Eating Disorders: Signs & Symptoms

What Are Eating Disorders?

Eating disorders are characterized by ongoing disturbances with food, body weight, self-esteem and control. These conditions are complex, and they transcend mealtimes and much more than “just about food.” Associated thoughts and feelings cause significant distress in one’s emotional well-being.¹ In severe cases, eating disorders can be fatal, and it’s estimated that they have the highest mortality rate of any mental illness.²

Unfortunately, even though they are largely misunderstood and stigmatized, eating disorders are common. According to recent eating disorder statistics, more than 28 million Americans will experience an eating disorder at some point in their life. While anyone can develop an eating disorder, the onset of symptoms usually occurs during adolescence or young adulthood.

Types of Eating Disorders

Common eating disorders include:

• Anorexia nervosa: Anorexia refers to a pattern of chronic food restriction and an intense fear of gaining weight. A person with anorexia typically has distorted views of their body, despite being underweight.
• Bulimia nervosa: Bulimia refers to cycles of bingeing and purging, where people consume large amounts of food quickly before attempting to “purge” themselves of calories. Eating disorder compensatory behaviors may include vomiting, laxative or diuretic abuse, or excessive exercise.
• Binge eating disorder: Binge eating disorder refers to consistent patterns of bingeing large amounts of food. Unlike bulimia, people with binge eating disorder do not regularly purge after a binge.
• Pica: Pica refers to consciously consuming non-food items, such as clay, dirt, paint, chalk, or other chemicals. Pica is most common in young children and pregnant women, and people do not consume these items to control weight or restrict calories.
• Avoidant/restrictive food intake disorder: ARFID refers to one severely limiting food intake, or failing to eat enough to meet nutritional needs. People with ARFID usually have phobia-like symptoms when eating, and many indicate that they have no interest in food.
• Rumination disorder: Rumination disorder refers to periods of regurgitating previously-chewed food before re-swallowing it or spitting it out. This can occur during infancy or childhood, and may disappear on its own.
• Other specified feeding/eating disorder (OSFED): OSFED refers to patterns of disordered eating that do not meet the full diagnostic criteria for another eating disorder. For example, those with OSFED may binge and purge occasionally, purge without binge eating, or exhibit symptoms of atypical anorexia (severe food restriction without being underweight).

Signs of an Eating Disorder

Some eating disorder signs can be challenging to understand or notice, and you may wonder how to know if you have an eating disorder. Symptoms of eating disorders occur on a spectrum, and many people try to conceal their habits due to shame or fear of getting in trouble for their behavior. That said, obsessive food rituals, chronic “diet talk,” skipping meals, frequent body-checking, or weight fluctuations may indicate an eating disorder.

Physical signs of an eating disorder may include:

• Extreme weight loss or weight gain
• Fainting
• Dizziness
• Dry skin
• Brittle or dry hair
• Dental erosions
• Gastrointestinal distress
• Chronic upper respiratory infections
• Fine hair growing on the body

Behavioral and mental health signs of an eating disorder may include:

• Preoccupation with calories or nutrition
• Skipping meals
• Only eating certain foods/food groups
• Displaying anxiety around eating
• Patterns of binge eating or emotional eating
• Presence of laxative abuse
• Frequent body-checking behaviors
• Wearing loose or baggy clothing
• Lying about food consumption
• Exercising excessively

What Are Common Eating Disorder Symptoms?

Eating disorder symptoms vary depending on the type of eating disorder someone has. However, there tend to be some visible trends throughout. Most people with eating disorders have a negative image of themselves, struggle with perfectionism, and seek to gain control in their life by monitoring food intake.

Anorexia Symptoms

People with anorexia intentionally and chronically restrict food. Eating often coincides with immense anxiety, and someone with this condition will have a pervasive fear of gaining weight or “losing control.” People with anorexia typically have low self-esteem and poor body image. While restriction is the main feature of anorexia, some people also binge and purge.

Common symptoms of anorexia include:

• Low body weight
• Distorted body image or body dysmorphia
• Preoccupation with gaining weight
• Anxiety when having to eat “fear foods”
• Rituals around eating
• Refusal to eat
• Flat mood or apathy

Bulimia Symptoms

A person with bulimia experiences patterns of bingeing and purging their food. A binge refers to eating a large amount of food very quickly (and often secretly), and purging is an attempt to block caloric absorption afterwards. Someone with bulimia may purge in a number of ways, which can lead to substantial and sometimes severe health effects.

