Eating Disorder Warning Signs & Symptoms

What Are the Signs & Symptoms of an Eating Disorder?

The signs of eating disorders are not always as apparent as they seem in movies and TV shows. While signs of an eating disorder can be evident in extreme, life-threatening cases, many cases of eating disorders are well hidden.

Many patients suffering from eating disorders will go to great lengths to hide any evidence of their disordered behavior, especially if they are not ready to accept treatment. However, there are some key signs to look out for if you suspect you or a loved one has issues with disordered eating.

Common Eating Disorders

Most people are familiar with disorders like anorexia, but several other types of eating disorders often go overlooked. Not all eating disorders are focused on body image; some eating disorders function like addictions or are related to neurodevelopmental conditions like autism.

The most common types of eating disorders include:

• Anorexia Nervosa: characterized by self-starvation for weight loss, obsession with low body weight, and warped perception of body shape
• Bulimia Nervosa: characterized by alternating between starvation and binging, with binge sessions resulting in purging
• Binge-Eating Disorder (BED): characterized by episodes of uncontrollable binging on large quantities of food with no compensatory behaviors like starvation or purging
• Avoidant/Restrictive Food Intake Disorder (ARFID): characterized by extremely picky eating, low appetite, or low interest in food that leads to malnutrition not based on body image concerns

Early Warning Signs of Eating Disorders

Each eating disorder can present very differently from person to person based on many factors such as age, metabolism, and genetics. Individuals who severely restrict their food can appear overweight, or individuals with binge-eating issues can appear underweight.

While weight changes can be among the many symptoms of an eating disorder, weight should not be the only criteria you look for, as many health factors contribute to a person’s body weight.

Anorexia Early Warning Signs

Individuals with anorexia typically engage in disordered eating to lose weight and have an incredibly warped view of the size and shape of their own bodies. Anorexia is typically broken down into two subtypes: restrictive type and binge-purge type.

Common early warning signs of anorexia may include:

• Fixation over the appearance, size, and weight of your body
• Obsessing over counting every single calorie and checking your weight and measurements
• Extreme low self-esteem and hatred of your body
• Struggling to see your body’s actual appearance due to distorted body image
• Wearing baggy clothes to hide extreme changes in body weight and appearance
• Eating far below the daily recommended calorie intake
• Early use of laxatives, diuretics, diet pills, and excessive exercise to accelerate weight loss
• Experiencing anxiety or panic around mealtimes
• Secretive behavior around eating habits
• Extreme weight loss not explained by other health conditions

Bulimia Early Warning Signs

Although bulimia and anorexia can occur together and have some overlap in symptoms, they are two different disorders. However, like anorexia, bulimia usually develops due to an irrational view of one’s body size and appearance.

Some early warning signs of bulimia may include:

• Unrealistic view of your body’s weight and size
• Obsessively worrying about weight gain
• Eating large amounts of food (binging) followed by self-induced vomiting or laxative abuse (purging)
• Going to great lengths to hide any evidence of binging and purging sessions
• Abusing laxatives and supplements to help purge or lose weight

Binge-Eating Disorder Early Warning Signs

Binge-eating disorder (BED) is often confused with bulimia due to their shared binge characteristics. However, patients with BED typically do not engage in purging behaviors like self-induced vomiting or laxative abuse.

Common early warning signs of binge-eating disorder include:

• Feeling out of control while eating high-calorie foods
• Continuing to eat even when not hungry or extremely full
• Eating to the point of making yourself sick (not intentionally)
• Eating very fast during binge sessions
• Feeling extremely stressed, guilty, or ashamed of your eating
• Hiding evidence of and lying about binge sessions

ARFID Early Warning Signs

Unlike anorexia or bulimia, individuals with avoidant/restrictive food intake disorder (ARFID) do not engage in disordered eating due to body image issues. While some patients with ARFID may have body image issues, their eating habits are not caused by a desire to lose weight.

Common early warning signs of avoidant/restrictive food intake disorder (ARFID) include:

• Extreme restrictiveness or pickiness when choosing what food to eat
• Avoidance of certain foods due to texture, taste, smell, color, food groups, etc.
• Struggling to feel hungry or have an appetite
• Frequently gagging or vomiting after exposure to certain foods
• Issues with chewing and digesting food that aren’t explained by other conditions
• Weight loss in adults that other conditions can’t explain
• Failure to gain weight in children and adolescents

Long-Term Signs of Eating Disorders

All eating disorders have severe risks in the long term. Many long-term signs of eating disorders do not fit the classic view of extreme thinness most people associate with disordered eating.

In addition, many long-term signs may not be immediately visible physical signs. Health effects like brain and heart damage, damage to tooth enamel and the esophagus, and gastroparesis may require testing to be noticed by others.

Anorexia Long-Term Signs

Of all eating disorders, anorexia has the highest mortality rate due to the risk of malnutrition. The long-term signs of anorexia are often life-threatening and require medical attention and intervention.

