Eating disorders can be difficult to identify. The sufferer is likely to go to extraordinary lengths to try and hide it. There are, however, certain signs and symptom that you can look out for if you suspect that someone you know is suffering from an eating disorder.
Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
Compulsive Overeating
Exercise Dependence
Muscle Dysmorphia
Eating Disorders Not Otherwise Specified
Why can’t they just eat and exercise normally?
Anorexia Nervosa
Sufferers of anorexia will restrict how much they eat and drink, rigorously control what and when they eat and, in some cases, exercise in order to burn off what they perceive as excessive calories. A combination of these behaviours will result in weight loss and chemical changes in the body that will affect the mood of the sufferer and their ability to make rational decisions about food.
How might a sufferer behave?
- Restrict their intake of food and drink.
- Use exercise or purging to get rid of what they perceive as excessive calories.
- Show repetitive or obsessive behaviour around food such as cutting food up into small pieces, eating at specific and exact times of day and using small plates and cutlery for eating.
- Restrict the range of foods they eat to foods perceived as ’safe’. ‘Safe foods’ will vary from one person to the next. Sufferers of Anorexia often reduce their intake of carbohydrate and fat restricting their diet to mainly fruit and vegetables.
- Become restless and hyperactive.
- Avoid eating food prepared by other and/or eating in company. Make excuses not to attend food based social events.
- Become defensive and angry when people talk about food, exercise and weight.
- Deny they have a problem even when those around them express concern.
- Obsessively check the calorie and/or fat content of food.
- Find excuses to skip meals.
- Increased or obsessive interest in diet and nutrition.
How might the sufferer be affected physically?
- Weight loss.
- Constipation and abdominal pains.
- Dizziness and feeling faint.
- Bloated stomach, puffy face and ankles.
- Growth of downy hair on the body.
- Feeling cold.
- Discomfort while sitting of lying down.
- Dry, rough, or discoloured skin.
- Disrupted menstrual cycle in women.
- Loss of libido.
- Reduction in bone mass possibly leading to osteoporosis.
How might the sufferer feel?
The sufferer is likely to go to great length to hide how they are feeling; their thoughts may make them feel ashamed, confused or embarrassed. Feelings will vary from person to person. Your loved one may experience one, all or none of the emotions listed below. The best way to find out is by talking to them. Having an idea about how the sufferer might be feeling will help you to do this in a sensitive and appropriate way.
- Intense fear of gaining weight.
- Irritable and anxious, especially around food.
- Distracted by thoughts of food and eating.
- Fat or overweight despite being low weight.
- Low self-esteem.
Bulimia Nervosa
Bulimia is characterised by cycles of binging and purging. The sufferer will eat large quantities of food in a short space of time, often in an attempt to ’swallow down’ unwanted or distressing emotions or in an attempt to satisfy a need that cannot be met by food alone. A binge will be followed by an uncontrollable urge to compensate for the food consumed by vomiting, using laxatives, exercising or reducing food intake.
How might a sufferer behave?
- Binge uncontrollably on large quantities of food in a short space of time.
- Vomit after meals.
- Use laxatives, diuretics or enemas to get rid of food consumed during a binge.
- Periodically fast to compensate for binge eating.
- Exercise excessively to compensate for binge eating.
- Be secretive about what and how much they are eating.
- Hoard food.
- Avoid social situations, especially when the event involves food.
- Eat irregularly.
How might the sufferer be affected physically?
- Frequent weight fluctuations.
- Sore throat and swollen salivary glands.
- Tooth decay and bad breath.
- Disrupted menstrual cycle in women.
- Loss of libido.
- Poor skin condition.
- Reduced energy and feelings of lethargy.
- Frequent headaches.
How might the sufferer feel?
The sufferer is likely to go to great length to hide how they are feeling; their thoughts may make them feel ashamed, confused or embarrassed. Feelings will vary from person to person. Your loved one may experience one, all or none of the emotions listed below. The best way to find out is by talking to them. Having an idea about how the sufferer might be feeling will help you to do this in a sensitive and appropriate way.
- Out of control and anxious around food.
- Distracted by thoughts of food and eating.
