Signs of an Eating Disorder You Shouldn't Ignore

Eating disorders are not occasional concerns about health, weight, or appearance. They are medical conditions that negatively affect a person's eating habits. These illnesses, which can become life-threatening in some cases, affect a person's physical and mental health.

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

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

Know the Symptoms

Some eating disorder symptoms are apparent, such as:

• Losing a lot of weight quickly
• Refusing to eat
• Regularly retreating to the bathroom for long periods after meals

However, anorexia, bulimia, and binge eating disorder may reveal themselves more subtly. In fact, a person may be very ill even if they look healthy.

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, sexual orientation, or gender experience eating disorders. While eating disorders often appear during adolescence, children and adults can also show signs of illness.

Not everyone with an eating disorder has the same symptoms, and most people with eating disorders won't display all warning signs at once. However, the following symptoms might suggest a problem.

Cooking Meals for Other People But Not Eating

Although people with eating disorders may avoid food themselves, they may be eager to see others eat. Sometimes they may go so far as to prepare meals for friends and family, without eating the meals themselves.

Studies have also found that people with negative eating habits are more likely to watch videos in which people eat copious amounts of food. Eating "through" others may be a form of vicarious pleasure.

Dry Skin

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

"Frequent purging and laxatives can seriously dehydrate you," Cynthia Bulik, PhD, founding director of the University of North Carolina Center of Excellence for Eating Disorders in Chapel Hill, N.C., told Health.

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 or the back of the hand, called Russell's sign.

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

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."

Rituals are mainly associated with anorexia (which often occurs alongside OCD). Still, they are sometimes early symptoms of other eating disorders.

"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.

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.

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 elite female athletes than among non-athletes (14% versus 5.1% respectively) in Norwegian high school students.

Here are two red flags: Does the person panic if they miss a day of exercise? 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 around other people can be related to anxiety issues. A person may think that others are watching and judging them, for instance. However, 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.

Feeling Cold

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.

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

Fine Body Hair

People who are continuously deprived of nutrition for extended periods may develop soft, downy hair—almost a thin film of fur—all over their bodies. This is called lanugo.

This type of hair growth is a physical adaptation to the perilously low weight and body fat loss seen in some people with eating disorders.

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

Poor Body Image

Negative or obsessive thoughts about body size can occur very early in the disease, noted Dr. Bulik. Those thoughts are critical in all eating disorders.

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

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

Strange Food Combinations

People who binge might prepare dishes using an odd mixture of ingredients.

Research has demonstrated that people who binge may be more likely to create unusual food concoctions. In addition, people who restrict their diets may concoct more often, largely due to cravings.

Often, this behavior occurs privately and causes a person with an eating disorder to feel ashamed. This shame and disgust might further aggravate the condition.

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 try to stay thin.

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

How to Help Someone if You Suspect They Have an Eating Disorder

Many people with eating disorders report that the support of friends and family is vital to their recovery, so you're in a unique position to help a loved one if they need it.

Reach Out to Your Loved One

Knowing the signs and symptoms of eating disorders is the first step. You'll also want to learn more about the facts and myths about nutrition, exercise, and weight.

The next step is to have a private chat with your loved one. You may want to rehearse beforehand what you plan to say.

This is when you will calmly raise your concerns about behaviors and changes you've noticed, including those that may not relate to weight and eating. The following tips may be helpful:

• Avoid overly simple solutions: Saying something like "just eat," for example, is likely to leave your loved one feeling annoyed or defensive.
• Avoid stigma: Reassure your loved one that having an eating disorder or other mental health issue is nothing to be ashamed of. Plenty of people have an eating disorder at some point in their lives, and it's possible to make a full recovery.
• Don't make rules or promises you will not keep: For example, it's best not to make statements like "I won't tell anyone" or "I'll never talk to you again if you keep doing this."
• Use "I" statements: "I" statements such as "I am worried about how often you are going to the gym" or "I've noticed you run to the bathroom after meals and I'm worried you might be making yourself throw up" are less likely to make a person feel defensive than statements like "You're exercising too much."
• Prepare for negative responses: While some people with eating disorders may feel relieved that someone has reached out, others may become hostile or dismissive. These are all normal responses. If you receive a negative reaction, then repeat your concerns, reassure them that you care, and leave the door open for future conversation.

At first, some people may feel more comfortable focusing on the side effects of their eating disorder, such as depression, social isolation, or feeling cold. This can be a stepping stone to addressing the eating disorder itself.

Offer your loved one a listening ear when they need it, and remind them of some reasons they may want to recover—for example, if they have life goals of going to college or having children.

Encourage Your Loved One to Get Help

Since treatment greatly increases a person's likelihood of recovering from an eating disorder, you'll want to encourage the person to get professional help—including therapy and medical checkups. If they don't have a therapist or healthcare provider, offer to help them find one and set up an appointment.

Ask if they would like you to accompany them to the appointment. Otherwise, follow up to make sure that they are making appointments and seeing their healthcare provider.

If all else fails, you may need to tell someone else about their symptoms. Parents and guardians of children under 18 can often require their children to receive help if they have an eating disorder. Call 911 or seek immediate medical attention if there is a medical or psychiatric emergency.

While you should regularly follow up to see how your loved one is doing and whether they are seeking or receiving treatment, they may try to avoid you if you force the topic. Make sure that your relationship doesn't revolve around the eating disorder. Help them feel included and valued by inviting them to join in activities and telling them how much you appreciate having them in your life.

Resources for People With Eating Disorders

You or your loved one can text or call the National Eating Disorders Association (NEDA) Helpline at 1-800-931-2237 for support, information, and resources. NEDA also has an online chat and can help you find treatment.

In fact, NEDA can point you or your loved one in the direction of affordable treatment options even if they don't have insurance, as well as free and affordable support options to supplement (not replace) professional help.

Let your loved one know that in times of crisis, they can text “NEDA” to 741741 to receive support from a volunteer counselor at the Crisis Text Line. Alternatively, they can text or call the Suicide & Crisis Lifeline at 988. Both of these resources are available 24/7.

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

A Quick Review

Eating disorders can harm a person's physical and mental well-being, and can even be life-threatening in some cases.

People with eating disorders are more likely to recover when they have support from friends and family. Understanding the warning signs can help you recognize whether a loved one might have an eating disorder, and allow you to offer help if needed.

If you or a loved one have an eating disorder, contact the National Eating Disorders Association (NEDA) Helpline for support and resources.