Signs of eating disorders
Though commonly used as synonyms, "signs" and "symptoms" actually have slightly different meanings. Signs of an eating disorder—or any other medical condition—include issues that can be tracked or measured by an outside party, via tests or medical instruments.
Signs of some common eating disorders, including anorexia nervosa (AN), binge eating disorder (BED), and bulimia nervosa (BN), include:1,2
- Abnormal blood work readings, including, low thyroid levels, low hormone levels, low potassium levels, low white and red blood cell counts
- Amenorrhea (loss of menstrual period)
- Anemia
- Bruises or cuts on the knuckles, from self-induced vomiting (called Russell's sign)
- Constipation
- Dry and/or yellow-tinted skin
- Dry or brittle hair
- Electrolyte imbalances
- Gastrointestinal issues, including acid reflux, gastroesophageal reflux disease (GERD), and other GI complications
- Growth of fine, soft hair (lanugo) across the body and/or face
- Low blood pressure
- Low body weight, rapid weight loss, or frequently fluctuating body weight
- Muscle wasting and/or weakness
- Oral health issues, including eroded tooth enamel, tooth decay, or tooth sensitivity
- Swelling of the salivary glands, creating a "puffy" appearance in the face or jaw (sometimes referred to as "bulimia cheeks")
- Thinning of the bones (osteopenia or osteoporosis)
It's of course possible for other physical signs of an eating disorder to manifest. And the appearance of these signs doesn't necessarily point to an eating disorder. But if someone is presenting with a number of these issues, it likely points to a deeper problem.
Symptoms of eating disorders
Symptoms of eating disorders and other medical conditions are effects that can be felt by the person experiencing them, but which are difficult or impossible to medically measure. Nonetheless, they often make a strong impact.
When it comes to eating disorders, symptoms encompass many of the emotional and behavioral issues involved with these conditions. Some common symptoms of the most common eating disorders include:1,2
- A preoccupation with weight, weight loss, and/or body image and body shape
- Avoidance of social events involving food, discomfort eating around others, or frequently eating alone
- Difficulty concentrating
- Dizziness or fainting
- Excessive exercise
- Extreme fear of gaining weight
- Extreme picky eating, especially around certain food colors, textures, or scents
- Fatigue or lethargy
- Feeling cold all the time
- Food rituals, such as cutting food into tiny pieces, chewing excessively, or not allowing certain foods to touch
- Frequently checking oneself in the mirror
- Low self-esteem or self-worth
- Hoarding or hiding food
- Measures to control food intake, including frequent dieting or restrictions around certain foods or food groups
- Mood swings
- Problems sleeping
- Skipping meals or eating only small portions
- Using laxatives when not constipated
- Withdrawal from friends or previously-enjoyed activities and/or social isolation
Again, this list is neither exhaustive nor definitive. Eating disorders can manifest as a number of other symptoms, and the presence of these symptoms don't necessarily mean someone has an eating disorder. But they frequently do indicate that a larger problem of some type is in play.
What eating disorders look like
Although eating disorders present differently for everyone, certain conditions are marked by certain thoughts or behaviors. Understanding how these conditions affect people can help you look for additional signs and symptoms in yourself or someone else.
And regardless of how they manifest, most forms of disordered eating aren't clinically considered part of an eating disorder until they occur with a certain amount of regularity, over consecutive months.
Anorexia nervosa is medically understood as a condition that involves:3
- Restriction of food intake leading to significantly low body weight in relation to sex, age, physical health, and developmental trajectory
- Intense fear of gaining weight
- Persistent behavior that interferes with weight gain
- Disturbed or distorted body image
- Self-worth influenced heavily by body weight or shape
- Lack of understanding or denial of the seriousness of low body weight
People with AN may express these feelings in many ways. Frequently, they will skip meals, eat small portions, or partake in rituals around food. They may also focus intently on dietary or nutritional information around certain foods, using that as a reason to exclude certain foods from their diet.1,2
And many people with AN also dress in baggy clothing or layers, both to hide the shape of their body and to keep warm if they’re frequently feeling cold.2
The clinical definition of bulimia nervosa includes:4
- Recurring binge eating episodes, which are characterized by eating an amount of food definitively larger than what most people would eat within a two-hour period and a sense of loss of control over what or how much is eaten
- The use of compensatory behaviors after these episodes, which can include self-induced vomiting, fasting, excessive exercise, misuse of laxatives or other medications
- Sense of self-worth derived heavily from body shape, weight, or appearance
In many cases, people with BN strive to hide the behaviors that mark the condition. Because of this, they may frequently eat alone or avoid occasions that involve food. When they do eat around others, they may frequently go to the bathroom soon after finishing a meal.