- Feelings of guilt and shame, especially after binging.
- Feelings of helplessness and isolation.
- Reduced self-esteem and confidence.
- Emotionally relieved following purging, restrictive eating or exercise.
Binge Eating Disorder
Binge eating disorder is characterised by periods of uncontrolled, impulsive or continuous eating that pushes the sufferer beyond the point of feeling comfortably full. Like Bulimia, binges are likely to result from a desire to ’swallow down’ unwanted emotions or to satisfy a need that cannot be met by food alone. Unlike Bulimia, sufferers of Binge eating disorder you will not purge after a binge although periods of binge eating may be interrupted by sporadic fasts or dieting.
How might a sufferer behave?
- Eat uncontrollably impulsively or continuously beyond feeling uncomfortably full.
- Eating when they are not hungry.
- Eating rapidly.
- Periodically fast or diet.
- Be secretive about what and how much they are eating.
- Prefer to eat alone.
- Hoard food.
- Eat irregularly.
How might the sufferer be affected physically?
- Increase in weight.
- Poor skin condition.
- Reduced energy and feelings of lethargy.
- Problems with blood pressure, heart disease and lack of fitness.
How might the sufferer feel?
The sufferer is likely to go to great length to hide how they are feeling; their thoughts may make them feel ashamed, confused or embarrassed. Feelings will vary from person to person. Your loved one may experience one, all or none of the emotions listed below. The best way to find out is by talking to them. Having an idea about how the sufferer might be feeling will help you to do this in a sensitive and appropriate way.
- Out of control and anxious around food.
- Distracted by thoughts of food and eating.
- Feelings of guilt and shame, especially after binging.
- Feelings of helplessness and isolation.
- Reduced self-esteem and confidence.
- Self conscious when eating with others.
Compulsive Overeating
Sufferers of compulsive overeating will eat at times when they are not hungry. The behaviour may occur regularly or it may come in cycles. Sufferers are likely to be overweight and may use their weight and eating disorder to protect themselves from emotional distress or as an excuse to avoid social situations. They may hide behind a happy, jolly façade that enables them to avoid confronting their problems.
How might a sufferer behave?
- Eat uncontrollably or continuously beyond being uncomfortably full.
- Eat when they are not hungry.
- Be secretive about what and how much they are eating.
- Prefer to eat alone.
- Hoard food.
- Hide their emotions behind a jolly façade.
- Avoid social interaction.
How might the sufferer be affected physically?
- Increase in weight.
- Poor skin condition.
- Reduced energy and feelings of lethargy.
- Problems with blood pressure, heart disease and lack of fitness.
How might the sufferer feel?
The sufferer is likely to go to great length to hide how they are feeling; their thoughts may make them feel ashamed, confused or embarrassed. Feelings will vary from person to person. Your loved one may experience one, all or none of the emotions listed below. The best way to find out is by talking to them. Having an idea about how the sufferer might be feeling will help you to do this in a sensitive and appropriate way.
- Out of control and anxious around food.
- Distracted by thoughts of food and eating.
- Feelings of guilt and shame.
- Feelings of helplessness and isolation.
- Low self-esteem and confidence.
Exercise dependence
We are regularly told that exercise is essential to good health and wellbeing. For some people, exercise may start off as a positive part of their lifestyle but end up taking control. This will occur when exercise starts being used as a way to cope with and avoid difficult emotions such as low self-esteem, anxiety and stress.
How might a sufferer behave?
- Exercise regardless of injury and illness.
- Exercise without a specific fitness or sports related goal.
- Prioritise exercise over their social life, work or study commitments.
- Alter their diet to allow them to exercise for longer or to help them to recover more rapidly (this may include the use of supplements and dangerous or illegal substances).
- Obsessive monitoring of physical progress.
How might the sufferer be affected physically?
- Frequent injury and periods of illness.
- Disruption of sleep pattern.
- Exhaustion.
- Changes in hormone levels (specifically in men).
- Stiffness and aching limbs.
How might the sufferer feel?
