Eating disorders are exceedingly common in the United States. According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), approximately 9% of the population (roughly 28.8 million Americans) suffer from an eating disorder. Recognizing and diagnosing an eating disorder is also complex… to say the least. With this piece, my hope is that we’re able to tease out some of these complexities and nuances of disordered eating.
For many, the words “eating disorder” bring to mind images of shockingly thin women. The myth that eating disorders only affect affluent Caucasian women is persistent in our culture. Anorexia nervosa (the medical term for anorexia) is certainly not uncommon—but disordered eating can look different for many. In truth, as only 6% of those diagnosed with an eating disorder are visibly underweight, it may not even have a “look” at all.
By the end of this article, perhaps you’ll be able to recognize some of the subtler eating disorder signs, and understand when seeking help or a re-evaluation of your own relationship with food might be necessary.
Feature image by Riley Reed
Breaking Down Eating Disorder Myths
It’s true that more women suffer from eating disorders than men. But men, athletes, and the transgender, gay, and BIPOC community are often vastly overlooked and underdiganosed. Binge eating, bulimia, and anorexia nervosa are the three most common forms of eating disorders, but there are many gray areas between and within each of these diagnoses.
The path to disordered eating and eating disorder signs looks different and varies widely for everyone. Because of this, it can make the disorder hard to diagnose. As a result, it can be common for eating disorders to be vastly underreported or even screened for in healthcare settings.
What might cause an eating disorder?
Disordered eating can stem from a myriad of social, PTSD, cultural, athletic, intrapersonal, and mental health complications. Oftentimes, many of these issues overlap. Many Americans, in part thanks to cultural and social pressures, have adapted subtle and less obvious forms of eating disorders. This can be anything from restrictive diets, excessive exercise, and control issues around food that may seem “healthy” but truly indicate harmful behavior. Let’s jump into the basic definitions of the three most common forms of disordered eating. From there, we’ll discuss the less recognizable, more subtle eating disorder signs to watch out for.
Note: If you or a loved one suffer from an eating disorder, skip to the bottom to read actions you can take to seek help.
Binge Eating Disorder
According to the National Eating Disorders Association, binge eating disorder is the most common eating disorder in the United States. It’s a serious condition in which those affected consume large quantities of food in a short time and are unable to stop eating despite feeling satisfied, full, or overly full.
Most of us overeat on occasion (think holidays or your favorite meal that you just can’t get enough of). The difference is that, with binge eating, people suffering from the disorder binge regularly and feel they can’t control themselves or stop the behavior. Additionally, binge eaters don’t “purge” the food they ate (induce vomiting), as those suffering from bulimia do. This high caloric intake on a regular basis often leads to obesity or being overweight.
According to the Mayo Clinic, common binge eating disorder signs include:
- Eating unusually large amounts of food in a specific amount of time
- Feeling that your eating behavior is out of control
- Eating even when you’re full or not hungry
- Eating rapidly during binge episodes
- Eating until you’re uncomfortably full
- Frequently eating alone or in secret
- Feeling depressed, disgusted, ashamed, guilty or upset about your eating
- Frequently dieting, possibly without weight loss
Individuals with eating disorders are experts in hiding their behavior. It’s important to note that this is a mental health diagnosis that deserves serious attention.
Anorexia Nervosa
Anorexia is the most well-known eating disorder. This disorder is characterized by extreme calorie restriction, control around food and what goes in one’s body, and obsession over the outward appearance of one’s body. Extreme fear of becoming “fat” is one of the hallmarks of this disease. According to The American Psychiatry Association, “anorexia has the highest mortality rate of any psychiatric diagnosis other than opioid use disorder.”
According to the Mayo Clinic, behaviors indicative of anorexia nervosa may include:
- Severely restricting food intake through dieting or fasting
- Exercising excessively
- Bingeing and self-induced vomiting to get rid of food, which may include the use of laxatives, enemas, diet aids or herbal products
Emotional and behavioral signs and symptoms may include:
- Preoccupation with food, which sometimes includes cooking elaborate meals for others but not eating them
- Frequently skipping meals or refusing to eat
- Denial of hunger or making excuses for not eating
- Eating only a few certain “safe” foods, usually those low in fat and calories
- Adopting rigid meal or eating rituals, such as spitting food out after chewing
- Not wanting to eat in public
- Lying about how much food has been eaten
- Fear of gaining weight that may include repeated weighing or measuring the body
- Frequent checking in the mirror for perceived flaws
- Complaining about being fat or having parts of the body that are fat
- Covering up in layers of clothing
- Flat mood (lack of emotion)
- Social withdrawal
- Irritability
- Insomnia
- Reduced interest in sex
This article provides more information as well as a list of physical symptoms someone living with anorexia may experience. Individuals with anorexia oftentimes deny that they need help or are resistant to receiving medical attention. The desire to stay thin or not gain weight is stronger than the desire to be healthy. Remember: This is a mental health diagnosis that deserves serious attention.
