How To Recognize Eating Disorders: Indicators And Telltale Symptoms

Eating disorders can compromise a person’s health and well-being in a variety of ways, yet they’re not always easy to recognize. An individual with an eating disorder often goes to considerable lengths to conceal their unhealthy behavior from others, and they may be reluctant to admit, even to themselves, that they have a mental illness. Correctly identifying that someone has a disorder of this kind may require watching for a combination of certain telltale warning signs.

Some of these eating disorder indicators can involve attitudes or habits that demonstrate an excessive concern with food, weight, or appearance. Others may be direct signs of the behavioral symptoms of anorexia or bulimia. Individually, these indicators aren’t necessarily problematic. However, when someone is displaying multiple potential warning signs of an eating disorder, it may be worth having a conversation with them about their health. If you believe you could be living with an eating disorder, consider reaching out to a therapist for support and guidance.

What are eating disorders?

An eating disorder can be described as a serious mental health condition that goes well beyond simple picky eating or occasional overindulgence. According to the American Psychiatric Association, this type of illness is usually defined by a “severe and persistent disturbance in eating behaviors,” typically accompanied by negative thoughts and emotions. 

Current medical practice recognizes seven distinct categories of eating disorders.

#1: Anorexia nervosa (AN)

Possibly the most widely recognized eating disorder, anorexia nervosa (also known as “AN” or simply “anorexia”) is defined by a combination of the following:

1. Restriction of eating to the point that caloric energy intake is lower than the amount the body requires, leading to severely underweight status
2. Persistent attempts to avoid gaining weight, typically motivated by a distorted body image and/or an intense fear of being fat

In addition to restricting food intake, some people with anorexia may experience episodes of binge eating — short bouts of compulsive overeating — followed by compensatory behaviors intended to avoid weight gain, such as excessive exercise. 

#2: Bulimia nervosa (BN)

Bulimia tends to be similar to anorexia in that it often involves a pathological fixation on reducing body weight or becoming slim. However, its principal symptom is usually a recurring pattern of binge eating followed by excessive attempts to avoid weight gain. This typically includes “purging” behavior, such as deliberate vomiting or inappropriate use of laxatives or diuretics.

#3: Binge eating disorder (BED)

As indicated by the name, binge eating disorder is a condition typically involving repeated binge episodes. What sets it apart from anorexia and bulimia is that these binges are rarely followed by purging or other unhealthy attempts to compensate for the food consumed.

#4: Avoidant/restrictive food intake disorder (ARFID)

People with avoidant/restrictive food intake disorder don’t normally experience the same preoccupations about body weight and appearance seen in anorexia and bulimia. Instead, these individuals usually have severe sensory discomfort related to specific kinds of food or an exaggerated fear of choking or vomiting due to overeating. As a result, they may eat a sharply restricted diet, often limiting themselves to a handful of foods they consider “safe.”

#5: Rumination disorder

Sometimes called “rumination syndrome,” this condition tends to be most commonly seen in children, but it can also affect adults in some cases. Rumination disorder generally involves a habit — often partly involuntary — of repeatedly regurgitating food after eating it. 

#6: Pica

A person with pica may experience a strong urge or compulsion to swallow non-food items or substances. The exact items consumed can vary from person to person, but common examples include clay, soil, paint chips, buttons, paper, and eggshells. Pica is another eating disorder that tends to be significantly more common in children than adults. 

#7: Other specified feeding and eating disorders (OSFED)

This category generally includes other kinds of disordered eating behavior that don’t precisely fit into the categories above, though they often have very similar pathologies. One example is atypical anorexia nervosa, in which a person displays the same behavioral and cognitive symptoms as in standard AN but isn’t underweight at the time of diagnosis. 

Indicators of anorexia or other restrictive eating disorders

The following signs and symptoms might indicate the presence of anorexia nervosa:

• Rapid weight loss
• Excessive interest in calories, dieting, weight loss, and related topics
• Frequent self-criticism related to appearance (especially body shape and weight)
• Distorted body image (perceiving oneself as overweight or fat despite appearing thin to others)
• Reluctance or refusal to eat with others, with frequent excuses or denial that they’re hungry
• Ritualistic food behaviors, such as chewing repetitively or rearranging food on the plate
• Frequent weakness, dizziness, or fatigue
• Feeling cold most of the time, often wearing multiple layers to compensate
• Fine hair growing on the body (lanugo)
• Dressing in loose clothing to hide body shape
• Thin, brittle hair and nails
• Dry or yellowing skin
• Constipation and other gastrointestinal disruptions
• Difficulty concentrating or thinking clearly
• Social withdrawal or isolation
• Irritability or mood swings
• Absent or irregular menstrual periods in women

These indicators can also be present in other eating disorders involving significant food restrictions, such as ARFID. 

Indicators of bulimia or purging behavior

Aside from the characteristic symptoms — binge eating and purging — what are the indicators of bulimia? 