Common symptoms of bulimia include:

• Recurring episodes of binge eating
• A strong need for control
• Swollen cheeks or jaw line
• Complaints of gastrointestinal problems
• Dental problems

Binge Eating Disorder Symptoms

People with binge eating disorder eat large amounts of food chronically and consistently. During these episodes, they experience a loss of control and a sense of helplessness when eating. However, unlike bulimia, people with binge eating disorder do not engage in purging behaviors.

Common symptoms of binge eating disorder include:

• Gradual or rapid weight gain
• Feelings of shame regarding eating behaviors
• Gastrointestinal problems
• Fatigue

Symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID)

People with ARFID restrict food regularly, because they dislike eating, or fear the risk of choking or consuming food they don’t like. Unlike many other eating disorders, ARFID does not inherently coincide with poor body image or a fear of gaining weight. ARFID tends to emerge in childhood; autism and a history of severe picky eating are common risk factors.

Common symptoms of ARFID include:

• Weight loss (or failure to gain weight as a child)
• Nutritional deficiencies
• Consistently reporting having no appetite
• Reported fears of choking or getting sick
• Extreme difficulties with certain food textures

Pica

Pica is characterized by consuming specific non-food items that lack any nutritional value. Pica may stem from mineral or nutritional deficiencies, but the compulsion to eat certain items may also mimic symptoms of OCD. Common examples of pica include the consumption of chalk, batteries, erasers, animal droppings, cigarette ash, glue, soap, and clay.

Common symptoms of pica include:

• Weight loss (or failure to gain weight as a child)
• Nausea and vomiting
• Constipation or diarrhea
• Strange or odd cravings
• Severe mineral deficiencies
• Lead toxicity
• Shame around eating habits

Rumination Disorder Symptoms

Someone with rumination disorder routinely regurgitates food. They typically engage in patterns of re-chewing, re-swallowing, or spitting out meals. These behaviors are not due to specific medical conditions or occur within the course of another eating disorder. Regurgitation may have something to do with weight control, but that isn’t one of its defining features, particularly when it presents in childhood.

Common symptoms of rumination disorder include:

• Frequently regurgitating and re-chewing food
• Dental problems
• Gastrointestinal distress
• Weight loss (sometimes may be unintentional)
• Chapped lips

OSFED Symptoms

People with OSFED exhibit disordered eating and behavioral patterns, without meeting the full criteria for other eating disorders. However, this does not mean the disorder is any less serious or problematic.⁴ Unfortunately, many people with OSFED do not get the help they need.

Common symptoms of OSFED include:

• Bulimia or binge eating behaviors of low or limited frequency
• Caloric restriction or fasting
• Orthorexia (extreme focus on “clean” eating)
• Preoccupation with exercise
• Purging without bingeing
• Displaying all anorexic symptoms, without being underweight
• Recurrent episodes of nighttime eating (without remembering it)

What Causes an Eating Disorder?

Experts haven’t pinpointed a single cause for eating disorders. Instead, they examine the complex interaction of various genetic and environmental factors. While no particular variable likely causes an eating disorder, some variables may increase someone’s risk of developing one.

Possible risk factors for eating disorders include:

• Family history of eating disorder: Certain conditions appear to run in families, and research shows there might be a genetic component to eating disorders, related to serotonin and opioid receptors.⁵
• History of obesity: Research shows that obesity can coincide with disordered eating behavior patterns. Moreover, pediatric obesity is a risk factor for developing an eating disorder.⁶
• Diet culture: Diet culture can play a role in influencing how people think about their bodies, food, and weight. Societal messages may inadvertently influence eating disorders.
• History of dieting: Crash or sporadic dieting may increase the risk of developing an eating disorder.
• Certain sports/recreational activities: There are high rates of eating disorders among athletes. This risk appears to be higher in ‘lean’ sports, such as gymnastics or dance,  where a “lean” body is believed to provide an advantage for competitors, sometimes leading to what is known as anorexia athletica.
• Themes of perfectionism: Perfectionism is a common risk factor in the development of an eating disorder. When a person wants to behave “perfectly,” this mindset can cause the infamous all-or-nothing thinking associated with eating disorders.