Bulimia Nervosa
Bulimia is a serious and difficult-to-diagnose eating disorder that involves bingeing and purging calories. Individuals affected by the disorder binge or consume large amounts of food, especially high calorie or “bad” food they wouldn’t normally eat. This is followed by purging or vomiting food to avoid the calories or weight gain from consumption. Individuals with bulimia are often a normal weight or slightly overweight as they are still obtaining some nutrients and calories from bingeing. This behavior is often extremely secretive. Bulimia can have profound health impacts due to the constant regurgitation of stomach acid and bile on the esophagus (throat), teeth, gums, and overall nutritional health of an individual.
According to the Mayo Clinic, symptoms of bulimia may include:
- Being preoccupied with your body shape and weight or living in fear of gaining weight
- Repeatedly eating unusually large quantities of food in one sitting, especially foods the person would normally avoid
- Feeling a loss of control during bingeing
- Forcing yourself to vomit or exercising too much to keep from gaining weight after bingeing
- Using laxatives, diuretics or enemas after eating when they’re not needed
- Fasting, restricting calories, or avoiding certain foods between binges
- Using dietary supplements or herbal products excessively for weight loss
- Strict dieting or fasting after binge eating
- Not wanting to eat in public or in front of others
- Going to the bathroom right after eating, during meals or for long periods of time
- Excessive exercise
- Having sores, scars or calluses on the knuckles or hands
- Damaged teeth and gums
- Changing weight
- Swelling in the hands and feet
- Facial and cheek swelling from enlarged glands
Subtler Eating Disorders You Should Know About
Orthorexia
Orthorexia nervosa is a fairly common but less well-known form of disordered eating that’s prevalent in our society today. It hasn’t been until recently that this condition has become better understood. It still in’t classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Disease (ICD-10), but many of the symptoms and consequences of the condition overlap with that of other forms of classified disordered eating.
According to an article by J Stahler in the Journal of Behavioral Addictions, “Many debate whether orthorexia is a lifestyle phenomenon or a disease, however, reports of physical (malnutrition and weight loss), psychological (fatigue and emotional instability), and social consequences (social isolation, diminished quality of life, and stigma) comply with current concepts of mental disorders.”
It’s likely that we all know someone who suffers from at least a form of this condition. It’s increasingly common in our diet, exercise, and healthy eating-obsessed culture. Lifestyle choices such as veganism, vegetarianism, or strict diets like intermittent fasting and the keto diet, while not harmful overall, can shield individuals suffering from disordered eating. These behaviors are often dismissed as “just healthy eating,” or “participating in a trendy diet.” This condition, like many disordered eating conditions, overlaps with symptoms of obsessive-compulsive disorder and anorexia nervosa.
According to a 2017 publication in the Federal Practitioner Journal, orthorexia can be defined as “an obsessive focus on healthy eating, as defined by a dietary theory or set of beliefs whose specific details may vary.” Oftentimes, when individuals are unable to follow the strict guidelines they set for themselves, it may be marked by emotional distress.
According to the foundation Eating Disorder Hope, some of the symptoms or signs an individual may suffer from orthorexia may include:
- Compulsive behavior or mental preoccupation around restrictive diet practices
- Anxiety and shame when not following a strict diet
- Low self-esteem/self-worth or history of past trauma
- Co-occurring mental health diagnoses, particularly of OCD or Generalized Anxiety Disorder
- History of dieting or need for control
- Core beliefs related to purity, cleanliness, and health as well as core beliefs related to food and self-worth, value, or morality
- Tendency toward extremism and obsessiveness
- Reportedly feeling pressure to be perfect or achieve perfection/success
- Obsession with the origin of foods (where/how prepared)
- Obsessive concerns regarding food and possible medical or health concerns
- Rigid food rules
- Increased supplement usage
- Reduced consumption of food based on food rules centered on beliefs of “health”
- Concern about/desire for control over food preparation and techniques
- Unwillingness to eat food not prepared by the individual themselves or whose preparation was not supervised by the individual
- Judgment of those that do not adhere to their food rules
- Obsessively checking nutrition labels
- Daily life revolves around food preparation or rules
Anorexia Athletica (Over-Exercising)
Anorexia athletica or over-exercising, is a disorder that impacts athletes or individuals with rigid interest and participation in sports. The disorder typically leads to individuals taking in limited calories despite high levels of activity and exercise. This disorder is categorized by the National Eating Disorder Association (NEDA) and other groups as an EDNOS or eating disorder not otherwise specified. The condition may lead to an increase in muscle or bone injuries as well as nutritional deficits, renal or liver failure secondary to malnourishment, arthritis, cardiovascular complications or hormonal imbalance (for example, when athletes stop menstruating).
