Warning Signs And Symptoms

The chance for recovery increases the earlier an eating disorder is detected. Therefore, it is important to be aware of some of the warning signs of an eating disorder.

This isn’t intended as a checklist. Someone struggling with an eating disorder generally won’t have all of these signs and symptoms at once, and the warning signs vary across eating disorders and don’t always fit into neat categories. Rather, these lists are intended as a general overview of the types of behaviors that may indicate a problem.

Common Symptoms of an Eating Disorder

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Emotional and Behavioral Signs and Symptoms:¹

• Preoccupation with weight loss, food, calories, and dieting
• Refuses to eat certain foods, and often eliminates whole food groups (carbohydrates, fats, etc.)
• Makes excuses to avoid mealtimes or situations involving food
• Develops food rituals (e.g., eating foods in certain orders, excessive chewing, rearranging food on a plate)
• Withdraws from friends and previously pleasurable activities and becomes more isolated and secretive
• Extreme concern with body size and shape
• Frequent checking in the mirror for perceived flaws in appearance
• Extreme mood swings

Physical Signs and Symptoms:¹

• Noticeable fluctuations in weight, both up and down
• Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
• Menstrual irregularities — primary or secondary amenorrhea (not starting the menstrual cycle or the loss of the menstrual cycle) or only experiencing a period when taking hormonal supplements.
• Difficulties concentrating
• Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low white and red blood cell counts) though some people with eating disorders do not have any laboratory abnormalities
• Dizziness, especially upon standing
• Fainting/syncope
• Feeling cold all the time
• Sleep problems
• Cuts and calluses across the top of finger joints (a result of inducing vomiting)
• Dental problems
• Dry skin and hair, and brittle nails
• Fine hair on body (lanugo)
• Muscle weakness
• Yellow skin (in context of eating large amounts of carrots)
• Cold, mottled hands and feet or swelling of feet
• Poor wound healing
• Impaired immune functioning

Anorexia Nervosa¹

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• Dramatic weight loss
• Dresses in layers to hide weight loss or stay warm
• Is preoccupied with weight, food, calories, fat grams, and dieting
• Makes frequent comments about feeling “fat”
• Has difficulties maintaining an appropriate body weight for height, age, and stature
• Maintains an excessive, rigid exercise regime – despite weather, fatigue, illness, or injury

Learn more about anorexia nervosa>

Bulimia Nervosa¹

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• Engages in episodes of binge eating large amounts of food in a short period of time, often in secret
• After episodes of binge eating, frequently engages in compensatory behaviors such as self-induced vomiting, diuretic/laxative use, fasting/restricting, excessive exercise or manipulation of insulin dosage
• Drinks excessive amounts of water or non-caloric beverages, and/or uses excessive amounts of mouthwash, mints, and gum
• Has cuts and calluses across the top of finger joints (a result of inducing vomiting)
• Dental problems due to purging include erosion of enamel; bleeding gums/periodontal disease; temperature sensitivity; cavities; discoloration of teeth; dry mouth; enlarged parotid/submandibular glands and swallowing problems

Learn more about bulimia nervosa>

Binge Eating Disorder¹

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• Engages in episodes of binge eating large amounts of food in a short period of time, often in secret (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances)
• Feels lack of control over ability to stop eating
• Experiences shame, guilt and despair after binge-eating episodes
• Steals or hoards food in strange places
• Creates lifestyle schedules or rituals to make time for binge sessions
• 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

Learn more about binge eating disorder>

Other Specified Feeding or Eating Disorders (OSFED)¹

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• Because OSFED encompasses a wide variety of eating disordered behaviors, any or all of the following symptoms may be present in people with OSFED
• After episodes of binge eating, frequently engages in compensatory behaviors such as self-induced vomiting, diuretic/laxative use, fasting/restricting, excessive exercise or manipulation of insulin dosage
• Self-esteem overly related to body image
• Engaging in fad diets, the elimination of whole food groups, vegetarianism/veganism in service of weight loss
• Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury—due to the need to “burn off ” calories

Learn more about OSFED>

Avoidant/ Restrictive Food Intake Disorder (ARFID)^1,2,3,4

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• Although weight loss is not always present in ARFID, dramatic weight loss or faltering growth can signal restrictive eating
• Limited range of preferred foods that becomes narrower over time (i.e., picky eating that progressively worsens)
• Fears of choking or vomiting
• No body image disturbance or fear of weight gain

Learn more about ARFID>

Pica¹

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• The persistent eating, over a period of at least one month, of substances that are not food and do not provide nutritional value
• Typical substances ingested tend to vary with age and availability. They may include paper, soap, cloth, hair, string, wool, soil, chalk, talcum powder, paint, gum, metal, pebbles, charcoal, ash, clay, starch, or ice
• The eating of these substances must be developmentally inappropriate

Learn more about pica>

Rumination Disorder¹

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• Repeated regurgitation of food for a period of at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out
• If occurring in the presence of another mental disorder (e.g., intellectual developmental disorder), it is severe enough to warrant independent clinical attention

Learn more about rumination disorder>

Other Food & Behavior Concerns:
 

Orthorexia⁵

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• Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
• An increase in concern about the quality of food ingredients; an inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
• Spending hours per day thinking about what food might be served at upcoming events
• Body image concerns may or may not be present

Learn more about orthorexia>

Excessive Exercise⁶

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• Exercise that significantly interferes with important activities, occurs at inappropriate times or in inappropriate settings, or when the individual continues to exercise despite injury or other medical complications
• Intense anxiety, depression, irritability, feelings of guilt, and/or distress if unable to exercise as planned
• Exercise that is secretive or occurs despite recommendations otherwise

Learn more about excessive exercise>

Diabulimia^{7,8,9,10,11,12}

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• Increasing neglect of diabetes management; infrequently fills prescriptions and/or avoids diabetes related appointments
• Secrecy about diabetes management; discomfort testing/injecting in front of others
• Fear that insulin causes weight gain
• Restricting certain food or food groups to lower insulin dosages
• A1c of 9.0 or higher on a continuous basis, A1c lower than 6.0 on a continuous basis and/or A1c inconsistent with meter readings

Learn more about diabulimia>

Laxative Misuse^{13,14,15,16,17}

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• Mistakenly believing that laxatives will work to rush out food and calories before they can be absorbed
• Attempts to eliminate unwanted calories, lose weight, “feel thin,” or “feel empty” through the repeated, frequent use of laxatives
• Severe dehydration may cause tremors, weakness, blurry vision, fainting, kidney damage, and, in extreme cases, death. Dehydration often requires medical treatment.

Learn more about laxative misuse>