For those of us who deal with young people this may be a particularly pertinent article, something to be on the look out for.
Eating disorders warning signs
Because everyone today seems concerned about weight, and because most people diet at least once in a while, it is hard to tell what is normal behavior and what is a problem that may escalate to threaten life and happiness. No one person will show all of the characteristics listed below, but people with eating disorders will manifest several.
In addition, the early stages of an eating disorder can be difficult to define. When does normative dieting become a health and emotional problem? When does weight loss cross the line and become pathological? Answering these questions is hard, especially when the person has not yet lost enough weight to qualify for a clinical diagnosis. Nevertheless, the questions are important. The sooner an eating disorder is treated, the easier it is for the person to recover. If warning signs and symptoms are allowed to persist until they become entrenched behaviors, the person may struggle for years before s/he can turn matters around.
- Food behaviors
The person skips meals, takes only tiny portions, will not eat in front of other people, eats in ritualistic ways, and mixes strange food combinations. May chew mouthfuls of food but spits them out before swallowing. Grocery shops and cooks for the entire household, but will not eat the tasty meals. Always has an excuse not to eat — is not hungry, just ate with a friend, is feeling ill, is upset, and so forth.
Becomes “disgusted” with former favorite foods like red meat and desserts. Will eat only a few “safe” foods. Boasts about how healthy the meals s/he does consume are. Becomes a “vegetarian” but will not eat the necessary fats, oils, whole grains, and the denser fruits and veggies (such as sweet potatoes and avocados) required by true vegetarianism. Chooses primarily low-fat items with low levels of other nutrients, foods such as lettuce, tomatoes, sprouts, and so forth.
Usually has a diet soda in hand. Drastically reduces or completely eliminates fat intake. Reads food labels religiously. If s/he breaks self-imposed rigid discipline and eats normal or large portions, excuses self from the table to vomit and get rid of the calories.
Or, in contrast to the above, the person gorges, usually in secret, emptying cupboards and refrigerator. May also buy special binge food. If panicked about weight gain, may purge to get rid of the calories. May leave clues that suggest discovery is desired — empty boxes, cans, and food packages; foul smelling bathrooms; running water to cover sounds of vomiting; excessive use of mouthwash and breath mints; and in some cases, containers of vomit poorly hidden that invite discovery.
Sometimes the person uses laxatives, diet pills, water pills, or “natural” products from health food stores to promote weight loss. May abuse alcohol or street drugs, sometimes to deaden appetite, sometimes to escape emotional pain, and usually in hopes of feeling better, at least temporarily.
- Appearance and body image behaviors
The person loses, or tries to lose, weight. Has frantic fears of weight gain and obesity. Wears baggy clothes, sometimes in layers, to hide fat, hide emaciation, and stay warm. Obsesses about clothing size. Complains that s/he is fat even though others truthfully say this is not so. S/he will not believe them.
Spends lots of time inspecting self in the mirror and usually finds something to criticize. Detests all or specific parts of the body, especially breasts, belly, thighs, and buttocks. Insists s/he cannot feel good about self unless s/he is thin, and s/he is never thin enough to satisfy her/himself.
- Exercise behaviors
The person exercises excessively and compulsively. May tire easily, keeping up a harsh regimen only through sheer will power. As time passes, athletic performance suffers. Even so, s/he refuses to change the routine.
May develop strange eating patterns, supposedly to enhance athletic performance. May consume sports drinks and supplements, but total calories are less than what an active lifestyle requires.
Up to five percent of high school girls and seven percent of middle-school girls have tried steroids in attempts to get bigger and stronger in sports and also to reduce body fat and control weight. Some say they don’t mind gaining weight as long as it’s muscle weight, not fat. Male abuse of steroids is also well documented. (Statistics provided by Charles Yesalis, professor of health and human development at Pennsylvania State University, 2005.)
Steroids, of course, have serious side effects including severe acne, smaller breasts in women, smaller genitalia in men, deeper, more masculine voices in women; irregular or absent menstrual periods; impaired fertility; excess facial hair; excess body hair; depression; paranoia; and out-of-proportion anger (‘rhoid rage). Steroids can stunt the height of growing adolescents, and lead to premature heart attacks, strokes, liver tumors, kidney failure and serious psychiatric problems. In addition, because steroids are often injected, users risk contracting or transmitting HIV and hepatitis.
