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Eating Disorders: Signs, Symptoms, and Treatment Steps

Eating Disorders: Signs, Symptoms, and Treatment Steps

“Everybody knows somebody.” “Be comfortable in your genes.” “I had no idea.” “3 minutes can save a life.” And most importantly, “It’s time to talk about it”.

These have all been slogans intended to raise eating disorder awareness over the years. The latter of these is the theme of this year’s National Eating Disorder Awareness Week. This week of body positivity, awareness, education, and support is an annual tradition of the National Eating Disorder Association (NEDA) and it is taking place February 26th through March 4th. The events of this week aim to help individuals, families, and communities who may be struggling with disordered eating and body image.

About Common Eating Disorders

Did you know that 10 million men and 20 million women are likely to suffer from eating disorders such as anorexia nervosa, bulimia nervosa, binge eating disorder or a specified or unspecified eating disorder in their lifetime? Or that Anorexia has the highest mortality rate of all mental illnesses?

Eating disorders are a class of diagnoses that describe unhealthy relationships with food, weight, and body image. These illnesses can have a negative impact on one’s physical health, their social relationships and their emotional well-being. Sometimes people with eating disorders, or those who show symptoms of disordered eating, may also struggle with depression, shame, guilt, or anxiety. Eating disorders, or difficulty with food and weight, impact individuals across all ages, races, genders, and socioeconomic statuses.

Eating disorders can develop as a result of biological, environment (e.g. seeing others exhibiting an unhealthy relationship with food, or dieting often) or emotional factors (e.g. having a people-pleasing temperament). If you are concerned about yourself or a loved one, you may benefit from reviewing the symptoms of common eating disorders and the warning signs written by NEDA provided below.

Anorexia Nervosa

Symptoms

  • Inadequate food intake leading to a weight that is clearly too low
  • Intense fear of weight gain, obsession with weight and persistent behavior to prevent weight gain
  • Self-esteem overly related to body image
  • Inability to appreciate the severity of the situation.
  • Binge-Eating/Purging Type involves binge eating and/or purging behaviors during the last three months
  • Restricting Type does not involve binge eating or purging

Warning Signs

  • Dramatic weight loss
  • Preoccupation with weight, food, calories, fat grams, and dieting
  • Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g. no carbohydrates, etc.)
  • Frequent comments about feeling “fat” or overweight despite weight loss
  • Anxiety about gaining weight or being “fat.”
  • Denial of hunger
  • Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate)
  • Consistent excuses to avoid mealtimes or situations involving food
  • Excessive, rigid exercise regimen–despite weather, fatigue, illness, or injury, the need to “burn off” calories taken in
  • Withdrawal from usual friends and activities

In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.

Bulimia Nervosa

Symptoms

  • Frequent episodes of consuming very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting
  • A feeling of being out of control during the binge-eating episodes
  • Self-esteem overly related to body image
  • The chance for recovery increases the earlier bulimia nervosa is detected. Therefore, it is important to be aware of some of the warning signs of bulimia nervosa

Warning Signs

  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or finding wrappers and containers indicating the consumption of large amounts of food
  • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics
  • Excessive, rigid exercise regimen–despite weather, fatigue, illness, or injury, the compulsive need to “burn off” calories taken in
  • Unusual swelling of the cheeks or jaw area
  • Calluses on the back of the hands and knuckles from self-induced vomiting
  • Discoloration or staining of the teeth
  • Creation of lifestyle schedules or rituals to make time for binge-and-purge sessions
  • Withdrawal from usual friends and activities
  • Continued exercise despite injury; overuse injuries

In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.

Binge Eating Disorder

Symptoms

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by eating in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances AND a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
  • Eating much more rapidly than normal
  • Eating until feeling uncomfortably full
  • Eating large amounts of food when not feeling physically hungry
  • Eating alone because of feeling embarrassed by how much one is eating
  • Feeling disgusted with oneself, depressed, or very guilty afterward
  • Distress regarding binge eating

Binge eating occurs, on average, at least once a week for 3 months. Binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g. purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa

Warning Signs

  • Evidence of binge eating, including the disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food
  • Secretive food behaviors, including eating secretly (e.g., eating alone or in the car, hiding wrappers) and stealing, hiding or hoarding food
  • Disruption in normal eating behaviors, including eating throughout the day with no planned mealtimes; skipping meals or taking small portions of food at regular meals; engaging in sporadic fasting or repetitive dieting; and developing food rituals (e.g., eating only a particular food or food group [e.g., condiments], excessive chewing, not allowing foods to touch)
  • Can involve extreme restriction and rigidity with food and periodic dieting and/or fasting
  • Has periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling uncomfortably full, but does not purge
  • Creating lifestyle schedules or rituals to make time for binge sessions
  • Experiencing feelings of anger, anxiety, worthlessness, or shame preceding binges. Initiating the binge is a means of relieving tension or numbing negative feelings
  • Co-occurring conditions such as depression may be present. Those with BED may also experience social isolation, moodiness, and irritability
  • Feeling disgusted about one’s body size. Those with BED may have been teased about their body while growing up
  • Avoiding conflict; trying to “keep the peace.”
  • Rigid and inflexible “all or nothing” thinking
  • A strong need to be in control
  • Difficulty expressing feelings and needs
  • Perfectionistic tendencies
  • Working hard to please others
  • Body weight varies from normal to mild, moderate, or severe obesity
  • Weight gain may or may not be associated with BED. It is important to note that while there is a correlation between BED and weight gain, not everyone who is overweight binges or has BED

Eating Disorder Treatments

Treatment for eating disorders may involve medical stabilization, nutritional counseling, or therapeutic intervention that addresses the relationship between the underlying thoughts, feelings, and behaviors that maintain the illness.

To help raise awareness, prevent eating disorders, and assist those struggling, here are some things you can do!

  • Refrain from criticizing yourself or others based on shape or weight
  • Avoid talking about “good” and “bad” foods. Focus on nourishment.
  • Provide compliments on someone’s style, personality, or skill rather than appearance
  • Learn more about eating disorders and recovery on the NEDA website
  • Complete a brief eating disorder screening for yourself or a loved one
  • Participate in an awareness walk
  • Educate your friends and family
  • Eat meals together
  • Identify “non-scale victories” or indicators of health and wellness other than weight
  • If you want to address your concerns with a loved one, do so in a calm, supportive way
  • Remember, eating disorders are not choices or lifestyles. They’re illnesses
  • Do not try to force, manipulate or bargain someone into eating
  • Encourage those who may be struggling to seek help
  • Be a role model to others and decrease your own risk for mental illness by attending to your own physical, mental and emotional needs

Eating disorders are serious mental illnesses but help and healing are available! While Fairmount Behavioral Health System does not have a specific treatment program for eating disorders, our facility offers clinicians trained in therapeutic, evidenced-based interventions for eating disorders. We have resources to provide treatment to those struggling with food and weight and associated conditions, as well as a desire and ability to help individuals find appropriate resources for recovery.

Erin Hopkins, M.A.


References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C: Author.
National Eating Disorder Association (2016) Learn. Retrieved from http://www.nationaleatingdisorders.org/learn

Here to Assist You 24/7

If a psychiatric disorder or chemical dependency affects you or a loved one, please call 215-487-4100. We are available 24 hours a day, seven days a week to perform no-cost assessments and answer questions on programs and admissions.