When I first developed an eating disorder, I didn’t realize that I had one. I was experiencing a bad flare-up of my fibromyalgia and irritable bowel syndrome (IBS). I got sick each time I ate, and developed a fear of food in the process. I eventually decided to “clean up my diet,” trying to eliminate all foods that triggered symptoms.
Pretty soon, I had just six foods in my diet, ate only once a day, and exercised non-stop—all in the name of better health. I was also irritable, rigid about my routine, and losing weight rapidly. My parents finally pointed out that I was starving myself with too few calories, and I began to eat more and exercise less. However, my eating was still disordered for years. Since the eating disorder was cloaked in my medical conditions, it took me a long time to parcel out what had happened to me.
At the time of my eating issues, I didn’t know how complex eating disorders could be. And, judging by their comments at the time, neither did my family and friends. Everyone seemed to focus on my weight, my weight, my weight. But no one brought up my behaviors, like the regimented way I ate, or how I obsessed over certain foods.
The truth is, eating disorders can be tricky to recognize and diagnose. Signs of an eating disorder aren't always obvious, which can make it hard to help a friend or loved one whom you may suspect has a problem. In addition, many people are familiar with the signs of eating disorders such as anorexia and bulimia, but less familiar with disorders such as orthorexia (obsessive compulsion with healthy foods or diets), compulsive overeating, or compulsive exercise.
If you get that nagging feeling in your gut that a friend or family member is struggling with an eating disorder, don't brush it off. An honest, compassionate conversation could be the spark that your friend needs to get professional help.
One of the best things you can do is non-judgmentally observe your loved one's behavior. For example, you've noticed that they only eat three specific foods, or that they exercise for two hours every day. It may take a few times to get through to someone, but consistently remind your friend that you’re there for them, Claire Mysko, CEO of the National Eating Disorders Association (NEDA), tells SELF. Don’t just drop it.
Here are some of the subtle behaviors that you may notice if a friend or loved one has an eating disorder.
Some of the most noticeable signs of an eating disorder are changes to a person’s regular routine. For example, a friend who used to be up for anything suddenly doesn’t want to come to group functions, always has to hit the gym, and may seem down or easily agitated. “There is a close link between eating disorders, and anxiety and depression,” says Mysko. “You will notice a disruption in relationships and social engagement first. You’ll generally feel a new disconnect with them.”
According to Beth Riley, executive director of Eating Recovery Center, The Carolinas (ERC), someone with an eating disorder may add a lot of condiments to their food—more specifically, condiments that have the most flavor for the least calories. This may include vinegar, lemon juice, hot sauce, salsa, and pepper. Obviously loving salsa doesn’t automatically signal an eating disorder, but this can be a small sign that, when combined with other eating disorder symptoms, may signal a bigger problem.
It’s tough in this day and age to separate “healthy habit” from “obsession.” However, Riley has coined the term “steporexia” to explain someone who is obsessed with fitness-related health. This person will never go anywhere without her fitness tracker, never skip a workout, and push their limits until they break.
Over-exercise coupled with a lack of nutrition temporarily changes the neurochemistry of the brain, and "the person becomes more obsessive,” Riley says. The profile of this eating disorder is typically type-A, overachieving, and perfectionistic. Again, simply enjoying tracking workouts doesn't mean a friend has an eating disorder. It’s when it becomes an obsession—and part of a larger problem with compulsive or excessive exercise—that it warrants concern.
Most of us probably don’t think about the calories in gum, breath mints, or even bite-sized food items, but someone with a restrictive eating disorder likely would. They might inquire about the calories or check the labels on even the smallest items—or they might flat-out refuse that stick of gum in an effort to avoid the calories.
Take note if your friend suddenly becomes unusually meticulous about her eating routine. “You may notice she only eats at certain times, only uses certain bowls and certain utensils, in addition to eating food only she prepares herself,” says Riley. You might also notice this person cutting up all food into tiny pieces, or ripping it into parts. These are part of the compulsive nature of many eating disorders.
Riley says some people with eating disorders can be found pulling and pinching their skin to check for excess fat. They can also become obsessed with eliminating fats from the diet, or only eating specific fats they deem acceptable. “Perhaps only avocado, nuts, and certain oils,” says Riley. (For the record, fats are a healthy—and, in fact, necessary—part of a balanced diet.)
Be alert for someone who shows other symptoms of anorexia or orthorexia after beginning a fad diet. Claiming to be vegan or gluten-free can be a smoke screen for disordered eating habits. In addition, a newfound obsession with cooking shows or preparing food may also be concerning. You wouldn’t imagine someone with an eating disorder would want to watch food shows, but they can take up cooking and Food Network as a new hobby. Sometimes the person wants to cook or bake for everyone, but never enjoys their own handiwork. In the case of binge eating, sometimes they will make a whole batch of extra food to consume privately.
The brain chemistry changes in men and women with restrictive eating disorders. So, while you might expect their energy levels to tank, Riley says you might notice the person can’t sit still, like they’re wired on caffeine. “Also, they want to burn extra calories,” she says. “Many are afraid that if they sit, they’ll gain weight.”
The most prevalent eating disorder in the United States is binge eating disorder, which can lead to weight gain instead of loss that even doctors can miss. “Sometimes they aren’t medically overweight, but still struggling,” says Mysko. “Other times, these people are regularly prescribed diets, when it’s actually a mental health problem, not a weight or health problem first.” People with binge eating disorder consume unusually large amounts of food at one time, and feel like they have little control once they start eating. In addition, they may eat until they're uncomfortable, feel guilt or shame after a binge, or hide their binges from others.
Binge eaters may also be found with lots of decadent foods on hand in mass quantities. Perhaps it’s a dozen donuts or cupcakes, or four flavors of ice cream. “They may pass it off with an excuse, like, ‘Oh, I have these for my son’s party at school,’ ” says Riley. It’s something to note if it happens frequently and with other symptoms of binge eating disorder, like refusing to eat in public or constant dieting without weight loss.
If you think your loved one may be suffering from an eating disorder, learn more about eating disorders by visiting the NEDA or ERC Web sites. Approach your friend privately first, and focus on the behavioral changes that concern you; avoid discussing weight.
Sometimes, it’s helpful if you can pick up on times when food is a natural topic of discussion—like over dinner, or after an exercise or yoga class. I’ve talked to a few of my friends about eating disorders. I always start with my experiences, and tell them I’m really trying to develop a healthier relationship with food and my body. This seems to make it safer for them to open up, too.
Riley says that if you’re still concerned, enlist a close relative to help as well, like a significant other or family member. If your friend or loved one does confess to an eating disorder, the most important thing to do is encourage them to get professional treatment. Don't try to play therapist yourself. If they're open to it, you might offer to help them find resources, such as psychologists in their area who specialize in eating disorders. The NEDA website offers a free treatment-finder tool, or you can call the NEDA hotline at 1-800-931-2237.
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