Common long-term signs of anorexia include:

• Eating in secret
• Dizziness or fainting
• Having a gaunt or skeletal appearance
• Insisting extreme thinness is not a problem
• Frequent constipation and cramping
• Infrequent menstrual cycles or not menstruating at all
• Infertility
• Dry skin and hair, brittle nails, and hair loss
• Brain and heart damage
• Intolerance of cold
• Irregular heart rhythms and abnormal blood counts
• Low blood pressure
• Dehydration
• Swelling of arms or legs
• Increased risk of heart attack and stroke

Bulimia Long-Term Signs

Bulimia can be life-threatening if not addressed and treated. Many of the long-term signs of bulimia overlap with those of anorexia. However, due to bulimia’s heavier focus on purging, the condition comes with its unique long-term issues.

Common long-term signs of bulimia include:

• Calluses or scars across the top of finger joints from inducing vomiting
• Damage to the esophagus and throat due to repeated vomiting
• Chronically inflamed and sore throat
• Damage to tooth enamel and dental decay from acidic stomach bile
• Acid reflux disorder and other gastrointestinal problems
• Severe dehydration and electrolyte imbalances due to purging fluids
• Swollen salivary glands in the neck and jaw area
• Intestinal issues and irritation due to laxative abuse

Binge-Eating Disorder Long-Term Signs

Many of the long-term signs associated with BED are related to the same risks found in obesity. However, not all individuals with BED will be overweight or obese.

Common long-term signs of binge-eating disorder include:

• Malnutrition due to binging on exclusively junk food or foods low in nutrients
• Extreme weight gain
• Developing joint problems, heart disease, type 2 diabetes, gastroesophageal reflux disease (GERD), or sleep-related breathing disorders due to weight gain
• Fatigue and lethargy
• Sleeping problems
• Nausea and vomiting due to overeating

ARFID Long-Term Signs

ARFID tends to affect children and can continue into adulthood. The biggest concern for ARFID patients is malnutrition for still-growing bodies that need regular food to develop properly. Luckily, because ARFID typically occurs in childhood, early interventions can be employed to help address malnutrition.

Common long-term signs of avoidant/restrictive food intake disorder include:

• Dramatic weight loss
• Failure to gain weight or be the average weight for the child’s age
• Stunted growth
• Restricting what foods are “safe” that only worsens with age
• Dependence on nutritional supplements, a feeding tube, or both
• Stomach problems without apparent reason
• Social isolation

What to Do If You Notice Eating Disorder Warning Signs

If you notice the warning signs of an eating disorder in yourself or a loved one, addressing it can be very challenging for everyone involved.

For individuals who know they have an eating disorder, they may not be ready to seek treatment. A loved one with signs of an eating disorder may become defensive and even hostile when questioned about their eating disorder.

If you believe you have an eating disorder, now is the time to enter eating disorder treatment before long-term health problems can arise. Start by talking to your healthcare provider about your symptoms and what treatment may best suit you.

If you believe a loved one has an eating disorder, try discussing your concerns with them in a calm manner, free of accusations or judgment. Try to encourage them to seek treatment and offer your support. They may be resistant initially, but consistent support shows them you care for their well-being.

Eating Disorder Diagnosis and Treatment

Eating disorders are screened and diagnosed similarly to any other mental illness, although some medical tests may be required to rule out other health conditions. Treatment can begin once a diagnosis is obtained and other conditions have been ruled out.

How Are Eating Disorders Diagnosed?

Eating disorders are typically diagnosed through several methods, including an interview to review the history of symptoms, screening tools like SCOFF or Eating Disorder Examination Questionnaire (EDE-Q), and medical tests to rule out other health conditions.

Your mental health professional will then compare results to the diagnostic criteria listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) and provide an official diagnosis. Once a diagnosis is obtained, treatment options can be recommended.

What Are the Treatments for Eating Disorders?

Counseling is the primary form of treatment for eating disorders.

In some cases, medications may be used to treat symptoms of any co-occurring mental health conditions, such as depression and anxiety. However, there is currently no medication approved to treat eating disorders.

Common types of counseling used to treat eating disorders include:

• Cognitive Behavioral Therapy (CBT)
• Dialectical Behavioral Therapy (DBT)
• Interpersonal Psychotherapy (IPT)
• Family-Based Therapy (FBT)
• Nutrition Counseling

Get Assessed for an Eating Disorder

If you suspect you or a loved one may have an eating disorder, now is the time to seek an assessment. You can start by speaking with your healthcare provider about your symptoms and seeking a formal screening and diagnosis.

You can also check out eating disorder helplines like the Eating Disorders Helpline offered by the National Association of Anorexia Nervosa and Associated Disorders (ANAD) or the National Eating Disorders Association Helpline.

SAMHSA also offers a treatment locator tool, or you can call 1-800-662-4357 (HELP) to learn what outpatient treatment options are available in your area.