Eating Disorders & Symptoms

Eating disorders are serious mental illnesses affecting over 10% of the population of the United States. Negative habits around food and body image are considered symptoms of eating disorders when they significantly impair one’s health, emotional stability, and function. While eating disorders are most common in young women, they affect people of every age, sex, and gender identity.

This article explores different types of eating disorders, common symptoms of an eating disorder, and resources you can recommend if you suspect you or a loved one might have an eating disorder. 

About eating disorders

Eating disorders are serious conditions characterized by abnormal eating behaviors, such as binge eating, where individuals consume large amounts of food. Or, for example, an individual with anorexia nervosa might avoid eating food due to an intense fear of gaining weight. 

Some eating disorders can lead to unhealthy eating habits aimed at extreme weight loss, despite already having a normal body weight. Signs and symptoms might also involve eating large amounts of food in secret or obsessively restricting food intake. Recognizing the signs and symptoms, such as drastic changes in body weight, attempts to lose weight through extreme measures, or ritualistic eating habits, is often crucial for early intervention and treatment.

Types of eating disorders

The most well-known eating disorders include anorexia nervosa and bulimia nervosa. However, over five eating disorders can be diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). 

Binge eating disorder and avoidant-restrictive food intake disorder (ARFID) are lesser-known but equally impactful eating disorders to be aware of. Other eating disorders listed in the DSM-5 include the following: 

• Other specified feeding and eating disorder
• Pica
• Rumination disorder

Skipping meals and avoiding food

Individuals may occasionally skip meals for various reasons. Breakfast and lunch can sometimes get crowded out by one’s schedule, and dinnertime may seem to fly by as one works late or meets up with friends. However, when individuals skip meals regularly and purposefully, it may signify an eating disorder. If someone is living with ARFID, they may skip meals accidentally or due to sensory challenges surrounding food, which is different than other restrictive eating disorders, like anorexia. 

A person who has started to develop disordered habits around their eating may begin by skipping meals or finding reasons to avoid situations where food is present. It can be vital to pay attention to restrictive eating when it first arises because fast intervention can prevent the disorder from becoming dangerous.

Adopting a strict diet

Orthorexia is an eating challenge not officially recognized in the DSM-5. It is categorized as an unhealthy focus on eating only healthy foods. Though eating nutritious foods can be beneficial, becoming obsessed with only eating food deemed "healthy" can be unhealthy. Those living with orthorexia may be extremely restrictive of what they put into their bodies and may have different ideas of what is healthy than other people in their communities. 

Orthorexia may be noticed with specific diets that eliminate food groups. However, adopting a vegetarian or vegan diet may not be a sign of this challenge unless that diet is overly restrictive and obsessive. For proper nutrition and health, vegetarian or vegan diets can include a wide variety of foods, including those high in protein and fiber. If the diet does not meet diverse food needs and is obsessively restricted, it may be a sign of orthorexia. 

Eating little food

Eating disorders like anorexia nervosa and avoidant-restrictive food intake disorder can cause food restriction, which may lead to a lack of intake of sufficient calories or energy through food. In addition, they might not be getting enough nutrients to support various body systems. People may limit their caloric intake over time to lose weight or because of sensory difficulties with food or forgetting to eat. 

In anorexia nervosa, calorie restriction is often due to a fear of gaining weight. Contrarily, people with ARFID can find it difficult to eat certain foods because of the food's taste, texture, smell, or sight. They may also forget to eat or find eating a “chore.” Both eating disorders are serious mental illnesses that a mental health professional can treat. 

Eating significant quantities of food

Because anorexia nervosa is one of the most well-known eating disorders, people might not realize that eating in excess can also signify an eating disorder. Bulimia nervosa and binge eating disorder can both include eating significant amounts of food. 

In these circumstances, the person with the eating disorder may believe they are out of control of their consumption and continue eating after their body has sent signals that they're full. After a binge, a person may experience profound shame or sadness. These emotions can lead someone to purge their food with laxatives, forced vomiting, or exercise if they are living with bulimia nervosa. In binge eating disorder, the person may not purge their food but can still experience shame around their binge eating symptoms. 

Eating in secret

Some eating disorders can cause shame about how one eats, so they may start to eat in secret. Eating alone is not the same as eating secretly. A late-night snack alone in the kitchen may not indicate an eating disorder. However, eating alone because of fear or shame can be a sign of a mental health condition. 

