*I am not a Doctor, Registered Dietitian, or Certified Mental Wellness professional. The resources used in this article are vetted, but my intention is not to diagnose anybody. My goal is simply to make readers aware of the warning signs of eating disorders. In light of National Eating Disorders Awareness (NEDA) week, it's pertinent to point out that many people suffer in silence, and many more do not have a platform like this to share their stories or advocate on behalf of themselves or others. Eating disorders are everywhere, and knowing what to look for is half the battle.
First, a definition: An eating disorder is any of a range of psychological disorders characterized by abnormal or disturbed eating habits that lead to disruption in one’s behaviors, thinking, and mood and can eventually leave one unable to function in any number of areas: interpersonal relationships, social situations, school, and work. Ultimately, eating disorders can lead to severe disruptions in overall health and are the most deadly psychiatric illness.
When someone says they have an eating disorder, the first thing many people think of is Anorexia Nervosa (characterized by extreme weight loss, starvation, and excessive exercise). We associate Anorexia with an eating disorder because some signs and symptoms are visible and often drastic. However, eating disorders wear more than one mask. They are mental disorders that cannot be seen or diagnosed just by looking at someone, and someone does not need to be emaciated to suffer from anorexia.
Bulimia Nervosa is characterized by cycles of extreme overeating (called bingeing) followed by purging. Purging often manifests in making oneself vomit, but extreme exercise is another common way many people "purge" to compensate for a binge.
Binge Eating Disorder (BED) is characterized by regular episodes of extreme overeating and feeling out of control around food.
Rumination Disorder is characterized by continually chewing and not swallowing food. Sometimes food is chewed and spit out, or food may be partially swallowed and regurgitated. Many people with Rumination Disorder start to binge due to malnutrition.
Eating Disorder Not Otherwise Specified (EDNOS) also known as Other Specified Feeding and Eating Disorder is diagnosed when an individual exhibits disordered eating symptoms that cause great distress but do not fit neatly within the strict criteria for anorexia, bulimia, or binge eating disorder. EDNOS is an extremely common diagnosis, and was my primary diagnosis when I first sought treatment.
Each of these disorders can take various forms and cycle through various levels of extremity. The most insidious myth about eating disorders is that they can be seen. Nothing could be further from the truth. Eating disorders are mental health disorders with deadly physical side effects. Thousands of people in bodies of all shapes and sizes suffer from eating disorders and it is impossible and short-sighted to believe any mental health problem can be seen.
There are a range of warning signs, from physical, emotional, social, and psychological. Not everyone will exhibit each warning sign, but there are a plethora of symptoms to watch for, including (but not limited to):
Alterations in Weight
-Unusually marked weight loss. If the person weighs less than 85 percent of their ideal body weight and exhibits other characteristic signs of an eating disorder, they can be diagnosed with anorexia nervosa.
-Patients at or above their ideal body weight can still have an eating disorder and can be diagnosed with anorexia.
Preoccupation with Body Image
-May spend an inordinate amount of time looking in the mirror or criticizing their body.
-May become preoccupied with comparing their bodies to celebrities, models, or other people.
-Makes negative comments about their physical appearance and insists that they are overweight (body dysmorphia).
-Wears baggy clothing to hide their body shape.
Disruptions in Eating Patterns
- Stops eating with friends or family.
-Develops strong dislikes to previously enjoyed foods.
-Preoccupied with counting calories and fat grams.
-Eats noticeably smaller portions or refuses to eat at all.
-Starts bingeing on certain foods.
-Drinks excessive amounts of water or caffeine to suppress appetite.
-Goes to the bathroom after meals (may be purging).
-Develops eating rituals such as: chewing for long periods of time before swallowing, cutting food into tiny pieces, moving food around the plate, taking a long time to eat, hiding food, not allowing different foods to touch.
Preoccupation with Nutritional Content of Foods
-Classifies foods as good or bad, healthy or unhealthy, safe or unsafe.
-Preoccupied with organic, fat-free, sugar-free, or "diet" foods.
-Frequently or obsessively reads or researches nutrition.
-May suddenly adopt a restrictive diet or engage in "cleanses."
-Use of laxatives, diet pills, diuretics, or other supplements to lose weight
Changes in Exercise Patterns
-Becomes preoccupied with physical fitness.
-Spends hours exercising in a ritualistic, rigid manner despite sickness, fatigue, or injury.
-Talks about or rigidly tracks the number of calories burned.
-Becomes irritated if their exercise routine is disrupted and eats even less to compensate.
-May increase irritability, depression, and anxiety.
-May stop socializing and lose interest in previously enjoyed activities.
Physical Eating Disorder Symptoms
-Fainting spells from malnutrition and dehydration.
-Chapped lips and gray or dry skin.
-Irregular or absent menstrual cycles.
-Disrupted sleep patterns.
-Increased injuries and/or pain from excessive exercise.
-Dental erosion from self-induced vomiting.
-Chronic constipation and/or gastrointestinal problems.
-Markedly low blood pressure and pulse.
-Prone to upper respiratory infections.
Lauren Muhlheim, Psy.D., a clinical psychologist for Eating Disorder Therapy LA, says "[Eating disorders] are very complicated illnesses that don’t stem from a single cause but from a complex interaction of biological, psychological, and environmental factors." It stands to reason that a complex illness may manifest in myriad, seemingly unrelated ways. And because diets are often perceived as good or healthy, some dieting behaviors that may be signs of an eating disorder are normalized (restricting food, food rituals, counting calories or macros, et cetera). The alarming normalization of disordered eating under the guise of "dieting" or "health" is disturbing and enormously harmful. Diet culture is a hefty topic that I'll save for a later date.
In the meantime, if you or someone you know may be suffering from an eating disorder, call the NEDA helpline at (800) 931-2237, find a therapist or treatment center near you HERE, or find a support group near you HERE