Subtle Signs of Eating Disorders
Know the symptoms
Some eating disorder signs are obvious: dramatic weight loss, a refusal to eat, retreating to the bathroom for long periods after meals. But anorexia, bulimia, and binge eating disorder also reveal themselves in more subtle ways.
How can you tell if a friend or family member is at risk? There's no surefire way, since people with eating disorders display a wide range of symptoms. (Not to mention personal characteristics: Eating disorders, once associated almost exclusively with adolescent girls, are now recognized more frequently in younger children and adults.) That said, these easy-to-overlook signs may help you spot an eating disorder—or disorder in the making—sooner.
Poor body image
Warning signs of poor body image include negative self-talk ("I'm so fat," "I have no self-control") and misinterpreting other people's remarks. "Comments like, 'My, you have filled out nicely' can be received as 'You look fat,'" Bulik says. This body insecurity, she adds, sometimes emergesor gets worsewhen young girls compare themselves to idealized figures such as Disney princesses and rail-thin actresses.
Defining "excessive" exercise can be tricky, however, especially when dealing with athletes or highly active young people. (A recent study of high school students found a higher rate of eating disorders among female athletes than non-athletes, 14% versus 3%.)
Here are two red flags: Does the person panic if they miss a day of exercise? And does he or she work out even when injured or sick? "These are pretty good indices that things have gone too far," Bulik says.
Fear of eating in public
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," Bulik says.
Fine body hair
"It is a symptom of starvation and [an] attempt by the body to keep itself warm," says Bulik, the author of The Woman in the Mirror: How to Stop Confusing What You Look Like with Who You Are.
Cooking elaborate meals for others
Similar behavior was observed in the famous Minnesota Starving Experiment, conducted in the mid-1940s. Volunteers who were semi-starved and lost more than 25% of their body weight became obsessed with food and eating. Several of the men became collectors of cookbooks and recipes, a behavior that has been noted in people with anorexia as well.
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, specifically, is the appearance of calluses on the knuckles. Know as Russell's sign (after the psychiatrist who first described it), these lesions are caused by repeatedly scraping the back of the hand against one's teeth while inducing vomiting.
Body fat stores energy and helps the body withstand cold. People with too little body fat can therefore have difficulty maintaining their body temperature, and in some cases may even develop hypothermia.
The puffy cheeks are a result of swollen salivary glands (parotid glands). The swelling can happen at any stage of the illness and depends on the person and how often they purge, Bulik says.
Fixating on 'safe' foods
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 very limited 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 signs is cutting out foods they used to like, or even entire food groups," Bulik says.
Rituals are "both a tactic not to eat and also a piece of the obsessionality associated with anorexia nervosa," Bulik explains. "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."
Strange food combinations
Often, though, this behavior takes place in private and becomes yet another thing for the person with the disorder to feel ashamed about. That shame and disgust can aggravate the disorder, the study authors write.