People who are ashamed of eating may also avoid social situations involving food. This avoidance can cause isolation, which may lead to further mental health challenges. It can be crucial to note that eating is necessary for well-being, but you don’t have to go through these feelings alone. Speaking to a licensed therapist can help you work through the shame and fear surrounding food. 

Not eating

Like skipping meals and making excuses about food, joining a group of people for mealtime but not eating can be a sign of an eating disorder, whether at home or out with others. People may also use techniques to appear like they've eaten more than they have, such as cutting their food into many pieces, pushing it to the side, feeding it to a pet, or eating slowly. These behaviors can become more present over time, but the more serious an eating disorder gets, the better a person may be at hiding it.

Leaving the table to use the bathroom often

One of the most common symptoms of bulimia nervosa is inducing vomiting to get rid of food or calories. If you are compelled to leave the table to vomit during or after a meal, it can be a significant sign to reach out for help. As a friend or family member, if you notice that your loved one often leaves for an extended amount of time in the middle of a meal, it may be a warning sign of an eating disorder.

There are other indicators that a person may be inducing vomiting, including but not limited to the following: 

• A scent of vomit after returning from the bathroom
• Bloodshot eyes
• A puffy face
• Swollen lymph nodes in the throat 
• Coughing due to agitated tissues 
• Gum and tooth erosion 
• Red knuckles on the hands 

Continued induced vomiting can cause long-lasting symptoms, which can require immediate treatment. 

Eating different foods 

Being unwilling to eat the same food as other friends or family members can be a symptom of an eating disorder. However, it doesn’t necessarily indicate one on its own, as some people have legitimate reasons to prepare or bring their own food. In combination with other problematic behaviors, it can indicate that a person is concerned with calories or the types of food they consider healthy. 

Symptoms of calorie restriction 

People with eating disorders, especially anorexia nervosa and bulimia nervosa, can become fixated on removing food or calories from their bodies after they have taken them in, which may occur in the following ways.  

Vomiting

Bingeing and induced vomiting are widely known as common signs of bulimia nervosa. Induced vomiting, however, is not restricted to people who experience bulimia nervosa. People with anorexia nervosa may also vomit food that they eat, even though they are not as likely to have binged in the first place. 

One sign of vomiting in friends or family can be calluses that form on the knuckles from using the fingers to induce vomiting. Another vomiting symptom can be losing tooth enamel from the acidity of vomiting, swollen lymph nodes, and a puffy face.

Laxatives, supplements, and herbs

Instead of inducing vomiting, some people with eating disorders use laxatives or other supplements to make food move through their digestive system faster. This process may make it difficult for their body to absorb energy and nutrients from the food. Any supplement or herb intended to block or change how bodies absorb food can also be a symptom of an eating disorder.

Supplements can take the form of teas, pills, or liquids. Not only do these prevent food from being absorbed by the body, but they can also cause dehydration and other gastrointestinal issues.

Excessive exercise

In some cases, rather than removing food from their bodies, people with eating disorders will exercise to attempt to burn off the calories consumed. This symptom is more common in those with anorexia nervosa. In some cases, people may become so anxious after eating food that they are compelled to exercise until they think they’ve "worked it off." If exercise is associated with significant anxiety or compulsion, it can signify a mental health condition. 

Though exercise is a healthy activity in moderation, too much can harm the body. It can also damage a person's mental health to exercise, with their primary focus being on calories burned. When exercise is done solely to burn calories and lose as much weight as possible, alongside not eating, a person is not consuming enough food to sustain muscle growth and adequate healing during and after exercise.

Mental symptoms of eating disorders

Below are some of the most common mental symptoms of several eating disorders. 

Obsession

It can be difficult not to worry or talk about weight or body image. Some people may compare themselves to a social standard or shape and size they see in the media. It can be normal to want to eat in a way that allows oneself to maintain energy and feel healthy. However, if doing so becomes an obsession, it may be a sign of an eating disorder or an obsessive and compulsive-related disorder like obsessive-compulsive disorder (OCD). 

Frequent conversation about weight 

If you or someone you know frequently talk, complain, or worry about their size, shape, or weight, you or they may be experiencing an eating disorder. This symptom is common in anorexia nervosa. Some people with anorexia become underweight due to their symptoms but remain anxious, ashamed, or disgusted with their bodies, believing they should “lose more weight.” Anorexia nervosa can change how a person perceives their body, so a mismatch between how they look and how they perceive themselves can indicate they are living with this condition. 

