What are the early signs of an eating disorder?

Often referred to as ‘the silent killer’, an estimated 200,000 people in Ireland are affected by an eating disorder, with 400 new cases each year resulting in 80 deaths annually.

Eating disorders such as anorexia nervosa and bulimia nervosa are serious mental health problems more common in women than in men.You may be diagnosed with an eating disorder if your eating habits threaten your health and happiness or that of the people who care for you.

The most common eating disorders are anorexia nervosa and bulimia nervosa. Both are serious mental health problems and anyone experiencing them needs a great deal of help and understanding.

What causes eating disorders?

Eating disorders usually have underlying emotional, stress or trauma-related causes. For example, if you are a young person, hormone changes and lack of confidence, or problems such as bullying or difficulties with schoolwork, can trigger the conditions. Refusing or bingeing on food may make you feel you have some control over your life.

Some people attribute eating disorders to media portrayal and fashion trends. It is fashionable to be slim but this is not possible for everyone, as we are naturally all different shapes and sizes. People with eating disorders very often feel that they can only ever be happy or successful if they are slim, in control.

People who develop them often experience anxiety, low self-esteem and a level of perfectionism that makes them very hard on themselves.

Anorexia Nervosa

The two most serious eating disorders are anorexia nervosa (anorexia) and bulimia nervosa (bulimia).

Anorexia is characterised by an intense fear of being obese and a relentless pursuit of thinness. Often, anorexia begins with a weight loss, resulting from either dieting or physical illness. Positive comments about the weight loss seem to encourage the person to believe that if thin is good, thinner is better. Starvation and erratic eating patterns can then become anorexia. Its symptoms include:

• A loss of at least 15% of body weight resulting from refusal to eat enough food, despite extreme hunger.
• An intense fear of becoming ‘fat’ and of losing control.
• A disturbance of perception of body image in that people may regard themselves as fat, over-estimating body size the thinner they become.
• A tendency to exercise obsessively.
• A preoccupation with determining ‘good’ and ‘bad’ foods, and with the preparation of food.
• Absence of menstrual periods.
• A significant proportion of people with anorexia will also develop bulimia.

Bulimia Nervosa

Bulimia is characterised by bingeing and purging. A person with bulimia is usually close to their normal body weight, so is less recognisable than a person with anorexia.

Bulimia often starts with rigid weight reduction dieting in the pursuit of thinness. Inadequate nutrition causes tiredness and powerful urges to binge eat. Vomiting after a binge seems to bring a sense of relief, but this is temporary and soon turns to depression and guilt.

Some people use laxatives, apparently unaware that laxatives do not reduce kilojoules/fat content, and only serve to eliminate vital trace elements and dehydrate the body. People with bulimia may experience chemical imbalances in their body that bring about lethargy, depression and clouded thinking. Its symptoms include:

• Eating binges that involve consumption of large amounts of calorie-rich foods, during which the person feels a loss of personal control and self-disgust.
• Purging attempts to compensate for binges and to avoid weight gain by self induced vomiting, and/or misuse of laxatives and fluid tablets.
• A combination of restricted eating and compulsive exercise so that control of weight dominates the person’s life.

Binge eating disorder

This eating disorder has only recently been recognised. People with binge eating disorder have episodes of binge eating in which they consume extreme quantities of food within short periods of time, and feel out of control while they are bingeing.

However, they do not make attempts to purge their food after bingeing. The binge eating can lead to serious health consequences such as obesity, diabetes, hypertension and cardiovascular disease.

Physical effects of anorexia and bulimia

The physical effects of anorexia and bulimia can be very serious, but are generally reversible if the illness is treated early. If left untreated, severe anorexia and bulimia can be life-threatening. Both illnesses, when severe, can cause:

• Harm to the kidneys.
• Urinary tract infections and damage to the colon.
• Dehydration, constipation and diarrhoea.
• Seizures, muscle spasms or cramps.
• Chronic indigestion.
• Loss of menstruation or irregular periods.
• Strain on most body organs.

Many of the effects of anorexia are related to malnutrition, including:

• Absence of menstrual periods.
• Severe sensitivity to the cold.
• Growth of down-like hair all over the body.
• Inability to concentrate and think rationally.

Emotional and psychological effects

People with an eating disorder will have difficulty with activities that involve food and deceptive behaviours related to food. This leads to loneliness, due to self-imposed isolation and a reluctance to develop personal relationships.

They may suffer severe mood swings, changes in personality,emotional outbursts and depression. Responding to early warning signs and obtaining early treatment for anorexia and bulimia is essential.

Early signs of an eating disorder

Body dissatisfaction, especially concern about weight, is the strongest predictor of eating disorders. As the person attempts to achieve the perfect weight or shape – which is actually an effort to cope with intense emotions and stress – their relationships can become difficult.

Some people show subtle, early signs of eating disorders. These may include:

Withdrawing from family or friends: Avoiding situations that cause stress or anxiety. They may isolate themselves by not participating in social functions or activities they typically enjoy.

A change in eating habits: Eating alone, hiding food, eating slowly, or cutting/separating food into tiny pieces, for example. They might fixate on food and recipes and cook for others, while restricting what they eat. There may be a pattern of eating when not hungry, eating to the point of discomfort and experiencing depression, disgust or guilt after a meal.

Body insecurity: Negative or obsessive thoughts about body size or shape. It’s also common to obsess over calories or fat content in food. Men may worry about their muscularity and feel the need to “bulk up” or lose weight.

Increased focus on body weight or shape: Focusing more than usual on dieting or weight loss, possibly with a strict or excessive exercise routine performed even when they’re injured or fatigued. They may persistently worry or complain about being fat, or feel they need to lose weight.

Changes in appearance: Significant or unusual weight loss or fluctuations may be the most obvious warning sign. They may deny having a low body weight.

Other physical signs include puffy cheeks, knuckle calluses from vomiting, hair loss, dry hair or skin, sensitivity to cold, absent or irregular menstruation, excessive facial or body hair, unusual sleep patterns, or feeling faint or tired.

How to help

If someone you care about has changed their relationship with food, is skipping meals or making excuses for not eating, adopts an overly restrictive diet and/or exercise plan, or focuses obsessively on healthy eating, please consider whether it’s an eating disorder.

Express your concerns in a forthright, caring manner. Find a safe, neutral, comforting place for both of you to talk and ask what would be most helpful. The person may deny problems, so it is important to keep the door open for future conversations. Gently but firmly encourage them to seek professional help and offer to attend the evaluation appointment with them.

Anyone of any age, gender, or background can develop an eating disorder, and if you’re worried that you or someone you know might have one, Tabor Goup is here to support you. It’s important to act quickly to ensure the best chance of recovery.

Tabor Group

Tabor Group is a leading provider of residential addiction treatment services in Ireland. We provide support and care to hundreds of clients suffering from addictions to alcohol, substances, gambling and eating disorders. For more information on Tabor Group’s services click here.