The sufferer is likely to go to great length to hide how they are feeling; their thoughts may make them feel ashamed, confused or embarrassed. Feelings will vary from person to person. Your loved one may experience one, all or none of the emotions listed below. The best way to find out is by talking to them. Having an idea about how the sufferer might be feeling will help you to do this in a sensitive and appropriate way.
- Angry, anxious or depressed especially if they are unable to complete their exercise regime.
- Panicked and anxious at the thought of taking a rest day.
- Feel exercise is the only way they can relax and cope with daily life.
- Distracted by thoughts of exercise and fitness.
- Irritable and restless.
- Unable to concentrate.
- Helpless and lonely.
Muscle dysmorphia
Muscle dysmorphia usually arises as a result of feeling vulnerable, having low self-esteem or from an intense dissatisfaction with body image, and more specifically with muscle size. The sufferer is likely to view themselves as small and weak despite being told otherwise. In order to increase strength and muscle size the sufferer will be driven to a rigorous exercise regime and strict diet.
How might a sufferer behave?
- Exercising regardless of injury and illness.
- Focus on a high protein diet sometimes at the expense of variety and nutrition.
- Increased spending on exercise and food supplements.
- Prioritising exercise over their social life, work or study commitments.
- Using supplement and steroids to improve performance and increase muscle mass.
- Wearing bulking clothes or multiple layers, even on warm days.
- Obsessively monitoring their progress.
- Reluctance expend energy that could be used to benefit their exercise regime.
- Withdrawn and uncommunicative.
How might the sufferer be affected physically?
- Increased muscle mass.
- Development of disproportionately large neck and shoulders.
- High blood pressure.
- Frequent injury and periods of illness.
- Disruption of sleep pattern.
- Exhaustion.
- Changes in hormone levels (specifically in men).
- Stiffness and aching limbs.
- Low body temperature.
How might the sufferer feel?
The sufferer is likely to go to great length to hide how they are feeling; their thoughts may make them feel ashamed, confused or embarrassed. Feelings will vary from person to person. Your loved one may experience one, all or none of the emotions listed below. The best way to find out is by talking to them. Having an idea about how the sufferer might be feeling will help you to do this in a sensitive and appropriate way.
- Angry, anxious or depressed especially if they are unable to complete their exercise regime.
- Preoccupied with thoughts of body image and exercise.
- Depressed and envious when comparing their body to others.
- Panicked and anxious at the thought of taking a rest day.
- Feel exercise is the only way they can relax and cope with daily life.
- Distracted by thoughts of exercise and fitness.
- Irritable and restless.
- Unable to concentrate.
- Vulnerable and lonely.
Eating Disorders Not Otherwise Specified (EDNOS)
Eating disorders are complex illnesses that can be difficult to fit into distinct categories. People that have some, but not all of the diagnostic symptoms of an eating disorder or combine behavioural characteristics of different eating disorders may be described as having an A-typical eating disorder or an EDNOS. This does not make the condition any less serious. The sufferer should still seek and receive help and support.
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Why can’t they just eat and exercise normally?
If you have never had any direct experience of an eating disorder they can be very difficult to understand. The sufferer will be putting themselves at tremendous physical risk. They are likely to experience low moods, reduced levels of concentration and exhaustion. Their work, social life and relationships will all suffer and may break down all together. All this, just because they won’t eat a balanced diet or reduce their exercise levels.
Unfortunately it is not that simple. Eating disorders are rarely about food. Far more likely, they will be centered around emotions and trigger events, that, when combined, make a person feel that they can no longer cope using their usual ways and means. These may include low self-esteem, exposure to high levels of pressure or stress, feelings of anxiety, loneliness, anger or shame or problems at university, home or work. A trigger event such as the death of a loved one or rapid change in lifestyle, such as starting university may also form significant contributing factors. In many cases the eating disorder will be used to help a person regain a sense of order and control in a seemingly chaotic life. In others it will provide a sense of achievement and confidence that may otherwise be missing. Some will find that the eating disorder provides them with a combination of the two.
When helping someone to recover from an eating disorder it is important to recognise, and try to understand, the underlying causes. Remember that it is not as easy as ‘just eating’. This will help you to provide them with the support they need.
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