Silent Signs of an Eating Disorder

If someone close to you had an eating disorder, would you know it? Many people assume they would—thinking that telltale symptoms like rapid weight loss or looking emaciated would be easy to spot. But the truth is, warning signs of an eating disorder can be more subtle, especially at first. Here are the red flags for the three main types of eating disorders—anorexia nervosa, bulimia, and binge eating disorder—and how to get help.

Signs of Anorexia Nervosa

Anorexia nervosa is when someone heavily restricts their eating in order to be thin. “People with anorexia see themselves as much bigger than other people might see,” says Susan Samuels, MD, a psychiatrist at NewYork-Presbyterian Hospital and Weill Cornell Medicine—even if they are dangerously underweight. Due to complications associated with starvation and instances of suicide, anorexia has the highest mortality rate of any mental health disorder.

People with anorexia tend to:

• Look emaciated (extremely thin)

• Restricts their eating

• Have an intense fear of gaining weight

• Have a distorted body image

• Think or talk about food often

Other physical symptoms to watch out for, include:

• Muscle weakness

• Dry, yellowish skin

• Brittle hair and nails

• Growth of fine hair all over the body

• Constipation

• Fatigue

• Signs of Bulimia Nervosa

Signs of Bulimia Nervosa

Bulimia involves two main elements: binging uncontrollably, then vomiting or partaking in other behavior that compensates for the overeating, such as excessive exercise or use of laxatives.

Besides this binging and purging pattern, the signs of bulimia are not as obvious. “With bulimia you’re not going to see someone who is particularly skinny or particularly overweight,” says Dr. Samuels. In fact, they’re usually at a healthy or relatively normal weight. What you may notice, however, is other physical changes as a result of frequent vomiting, like:

• Chronically inflamed or sore throat

• Swollen salivary glands

• Worn tooth enamel

• Acid reflux

• Dehydration (from lack of fluids)

Signs of Binge Eating Disorder

People with binge eating disorder lose control over their eating, and tend to consume unusually large amounts of food whether they’re hungry or not. Unlike bulimia, these episodes are not followed by purging, which means people who suffer from this disorder are often overweight or obese. Those with binge eating disorder might:

• Eat until they’re uncomfortably full

• Eat alone to avoid embarrassment

• Diet often

• Feel guilty or ashamed after eating

How to Help Someone with an Eating Disorder

Emotional support and expressing concern is extremely important. “I think we tip-toe around asking if someone’s OK, when the best thing you can do is just say, ‘hey, I’m worried about you, here’s my observation,’ without any judgement,” says Jennifer Hartstein, PsyD, a psychologist based in New York City. “People who are not well will be defensive and fight back, [but] some of them might be relieved that you’re noticing.”

If you suspect someone has an eating disorder, it’s important to get help—from a medical professional or the National Eating Disorder Association hotline (1-800-931-2237)—right away.