder in their lifetime. Males are also diagnosed with anorexia, but at a much lower rate.

Work as a small group
An excruciating feature of the disorder is that it can seem to unfold in slow motion in front of friends and family as the sufferer gets progressively thinner. Loved ones are typically tormented by the same questions: Should I say anything? What do I say? When?

Talking about eating disorders
Dr. Gina Scarano-Osika, a psychologist in Glens Falls, N.Y., said anorexics need to be made aware there is a problem before it becomes severe. But she offers a crucial warning to friends: Do not try to “save” someone on your own.

“A lot of kids think they can save the person themselves; if they just meet and have sleep-overs and talk about this and teach them how to eat, it will be OK,” Scarano-Osika said. “It’s not true.”

Instead, she suggests talking to friends and family to organize an intervention in a comfortable place. Friends should involve adults such as parents, counselors, teachers — someone the person trusts, Scarano-Osika said. Bunnell advises having a folder at the ready with names of medical professionals and helpful Web addresses.

Small groups are better, Scarano-Osika said, because the person may be sheepish, embarrassed or defensive.

The eating disorders association cautions not to worsen the situation with admonitions like “You just need to eat!” or “You are acting irresponsibly.” Try a softer tack, with phrases like “I’m concerned about you.” Be supportive.

“One of the hallmarks of the illness is denial of the illness,” Bunnell said. “So if you go at someone really harshly or in a confrontational way, you’re just going to evoke a real defensive reaction.”

Lisa Roy tried to stay non-confrontational in her letter to her old college friend. Other friends helped her find professional help.

An intervention does not always work the first time. Hard as it may be to do so, Bunnell said, friends and family have to accept that they are powerless. All they can do, he said, is keep speaking honestly about their concerns.

“You cannot personally put yourself on the hook for it,” he said.

© 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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