How to Know if You Have an Eating Disorder

Understanding Eating Disorders

Eating disorders are insidious mental health conditions that affect people of all ages and demographics. They are among some of the most fatal illnesses. It’s estimated that about 9% of the U.S. population experiences an eating disorder at some point during their life. Despite common misconceptions, fewer than 6% of people with eating disorders are underweight.¹

Eating disorders fall under a few broad categories, including: 

• Anorexia nervosa: Anorexia nervosa refers to a chronic pattern of restrictive eating habits. Some people with anorexia also binge and purge in addition to restriction.
• Anorexia athletica: Also known as exercise anorexia, anorexia athletica is not an official clinical disorder. However, it’s often used to describe a subtype of anorexia characterized by frequent, obsessive exercise.
• Bulimia nervosa: Bulimia nervosa refers to patterns of binging large amounts of food and purging. Purging may include any compensatory behavior, including self-induced vomiting, laxative misuse, diuretic misuse, compulsive exercise, and fasting.
• Binge eating disorder: Binge eating disorder refers to patterns of binge eating without the same compensatory purging behaviors associated with bulimia. It’s estimated that binge eating disorder is the most common eating disorder.
• Avoidant/restrictive food intake disorder (ARFID): ARFID refers to limiting food due to anxiety, discomfort, or disinterest in eating. Unlike anorexia, however, people with AFRID do not experience distress over their body size or shape.
• Pica: Pica refers to voluntarily eating non-food items that don’t contain any nutritional value. People may experience this condition as a result of mineral deficiencies, whereas others experience compulsive drives to engage in these eating patterns.
• Purging disorder: Purging disorder refers to intentionally purging to induce weight loss. Unlike bulimia, people with this condition do not have episodes of binge eating.

Who Is at Risk of Developing an Eating Disorder?

Anyone can develop an eating disorder, but certain populations may be more susceptible to this risk. Research shows that people with eating disorders are more likely to have low self-esteem, poor body image, and histories of abuse or trauma.² They also tend to have other co-occurring diagnoses, such as depression, anxiety, PTSD, or substance use disorders.

While girls and women tend to be in the spotlight of eating disorders, it’s estimated that 25% of individuals with bulimia and anorexia are men, and upwards of half of people with binge eating disorders are men.³ In addition, although eating disorders are often considered an adolescent or young adult problem, people of all ages struggle.

Possible causes of eating disorders include:

• Family history of eating disorders: Eating disorders can be genetic and run in families, and people with these conditions are likely to have a first-degree relative with an eating disorder or pattern of disordered eating.
• Childhood trauma: Some people develop eating disorders as a way to cope with childhood trauma. Overeating, exercising, undereating, or seeking to “perfect” one’s body can be a way of establishing a sense of control.
• History of dieting: Dieting can impact satiety cues and body trust, which can coincide with eating disorder habits. Diet culture, even for seemingly benign diets, may have undertones of restriction or compensatory behaviors.
• Weight-related bullying: Bullying can have significant physical and mental health consequences. Some people develop eating disorders in response to being bullied.
• Societal messaging: Society tends to emphasize certain beauty standards, and some people develop eating disorders to best conform to those standards. Social media can increase the risk of developing an eating disorder, particularly with many people editing their photos or otherwise distorting their reality.

How to Know if You Have an Eating Disorder

Eating disorders are complex, and the line between disordered eating and eating disorders can be blurry. There are also many different types of eating disorders, each with their own eating disorder symptoms, which further complicates things. You may have an eating disorder if you have a disturbed relationship with food and exercise, as well as have a negative body image.

Eating disorders also affect one’s emotional well-being. People may be particularly anxious or irritated around mealtimes, and they might have specific rituals around food and eating. Eating disorders can also exacerbate symptoms of other mental health conditions, including depression, anxiety, and PTSD. While some people may be open about their struggles, many tend to be secretive.

Here are ten signs you have an eating disorder:

1. Difficulty Eating in Front of Others

Some people with eating disorders struggle to eat “normally” in front of others. They may avoid social settings where food is involved, and they might skip out on family meals or make excuses about just having eaten. If they do eat in front of others, there may be evidence of specific rituals (i.e. cutting food into small pieces or only eating food from certain food groups).

Others may seemingly eat normally in front of others. They will participate in meals and present as if everything is okay. This may be a way to present as if there are no problems around food. However, when they are alone, there is evidence of disordered patterns.

2. Strict Rules Around Eating

Many people with eating disorders develop rigid routines and rules around eating. For example, someone might only eat at certain times of the day. They may only eat from a selective list of safe foods. They might also follow strict caloric or macronutrient counts. Deviating from these rules often coincides with immense anxiety and discomfort.

3. Guilt or Shame Around Food or Eating

People with eating disorders often experience heightened shame or guilt around food and eating. They may feel “bad” about eating a certain type of food or “not” engaging in a specific ritual (i.e. exercising that day). These intense feelings can perpetuate more disordered habits and erode the individual’s self-esteem.

Some people also experience guilt and shame around the eating disorder itself. They may be embarrassed by their symptoms, causing them to conceal their struggles to others. The fear of “getting caught” can feel unnerving, which can explain why some people eat secretively or lie about their habits to others.

