Living: Recognizing an Eating Disorder

February is Eating Disorder Awareness Month, drawing attention to a disease that can often be difficult to identify, especially early on. What follows is valuable information regarding both symptoms and statistics, information that could be the first step in helping someone get much-needed help.


In my profession, there are few diagnoses that have a mortality risk. Major depression and eating disorders are two. I don’t treat people who have eating disorders, though I do treat people with various kinds of depression. I refer individuals who suffer from eating disorders — such as bulimia, anorexia, or binge eating — to therapists who specialize in these treatments.

Eating disorders were once primarily associated with teenage girls, but they are now also associated with young adults and younger children.

Most often the signs of an eating disorder are obvious: noticeable weight loss; eating very little food at meals; tooth enamel decay; dry skin; and retreating to the bathroom after meals. I imagine you’ve likely seen photographs of teenage girls so emaciated you can count their ribs and see their hipbones and elbow joints. It is heartbreaking, and you wonder immediately what has gone wrong.

But what about people who suffer from eating disorders that aren’t so obvious? They look fine and seem to be healthy. For instance, bulimics often maintain normal weight due to the purging associated with the disorder. So, how can you tell if a friend or family member has an eating disorder? What are the symptoms to look for?

Poor body image is a marker for possible eating issues. When you hear someone talk a lot about his or her body in negative terms, take note. He or she may often say things like, “I just hate my hips. They’re huge.” And, “I look fat no matter what I wear” or “I think I look bloated and miserable.”

Excessive exercising is another possible sign. Many who have eating disorders use exercising, rather than vomiting, as a way to purge the food they’ve eaten. These folks will run miles a day, spend hours working out, and allow almost nothing to interfere with their routines.

Eating in public is another no-no for many with eating disorders. They often think others are critically watching their eating behaviors. Also, if they cannot control the ingredients in the food they’re eating, they often obsess about fat and carb content. And, if forced to eat out, they will frequently move food around or cut it up on their plates to make it look as if they’re eating, when in truth they may have only taken a few bites.

A preoccupation with safe foods, called orthorexia, is often a precursor to anorexia. While not an official diagnosis, those with orthorexia are highly concerned with the quality of food, only eating what they know to be healthy and free of “bad things,” such as fat, calories and sugar. People with anorexia focus more on quantity, though they, too, generally have very limited diets and eat the same “safe foods,” over and over.

People with eating disorders are also generally malnourished and have low body fat, which makes them cold, and you will see them almost always in long sleeves and layers of clothing. While trying to keep their body temperatures normal, they are often aware that others think they look “too thin” and don’t want them to see their arms or legs.

Another appearance-oriented indication of anorexia or bulimia is dry and blotchy skin, which stems from dehydration due to frequent purging and the use of laxatives. In bulimics, there may be calluses on the knuckles caused by frequently induced vomiting. Also, swelling along the jaw line may indicate bulimic behavior. In fact, it can be a sign of any eating disorder in which there is regular purging. Swollen cheeks, resulting from enlarged salivary glands, are also a sign of purging behavior. One of the most noticeable physical signs of an eating disorder is a symptom called Lanuga, which is a soft, downy growth of body hair on arms and other parts of the body. It’s like a very fine film of fur that grows on the body to compensate for low body fat and lack of nutrition; it’s the body’s attempt to keep warm and is an indication of starvation.

Eating disorders affect up to 30 million people of all ages and genders in the United States. While women are much more likely than men to develop eating disorders, each case is serious. Mortality rates for anorexia nervosa, for instance, are about 4 percent and almost that high for bulimia nervosa. The mortality rate for eating disorders not otherwise specified is about 5.2 percent; these rates are not particularly reliable, however, because those who suffer and die from eating disorders may ultimately die of heart or organ failure, malnutrition or suicide.

If you think you have an eating disorder or if you think one of your friends, colleagues or a family member might be afflicted, please seek treatment. Start a dialogue. As discussed, eating disorders can be deadly and should not be ignored. Luckily, there are good treatments, and people do recover.

As always, the first step is to admit there is a problem. Then healing can begin.




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