Signs of an Eating Disorder: Warning Signs You Shouldn’t Ignore

Anorexia Symptoms

Anorexia nervosa is a condition in which someone tries to control their body weight by restricting food intake and exercising too much.^[1] It’s the most well-studied and familiar eating disorder, typically occurring more frequently in women than men. But men do get anorexia, and are sometimes diagnosed later because people aren’t looking for it.

People with anorexia are typically:^[2]

• Extremely frightened of gaining weight.
• Extremely underweight.
• In denial about being dangerously underweight.
• Preoccupied with body weight and food.
• Continuing to engage in weight-loss behaviors.

These characteristics can lead to many behavioral and physical health symptoms. The potential warning signs of anorexia include:^[2][3]

• Always using the same cutlery to eat with.
• Cutting food into small pieces.
• Missing periods.
• Brittle hair and nails.
• Dry skin.
• Constipation.
• Low tolerance for cold temperatures.

Anorexia is more common in women who work as models, actors, or dancers, as their work can put pressure on them to conform to a thinner body type.^[3]

Bulimia Symptoms

When someone has bulimia, they struggle to control how much food they eat and then take drastic action (like making themselves vomit) to avoid putting on weight.^[1]

Bulimia is more common than anorexia and typically begins in late adolescence or young adulthood. Its key features include:^[2]

• Eating large portions of food in short periods of time (also known as binging).
• Losing control during binges.
• Intentional vomiting after eating (also known as purging).
• Using laxatives after binging.
• Restricting food or exercising excessively.

Though anorexia can sometimes involve binging and purging, people with bulimia tend to maintain a normal weight or remain overweight. Some will be underweight, but this is rarer.^[2] This also means bulimia can be invisible, and someone at a normal weight can actually be seriously ill.

Due to frequent vomiting and laxative usage, people with bulimia can have significant physical health complications, including:^[2]

• Sore throat.
• Acid reflux.
• Tooth decay.
• Electrolyte imbalances.
• Hormonal disturbances.

Binge Eating Disorder Symptoms

Binge eating disorder (BED) involves eating large portions of food in a short period of time, causing someone to feel uncomfortably full.^[1] BED differs from bulimia in that people with this condition don’t use purging or food restriction to compensate for their binges.^[2]

Symptoms of binge eating disorder include:^[2]

• Eating large portions of food in one sitting.
• Losing self-control during a binge.
• Feelings of guilt about eating habits.
• Not engaging in compensatory behaviors, such as purging.

Health complications from BED include obesity and its associated conditions like heart disease and diabetes.^[2]

You may notice that someone with BED refuses to eat with other people because they feel embarrassed by their eating habits. Alternatively, they may eat normally in public and binge in private. In addition, people with BED commonly also experience:^[4]

• Anxiety.
• Phobias.
• Major depressive disorder
• Alcohol misuse.

Orthorexia Symptoms

Disordered eating can also take the form of extreme “healthy” eating behaviors, which are known as orthorexia. This eating disorder is when someone is excessively preoccupied with healthy food habits, causing significant disruption to daily life.^[5]

Signs of orthorexia include:^[5]

• Having a very narrow group of “safe” foods.
• Splitting foods into “pure” and “bad.”
• Compulsively checking ingredient lists and nutrition labels.
• Taking an intrusive interest in other people’s eating habits and feeling superior about their own.
• Spending a great deal of time and money on having a healthy diet.
• Feeling extremely scared and guilty after breaking self-imposed food rules.

Though someone with orthorexia may seem to be incredibly healthy, the extreme restriction of foods can lead to malnutrition, deficiencies, and other nutrition-related health problems.

Furthermore, it can have significant social impacts whereby someone with orthorexia cannot attend social gatherings where they can’t control the food. Orthorexia is a mental health condition because it has obsessive-compulsive features and involves a great deal of emotional distress.^[5]

Avoidant/Restrictive Food Intake Disorder (ARFID) Symptoms

Avoidant/restrictive food intake disorder (ARFID) may involve restricting how much one eats, but it can also involve avoiding certain foods. Usually, ARFID arises when someone has a bad experience with a certain type of food, such as choking or being sick after eating it.^[1]

ARFID can also be caused by having negative feelings about a particular food’s:^[1]

• Smell.
• Texture.
• Taste.

For example, the texture of certain foods might cause gagging, or their smell might cause nausea. These aren’t preferences like we all have. They’re intense physical reactions.

ARFID is usually diagnosed in children, but it can occur in adulthood. It’s different from being a picky eater, which is a common trait. Crucially, ARFID significantly impairs someone’s ability to participate in social events and frequently causes deficiencies and low weight.^[2] Warning signs and risk factors include:

• Eating a limited range of “safe” foods.
• Having an intense aversion to certain smells, tastes, and textures.
• Previously having a bad experience connected with food.
• A lack of interest in eating.
• Feeling anxious about eating.
• Avoiding social events that involve food.

Inpatient Treatment

If someone’s eating disorder symptoms have escalated to a point where they are at a high risk of harm or death, they may need inpatient services. This could be:

• Day treatment.
• Residential treatment.
• 24/7 hospitalization.

Whether they move between these services (or change to outpatient care) depends on the severity of their symptoms and medical stability.^[6]

Inpatient services can be necessary for stabilizing someone’s physical health, delivering intensive mental health support, and monitoring food intake.^[6]

Often, when the eating disorder is no longer in charge, a person is overwhelmed by the depth of emotion it was numbing or avoiding. One of the main goals of inpatient services is to support people in developing more effective coping strategies and emotional regulation skills so that they don’t revert to disordered eating.

Eating disorder treatment programs will normally have personalized meal plans to ensure each person is getting the nutrition they need. They may also provide classes in grocery shopping and meal prepping to help people build a better relationship with food, which will support them in everyday life.

Counseling and Psychotherapy

Different therapeutic options approach the treatment of eating disorder symptoms differently. Some tackle behaviors; others work to increase psychological flexibility. Here are several of the main therapy and counseling approaches used in eating disorder treatment:^[7]

• Cognitive behavioral therapy (CBT) is the first-line treatment for bulimia, challenging the thoughts and behaviors that perpetuate the condition.
• Acceptance and commitment therapy (ACT) helps people with eating disorders tend to their physical and emotional needs with healthier coping mechanisms.
• Dialectical behavior therapy (DBT) works for treating eating disorders by improving emotion regulation skills.
• Cognitive remediation therapy (CRT) is an emerging approach for anorexia that encourages viewing the world more flexibly instead of directly addressing eating and weight issues.
• Exposure and response prevention (ERP) gradually challenges people with eating disorders to tolerate anxiety-inducing situations (such as feared foods) to reduce the distress they cause.

Medication

Currently, there is no medication approved for treating anorexia. Though some studies find that psychiatric medications can improve mood and anxiety symptoms in people with anorexia, none have been found to improve weight gain.^[7]

On the other hand, the antidepressant fluoxetine is approved to treat people with bulimia. This is because it helps improve mood symptoms and augments the sense of fullness after eating, thus reducing binging.^[7]

While psychiatric medication can be helpful to curb the most severe emotional symptoms, it doesn’t address the root causes of an eating disorder. More often than not, people with eating disorders will need to understand and reflect on their life experiences and have in-depth support for sitting with strong emotions.