4. Compensatory Behaviors for Eating

Many people with eating disorders engage in compensatory behaviors to induce weight loss or counteract the effects of eating. Compensatory behaviors can exist on a wide spectrum, but they may include self-induced vomiting, abusing laxatives or diuretics, fasting or restricting foods, or compulsively exercising.⁴ There is often significant time and effort spent engaging in these various behaviors.

5. Body Dysmorphia

Not everyone with body dysmorphia has an eating disorder, but there is a strong relationship between both conditions. It’s estimated that over 32% of people with body dysmorphic disorder have a comorbid eating disorder.⁵ People with eating disorders may have obsessive thoughts, repetitive behaviors, and other mental acts in relation to their perceived external flaws.

6. Preoccupation With Weight Loss

Many people with eating disorders feel obsessed with losing weight. This desire can be the catalyst that first puts people on a diet and spirals into an eating disorder. The preoccupation can result in people weighing themselves multiple times a day and fixating on scale fluctuations. That said, there isn’t a number that feels “low” enough.

7. Safe Vs. Unsafe Foods

People with eating disorders often categorize foods as safe and unsafe or “good” and “bad.” Good foods feel physically and emotionally safe to eat in specific quantities. Bad foods, on the other hand, may feel emotionally triggering and may coincide with binges or intense emotional reactions. People may categorize these foods based on nutritional information.

8. Thinking About Food Constantly

Eating disorders can feel obsessive in nature, and people experiencing these conditions often report a consistent preoccupation with food and eating. They may spend a good portion of their day thinking about upcoming meals, caloric breakdowns, or other specific details about food. They might also read recipes, cook for others, or work in the food industry.

9. Lying to Others About Eating

It’s common for people with eating disorders to lie about their eating habits with others. This often has to do with shame (of what’s going on) and fear (about getting into trouble or being rejected). Some people will insist they “just ate” as a rationale for why they are not eating a meal. Others might eat normally in front of others but then engage in secretive, disordered habits when alone.

10. Others Expressing Concern About Your Eating or Weight

Eating disorders aren’t always visible, but close loved ones might pick up on certain symptoms. They may notice physical changes (weight fluctuations, increased fatigue, evidence of purging) or emotional changes (social withdrawal, irritability, increased anxiety). If people have expressed their worries about your eating habits or weight, it may indicate that you’re struggling with an eating disorder.

What to Do if You Think You Have an Eating Disorder

Coming to terms with having an eating disorder can be unnerving. While there are mixed opinions about the benefits of self-diagnosing, most healthcare professionals agree that identifying your symptoms is certainly a good starting point. Telling someone can be an essential first step. Reach out to a friend or family member who you believe might be a source of support.

You may not be able to recover on your own. That doesn’t make you weak or sick- most people benefit from having some form of professional support. Consider having a conversation with your primary care physician or scheduling an appointment with a therapist who specializes in eating disorders. Doing so can get the ball rolling on your initial recovery plan.

Treatment Options for Eating Disorders

While there isn’t a universal cure for eating disorders, people have several treatment options available to them. Depending on the type and severity of the condition, the recovery care may be multifaceted and consist of several professionals and different types of eating disorder therapies working together via a treatment team. Treatment effectiveness varies, and it’s imperative to have a personalized approach tailored to your specific condition and goals.

Treatment options for eating disorders include:

• Enhanced cognitive behavior therapy (CBT-E): CBT-E is a type of CBT specifically intended to treat eating disorders. It blends psychoeducation along with cognitive and behavioral techniques.
• Online eating disorder treatment programs: Online eating disorder treatment programs like Equip Health and Within Health offer comprehensive partial hospitalization programs (PHP) and intensive outpatient programs (IOP) programs. These structured programs may be beneficial for people with mild or moderate conditions.
• Group therapy: Group therapy for eating disorders focuses on psychoeducation, peer support, and routine accountability. It can be validating to know that you’re not alone in your struggles, and groups can provide a safe place for processing your emotions and sharing your struggles.
• Family-based therapy: Family therapy can be helpful for children or adolescents experiencing eating disorders. This treatment entails helping everyone understand the condition and maintain healthy communication habits and boundaries.
• Psychodynamic therapy: Psychodynamic therapy addresses the underlying causes of eating disorders, and it may entail working through trauma or understanding early attachment patterns. Addressing unresolved needs can help reduce eating disorder symptoms.

Questions to Ask Eating Disorder Treatment Providers

It’s important to find a qualified treatment provider who can help you manage your symptoms and support your recovery. Not every healthcare professional has expertise in this topic, so you may need to do some research to determine who’s in your local area and/or accepts your insurance. The relationship is paramount, and you want to work with someone you feel you can trust.

Questions to ask when interviewing treatment providers include:

• What is your experience in treating disorders?
• What certifications do you hold?
• Do you treat coexisting mental health conditions like anxiety and depression? How?
• How would you decide if I will require more intensive inpatient eating disorder treatment?
• What are your beliefs about people achieving a full recovery?
• What are your policies about communication between our sessions?
• What types of coping skills for eating disorders will I learn with you?
• What is your theoretical approach toward treating eating disorders?
• How do you integrate other treatment professionals like dietitians or psychiatrists into your treatment process?