How to Recognize the Warning Signs of Disordered Eating (and What to Do)

Disordered eating covers a broad range of conditions, including anorexia, bulimia and binge eating disorder. But there’s a much larger percentage of people (5 to 20%) who struggle with symptoms that do not meet the full criteria of a problematic eating pattern.

For example, some may purge at times but not often enough to signify bulimia. Like full-blown eating disorders, these below-threshold conditions can lead to significant distress, impacting a person’s overall health and quality of life.

Regardless of type, disordered eating triggers a variety of challenges when it comes to diagnosis and treatment. Recognizing the problem is often the hardest yet most important first step. Here, Leslie Heinberg, PhD, Vice Chair for Psychology, Department of Psychiatry and Psychology, shares some vital insights on identifying and battling disordered eating.

Debunking some common misconceptions

“One of the most common misconceptions about disordered eating is that it’s a young white woman’s disease,” reveals Dr. Heinberg. “The truth is that disordered eating can affect any sex, race or age. In fact, men account for 25% of disordered eating cases.” Because doctors often overlook this possibility, men may experience delays in treatment and be enrolled in female-centric treatment programs.

Another misconception is that only underweight individuals can be diagnosed with an eating disorder. The truth is that people who have a BMI > 25 (have overweight) or a BMI > 30 (have obesity) can also develop an eating disorder and its associated health and lifestyle consequences. “All patients should be screened for disordered eating, not just those with a low BMI,” notes Dr. Heinberg.

Know the physical and emotional signs of disordered eating

The following are the most common physical signs of disordered eating:

• Significant fluctuations in weight.
• Stomach complaints and pain.
• Changes in bowel habits.
• Changes in menstrual regularity, including stopped or missed periods.
• Feeling dizzy, weak and/or tired.
• Fainting.
• Changes in skin and hair (such as being dry and brittle).
• Acid-related dental problems, including cavities and erosion of enamel (caused by bulimia).

The emotional signs of disordered eating include the following:

• Being preoccupied with weight, food, dieting, calories and carbohydrates to the point that eating and managing weight become a primary concern over other activities.
• Being preoccupied with body image, body size/shape, a specific part of the body and/or the number on the scale.
• Significantly limiting the repertoire of foods by restricting whole categories of food and only considering a very small number of foods safe to eat.
• Performing specific food rituals.
• Withdrawing from social eating activities.

The dos and don’ts of intervention

If you recognize some warning signs in yourself or a loved one, consider the following recommendations:

1. Do something fast. “Early intervention is associated with the best outcomes,” says Dr. Heinberg. “Once disordered eating becomes entrenched in a person’s daily life, it’s much harder to address. In fact, the patient may deny that it’s causing problems at all.” Patients with bulimia or anorexia often refuse to recognize that they need help.
2. Don’t let an overwhelming fear of gaining weight stop you. Most people with anorexia fear that getting treatment will mean that they have to start eating normally, which will result in weight gain and a variety of perceived horrible consequences. According to Dr. Heinberg, the starved brain tends to perpetuate this kind of irrational thinking.
3. Don’t ignore the problem and hope it goes away. “Disordered eating is a scary and upsetting topic for most people to think about,” notes Dr. Heinberg. “But that shouldn’t make you dismiss serious symptoms as a phase that will pass. That strategy doesn’t work and can delay effective treatment.”
4. Don’t give up! Do whatever you can to encourage someone with a potential eating disorder to seek professional help. Follow up on appointments as well as the milestones related to treatment and recovery.

Strategies for effective treatment

Consult your family doctor for an assessment or a referral to an appropriate specialist. There are a variety of specialists, including adolescent medicine, who are specially trained to diagnose and treat disordered eating. “Trying to address it on your own is often difficult and ineffective,” notes Dr. Heinberg.

From the beginning, having family support is associated with better outcomes for patients with disordered eating. Family-based treatments are considered the most effective in treating adolescents and young adults. However, the involvement of a support system is very helpful for patients of any age.

Understanding the long-term big picture

Dr. Heinberg reemphasizes the earlier the diagnosis and treatment, the better the chances for a positive long-term outcome. Here’s a look at statistics that reveal recovery outcomes for three common eating disorders:

• Anorexia: According to Dr. Heinberg, once anorexia has developed, about half of patients make a full recovery. About 25% continue to suffer from relapse and recovery. For the remaining 25% of patients, anorexia becomes a chronic condition. Among all psychiatric disorders, anorexia has the highest rate of mortality — with 1 in 5 deaths by suicide.
• Binge eating disorder: Of all types of disordered eating, binge eating has the best long-term outcomes. In fact, about 70% of patients experience good long-term outcomes.
• Bulimia: When it comes to bulimia, approximately half of all patients fully recover, while about 30% experience a partial recovery. Approximately 10% of bulimics experience poor long-term outcomes.