12 Signs of an Eating Disorder You Shouldn't Ignore

They can affect a person's physical and mental health. In some cases, they can be life-threatening.

Eating disorders are not occasional concerns about health, weight, or appearance. They are life-threatening medical conditions that burden the eating habits of those afflicted by the illnesses.

A person struggling with an eating disorder may become obsessed with losing weight, examining their body weight or shape, and carefully controlling their eating habits.

With treatment, people can recover from eating disorders, which is why it's essential to know the signs and symptoms of one. Here are some easy-to-overlook symptoms that can help you spot an eating disorder—or disorder in the making—sooner.

Know the Symptoms

Some eating disorder symptoms are apparent—including losing a lot of weight quickly, refusing to eat, and retreating to the bathroom for long periods after meals

But anorexia, bulimia, and binge eating disorder reveal themselves more subtly.

How can you tell if a friend or family member is at risk? There's no surefire way since people with eating disorders display many symptoms. And eating disorders affect a wide range of people.

Eating disorders can affect anyone. People of any race, ethnicity, body weight, or gender experience eating disorders. And although eating disorders typically first appear during adolescence, adults can also show signs of illness.

Poor Body Image

Negative or obsessive thoughts about body size can occur very early in the disease, said Cynthia Bulik, PhD, founding director of the University of North Carolina Center of Excellence for Eating Disorders in Chapel Hill, N.C. Those thoughts are critical in all eating disorders.

Warning signs of poor body image include negative self-talk ("I'm so fat" or "I have no self-control") and misinterpreting other people's remarks, according to Dr. Bulik.

Body insecurity, Dr. Bulik added, sometimes emerges—or becomes worse—when young people compare themselves to idealized figures, such as Disney princesses and actors.

Excessive Exercise

Dr. Bulik said that over-the-top workout habits—sometimes referred to as "exercise anorexia"—can go hand in hand with disordered eating and appear to be on the rise.

However, defining "excessive" exercise can be tricky, especially with athletes or highly active young people.

Research has suggested a higher rate of eating disorders among female athletes than among non-athletes (14% versus 3%, respectively) in high school students.

Here are two red flags: Does the person panic if they miss a day of exercise? And do they work out even when injured or sick?

"These are pretty good indices that things have gone too far," said Dr. Bulik.

Fear of Eating in Public

Feeling shy or self-conscious about eating in public can be related to body image issues—a person may think that others are watching and judging, for instance. But it can also indicate that eating, period, has become nerve-wracking.

"Eating can be enormously anxiety-provoking for someone with an eating disorder," explained Dr. Bulik. "Doing it in public just compounds the enormity of the task."

Although not wanting to eat around other people is a hallmark of anorexia, it can occur with all eating disorders. 

"Even people with binge eating disorder will eat very small amounts when in public, then binge when alone," noted Dr. Bulik.

Fine Body Hair

People who continuously deprive their bodies of nutrition for extended periods may develop soft, downy body hair—almost a thin film of fur—on their arms and other body parts.

That hair growth is a physical adaptation to the perilously low weight and body fat loss seen in some people with anorexia.

"It is a symptom of starvation and [an] attempt by the body to keep itself warm," explained Dr. Bulik.

Cooking Elaborate Meals for Others

Although people with anorexia may avoid food themselves, they are often eager to see others eat. Sometimes that goes so far as to prepare elaborate meals for friends and family. That may be a form of vicarious pleasure, or eating "through" others.

One example of a source of vicarious pleasure, since around 2015, is mukbang videos, or "eating broadcasts," on YouTube, in which people eat copious amounts of food.

Studies have demonstrated a direct correlation between mukbang videos and negative eating habits among viewers. Particularly, viewers may substitute actually consuming food with watching others eat.

Dry Skin

Dry and blotchy skin stemming from dehydration sometimes signals ongoing anorexia or bulimia.

"Frequent purging and laxatives can seriously dehydrate you," explained Dr. Bulik.

Dry skin isn't the only mark of dehydration in people with eating disorders. Dry mouth, sunken cheeks and eyes, and severe electrolyte imbalances also can occur.

Another skin change that's a telltale sign of bulimia is the appearance of calluses on the knuckles, called Russell's sign.

In 1979, psychiatrist Gerald Russell identified those calluses as the product of repeatedly scraping the back of the hand against one's teeth while inducing vomiting. 

Feeling Cold

Because of malnutrition and low body fat, feeling cold is a symptom more often associated with anorexia than with bulimia or binge eating disorder.

Frequently complaining about being cold or wearing sweaters and other heavy clothing, even in mild weather, are common tip-offs in people with eating disorders.

Body fat stores energy and helps the body withstand cold. People with too little body fat can have difficulty maintaining their body temperature and, in some cases, may even develop hypothermia.

Swollen Cheeks

Dr. Bulik explained that swelling along the jawline is primarily associated with bulimia. But it can occur with any eating disorder that includes purging.

Some people with anorexia purge to stay thin. Unlike anorexia, people with bulimia are often of average or above-normal weight.

The puffy cheeks result from swollen salivary glands (also called parotid glands). The swelling can happen at any stage of the illness and depends on the person and how often they purge, noted Dr. Bulik.

Fixating on 'Safe' Foods

A preoccupation with foods deemed to be "safe" or "healthy" is the hallmark of a condition that has come to be known as orthorexia.

Studies have noted that orthorexia is an approach to eating that "reflects a clinically meaningful, pathological obsession with eating only healthy, 'pure' foods."

Although not an official diagnosis, orthorexia can sometimes be a stepping-stone to full-blown anorexia nervosa, said Dr. Bulik.

Although people with orthorexia tend to focus on the quality of food and people with anorexia tend to focus on quantity, the two conditions sometimes overlap. Some people with anorexia, for instance, have a minimal diet and prefer to eat the same foods over and over.

"When people are going down the path toward an eating disorder, one of the early symptoms is cutting out foods they used to like, or even entire food groups," explained Dr. Bulik.

Eating Rituals

Compulsive behaviors similar to those seen in obsessive-compulsive disorder (OCD) can also appear with eating disorders. Also called rituals, some people may cut their food into tiny morsels or arrange food into specific patterns that feel "right."

Dr. Bulik explained that those rituals are "both a tactic not to eat and also a piece of the obsessionality associated with anorexia nervosa."

They are mainly associated with anorexia (which often occurs alongside OCD). Still, they are sometimes an early symptom of binge eating disorder.

"When eating disorders are starting, people will try to make it look like they are eating by cutting things up and shifting food around on the plate so as not to draw attention to how little they are eating," said Dr. Bulik.

Strange Food Combinations

Binge eaters are said to prepare dishes using an odd mixture of ingredients. Research has demonstrated that people who create their food concoctions are more likely to binge than people who overeat.

Often, this behavior occurs privately and causes the person with the disorder to feel ashamed. And often, that shame and disgust can aggravate the condition.

Summary

Eating disorders can affect a person's physical and mental health and, in some cases, can be life-threatening. If you or a loved one are coping with an eating disorder, contact the National Eating Disorders Association (NEDA) Helpline for support at 1-800-931-2237.

For more mental health resources, see our National Helpline Database.