You can’t always tell by looking at somebody if they have an eating disorder, so be sure to check that misconception at the door. In fact, it can be pretty difficult to spot the signs of an eating disorder in somebody that you care about, partly because a lot of the food, exercise, and weight loss behaviours associated with eating disorders have become normalised in our culture. There’s a fine line between dieting and disordered eating, and there’s an equally fine line between disordered eating and clinical eating disorders. Somebody can be suffering even if they don’t qualify to be clinically diagnosed with an eating disorder. But unfortunately, many people don’t seek support for chronic dieting or disordered eating because they fear not being “sick enough”— so if you’re worried for somebody, don’t be afraid to let them know. Simultaneously, if you read this and recognise yourself in anything I'm talking about, please consider reaching out for support.
Some of the signs that someone might have disordered eating or an eating disorder include:
Restrictive food behaviour like chronic dieting, cutting out certain foods that they once enjoyed, refusing to eat entire food groups, only eating specifically small amounts of food.
The development of ritualistic and obsessive behaviours around food, like rigidly only eating at specific times, specific amounts, or with specific utensils.
Social withdrawal from family and friends
The categorisation and moralisation of foods as “good and bad”, “healthy and unhealthy”, “clean and unclean”. And heightened anxiety, distress and compensation through restriction, exercise, purging, or laxative use after eating foods deemed negative.
Changes in mood - increased depression, irritability, anxiety.
Compulsive exercise, and making exercise a rigid priority (ie. routinely cancelling plans with friends to make a gym class).
Secretive food behaviour ( not eating around others, hiding food in unusual places, eating food from unusual places)
Rigid black-and-white thinking (seeing things, including food and exercise, as either good or bad)
Acting compulsively, without appearing to think about the consequences
Frequently making excuses to avoid eating in front of others
Weight fluctuations - not always.
Dry skin
Brittle hair and nails
Frequent trips to the bathroom during or after meals
Tooth erosion
A fine white coating of hair on the body
Consistent use of laxatives, enemas, or other diuretics
A negative preoccupation with their body size, shape, or appearance
Ritualistic behaviours around food and exercise that cause marked distress when disrupted
Denial of hunger
Fear of gaining weight
Preoccupation with weight loss
Heightened anxiety around meals, clothes shopping or situations that disrupt food and exercise routine.
Distorted body image
Now, while these are some of the common signs of eating disorders it’s important to note that everybody is different, and eating disorders can manifest differently for each individual. So, again, if you’re concerned about somebody please don’t hesitate to let them know. And below I have some tips to support you through that process in a mindful and compassionate way.
What to do if you suspect someone you care about is struggling with an eating disorder.
Firstly, check your beliefs about eating disorders and read up about them to ensure that you aren’t upholding any misconceptions or stigma. Many individuals avoid reaching out for support for fear of being misunderstood and there’s a lot of stigma surrounding eating disorders. NEDA and B-eat are two charities that offer foundational information about eating disorders. The most important thing is that you challenge any misconceptions and stigma for yourself.
Here is a short list of misconceptions, and clarifications about eating disorders to help get you started:
“Eating disorders stem from vanity or obsession with appearance”—- Whilst a preoccupation with appearance is a common feature of eating disorders, it’s actually been shown to be a psychological symptom of prolonged restriction, dieting, and malnutrition. Moreover, body image and appearance related concerns are also linked to our socio-cultural context and then internalisation of unrealistic ideals.
“They just need to eat or stop eating so much and everything will be fine” —- what your loved one is experiencing is not the result of willpower or lack thereof. There’s no simple fix. Many food related behaviours are connected to emotions and past experiences, and they can only be fully resolved once the underlying psychological components have been addressed.
“Changing their body or their weight will help their negative body image” — To be blunt, it won’t. Body image is the perception someone has about what their body looks like and it’s influenced by early childhood experiences, trauma, cultural ideals, as well as how they feel about themselves. Also, when somebody has an eating disorder they can have distorted perceptions of what they look like.
“They can’t be that sick because their weight seems normal” —- You can’t always tell if someone has an eating disorder just based on their appearance. Some of my most unwell and distressed clients have “normal” body weight. Outer appearances don’t always reflect inner turmoil.
Educating yourself and checking your misconceptions at the door so you can approach your loved one w an open mind and open heart will help them to feel supported and seen by you and less likely to feel judged or misunderstood.
How can you help someone that you suspect has an eating disorder?
It’s important to start by addressing a couple of things within yourself first. Namely that it’s not your responsibility to fix or rescue them. When we love someone it sucks to see them in pain, and it’s easy to fall in to the trap of trying to fix or take away their pain. But as much as you may want to, this unfortunately isn’t possible. Despite best intentions, our attempts to try and fix or rescue others can communicate that we believe they’re broken or that they’re not doing enough to help themselves, which can contribute to shame and guilt. It can also foster frustration and anxiety for you, which can contribute to their anxiety. This can become a bit of a viscious cycle that can disrupt your bond, which would be upsetting for both of you. As difficult as it may be, try and trust that your unconditional love and desire to support them is what they need the most.
Let them know that you can see that they’re struggling. Voice, in a non judgemental way, your observations and concerns.
Name that you feel worried because you care about them, and let them know that there’s no shame involved in seeking support. Avoid telling them what you think they need to do -- this can fall in to the realm of “fixing”. Let them know that you see them, you’re concerned for them, that you care about them and that you’re here for them. You can look in to local treatment options. Many therapists or eating disorder clinics have detailed websites that you can read through to get a better idea of what they offer. At the end of the day though, if they’re over the age of 18, it’s up to them to decide whether they seek professional support.
And finally, If they decide to open up tell you about their experience, listen with compassion and an open heart. Try and ask gentle and thoughtful questions, and try your best not to get frustrated with them. Living with an eating disorder is like living with a malicious bully inside of your head that eats away (no pun intended) at your self-esteem and self-worth — and living this way wasn’t a choice.
Recovery is absolutely possible, and support is out there! xx