Some physical signs of this behavior also commonly present, including puffy cheeks and cuts or bruises on the knuckles caused by self-induced vomiting.1
Binge eating disorder is one of the newest eating disorders to receive an official definition, but it's widely considered the most common eating disorder in the United States.5
As explained in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the record of all officially-recognized mental health disorders, BED constitutes:6
- Recurring binge eating episodes, which are characterized by eating an amount of food definitively larger than what most people would eat within a two-hour period and a sense of loss of control over what or how much is eaten
- At least three of the following symptoms accompanying binge eating episodes—eating much more rapidly than normal, eating until uncomfortably full, eating alone due to embarrassment over eating behavior, feelings of self-disgust, guilt, or depression after binging episodes
While everyone overeats from time to time, someone with BED must exhibit these behaviors at least once a week, over the course of three consecutive months, in order for their behavior to be considered part of the condition.6
Unlike with BN, compensatory behaviors for binging episodes don't present with BED, but people with this condition do experience distress around their eating habits and frequently participate in diets. Because of this, their weight may fluctuate frequently.7
The shame and guilt involved also frequently drives people with BED to eat in private or try to hide their eating behaviors. Evidence of binging episodes can include large quantities of food that goes missing, food hoarding, hiding food, or discovering wrappers and other evidence of food either hidden or in the garbage.2
Avoidant restrictive food intake disorder (ARFID) is another eating disorder that's been officially defined relatively recently. In the latest version of the DSM, it's described as:
- A consistent eating or feeding disturbance, based around a lack of interest in food or eating, avoiding foods based on certain sensory characteristics (smell, color, or texture), overt concern over choking, vomiting, or experiencing other negative side-effects from eating8
- Failure to meet dietary needs, due to these behaviors
- At least one of these issues caused by disturbed eating behaviors—significant weight loss or, in children, failure to meet expected weight, significant nutritional deficiency, dependence on oral supplements or enteral feeding, noted interference with psychosocial functioning
ARFID can easily be confused with anorexia nervosa or picky eating, especially in young children who commonly go through periods of changing dietary preferences. But unlike AN, eating behaviors have nothing to do with body image; and ARFID goes much further than picky eating, with a disinterest in food that continues to the point of severe nutritional deficiencies.
There's also a strong overlap between ARFID and autism, which is thought to drive many of the sensory-specific issues people with ARFID have around food.9 In any case, the refusal to eat certain foods can be drastic, including tantrum-like behavior and other extreme emotional reactions.10
Eating disorders and diet culture
When looking for signs or symptoms of eating disorders, it's also important to understand these conditions in the context of diet culture.
While not specifically defined, the term refers to the widespread messaging and beliefs around body shape and fitness, which often depict achieving a certain body type—generally, thin or lean and toned or muscular—as the ultimate goal.
These ideas may present themselves as health-focused, but they can be a slippery slope toward disordered eating behavior. Some experts believe the pervasiveness of diet culture is even responsible for increasing numbers of eating disorder cases and people experiencing these issues at younger ages.11
Healthy vs. unhealthy behavior
In many cases, it can be difficult to determine where a focus on health ends and disordered thoughts and behaviors begin. In these situations, it might be helpful to focus on the motivations behind the behavior.
There is a difference between eating or exercising a certain way because it feels good, and doing so in order to achieve specific body- or weight-related goals.
For example, when it comes to working out, "healthy exercise" is generally considered movement that is motivated by an improved quality of life, but not practiced to the point of disrupting someone's life. Excessive exercise, on the other hand, persists despite illness or injury, frequently lasts longer than intended, and can eclipse other priorities.12
If you're finding that you or a loved one are increasingly focused on "getting in shape," reaching a certain weight, or achieving a certain body type—as opposed to eating or moving your body in ways that feel good or more natural to you—it might be a sign of a developing problem, and a time to reevaluate your motives or seek out further help.
Finding help for an eating disorder
Eating disorders are serious mental health conditions, which cause an array of mental, physical, and emotional health issues. For a number of reasons, it’s important to seek appropriate treatment for these conditions as quickly as possible.
Your primary care doctor, therapist, or another trusted medical professional can be a good place to start. These experts are often versed in eating disorder behavior and may be able to give you an official diagnosis or help guide your best next steps.
Learn more about remote treament
If you don't live near a treatment facility, have difficulty around mobility or transportation, or if you'd rather receive care for an eating disorder at home for any reason, you can also contact us at Within Health.
Our talented team comes from multi-disciplinary backgrounds, allowing them to tailor treatment plans to your specific needs and help promote healing on a physical, mental, and emotional level. And our unique program allows you to access this help from the comfort of your own home.
Regardless, taking any step in the direction of treatment is one of the best things you can do. It is often the first step on the road toward a healthier and happier future.
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