Some physical and behavioral symptoms may match those seen in anorexia. For example, both disorders can involve an overly intense focus on body shape and weight gain or loss, as well as avoiding eating around others. Individuals with bulimia may also experience gastrointestinal difficulties and dizziness or faintness, often resulting from dehydration. 

Other indicators may be specific to bulimia-related binge eating and purging, including the following:

• Repeatedly disappearing or visiting the bathroom after eating
• Expressing feelings of shame about food
• Hiding food or attempting to conceal food-related garbage
• Buying large amounts of food, diuretics, or laxatives
• Fluctuating weight
• Frequent sore throat or hoarse voice
• Swelling of glands in the cheeks and neck
• Scarring on the fingers or knuckles
• Dental yellowing or decay
• Tachycardia due to electrolyte imbalance
• Acid reflux and other forms of gastrointestinal distress
• Burst blood vessels in the eyes

These signs may also be seen in various “other specified eating disorders” when they involve purging behaviors.

Indicators of binge eating disorder

Binge eating disorder can be associated with high levels of shame, which frequently leads people with this condition to conceal the evidence of their disordered eating behavior. This can make it difficult to identify from the outside. If you frequently eat until you’re painfully full and sense that you are unable to stop, this can be a strong indicator that you might have BED — but how can people recognize this illness in their loved ones? 

The following could be signs of binge eating disorder:

• Hiding stores of food, especially unhealthy “comfort” foods
• Dieting often without apparent weight loss
• Frequently eating alone or concealing eating
• Expressing shame, guilt, and other negative emotions about food
• Unexplained weight gain
• Loss of sexual desire

Long-term eating disorder health impacts

Prolonged eating disorders may lead to more serious symptoms than those described above. In some cases, these mental disorders may go unrecognized until their health consequences become pronounced enough that they’re apparent to third parties or drastically interfering with daily function.

These medical complications can vary based on the specific pathology involved. Anorexia and other food-restricting illnesses may impact virtually every part of the body through malnutrition, leading to effects like those listed below:

• Neurological deficits
• Heart tissue atrophy and cardiac arrest
• Vision loss
• Respiratory weakness, sometimes causing aspiration of food or vomit
• Hepatitis
• Skeletal weakness and fracture
• Weakened infection resistance 

Bulimia can have various health effects, including the following:

• Kidney dysfunction
• Gastrointestinal dilation or rupture
• Irregular heartbeat
• Damage to the esophagus
• Cardiomyopathy

Long-term issues linked to binge eating disorder are typically linked to obesity and high blood sugar. For example, metabolic syndrome and type 2 diabetes can be common pathologies. Gastrointestinal damage or dysfunction can also result from the physical effects of overeating.

Risk factors for developing an eating disorder

While successfully recognizing and treating eating disorders can have a dramatic positive effect on the well-being of those affected, preventing them from developing may be even more beneficial. Researchers have identified several possible risk factors for these conditions that may help identify who could benefit the most from preventative measures. 

These factors include the following:

• A family history of eating disorders
• Female sex
• Other mental illnesses, including ADHD, obsessive-compulsive disorder, and depression
• Trauma, including childhood abuse or neglect

Sociocultural eating disorder risk factors

Evidence suggests that societal factors may also play a role in promoting unhealthy eating behaviors. Researchers have found that internalizing beauty standards and cultural messaging that emphasize the importance of thinness can significantly increase the likelihood of developing an eating disorder. 

Talking to someone you think may have an eating disorder

If you think that someone you know may be exhibiting some of the signs of an eating disorder, encouraging them to seek help could make a significant difference in their long-term well-being. However, it can also be challenging, since people with these conditions are often resistant to the idea that their behavior is problematic. 

You might also benefit from avoiding speculation. Instead, you can simply point out behaviors you’ve directly observed and explain why you think they might be detrimental. Asking about any sources of stress or challenging emotions and letting them know you’re there for them if they need support can be helpful. If the other person is receptive to your concerns, you can suggest that they might want to talk about what they’re experiencing with a therapist.

Effective eating disorder treatments

If you or someone you know needs help with an eating disorder, talking with a physician is often a good idea. Medical supervision may be crucial for safe and healthy eating disorder recovery. 

Successful treatment also typically involves evidence-based psychotherapy. The methods that have been found effective for eating disorders include those listed below:

• Cognitive behavioral therapy (CBT)
• Interpersonal therapy (IPT)
• Family-based therapy (FBT)
• Dialectical behavior therapy (DBT)
• Exposure therapy
• Acceptance and commitment therapy (ACT)
• Mindfulness-based therapies

Online treatment for eating disorders

Some people with eating disorders opt for therapy delivered over the internet, which can offer some advantages in terms of convenience. Since you can attend online therapy from home, it’s often easier to schedule, which can be helpful when you’re trying to manage the many facets of eating disorder recovery. 

Research on the benefits of online eating disorder treatment is in its early stages, but the current evidence suggests that it can work well for many people. For example, one review from 2023 examined more than a dozen trials of online cognitive behavioral therapy (ICBT) for eating disorders. The authors found that the evidence supports the effectiveness of this treatment method, though more studies may be needed for confirmation.