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Dear Dr. Wes & Samantha: My friend has decided to eat an unhealthily low amount of food each day. She’s afraid of weight gain or something despite multiple people telling her that starving herself isn’t the way. Facts have been pulled and all but ignored. There are a few other things that have happened in her life, and I personally don’t believe she’s given the whole story. Is it possible that this is tied to depression — which she is about to be tested for — or not? What should I do either way, with or without the whole story and with or without the depression factor?

Samantha: You are right to think that depression and an eating disorder could be linked. Some people have body image issues that make them depressed, so they try to change their approach to eating. Then the results come too slowly and they try a more drastic approach. That may be your friend’s situation.

Your friend hasn’t given you all the facts, but you don’t need to know everything to be a good friend. It’s not your job to solve this problem alone. However, there are things you can do to help. Find out which adult she would trust with this problem. If her mom is the one telling her she’s fat, telling her mom may not be the way to go. An adult your friend really trusts can direct her to the professional she needs, be it a psychologist (like the one who tested her for depression) or a nutritionist.

Don’t make her feel stupid for wanting to change her eating habits. Show her that, when it comes to healthy eating, you’re in it together. If she really needs to lose weight, show your support by bringing a big bag of carrot sticks for the two of you to share during passing periods. If she really has a problem with anorexia, however, leave her diet to the experts.

Establish a 15-minute weekly walk with her during lunch or after school. It’s a friendly gesture that will give her the vitamin D and endorphins to send happy messages to her brain. You’ve also given yourself a way to check in on her weekly.

Implementing all of these ideas will be hard and may cause tension between you and your friend. But if you can accomplish just one, you will have made a major difference in her life.

In your efforts to help her, don’t shove yourself and your own needs to the side of the plate. Find an adult YOU can trust and talk to him or her about how the situation makes you feel. Most importantly, if your friend gets mad at you for what you’ve done to help her, don’t feel like you made the wrong decision. Tell her you did it because you care about her and that you will be there for her whenever she is ready.

Wes: I’d take no issue with Samantha’s suggestions. However, real eating problems rarely have much to do with nutrition or a lack of information about how to treat one’s body. Overeating may result from poor-quality information, but undereating is almost always linked to deeper psychological issues. While some professionals may have different experiences, I’ve never seen a person with a correctly diagnosed eating disorder benefit from nutrition advice. That’s a lot like telling cutters that hurting themselves will leave scars. You go straight to a “duh moment” in therapy or friendly conversation.

As we’ve discussed, anorexia tends to emerge from the interaction between an anxious personality style and a high-expectation family atmosphere — with many of those expectations coming in “under the radar” at an unconscious level. You have to look very close to see what’s going on. Non-anxious teens can handle the high-expectation family, and calm families can handle the anxious teens. It’s when the two come together that the danger appears.

If your friend is anorexic, it’s very likely that the multiple layers of her story have yet to be told, and you are a particularly wise friend for suspecting as much. As Samantha suggests, this could include depression, but it’s unclear how depression and anorexia relate in a given case. Is the person depressed so she doesn’t eat? Does she get depressed because she cannot be perfect and meet the high expectations, or does she get depressed as a separate problem altogether?

It’s no fun to be anxious, and a great many people who are also have depressive symptoms. How that question gets answered often guides or misguides intervention. In short, knowing someone is depressed and anorexic probably won’t tell you as much about how to solve the problem as understanding and helping to rewrite the “untold story.” That’s a good topic for a whole other column — because as you are learning, few young people are more difficult to get to know than those who fear being known. And that describes the struggle of the anorexic pretty well.

Be a friend to your friend and her family. If they want to include you in her treatment, follow the therapist’s advice. I’ve found this helpful in many cases. It’s definitely not a do-it-yourself situation. Thanks for caring. Frustrated as she may be with your concerns, your friend is lucky to have you.

Next week: Talking with your son about pregnancy.

— Dr. Wes Crenshaw is a board-certified family psychologist and director of the Family Therapy Institute Midwest. Samantha Schwartz is a senior at Lawrence High School. Opinions and advice given here are not meant as a substitute for psychological evaluation or therapy services. Send your questions about adolescent issues (limited to 200 words) to doubletake@ljworld.com. All correspondence is strictly confidential.