Body dysmorphic disorder is another mental health condition that can affect the way a person sees themselves. Body dysmorphic disorder is an obsessive and compulsive-related disorder in the DSM-5. Though not all people with body dysmorphia necessarily have eating disorders, the two often co-occur. People with body dysmorphia see an altered version of themselves in the mirror, and they may become fixated on specific body parts that they believe are unattractive.

Note that weight does not necessarily predict whether someone is obsessed with their appearance. People who seem not to be underweight may sometimes be overlooked because cultural signals can wrongfully indicate that it's appropriate to be ashamed of or obsessed with body weight if you aren't underweight. However, people of all body types can struggle with body image and eating disorders. You do not have to be underweight to live with a restrictive eating disorder or overweight to live with a binge eating disorder.  

Shame or disgust

If a person expresses significant shame or disgust about their body, it can be a symptom of an eating disorder. While people with anorexia nervosa often misperceive the size and shape of their body, disgust or self-loathing can occur in anyone, including those with other eating disorders. 

People who struggle with eating disorders may feel shame or disgust about food, as well. They may avoid certain foods altogether or become uncomfortable when food is present. It can also be possible for them to be judgmental of others who indulge in foods they restrict from.

A hyperfocus on healthy eating

While eating for energy and health is often positive, an obsessive focus on what a person perceives as healthy eating can be a sign of an eating disorder. If the person’s idea of healthy eating is restrictive or based on maladaptive beliefs, it can lead to justifying disordered eating. If an individual is afraid, disgusted, or ashamed of the idea of eating a food they don't think is healthy, it may be beneficial for them to reach out for professional support. 

Obsessively checking 

If you obsessively check the mirror to find and criticize imperfections, it may be a sign of an eating disorder or body dysmorphic disorder. If your friend or loved one spends a lot of time with the mirror and comes away from it sad, angry, or disgusted, it may be beneficial to offer support. However, in some cases, people with eating disorders may also avoid looking in the mirror not to have to think about or look at their bodies. 

Eating disorder terminology

Below are some of the most common terms you may hear about when learning about eating disorders, as well as their meanings. 

Bingeing

For people with a binge eating disorder, eating is not necessarily connected with enjoyment. During a binge, a person might be uncomfortable or want to stop eating and believe they are unable to stop. Those living with this disordered eating behavior may use food as an unhealthy coping mechanism for stress and uncomfortable emotions. Food can start to seem like a comfort item. However, after a binge caused by a binge eating challenge, a person may feel ashamed of their behavior. This shame can lead to a continued cycle that is difficult to manage without adequate treatment.

In addition to believing they are out of control while bingeing, people with an eating disorder might believe they can't control how often it happens. People sometimes eat more than usual for birthdays, holidays, and special occasions. However, for people with binge eating disorder, binges happen regularly and often. This behavior can be isolating and take enjoyment away from food. 

Restricting

Some people with anorexia nervosa or other eating disorders that restrict food intake may be unaware that they are experiencing symptoms of an eating disorder. Others may know their food restrictions are unhealthy but believe they cannot stop. This restriction can be focused on caloric content or specific kinds of food. People who excessively restrict their food may look at certain foods as "good" or "safe" and other foods as "bad." This labeling can heighten emotions when foods they perceive as “bad” are present.

The emotional aspects of an eating disorder, like shame, fear, and disgust, can be a factor in this lack of control. Other people may not purposely restrict calories but follow diets that don't eat certain foods. If these restrictions seem out of control and are accompanied by negative emotions, it can be a sign that a supposedly “healthy” diet is unhealthy. 

Exercise

One way to tell if you or a loved one's exercise habits are problematic is to consider the emotions attached to them. If you are often compelled to exercise, afraid of what will happen if you stop, or believe you must exercise after eating, it could mean that the exercise is part of an eating disorder.

Trauma

Previous trauma is a risk factor for eating disorders because disordered and harmful eating patterns can emerge from trauma's other psychological effects. Low self-worth and misdirected blame or anger can negatively impact one’s eating habits. In addition, trauma can sometimes make a person believe they are not in control of themselves or their lives. Eating disorders can be part of their efforts to regain or experience a sense of control.

