Written by Serena Benali, Registered Dietitian
You may be concerned about a friend, loved one or your child that they have developed an eating disorder. Or perhaps you’re here because you feel you may have an eating disorder. You may be wondering what are the warning signs of an eating disorder? What should I be looking out for?
In this blog article, we go over the different kinds of eating disorders and what the warning signs are, what you should look out for and how to start the journey to recovery.
What Are Eating Disorders?
Eating disorders are mental health illnesses that seriously impact the life of those enduring them. They can become life threatening mental illnesses. Eating disorders are behavioural conditions that affect how someone relates to food and their body, affecting them psychologically, physically and socially.
Eating disorders can consume one's thoughts and behaviours. This can include how one thinks about food and their body, eats food, socializes and interacts with food.
No one chooses to have an eating disorder. Eating disorders are complex and multifaceted. Eating disorders affect people of all genders, races, ethnic backgrounds, body shapes, ages and socioeconomic class.
Eating disorders are classified under the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria (1). Common eating disorders include anorexia nervosa, bulimia nervosa and binge eating disorder. It’s important to know that people with eating disorders may appear to be healthy so knowing what signs to look for is crucial.
What is Binge Eating Disorder?
Binge eating disorder is a condition characterized by eating large amounts of food in a short amount of time with feelings of loss of control. The person may eat rapidly and eat past feeling uncomfortably full. These episodes may occur in secret and when they’re alone. Afterwards the person can feel flooded with emotional distress and feelings of guilt, embarrassment and disgust.
Binge eating disorder is recognized with occurrences of at least once a week over three months (2).
Warning Signs of Binge Eating Disorder (3)
Large amounts of food disappearing in a short period of time, lots of empty wrappers and containers
Hides or hoards food in strange places (bedroom closet)
Not eating around others or appears uncomfortable eating around others
Shows concern or distress over body weight and shape
Dental issues: enamel erosion, cavities, tooth sensitivity
Social changes: making rituals or scheduled times for binge sessions
Changes in eating patterns: skipping meals, eating small amounts around others, no regular meal times, cutting out food groups (carbs, dairy etc.)
Withdrawal from social life
Fluctuations in weight
Binge eating disorder is the most commonly occurring eating disorder. It is a treatable eating disorder. We offer a unique one-on-one all-encompassing binge eating program that addresses the psychological, behavioural and food relationship issues to provide full recovery.
If you or someone you care about is ready to start the healing journey with binge eating, we’ve got you covered with our dietitian picked best binge eating books.
What is Bulimia Nervosa?
Bulimia nervosa is a condition characterized by cycles of bingeing and purging. Similarly to binge eating disorder, large amounts of food are consumed in a short period of time with feelings of a lack of control over food consumed. Eating continues regardless of feeling uncomfortably full. With bulimia there is compensatory behaviour to compensate or “undo” the effects of the binge by purging. Purging is done by: vomiting, laxatives, diuretics or by non-purging ways: fasting or excessive exercising.
Bulimia can be difficult to identify as most individuals with bulimia nervosa are within normal weight or may be overweight. There is an intense preoccupation with body shape and weight. There is also extreme secrecy and isolation from this illness.
Bulimia nervosa is recognized with occurrences of binge eating and compensatory behaviour occurs once a week for three months or more. (2).
Warning Signs of Bulimia Nervosa (4)
Weight fluctuations: body weight can be within a normal range or may be overweight
Avoids eating with others or in public, appears uncomfortable eating with others
Skipping meals or eating small amounts of food
Frequent trips to the washroom after eating
Empty wrappers and containers
Packages of laxative or diuretics
Hiding and hoarding large amounts of food (ex: bedroom closet)
Hidden purging container (vomiting may occur in bedroom to reduce suspicion of others, when no one is around the contents are discarded in the washroom)
Signs or smells of vomiting
Lots of money spent on food especially food for planned binges and purges
An excessively rigid exercise program
Withdrawal from friends and social activities
Sensitive teeth, enamel erosion
Chronically sore throat
Swollen neck and jaw area
Thinning of hair
Loss of menstruation
Cold intolerance/feeling cold all the time
Extreme mood swings
Cuts or calluses across top of hands (from induced vomiting)
Bingeing and purging can lead to a range of serious medical complications including electrolyte imbalance, arrhythmia (irregular heartbeat), esophageal tears, gastric disruptions and problems with fertility (5).
Those with bulimia nervosa can also struggle with co-occurring conditions such as substance use, self-harm and impulsivity (risky sexual behaviours, shoplifting) (6). There is also a high incidence of psychiatric disorders such as mood and anxiety disorders (5).
Those struggling with bulimia experience a great deal of shame and embarrassment about their eating and go to great lengths to be as inconspicuous as possible. The shame and secrecy can delay detection and treatment. Family and loved ones play a crucial role in offering support.
What is Anorexia Nervosa?
Anorexia nervosa is a condition characterized by a profound and irrational fear of weight gain and a distorted body image. People suffering with anorexia avoid and restrict food to very small amounts by means of excessive dieting, avoiding complete food groups and self-monitoring calorie intake.