When to Seek Professional Help for Eating Disorders

Most eating disorder specialists recommend preventative care or early intervention when it comes to treatment. Even people struggling with mild signs of disordered eating may benefit from seeking support. Disordered eating may look like crash dieting, going on excessive fasts, using appetite suppressants, or frequently thinking about food.

Disordered eating may not meet the full criteria for an eating disorder, but these behaviors and beliefs can progressively worsen when left untreated. If your thoughts and feelings about food interfere with other parts of your life (your relationships, self-esteem, work, academics, etc.), it may be beneficial to seek professional treatment.

Treatment for Eating Disorders

Eating disorder treatment varies based on the individual and the severity of the condition. When seeking care, it’s essential to prioritize finding a therapist who specializes in eating disorders. You can start by searching for one in an online directory, or you can find help through an online program like Equip Health. If you are concerned about a loved one, encourage them to seek professional help. If you aren’t sure where to start, contact the NEDA Helpline via chat, text, or call; they can direct you to the right resources.⁷

Therapy for Eating Disorders

Research shows that therapy can be beneficial in the treatment of eating disorders. It’s important to feel comfortable sharing your thoughts and feelings with your provider. Even though you may worry about being judged, your therapist will want to help support and guide you into recovery.

Therapy options for eating disorders include:

• Exposure therapy: Exposure therapy can help you confront your fears regarding food and eating. Your therapist will gradually “expose” you to certain distressing stimuli until you feel more comfortable around them.
• Enhanced cognitive behavioral therapy (CBT-E): CBT-E focuses on disrupting and changing variables that maintain an eating disorder. You will receive helpful education and specific tips for managing your symptoms.
• Dialectical behavior therapy (DBT): DBT for eating disorders helps a client improve their emotional regulation and distress tolerance. It also introduces concepts of mindfulness, which can be helpful in reducing anxiety around food.
• Acceptance and commitment therapy (ACT): ACT teaches a client how to practice more mindfulness and acceptance of their feelings. This therapy supports living life meaningfully and authentically, regardless of one’s current situation.
• Family therapy: Family therapy, like the Maudsley method, can be beneficial when a child or adolescent experiences an eating disorder. This treatment helps the whole family provide support and avoid enabling together.
• Group therapy: Eating disorder group therapy can be beneficial for providing validation, resources, and support. In these types of settings, group attendees can see and understand that they’re not alone in their struggles.

Hospitalization & Residential Clinics for Eating Disorders

In the case of severe eating disorders, someone may need hospitalization for their eating disorder to manage their acute symptoms. This may be due to severe dehydration, malnourishment, or psychological distress (such as when a person feels actively suicidal). Hospitalization provides monitoring and nutritional stabilization.

Inpatient or residential treatment may be advised for some more moderate or severe eating disorders. These facilities offer 24/7 structure, support, and supervision. People may benefit from these programs if they did not respond well to outpatient care, or if they continue to relapse. These facilities tend to implement a combination of individual and group therapy, along with nutrition and psychiatry support.

Eating Disorder Medications

Sometimes, medication may be incorporated as part of a treatment plan. There are no FDA-approved medications for anorexia; however, certain antidepressants and antiepileptics can help those with bulimia or binge eating disorder. Likewise, treating the underlying anxiety or depression (via medication) may reduce some of the eating disorder symptoms.⁸

How to Help Someone With an Eating Disorder

It’s important to be proactive when trying to help someone with an eating disorder. Loved ones can be influential in providing support and reassurance. Aim to be compassionate and open-minded. Trying to shame someone into acting differently or accusing them of seeking attention will inevitably backfire.

Here are some ways to help a loved one with an eating disorder:

• Educate yourself: Learn about eating disorders so you can better understand how your loved one is feeling.
• Be patient: Remember that change takes time, and the thought of recovery often feels frightening for those facing it.
• Offer support: Aim to be a safe person for your loved one. If they talk to you about how they feel, try to be empathic and kind.
• Encourage treatment: Help your loved one secure treatment. Offer to look for doctors or therapists with them.
• Be mindful of your own habits and behaviors: If you struggle with any disordered eating or problematic habits, consider getting your own support. You may be inadvertently affecting your loved one.
• Practice self-care: You cannot control how your loved one responds, but it’s still important to take care of your own needs and well-being by practicing self-care.