To Tell or Not To Tell – By Dr. Sarah Ravin

Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

We are happy to announce that today’s post is written by psychologist Dr. Sarah Ravin. Dr. Ravin utilizes DBT, CBT, and ACT to treat adolescents and young adults with eating disorders, body dissatisfaction, anxiety, depression, OCD, and self-injury. We have often linked to and are inspired by the posts on her blog. A big thank you to Dr. Ravin for her contribution to our blog!

If you have an eating disorder, you have probably struggled with the question of whether to reveal your diagnosis to others.

Teenagers and young adults with eating disorders run the gamut of self-disclosure: some of them never tell a single soul about their illness, while others write about it on Facebook or tweet about it daily to hundreds of followers. In my practice, I advise patients to think carefully before revealing their illness to anyone. In this age of tell-all books, tabloid magazines, and Jerry Springer, it is easy to forget that the concept of revealing deeply personal information to large numbers of people is relatively new and quite controversial. There are consequences – both positive and negative – to telling people about your eating disorder.

In considering whom to tell, it is important to balance the desire for privacy with the need for social support. On the one hand, having an illness is a personal matter and is not typically something you would share with a large number of people. Think about whom you would tell if you had asthma or a learning disability. Most people would share this information with their close friends, relatives, and doctors. Most people would not share this information on a first date, on a job interview, or on their Facebook page.

On the other hand, someone going through an eating disorder needs a tremendous amount of support in order to get well. Friends and loved ones can only support you if they are aware that you are struggling and that you need their help. Suffering from an eating disorder can be a lonely and isolating experience, particularly if you keep your illness a secret from everyone.

Then there is the issue of stigma. The sad reality is that people with mental illnesses are judged, misunderstood, marginalized, and discriminated against. The general population is not well informed about eating disorders, and stereotypes abound. The problem, of course, lies not with eating disorder patients themselves but with those who judge and discriminate against them. Given that this ignorance exists, however, it is wise to protect yourself from it when you can.

Before revealing your eating disorder to someone, I recommend asking yourself a few questions:

• Why am I telling this person about my eating disorder?
• What might this person do with the information I give them?
• Do I trust this person?
• If I talk about my eating disorder with this person, how can he/she help me?
• How might I be harmed by telling this person about my eating disorder?

Decisions about disclosing your illness are deeply personal, and there is no clear-cut formula to help you determine whether to tell someone. It is best to find a middle ground between complete secrecy and indiscriminate disclosure.

Here are some general guidelines to consider as you think about disclosing your eating disorder:

• Tell all of your healthcare providers, even if you are seeing them for something unrelated to your eating disorder. The eating disorder is part of your medical history and may be relevant in some way. Further, personal health information is protected by privacy laws, so you can rest assured that it is confidential.
• Tell your immediate family members so that they can participate in your treatment and/or support you at home.
• Tell your closest friends, and explain to them how they can help you when you are struggling. Self-disclosure tends to increase feelings of closeness, belonging, and empathy, which is exactly what you need to make it through difficult times.
• Don’t disclose your eating disorder on Facebook, Twitter, Tumblr, Pinterest, blogs, or other social networking sites unless you use an alias. It is easier than you may think for people to access your personal information online.
• Don’t disclose your eating disorder in an evaluative situation, such as a job interview or a college application essay. While it is illegal to discriminate against someone based on a health condition, it happens regardless. A college or an employer may not want to assume the liability of accepting a student or employee with an eating disorder.
• Don’t disclose your eating disorder the first time you meet someone. Wait until you’ve gotten to know one another and built a mutual trust.

Take advantage of the opportunity to educate the people you tell. The easiest way to correct misconceptions about eating disorders is to get to know someone who has one.