- Thoughts and beliefs
In spite of average or above-average intelligence, the person thinks in magical and simplistic ways, for example, “If I am thinner, I will feel better about myself.” S/he loses the ability to think logically, evaluate reality objectively, and admit and correct undesirable consequences of choices and actions.
Becomes irrational and denies that anything is wrong. Argues with people who try to help, and then withdraws, sulks, or throws a tantrum. Wanting to be special, s/he becomes competitive. Strives to be the best, the smallest, the thinnest, and so forth.
Has trouble concentrating. Obsesses about food and weight and holds to rigid, perfectionistic standards for self and others.
Is envious of thin people in general and thinner people in particular. Seeks to emulate them.
Note: Not all, but a subset of people with eating disorders think they do not deserve to eat or enjoy tasty food. They starve, stuff, or purge in deliberate attempts to punish themselves. They may also cut their flesh or otherwise hurt themselves. Some want to become increasingly debilitated, even suffer the indignities of tube feedings and IVs, and eventually weaken and die. They see this not as a cry for help or attention, or an attempt to control their lives, but as well-deserved punishment for misperceived flaws and misdeeds. Their extreme self-hatred must be dealt with in therapy if they are to recover.
Has trouble talking about feelings, especially anger. Denies anger, saying something like, “Everything is OK. I am just tired and stressed.” Escapes stress by turning to binge food, exercise, or anorexic rituals.
Becomes moody, irritable, cross, snappish, and touchy. Responds to confrontation and even low-intensity interactions with tears, tantrums, or withdrawal. Feels s/he does not fit in and therefore avoids friends and activities. Withdraws into self and feelings, becoming socially isolated.
Feels inadequate, fearful of not measuring up. Frequently experiences depression, anxiety, guilt, loneliness, and at times overwhelming emptiness, meaninglessness, hopelessness, and despair.
- Self-harm and self-injury
In some people the above mentioned feelings are overwhelming, too many and too strong to be endured. To cope, to release the pain, to escape it, to distract themselves, some people hurt their bodies. They cut their flesh or burn it. They bang their heads or swallow foreign objects. They report that while they are engaged in self-harm, they experience peace, tranquility and calm — a sense of being grounded after feeling tossed about by chaos and misery — at least for a while, until stress and tension mount again.
In some cases, past trauma (especially sexual abuse) has been so devastating that all feelings have been numbed. Then the person self-injures in order to feel something, anything.
In spite of appearances, the person who self-injures is not consciously trying to commit suicide. Neither is s/he “only” seeking attention. Self-harm is frequently a symptom of Borderline Personality Disorder, a problem that often co-exists with an eating disorder. Treatment is available and can be combined with treatment for an eating disorder. Evaluation by a mental health care provider is essential. Since people who hurt themselves can inadvertantly create a medical crisis, sooner is better than later.
- Social behaviors
Tries to please everyone and withdraws when this is not possible. Tries to take care of others when s/he is the person who needs care. May present self as needy and dependent or conversely as fiercely independent and rejecting of all attempts to help. Anorexics tend to avoid sexual activity. Bulimics may engage in casual or even promiscuous sex.
Person tries to control what and where the family eats. To the dismay of others, s/he consistently selects low-fat, low-sugar non-threatening — and unappealing — foods and restaurants that provide these “safe” items.
Relationships tend to be either superficial or dependent. Person craves true intimacy but at the same time is terrified of it. As in all other areas of life, anorexics tend to be rigidly controlling while bulimics have problems with lack of impulse control that can lead to rash and regrettable decisions about sex, money, stealing, commitments, careers, and all forms of social risk taking.
- Other behaviors
Eating disorders frequently occur in combination with other problems. All of the following deserve professional attention in their own right. When they appear in the company of an eating disorder, the need for professional attention is even more urgent to prevent harm or death:
- Alcohol abuse
- Abuse of prescription medications (including insulin, Ritalin, and pain killers)
- Abuse of recreational drugs (speed, cocaine, steroids, diet pills, so-called club drugs, etc.)
- Abuse of laxatives and diuretics (water pills)
- Physical, emotional, or sexual abuse
- Threats of suicide or suicide attempts
- Cutting, burning, hair pulling or other self-harm behaviors
- Rage attacks
- Placing oneself in dangerous situations
- Homicidal threats or attempts
- Stealing and other criminal acts
- Any other behaviors that can logically be expected to bring harm to self or others.