Athletes or hobby sportsmen and women with this condition often fail to recognize that their behavior isn’t “normal” or admit how unhealthy it is. This is sometimes due to the fact that they’re surrounded by others with similar unhealthy habits—and it’s all compounded by the fact that we celebrate athletic achievement and hard work. If an athlete is medaling routinely, how dare we keep them from winning? They’re just committed, right? Unfortunately, excessive dieting and calorie restriction combined with intense physical exercise can lead to long-term consequences and be quite dangerous at such high levels of competition.
Signs of anorexia athletica include:
- Low energy levels or fatigue
- Problems with concentration or focus
- Lightheadedness or dizziness
- Irritability
- Needing a longer recovery time between workouts, practices, or competitions
- Frequent injuries
- Denying that excessive exercise is a problem
- Enjoyment of sports and activity is diminished or non-existent
- Obsessive thoughts and behaviors surrounding calories, body image, and weight
- Excessive exercise
Athletes who suffer from this disease have a hard time admitting they need help and may also experience obsessive-compulsive tendencies. They also may be perfectionists or “Type A” personalities.
Subtle Eating Disorder Signs
We know that eating disorders are hard to diagnose and that individuals afflicted with such diagnoses rarely “check every box” when it comes to symptoms. The water is as clear as mud when it comes to diagnosing, and even muddier when it comes to admitting the truth to yourself or your community. If you’re worried about someone or you recognize some of these behaviors in yourself, it’s possible that there may be some form of disordered eating worth delving into.
The issues are widespread and hyper-prevalent in society today, especially with the advent of social media and the internet. I’ve adapted and added to a list written by Ai’Pono, an eating disorder treatment facility in Hawaii, that may help you recognize more subtle signs of disordered eating.
- You “let yourself” have an extra serving of something, a treat or something you’re craving but only if you “work it off” later
- You routinely deny yourself desserts or treats even when you want to say yes
- You can’t stop fad-dieting, for example: moving from carb-free to keto to intermittent fasting and never taking “breaks” from dieting or feeling satisfied with your weight
- You never feel relaxed around food
- You obsessively plan out your grocery shopping, meals, and outings to align with your strict diet
- You use specific plates, bowls, or utensils, sometimes child-sized in order to eat slower or less
- You bring your own food to events, restaurants, or other people’s houses
- You are an extremely picky eater, not due to food allergies
- You leave off all caloric dressings and condiments or obsessively order them “on the side” so as to have more control over your intake
- You’re hyper-focused on food when eating, or disconnect entirely
- You always go with the lower-calorie option
- You would never eat in the car, on the couch, while walking or in a social gathering
- You consume excessive amounts of food-related media and content
- When you eat with others, you find yourself comparing your meals and judging yourself and others for their choices
- You record all of the food you eat
- You stave off hunger with water, gum, or calorie-free drinks
Complications From Eating Disorders
It can be extremely difficult for an individual living with an eating disorder to admit that they may need to re-evaluate their relationship to food or that they have a disorder that’s negatively impacting their health or intrapersonal relationships.
Some of the long-term complications associated with eating disorders when left untreated include:
- Negative self-esteem and problems with relationships and social functioning
- Dehydration, which can lead to major medical problems, such as kidney failure or liver failure
- Heart problems, such as an irregular heartbeat or heart failure
- Sudden death by heart attack due to electrolyte imbalance
- Severe tooth decay and gum disease
- Absent or irregular periods in females
- Digestive problems
- Anxiety, depression, personality disorders or bipolar disorder
- Misuse of alcohol or drugs
- Self-injury, suicidal thoughts, or suicide
- Loss of intrapersonal relationships or tension within relationships
How to Get Help
Due to the nature of eating disorders often consisting of a mix of underlying mental health diagnoses, as well as socially-acquired and genetic components, they can be extremely ingrained and difficult to change. But trust me: There is hope. Treatment is widely available and there are a multitude of resources available. If you’re reading this today and are concerned for yourself or worried about someone you know, think about saving a few of these resources. You may not be ready now, but perhaps in the future they could could help or even save your life. Deep breaths everyone, you’re perfect just as you are!
Information on Where to Start
Where to Start from NEDA
Eating Disorder Treatment Centers in the United States
Eating Disorder Hope
The Eating Disorder Helpline
Call the Eating Disorder Help Line
Online Forum for Peer Support
Online Forum
