I am in my early 50s, and I have struggled with a severe and debilitating eating disorder since I was six.

I suffer from anorexia, but there are many other serious, debilitating eating disorders, including bulimia, binge eating and others.

People with these disorder may be underweight, normal weight, overweight or obese, and may die at any size from any of the disorders. They can be young or old, male or female, any colour, nationality or religion.

How can people help? The answer to that is "nothing" and "everything."

Eating disorders are mental illnesses which often result in medical problems. There is increasing evidence of a genetic predisposition to eating disorders, and the trigger for activating a disorder may be any number of things.

Whatever the trigger and whatever the disorder, most of us share a number of commonalities.

Many of us have an "Eating disorder voice" inside our heads. The voice is there 24/7; it underlies our thoughts and behaviours, it judges every bite of food, and it haunts us in our sleep.

The voice is our critic: We are fat, ugly, greedy, worthless, useless, disgusting, lazy, selfish, and it is always our fault if something bad happens or has happened to us. We deserve to suffer.

Other people are sicker and more needy and deserving of treatment. We are "different." Our bodies don't need as much nutrition as others. We are not at risk of any eating disorder complications because we are not "that skinny."

The voice distorts, so someone telling me I look better is translated into "I am fat, I must stop eating or compensate for it." We have little self-compassion and often a lot of anger.

While low weight is a significant health risk, it is often the compensatory behaviours that cause the greatest permanent damage or death. We may do many things to satisfy that voice: purging though vomiting, laxative abuse, diuretics, "diet pills," compulsive over-exercise and deliberate self-injury, to name a few. Not surprisingly, eating disorders have the highest death rate of any mental illness. Between 10 and 20 per cent of sufferers die, about half from medical complications and about half by suicide. Medical complications include electrolyte imbalance leading to sudden heart failure, loss of bone density, amenorrhea, ruptured esophagus, loss of bowel function, kidney failure and more.

We are difficult to treat and prone to relapse. Many of us also suffer other concurrent mental illnesses and personality disorders. Post-traumatic stress disorder walks hand in hand with eating disorders. There are no medications to cure eating disorders, although some drugs have had limited success in limited populations.

So, back to what you can do.

First, recognize some of the symptoms that someone has or is developing an eating disorder, including excessive dieting, preoccupation with food, cooking or cookbooks, excessive calorie counting, elimination of entire food groups, rigid diet and weird eating patterns, compulsive overexercise, dramatic weight change, skipping or disappearing after meals, withdrawal from family and friends, impairment at work or school.

Any child or adult showing these kinds of behaviours needs a medical examination, blood tests and electro-cardiograms and assessment by a specialist in eating disorders. Check for specialized resources in your area at keltyeatingdisorders.ca.

But remember: You cannot cure us. Whatever your relationship to us, open the door to discussion, express your concern, ask if you can help. Do not try to force or guilt feed us. Support us. Be patient. Validate our pain but do not become our "therapists." Offer to make or go to appointments with us.

But most importantly: forgive us. We don't do this to hurt you or drive you away; we still love you but we are fighting a battle to the death within.

Recovery is possible; it may look different for different people, but with the right support and therapy it is possible for all of us to live fulfilling and healthy lives.

Don't tell me how hard recovery is, those of you who share my struggle. I know. I live that struggle every minute of every day, decision by decision.

Sally Chaster is with the Advocacy Group for Adults with Eating Disorders in B.C. This week is Eating Disorders Awareness Week in Canada.