Eating Disorders: Recognizing Signs

According to DSM-5 (Diagnostic & Statistical Manual of Mental Disorders), eating disorders fall under the category “Feeding & Eating Disorders” which characterizes them as:

1. A recurring disturbance of eating-related illness;
2. Results in altered, abnormal consumption of food;
3. Impairs physical and psychological normalcy.

Eating disorders are complicated disturbances that differ from person to person. However, there are some commonalities that research has been able to delineate, regardless of the nuanced nature of the problems.

Some Facts of Eating Disorders

Here are some of the facts regarding eating disorders, that, as addressed above tries to bring some common ground to better understand the phenomenon:

1. Eating disorders are observed in individuals of all ages, racial/ethnic backgrounds, body weights, and genders.
2. Eating disorders generally onset in adolescence or young adulthood but are not restricted to these life stages.
3. There aren’t any “exact” causes to why these illness happen. Research points towards several genetic, biological, behavioral, psychological, and social factors that can lead to eating disorder development.
4. Eating disorders could develop into something life-threatening, and continues to have one of the highest mortality rates of any mental illness.
5. Eating disorders do not have a concrete “cure”, like diseases caused by pathogens, etc. but have evidence-based practices proven to support recovery.

Types of eating disorders include (i) anorexia nervosa, (ii) bulimia nervosa, (iii) binge eating disorder, (iv) avoidant restrictive food intake disorder. Eating abnormality affect up to 9% of the population, often developing in adolescence and young adulthood.

Disorders like anorexia nervosa and bulimia nervosa are especially common in women, but they can all occur irrespective of age and affect any gender. Eating disorders are generally associated with engrossment with food, weight, or shape or with anxiety about eating.

Behaviors, on the other hand, associated with eating disorders include restrictive eating or avoidance of certain foods, binge eating, purging by vomiting, or laxative misuse or compulsive exercise. These behaviors can seem to appear similar to an addiction.

Recognizing Signs of Eating Disorders

Signs of Anorexia Nervosa

The most common sign of anorexia nervosa in individuals is the extreme fear of gaining weight. They tend to diet and exercise regularly, sometimes cutting calories to the point of starvation. Around 50% of anorexics also binge and purge by vomiting or using drugs such as laxatives.

They have a distorted body image, leading them to think they are overweight when in fact they are underweight. They are also often counting calories obsessively and only consume tiny portions of certain specific foods.

When brought up, people with anorexia will often deny the existence of a problem. The general signs of anorexia can be subtle since it develops gradually. It could start from an interest in dieting before an event like a school dance or a beach vacation, but as the illness takes hold, the obsession with weight control intensifies.

This manifests into a vicious cycle: The more weight is lost, the more obsession about weight increases.

The following signs are telling of people with anorexia:

1. Sizable loss of weight
2. Choice of loose, bulky clothes to hide weight loss
3. Obsession with food, dieting, counting calories, etc.
4. Avoiding certain foods, such as carbs or fats
5. Cutting mealtimes or even eating in front of others
6. Planning and making elaborate meals for others but refusing to eat them
7. Excessive exercises
8. Regularly passing comments about being “fat”
9. Change in hormonal balance, such as stopping menstruating
10. Commonly experiencing constipation or stomach pain
11. Refusing to accept that extreme thinness is a problem

Since individuals with anorexia are good at hiding their condition, the disorder may become severe before anyone around them notices. If you have concerns over someone having anorexia, it’s important to have them diagnosed by a doctor right away. When untreated, anorexia can lead to serious complications such as malnutrition and organ failure.

However, through treatment, most people can gain back the weight they lost, and the physical problems that came about as a result of anorexia will get better.

Signs of Bulimia Nervosa

The most common sign of bulimia nervosa in individuals is episodes of eating large amounts of food (also known as binging) followed by purging (vomiting or using laxatives), fasting, or exercising excessively to compensate for overeating. Contrary to anorexia, individuals dealing with bulimia are often a normal weight. However, the same intense fear of gaining weight and distorted body image exists for them as well.

They think of themselves as “fat” and desperately wish to lose weight. They likely feel ashamed and disgusted with themselves and thus become very good at hiding bulimic behaviors.

The following signs are telling of people with bulimia:

1. The habit of binge eating, consumption of large amounts of food in a short time, or having lots of empty food wrappers or containers
2. The habit of purging, taking frequent trips to the bathroom after meals, sounds or smells of vomiting, or packages of laxatives or diuretics
3. Avoiding meals or eating in front of others, or eating in small portions
4. Excessive exercising
5. Clothing being baggy to hide the body
6. Commenting about being “fat”
7. Excessive use of gum, mouthwash, or mints
8. Obsessive dieting
9. Scarred knuckles from inducing vomiting regularly

When untreated, bulimia could develop into long-term health problems such as abnormal heart rhythms, esophagus rupture, and bleeding due to excessive reflux of stomach acid, dental problems, and kidney problems.

Bulimia can be treated, however, successfully through cognitive-behavioral therapy, certain anticonvulsant medicines, antidepressants, or combinations of these therapies. The most important thing to seek help if you worry that someone has signs of bulimia.

Signs of Binge Eating Disorder

People with binge eating disorders have recurring phases where they binge on large quantities of food, rather than consuming large quantities at once. Similar to signs of bulimia, people often feel out of control during these episodes and later feel guilty or shameful.

This habit forms a vicious cycle because the more distressed they feel about binging, the higher chance it is of them doing it. Binge eating disorders don’t have signs of purging, fasting, or exercising after they binge, leading them to be normally overweight or obese.

Contrary to other eating disorders, binge eating disorder is almost as common in men as it is in women. Statistics from the National Institute of Mental Health suggest the average age at onset for binge eating disorder to be 25 and is found to be common in people under age 60.

The following signs are telling of people with binge eating disorder:

1. Proof of binge eating, including consumption of large amounts of food in a short time, or having lots of empty food wrappers or containers
2. The habit of hoarding or hiding large quantities of food in strange places
3. Hiding the body by wearing baggy clothes
4. Avoiding meals or eating in front of others
5. Regularly dieting, but rarely losing weight

Since binge eating leads to obesity, it has the potential to lead to serious health consequences if left unattended. Behavioral weight reduction programs are useful both with weight loss and with controlling the urge to binge eat. The stimulant drug Vyvanse is FDA-approved for the treatment of binge eating disorders. Due to the fact that depression often goes hand in hand with binge eating dysfunction, antidepressants and psychotherapy may help.

Conclusion

Recognizing the signs and symptoms of an eating disorder is the first step toward getting help for it. Eating disorders are treatable, and with the right treatment and support, most people with an eating disorder can learn healthy eating habits and get their lives back on track.

The goal is to always remain observant of the changes happening in your mind and body, and reach out to friends, family & then professionals to start the process of treatment. As these illness come in many forms, they tend to be very personal and nuanced for an individual so even if you see something, not on the list above it’s always recommended to ask an expert.