Often misunderstood, eating disorders are very real, complex medical and psychiatric illnesses that can have serious consequences for health and overall well-being.
"Eating disorders are not a fad, phase or lifestyle choice," said Janet Milner, a registered dietitian nutritionist who specializes in eating disorder treatment. "They can be triggered by a combination of long-standing biological, behavioral, psychological, emotional, interpersonal and social factors."
When someone is struggling with an eating disorder, they may be hesitant to talk about it, admit it or even recognize that they have one. But as their loved one, there are signs and symptoms you can look for that might signal an eating disorder such as anorexia, bulimia or binge eating disorder.
"These signs aren't just physical, they're also emotional and behavioral," Milner said.
Meal times are very stressful for someone with an eating disorder and it can cause significant anxiety. Some people may have a fear of eating in public or with others, avoiding it altogether. They may also eat tiny portions or refuse to eat at all, possibly making excuses for not eating. In some cases, an individual with an eating disorder may eat in secret, hoard or hide food.
"Some individuals with eating disorders will practice unusual food rituals, like cutting their food into very small pieces, eating very slowly, eating one food group at a time, chewing each bite of food an unusually large number of times or regurgitating chewed food," Milner said.
If someone has an eating disorder, they usually become preoccupied with behaviors and attitudes that indicate weight loss, dieting and control of food are their top priority. They may show an intense fear of gaining weight or little concern over extreme weight loss, hide weight loss under loose-fitting clothes, exercise excessively, and even exercise when they're sick or hurt to burn more calories. Withdrawal from friends and activities is also common.
Their mood can show signs of an eating disorder as well - they may exhibit a flat mood or lack of emotion, irritability and mood swings. Many people with eating disorders also suffer with anxiety, depression and other mental health issues.
The physical side effects can vary depending on what type of eating disorder they have, but there are some general physical symptoms you can be aware of:
- Weight fluctuations, both up and down
- For women, menstrual irregularities
- Difficulty concentrating
- Dizziness or fainting
- Feeling cold all of the time
- Sleep issues
- Muscle weakness
- Stomach cramps
- Other gastrointestinal complaints such as sore throat; burning, inflammation or erosion of esophagus; constipation; spitting up blood
- Dental problems
- Abnormal lab findings, such as anemia, low hormone and thyroid levels, low blood cell counts, low potassium, or a slow heart rate
"If someone is struggling with anorexia nervosa, you may notice dramatic weight loss, or a resistance to maintaining a body weight that's appropriate for their height, build and age," Milner said. "They may also be preoccupied with weight, food, calories, fat grams and dieting."
Additionally, someone with anorexia may make frequent comments about feeling "fat" or overweight despite losing weight, or even have an intense fear of gaining weight or becoming overweight no matter how thin they may be.
When it comes to bulimia nervosa, some physical signs include unusual swelling of their cheeks or jaw, blood shot eyes, having calluses on the back of their hands or knuckles, or discolored teeth, which are signs of self-induced vomiting. Loved ones may notice they take frequent trips to the bathroom after meals. Other behaviors to purge calories may also include excessive exercise or laxative or diet pill abuse.
"Someone with bulimia won't have dramatic weight loss like someone struggling with anorexia. Their weight is typically within the normal range - they may even be overweight," Milner said. Binging and purging can have that effect on their weight and internal organs.
While weight gain can be an indicator, those with binge eating disorder may also eat rapidly and consume much more food in one sitting than normal - often to the point of discomfort or pain. Unlike bulimia, binge eating does not include behavior to purge the calories. Loved ones might notice the disappearance of large amounts of food in short periods of time or find wrappers and containers indicating the consumption of large amounts of food.
"Sufferers of binge eating disorder often describe their eating as 'feeling out of control,'" Milner said. "They often eat in secret and then have intense feelings of disgust, guilt and shame over their eating behavior."
"If your loved one is showing any of these signs of an eating disorder, you should encourage them to seek out professional help," Milner said. "A good treatment plan will include a team approach with a registered dietitian nutritionist and mental health professional experienced in treating eating disorders, as well as coordination with a primary care physician."