Six Signs to Assess an Eating Disorder

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February may have been Eating Disorder Awareness Month, but the fact is that millions of people suffer from the psychological, emotional, and physical effects of anorexia, bingeing, bulimia, and exercise bulimia all year round so it’s important to keep a spotlight on the issue. We know these behaviors are debilitating for those who engage in them. But it’s important to acknowledge loved ones who also struggle. They can feel confused about whether or not the problem is serious. Oftentimes, symptoms and behaviors are rationalized and minimized by the person who engages in them. I’m often asked if there are signs to look for to help assess for the severity of the problem.

1. Secrecy and isolation are big red flags.

Sadly, there is a lot of guilt and shame attached to these behaviors so they tend to be done in private. Someone who is struggling with an eating disorder may attempt to eat “normally” in the presence of others, and then look for opportunities to be alone to find ways to binge or purge. These behaviors can take up hours of time, so people who do them tend to isolate more, make excuses and turn down opportunities to spend time with friends and family — especially when the gatherings involve food — and wind up spending more and more time alone.

2. Anger and being on the defensive.

Anyone who is has an eating disorder is very invested in maintaining the thoughts and behaviors that fuel it, so when a loved one expresses concern they may be met with anger or defensiveness. The behaviors might get downplayed or even flat out denied by the person who is trying to sustain them.

3. Disparity between what is and what is not real.

If there is a big disparity between the eating disordered person’s perceptions about their weight, eating and exercise habits, and body image, and loved one’s perceptions, that can be a significant red flag, too.

4. An increase in anxiety and irritability or depression.

The person restricting calories, bingeing, purging, or excessively exercising may become anxious about getting caught or irritable when accusing a loved one of being unfairly suspicious or “controlling.” It is also easy for the individual to become irritable when they haven’t taken in enough calories. Symptoms of depression including sleep disturbance, excessive guilt, feelings of helplessness or hopelessness and loss of interest in activities that used to be pleasurable, can be the byproduct of feeling trapped or stuck in a behavior that they know on some level is harmful to them.

5. Hide weight loss and restriction of food

When looking specifically at anorexia, people who restrict will obviously begin to lose weight, wear baggier clothing to hide it, move their food around on the plate but not eat it, chew food and spit it out. As a result, girls and women are likely to lose their periods as the hormone that is needed to menstruate is stored in fat cells and food with fat is typically eliminated from the diet.

6. Overspend on and hide food.

In the case of bingeing, food bills go up, food is often hidden, empty wrappers are found in unlikely places, and food keeps disappearing from the pantry. People who are purging tend to go to the bathroom immediately after eating, and use breath mints and bathroom spray to cover the odor of vomit. They get scarring on the finger they bite down on to do self-imposed vomiting and tend to develop dental problems as well.

In all these scenarios, the body is being abused and serious medical and mental health consequences ensue. When it’s clear that the issue warrants professional attention, loved ones can still feel helpless in their attempts to intervene. But if you suspect a loved one is engaging in an eating disorder- express your concern lovingly and without anger, identify the specific behaviors that worry you, and encourage them to get the support they need and deserve by making resources available to them.