Fortunately, therapy, medical treatment and monitoring, and nutritional counseling can help people overcome eating disorders and live a healthy life. The most common eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder. Symptoms of an eating disorder vary depending on the illness.

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Common symptoms of eating a disorders are emotional, behavioral and physical as listed below;

Emotional and behavioral

• In general, behaviors and attitudes that indicate that weight loss, dieting, and control of food are becoming primary concerns

• Preoccupation with weight, food, calories, carbohydrates, fat grams, and dieting

• Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)

• Appears uncomfortable eating around others

• Food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch)

• Skipping meals or taking small portions of food at regular meals

• Any new practices with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)

• Withdrawal from usual friends and activities

• Frequent dieting

• Extreme concern with body size and shape 

• Frequent checking in the mirror for perceived flaws in appearance

• Extreme mood swings

Physical 

• Noticeable fluctuations in weight, both up and down

• Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

• Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)

• Difficulties concentrating

• Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low white and red blood cell counts)

• 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, such as enamel erosion, cavities, and tooth sensitivity

• Dry skin and hair, and brittle nails

• Swelling around area of salivary glands

• Fine hair on body (lanugo)

• Cavities, or discoloration of teeth, from vomiting

• 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

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What are the types of eating disorders?

ANOREXIA NERVOSA

• Dramatic weight loss

• Dresses in layers to hide weight loss or stay warm

• Preoccupation with weight, food, calories, fat grams, and dieting. Makes frequent comments about feeling “fat.’

• Resists or is unable to maintain a body weight appropriate for their age, height, and build

• Maintains an excessive, rigid exercise regime – despite weather, fatigue, illness, or injury

BULIMIA NERVOSA

• Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food

• Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics

• Drinks excessive amounts of water or non-caloric beverages, and/or uses excessive amounts of mouthwash, mints, and gum

• Has calluses on the back of the hands and knuckles from self- induced vomiting

• Dental problems, such as enamel erosion, cavities, discoloration of teeth from vomiting, and tooth sensitivity 

BINGE EATING DISORDER

• Secret recurring episodes of binge eating (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

• Feelings of disgust, depression, or guilt after overeating, and/or feelings of low self-esteem

• Steals or hoards food in strange places

• Creates lifestyle schedules or rituals to make time for binge sessions

• Evidence of binge eating, including the disappearance of large amounts of food in a short time period or a lot of empty wrappers and containers indicating consumption of large amounts of food

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OTHERWISE SPECIFIED FEEDING OR EATING DISORDER (OSFED) These types are not as common however are mentioned here as they should never be overlooked. Because OSFED encompasses a wide variety of eating disordered behaviors, any or all of the following symptoms may be present in people with OSFED.

• Frequent episodes of consuming very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting

• Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food

• Self-esteem overly related to body image

• Dieting behavior (reducing the amount or types of foods consumed)

• Expresses a need to “burn off” calories taken in

• Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics

AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER (ARFID)

• Dramatic weight loss

• 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

PICA

• 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

RUMINATION DISORDER

• 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

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Other Food & Behavior Concerns

ORTHOREXIA 

• 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 health of 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

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COMPULSIVE EXERCISE

• Exercise that significantly interferes with important activities, occurs at inappropriate times or in inappropriate settings, or occurs when the individual exercises despite injury or other medical complications

• Intense anxiety, depression and/or distress if unable to exercise

• Exercise takes place despite injury or fatigue

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Getting a diagnosis is only the first step towards recovery from an eating disorder.

Treating an eating disorder generally involves a combination of psychological and nutritional counseling, along with medical and psychiatric monitoring. Treatment must address;

• the eating disorder symptoms

• medical consequences

• psychological, biological, interpersonal, and cultural forces that contribute to or maintain the eating disorder.  

 

Nutritional counseling is necessary and should incorporate education about nutritional needs, as well as planning for and monitoring rational choices by the individual patient. There are a variety of treatments that have been shown to be effective in treating eating disorders. Generally, treatment is more effective before the disorder becomes chronic, but even people with long-standing eating disorders can and do recover.

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It is important that people with eating disorders seek professional help.

Eating disorder treatment can be delivered in a variety of settings. Understanding the different levels of care and methodologies can be helpful when selecting a provider depending on the stage of healing you are in;

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Treatment Process

Many people utilize a treatment team to treat the multi-faceted aspects of an eating disorder. Treatment teams commonly include the following types of providers: 

• Physician (primary care physician, pediatrician, cardiologist, etc.)

• Psychotherapist

• Dietitian

• Psychiatrist

• Additional therapists as required (yoga therapist, art therapist, etc.)

• Case manager at your insurance company (if needed)

A primary care physician, such as a pediatrician, internist, or family doctor, may have referrals to local therapists, such as myself, and dietitians who have experience in treating eating disorders, as might other specialists like adolescent medicine physicians and gynecologists. Not all areas have such clinicians available, nor are all physicians familiar with eating disorder treatment. 

 

For dangerously underweight individuals, the first step is restoring normal eating patterns and returning to a healthy body weight for that person’s individual shape and size. When someone is severely malnourished, it can be hard to make use of psychotherapy as the eating disorder interferes with a person’s ability to concentrate and change patterns of behavior. 

Although there may be exceptions, eating disorder treatment generally addresses the following factors in roughly this order: 

1. Correct life-threatening medical and psychiatric symptoms

2. Interrupt eating disorder behaviors (food restriction, excessive exercise, binge eating, purging, etc.)

3. Establish normalized eating and nutritional rehabilitation

4. Challenge unhelpful and unhealthy eating disorder and ED-related thoughts and behaviors

5. Address ongoing medical and mental health issues

6. Establish a plan to prevent relapse

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While seeking professional help is important, don’t underestimate your own role in recovery. The more motivated you are to understand why you developed an eating disorder, and to learn healthier coping skills, the quicker you will see change and healing.