Eating Disorder Warning Signs

When Jana Christian started restrictive eating, it made her feel confident and strong.

"I fought a constant battle in my head between what I wanted — food and sleep — and what I felt like I deserved: more strenuous exercise and less food," said the Cleveland mother of two. "As I got used to the physical fatigue, severe anxiety and emotional instability kicked in to signal warning flags, which I chose to ignore."

She fought this for 15 years. It eventually left her hospitalized and fed through a tube inserted into her small intestine.

"The very thoughts that kept me motivated to control my food intake and increase the intensity of my workouts quickly turned threatening," she said. "It became a type of self-punishment, pushing my physical body to the very brink."

Many have shared Christian's struggle. Up to 24 million people of all ages and both genders in the United States suffer from anorexia, bulimia or binge eating disorder, according to a Renfrew Center Foundation for Eating Disorders report published in 2003.

While there are many causes — genetics, societal ideals, childhood trauma and peer pressure among them — prompt treatment is key to recovery.

"We know from research and clinical observation that the quicker one heals from her eating disorder, the better the prognosis," said Julie Duffy Dillon, a Greensboro, North Carolina-based registered dietitian who specializes in eating disorders. "Unfortunately, the average length of time one suffers before getting help is 13 months — too long."

Understanding the warning signs of an eating disorder may help guide you or a loved one toward obtaining help and healing.

Anorexia

Anorexia literally means "loss of appetite." This is a misnomer, according to the National Alliance on Mental Illness, because most sufferers deny their hunger pangs. To be diagnosed as anorexic, your body weight must fall at least 15 percent below your ideal range. Self-starvation, although the best-known characteristic, is merely one aspect of the disease.

"People can see it," said Michelle Cleere, a clinical psychologist and eating disorder specialist based in the San Francisco Bay area. "What people cannot see is what’s happening below the surface."

Cleere says many people with anorexia experience insecurity, depression, loneliness, perfectionism and a sense of lost control. These factors combine to form an intense fear of weight gain, a distorted self-perception and an obsession with weight control.

Like the symptoms of all eating disorders, those of anorexia typically appear and worsen gradually, then snowball into serious complications. Dillon says common warning signs include eliminating certain foods, taking only tiny bites, eating extremely slowly, showing a disinterest in social eating situations, and discomfort with spontaneous food choices.

"Eating too few calories can promote obsessive thoughts about food, irritability, insomnia, apathy, sexual dysfunction and depression," Dillon said. Consuming too few carbohydrates, she says, triggers constipation, irritability, fatigue, low muscle strength and poor sleep. Deficient protein intake can also lead to weak immune function, menstrual problems and anxiety.

The Good News

Eating disorders, although serious, can be overcome.

"Because of some amazing research and brave survivors, we have lots of tools to promote recovery," said Greensboro, North Carolina-based registered dietitian Julie Duffy Dillon.

If eating disorder symptoms are addressed early on, the National Eating Disorders Association says, secondary prevention is possible. This involves efforts and programs targeted at early identification of the illness and treatment before symptoms spiral out of control.

Dillon said the hard work required to recover from an eating disorder often results in heightened self-awareness — more so than among people without the illnesses. The person also needs an appropriate support system of treatment professionals and loved ones to increase the chances of a lasting recovery.

"Those in recovery from an eating disorder do not label food as good versus bad; (They) reject the diet mentality and actively work on respecting their body," Dillon said.

Jana Christian, a Cleveland resident who has recovered from an eating disorder, said that while it is possible to reinvent yourself, you must get outside yourself.

"Hypnosis and meditation, intuitive eating, and volunteering are all positive and cathartic coping mechanisms that force you to reevaluate your priorities and slow down the out-of-control thoughts," she said.

Bulimia

Bulimia is characterized by a repetitive cycle of binge-eating and attempts to "un-eat" ingested food. A person with the purging type of bulimia will induce vomiting or misuse diuretics, laxatives or enemas. Non-purging bulimia involves fasting or excessive exercise to control weight, and little, if any, purging. Cleere says a bulimic person may also have a persistent concern with body weight or shape and an absence of anorexia.

Common warning signs of bulimia, she says, include secrecy surrounding eating, consumption of unusually large amounts of food, and alternating between overeating and fasting. People with bulimia may also get into excessive exercising. Calluses or scars may be visible on their knuckles or hands — the result of skin grating against teeth during self-induced vomiting.

Loved ones might discover large amounts of empty food packages in the trash or notice that groceries seem to disappear from the kitchen. Dillon says bulimia sufferers may also exercise intensely for two or more hours at a time and rush to the restroom after meals.

Like anorexia, bulimia causes an intense fixation on weight control, poor body image and depression or anxiety.

Orthorexia

If your interest in healthy eating has become obsessive, you may have orthorexia, which means "fixation on righteous eating." Although not an officially recognized disorder, orthorexia causes symptoms similar to anorexia and bulimia, according to the National Eating Disorders Association. Most eating disorder experts agree that treatment is crucial.

"People with orthorexia spend a great deal of time thinking about food choices, which detracts from their quality of life," Cleere said. "They experience a lot of guilt and self-loathing if they don’t eat healthy food, and tend to socially isolate."

As with other eating disorders, thoughts and emotions underlie orthorexia symptoms, Cleere says. You may also exhibit other eating disorder traits, such as exercise obsession, anxiety or body weight fixation.

Because many popular diets encourage heavy restriction of calories or nutrient groups, such as carbohydrates, orthorexia can be mistaken for dieting.

"Many of these signs are overlooked because of what I call 'fat phobia,' " Dillon said. Society is so concerned about obesity, she says, that if a person exercises a lot, takes a long time to eat, chooses healthy foods and looks at food ingredients, it may all seem health-promoting when it is potentially harmful.

Binge Eating Disorder

Binge eating disorder, like bulimia, involves repeated binging, poor body image and depression. People with BED, however, do not purge, fast or take other measures to eliminate consumed food. They may maintain a normal weight or carry excess pounds. In some cases, BED leads to obesity.

Warning signs for BED, said Cleere, include an inability to stop eating, rapid consumption of large amounts of food, eating even when you're full, and stockpiling or hiding food to eat later. You may eat normally around others, then gorge in private or eat continuously throughout the day, with no planned meal times. Food intake for a person with BED might be described as "chaotic."

One 42-year-old woman who struggled with BED began to emerge from the chaos after a friend expressed concerns for her well-being, and she is now in the early stages of recovery.

"All she ever saw me eat was light, healthy meals, yet I gained close to 100 pounds in a year," said the woman, who asked that her name not be mentioned. "I made excuses at first ... blamed a made-up thyroid problem. When she asked me flat out if I was binging, I was so ashamed. But finally talking to someone was a relief. I felt ready to get help."