Other mental health conditions

Eating disorders often follow or exist alongside other mental health diagnoses like anxiety disorder, depressive disorders, or obsessive-compulsive disorder. If you or your loved one has a history of being anxious, depressed, or compulsive, it can be especially crucial to be on the lookout for signs of an eating disorder.

How to find support

If you recognize yourself or a loved one in the above symptoms, you might experience various emotional responses, such as relief or a sense of being overwhelmed. Acknowledging that you are experiencing these challenges can be the first step to finding support, whether through any of the following resources. 

Treatment

Treatment for eating disorders often involves a team of medical professionals and a support network of friends and family. There are a few places to start if you suspect that you may have an eating disorder. Your primary care physician can help with a diagnosis and refer you to other professionals who can help. You may also start the process by contacting a mental health professional. A therapist or counselor can help you get started on your eating disorder treatment.

The National Eating Disorder Association (NEDA) also offers resources. Although their hotline is no longer available, they offer a free screening tool, multiple resources, and support groups you can sign up for online. 

Medical treatment

Medical treatment for eating disorders might involve a primary care physician, a trained dietician, and other specialists as necessary. Medical treatment aims to care for the body, including helping the client reach a healthy weight and stabilize any body systems impacted by their eating disorder. 

Some medications can be prescribed for eating disorders, such as certain stimulants and anti-seizure drugs that may reduce bingeing behavior. Doctors can also prescribe antidepressants, which may help people to moderate their problematic thinking patterns and behaviors. Connect with your primary care doctor before starting, changing, or stopping a medication. 

Mental health treatment

Mental health treatment can be a crucial part of treatment for eating disorders. Types of therapy like cognitive-behavioral therapy (CBT) can help people with eating disorders recognize the disordered thought patterns that often precede and follow disordered eating. CBT helps clients replace unhealthy or false thought patterns with healthier thoughts. In cases where eating disorders stem from past trauma, talk therapy can help clients process trauma and learn healthy coping strategies.

How to support loved ones with an eating disorder

Being the friend or family member of a person experiencing an eating disorder can be difficult. In some cases, the people around an individual with disordered eating recognize that they may have an eating disorder before they do. People with eating disorders might be resistant to acknowledging that they are at risk of complications. They might not believe their loved ones or could become angry and defensive when someone tries to bring it up with them. 

Be cautious when approaching someone with your concerns. Being supported by loved ones can be incredibly helpful for people who are in the recovery process. Below are a few ways to offer this type of support. 

Be loving 

When you're talking with someone who may have an eating disorder, try to remember that eating disorders can cause a significant amount of shame. Keep your concerns positive and proactive. 

In addition to being kind to your loved ones, check into your relationship with your body. If you use shaming or hurtful words for yourself, convincing others that they shouldn't do the same may be difficult. You may want to adjust how you think and talk about bodies to support your loved one better. Doing so may create a space where they are more comfortable opening up about their symptoms and challenges. 

Stay available

Your loved one may not acknowledge your concerns immediately when you bring them up. They might be angry or in denial. Try not to drive them away or reject them for this reaction. Recognize that eating disorders often affect how people think and process, which can make it difficult to realize that one is experiencing difficulty. 

Be patient with your loved one. When they are ready to recognize their eating disorder and understand that they want and need help, try to do your best to provide a patient, open, safe space for them to come to you. 

Alternative support options 

Eating disorder treatment can be a complex process. However, it often has positive results and can result in a total reduction in symptoms. As a person with an eating disorder, it can be crucial to reach out for help as soon as you can and build strong support networks. However, you don’t have to have a mental illness to seek guidance. If you are a support person for someone with an eating disorder or believe you might relate to some of the symptoms above, you can also reach out for guidance. Therapy is for everyone. 

In some cases, individuals may avoid therapy because of shame or a lack of resources and time. In these cases, online therapy platforms like BetterHelp may be more available. Online treatment is often less expensive than traditional therapy since you don’t have to commute to appointments, and therapists don’t have to increase rates to account for office rentals and utilities.

Studies also back up the effectiveness and convenience of online therapy. In one online cognitive-behavioral therapy (I-CBT) study, researchers found that 71% of participants reported I-CBT as more effective than in-person options. In addition, 80% of the participants found it more affordable.