Eating Disturbances

• Behaviors and attitudes that indicate that weight loss, dieting, and controlling food are primary concerns.
• Preoccupations with weight, food, calories, carbohydrates, fats, and dieting.
• Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g. carbohydrates).
• Sense of discomfort eating around others.
• Food rituals/rules (e.g. eating only a particular food or food group, chewing excessively, not allowing foods to touch).
• Skipping meals or eating only small portions at regular meals.
• New practices with food and/or fad diets, including cutting out entire food groups; high frequency of these practices.
• Withdrawal from usual friends, activities, and social engagements. 
• Extreme concern with body shape and size, often manifesting as frequent “body checking” (examining oneself in the mirror for perceived flaws, etc.)

• Noticeable fluctuations in weight, both losses and gains.
• Stomach cramps and/or other nonspecific gastrointestinal complaints (e.g. constipation, acid reflux, etc.)
• Menstrual irregularities — missing periods, only having a period while on hormonal treatment
• Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low white and red blood cell counts)
• Difficulties concentrating
• Dizziness (especially upon standing), fainting, feeling constantly cold, sleep problems, dry skin and hair, brittle nails, fine hair growth on the body (lanugo), muscle weakness, yellow skin, cold/mottled hands and feet, swelling feet, poor wound healing, impaired immune functioning.
• Effects of frequent vomiting: cuts/calluses across the top of finger joints, dental problems (enamel erosion, cavities, tooth sensitivity, discoloration of the teeth), swelling of the salivary glands.

Anorexia nervosa is an eating disorder characterized by weight loss, difficulties maintaining an appropriate body weight, distorted body image, and usually manifests as a major restriction of calories and types of food eaten. Those suffering from anorexia nervosa also often experience an irrational fear of gaining weight. Some specific symptoms/warning signs of anorexia nervosa include:

• Dramatic weight loss
• Dressing in layers to hide weight loss and/or stay warm
• Preoccupation with food, weight, calories, fat grams, dieting; sometimes accompanied by frequent comments about feeling/being “fat”
• Resisting or unable to maintain an appropriate body weight
• Maintaining an excessive or rigid exercise regime, depiste weather, fatigue, illness, and/or injury

Bulimia nervosa is an eating disorder characterized by a life-threatening cycle of bingeing and behaviors engaged in to compensate for the over-consumption of calories, such as self-induced vomiting or ingesting laxatives. Some specific symptoms/warning signs of bulimia nervosa include:

• Evidence of binge-eating, including disappearance of large amounts of food in short periods of time.
• Evidence of purging behaviors (frequent trips to the bathroom following meals, signs/smells of vomiting, packages/wrappers of laxatives or diuretics)
• Drinking excessive amounts of water or non-caloric beverages and/or heavy use of mouthwash, mints, and gum
• Cuts/calluses on the backs of the hands, dental problems

Binge-eating disorder is an eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly or to the point of discomfort), feelings of loss of control during the binge, feelings of distress/guilt/shame following the binge, but without the presence of compensatory behaviors like those seen in bulimia nervosa. Specific symptoms/warning signs of binge-eating disorder include:

• Secret recurring episodes of binge eating accompanied by a feeling of a lack of control over ability to stop eating
• Feelings of disgust, depression, guilt, or low self-esteem after overeating
• Stealing or hoarding food in strange places
• Creating lifestyle schedules or rituals to accommodate or make time for binge sessions

Orthorexia refers to an obsession with proper or “healthful” eating which can quickly become a fixation that can actually damage the individual’s well-being. Orthorexia has been found to be closely related to obsessive-compulsive disorder. Some specific symptoms/warning signs of orthorexia include:

• Cutting out an increasing number of food groups
• An increase in concern about the health of ingredients, an inability to eat anything but a narrow group of foods deemed “healthy,” “pure,” or “safe”
• Spending hours thinking about what food might be served at upcoming events

• The first step toward treatment can be deciding to share your concerns about your eating behaviors with someone you trust. It is never too early to reach out for concerns surrounding disordered eating, and there is no “threshold” of disordered eating behaviors that must be reached before someone can seek help. If you notice that disordered eating habits are affecting and interfering with your life, it’s important to talk to someone.
• If you’ve recognized these behaviors in yourself, that’s already a crucial first step toward a happy and balanced life. More importantly, you do not have to address and handle these behaviors alone. Telling someone you trust can provide comfort, support, and direction in recovery.
• If you’re ready to reach out to someone, the following guidelines might help make the conversation easier:
  • Identify someone you trust and are comfortable sharing with, like a family member, friend, professional counselor, or nutritionist. 
  • Set aside a specific time to speak with the person, and try to find a private, comfortable space without other people or distractions.
  • Explain your thoughts, feelings, and behaviors with as many details as you feel comfortable sharing. 
  • Remember that the person you’re talking to might not understand right away. There are other places you can turn to for support, like the NEDA Helpline, ANAD Online Support Groups, and 18percent. 
  • Remind them (and yourself) that recovery is a gradual process and won’t happen overnight. Patience, understanding, and support are what matters along the way.

• Learn as much as you can about eating disorders: reading books, articles, and brochures will help you know the difference between facts and myths as well as help you reason with your friend about any inaccurate ideas and beliefs that may be fueling their disordered eating patterns.
• Rehearse what you want to say: opening a conversation like this can be scary, even with someone you’re close to. Going over what you want to say ahead of time might help reduce anxiety.
• Consider reaching out to a professional for guidance on how to have this conversation and to get your own support. Contact HES (202-687-8949) or CAPS (202-687-6985) to discuss how to help a friend.
• Find a private place and set a time to talk: no one wants to talk about their personal issues in front of other people.
• Be deliberate and honest in your conversation: be honest, talk openly about your concerns, use “I” statements (point out what you’ve personally observed), stick to the facts rather than letting emotions take over, and be caring but firm.
• Remove potential stigma: remind your friend that they shouldn’t be ashamed to admit that they’re struggling with an eating disorder or other mental health issue.
• Avoid overly simplistic solutions: it doesn’t help to say “just stop,” or “just eat.” These issues are much more complex, and these solutions can leave your friend feeling frustrated, defensive, and misunderstood.
• Be prepared for negative reactions: all people struggling with eating disturbances respond differently to someone noticing that they’re struggling. Be prepared for your friend to become angry or hostile, to brush off your concerns, or to minimize potential dangers.
• Encourage them to seek professional help: many people struggling with disordered eating need professional help to start recovering. Offer to help your friend find a professional, or even attend the appointment as moral support. If you’re worried about your friend’s safety and/or offering support on your own, tell someone else who can help you determine next steps.
• Showing concern is important: even if you feel like the discussion didn’t go well, know that your concern and care still made an impact. You may have planted the seed for them to seek out professional help. Ask if you can check back in with them later on.