Of all the eating disorders, anorexia has the highest mortality rate, death may result due to suicide, starvation, or electrolyte imbalance. Denial of a problem or illness is common. This illness can lead to severe mental health issues, social isolation and major depression (7).
Anorexia nervosa is recognized with the criteria of: restricting food intake leading to significantly low body weight, an intense fear of weight gain although underweight, distorted image in how on sees their body or denial or current low body weight (8).
Warning Signs of Anorexia (9)
Extreme weight loss in a short amount of time
Only eating certain foods (foods deemed “safe”)
Severely restricting food
Makes excuses to avoid eating in public or with others
Preoccupation with food, calories, fat, sugar
Cooks or bakes food for others but doesn’t eat it
Frequent mirror checking or body-checking
Excessive exercise: maintains regimen despite weather, sickness
Loss of menstrual cycles
Digestive issues: abdominal pain, constipation
Dizziness or fainting
Thin hair that breaks or falls out
Low blood pressure
Fatigue and lethargy
Cold intolerance/feeling cold all the time
Covering up body with layers of clothing (to hide body and/or to stay warm)
Social isolation or withdrawal
Use of laxatives or purging
The human body is extremely resilient with its will to survive. With anorexia the body does not receive the nutrition and calories it needs and overtime this manifests physically by the body beginning to slow down what it deems non-essential functions like hair growth, nail growth and cell turnover. Blood tests often do not reflect the level of inadequate food intake and starvation. Laboratory results can seem normal. Someone may present as healthy but be very ill.
The incidences of anorexia nervosa are increasing in younger people (less than 15 years old).
(10). Those who suffer with anorexia are often reluctant to seek treatment, in spite of the detrimental effects of the illness (11). The experience of this illness is diverse, therefore it is important to understand how this illness affects one’s physical, mental and behavioural aspects.
What is Orthorexia Nervosa?
Although not recognized as an eating disorder, orthorexia can cause severe mental distress, health consequences and lead to an eating disorder. Orthorexia can be described as an unhealthy obsession with healthy eating or disordered healthy eating. Many of the warning signs described for orthorexia mirror those of anorexia nervosa and obsessive compulsive disorder (OCD) (12).
Orthorexia can begin with a well-intended intention to be healthier with the pursuit of optimal nutrition but turns obsessive, restrictive and unhealthy. The motivation behind orthorexia is a fixation on food quality to be healthy, natural and pure (12).
The term orthorexia nervosa was first coined in 1997 by physician Steven Bratman where he witnessed pathological obsessions with healthy eating. The word “ortho” comes from the Greek word to mean straight or correct and orexi meaning appetite.
Social media use continues to increase in youth and young adults and has been shown to have negative effects on body image and disordered eating. Its use is associated with mental health problems with higher incidences of depression and eating disorders. Higher instagram use is associated with greater tendency towards orthorexia (14).
With orthorexia not being considered an eating disorder there is no formal DSM-5 criteria. However symptoms and warning signs can help you identify if someone is struggling with orthorexia.
Warning signs of Orthorexia
Spending considerable time planning meals
Being more concerned with nutritional value of a meal rather than the pleasure of eating
Cutting out entire foods or food groups (carbs, sugar, dairy, meat, animal products)
Giving up foods one used to enjoy in order to eat the “right” foods
Eating habits make it difficult to eat out or at friends and family
Avoidance of food deemed “unhealthy”
Feelings of guilt when eating foods deemed “unhealthy”
Overly critical of the nutrient content of food
Intolerance of other’s food beliefs or preferences
Eating rituals (eg: rules governing which foods can be combined)
Rigid rules for what one can and can’t eat
Orthorexia can lead to eating disorders, particularly anorexia. It is commonly present with obsessive compulsive disorder. In contrast to eating disorders, those with orthorexia are more readily responsive to treatment, this can be attributed to their pursuit and emphasis on wellness (15).
Other Eating Disorders
Avoidant Restrictive Food Intake Disorder (ARFID)
Similar to anorexia nervosa ARFID involves restricting food intake however it does not involve a fear of weight gain or a distorted body image. ARFID presents as a lack of interest in food, avoidance based on sensory characteristics of food.
Pica involves eating items that would not be considered food or typically thought of as food such as: chalk, paint, clay, paper, soil or charcoal. Diagnosis for Pica is made from a clinical history of the patient.
Rumination disorder involves regurgitating (spitting up) undigested food from the stomach and re-chewing it then either re-swallowing it or spitting it out.
Atypical Anorexia Nervosa
Similar to anorexia nervosa, atypical anorexia involves restricting food intake that results in significant weight loss, an intense fear of weight gain and distorted image in how one sees their body. With atypical anorexia however the individual's weight is within or above normal range.
Recurrent purging behaviour (vomiting, laxatives, diuretics, exercise) to influence weight or shape in the absence of binge eating
Night Eating Syndrome
Recurrent episodes of night eating. Eating after awakening from sleep or by excessive food consumption in the evening (after the evening meal). With this behaviour comes significant mental distress.
The Truth about Eating Disorders
The Academy of Eating Disorders took common myths about eating disorders and reframed them into truths. The 9 truths about eating disorders depicted below can help you understand more about the complex nature of eating disorders.
Whether you or someone you care about is enduring an eating