What are the signs of an eating disorder?
Updated: Mar 2
This week, February 27-March 5, 2023, marks National Eating Disorder Awareness Week. As a person who has recovered from an eating disorder and a physician who treats many patients who are in recovery, I think it is extremely important to take advantage of this week every year to spread awareness. If you or someone you love is suffering, I hope that this information will help you find the resources you need to find recovery.
Eating disorders are considered mental health conditions but they affect every aspect of a person's health. There is no one "cause" for eating disorders- a combination of biological, psychological, and social factors contribute to their development. There is a genetic link to the development of an eating disorder- over 50% of a person's risk of developing an eating disorder may be attributed to inherited factors. Genes alone do not guarantee that a person will develop an eating disorder. Factors such as a history of trauma (abuse, neglect, sexual assault, attachment trauma, etc), life stressors including serious physical or mental illness, and social influences that portray thinness as an ideal and promote dieting combine with an underlying genetic predisposition to contribute to development of an eating disorder.
Eating disorders are some of the most deadly of mental health conditions, second only to opiate addiction. Eating disorders affect people of all ages, races, and genders. Less than 6% of people who have an eating disorder are considered "underweight," and those who live in larger bodies are significantly less likely to be diagnosed and access proper treatment. 30% of people who seek medical care for weight loss show signs of binge eating disorder.
There are four main categories of eating disorders described in the DSM-5, but many people who are suffering do not neatly fit into these categories. That does not make their eating disorder any less serious. There is a fifth category, "Other Specified Feeding or Eating Disorder," that captures the symptoms that these patients experience. Many patients will experience symptoms from more than one of these categories at some point in their course.
Restriction of energy intake leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health
Intense fear of gaining weight, even though underweight
Body image disturbance, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
Bulimia Nervosa: Recurring binge eating episodes characterized by the following:
Eating large amounts of food within a 2-hour period and sense of lack of control
Recurring inappropriate compensatory behavior (vomiting, laxatives, exercise, diet pills)
Binge eating and compensatory behaviors occur, on average, at least once a week for three months
Self-evaluation is unduly influenced by body shape and weight
Binge Eating Disorder
Recurring episodes of eating large amounts of food, more than most people would eat in similar circumstances in a short period of time
Eating rapidly, eating beyond fullness and secret eating marked with distress around binges
Sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)
Binge episodes average at least once a week for three months
Avoidant Restrictive Food Intake Disorder (ARFID)
An eating or feeding disturbance so pervasive that the person is unable to meet appropriate nutritional needs, resulting in one (or more) of the following: significant weight loss, nutritional deficiency, dependency on nutritional supplements, or interference in social functioning
This problem with eating is not explained by a lack of food being available
This is different from both anorexia nervosa and bulimia nervosa in that the problems with eating are in no way related to what the person believes about his/her size, weight, and/or shape
This disturbance is not caused by a medical condition or another mental disorder
So what are the signs of an eating disorder? And how can you get help or help your loved one who is struggling?
Some signs that you can look for in yourself or a loved one include:
Concern about body size or shape out of proportion to others or that is not consistent with what others observe about one's body
Intense fear of gaining weight
Rapid weight loss (more than 14lb in 3 months)
Eating to the point of feeling uncomfortably full or making oneself sick after eating, or seeing someone always go to the bathroom immediately after eating
Exercising excessively or using substances such as laxatives or diuretics to compensate for food that was eaten
Feeling out of control while eating
Eating in secret or finding hidden food wrappers/containers
Preoccupation with food including rigid eating patterns, avoiding specific foods without a medical reason to do so
Feeling distressed or unhappy with eating patterns
If you observe these signs in yourself or someone else- get help! The diagnosis of an eating disorder is often made by a physician and medical evaluation is needed to determine the appropriate level of care, but treatment requires a team approach, often including a mental health professional (therapist, psychologist, and/or psychiatrist) as well as a registered dietitian specialized in the care of patients with eating disorders. The National Eating Disorder Association website has a helpline you can call to help get connected to help. Project Heal is another fantastic resource that helps patients navigate insurance or get help with the costs for treatment if the patient is uninsured or underinsured.