Recognizing Eating Disorders and Getting Help

Full-fledged eating disorders are abnormal, disordered patterns of eating that become out of control. All types of eating disorders represent serious and immediate threats to the health, well-being, and happiness of the individuals caught up in them.

For practical purposes, it’s less important to know the clinical criteria that doctors use to diagnose these disorders than it is to simply recognize the typical behaviors and thoughts that people tend to exhibit. Many people start slipping into these patterns well before they meet the formal requirements for diagnosis. Likewise, a basic understanding of how people use these "disordered" behaviors and thought patterns to solve the problems they are experiencing in daily life can point the way to finding better solutions. This will help individuals and their loved ones figure out if professional help is needed.

Common Signs & Behaviors

The following behaviors can be signs of an active eating disorder:
  • Refusal to maintain a minimum, healthy weight and adequate nutrition. This is usually due to intense fear of gaining weight, not losing weight or becoming fat.
  • A distorted body image. You see yourself as fat even when you are underweight or at a normal, healthy weight. Your weight, shape and appearance are primary factors for determining your self-worth and self-image.
  • Severely restricting food intake. This may also include a rigid unwillingness to eat certain types of food due to their caloric contents, such as sweets and fats.
  • Eating large quantities of food twice per week (or more). "Large quantities" are obviously more food than most people would eat under similar circumstances. These binges usually occur within a short time (two hours or less), and are accompanied by out-of-control feelings and an inability to stop oneself.
  • Purging behaviors. This includes self-induced vomiting, taking laxatives, enemas or diuretics, and/or exercising excessively. The purpose of "purging" is to eliminate calories eaten, to get "bad" foods out of the body, to prevent weight gain and/or to reduce strong feelings of guilt, anxiety or shame.
  • Overeating frequently. This may involve several of the following factors: eating much faster than normal; eating until you are uncomfortably full; eating large amounts when you know you aren’t really hungry; eating alone out of embarrassment or hiding your eating from others; and feeling depressed, guilty or disgusted with yourself because of your eating.
As you can see, the differences between dieting and anorexia nervosa, and between overeating and binge eating disorder, can get pretty hazy. What starts out as "normal" can easily cross the line and become disordered, especially when you are focused primarily on weight and calories instead of healthy eating and exercising. Recognizing problems as early as possible is one key to getting them under control.

Beneath the Surface

Many people with clinical eating disorders have certain genetic or biochemical susceptibilities to strong emotions, or histories of emotional, physical or sexual abuse that further amplify the intensity of feelings and short-circuit the development of normal emotional management skills. There is also strong evidence that disordered eating can be "passed down" from generation to generation within families.

Although biology and genes play significant roles in eating disorders, it's a mistake to think that people develop eating disorders because there is something wrong with them. People turn to these behaviors because, to them, they solve an important problem or accomplish some necessary purpose. And even when the "solution" starts causing serious problems of its own, people may consciously or unconsciously stick to their disordered eating patterns until they can come up with some alternative way of meeting the original need.

It’s a lot easier to find a way to meet that need when you have some idea of the original purpose or problem. Let’s take a brief look at some of the most common problems and needs that, according to people who have successfully struggled with their own eating disorders, got them headed down the road to trouble in the first place:
  • "There’s nothing special or interesting about me. I thought that if I could make myself the thinnest person in my school, people would notice me."
  • "My boyfriend dumped me for a skinnier girl. I hated my fat body and was determined not to let it ruin my life."
  • "I was so puny that I was embarrassed to take a shower at school. I spent hours at the gym every day trying to put on some muscle."
  • "The idea of dating and sexuality was too much for me to handle. Who needed all that worry about whether I’d get asked out at all or get dumped? I got fat so people would find me unattractive and undesirable, and leave me alone."
  • "Nothing I did was ever good enough for anyone. I knew I could be very good at controlling what I ate, and exercising like a fiend, and that made me feel good."
  • "If I didn’t have my food problems to worry and feel bad about, I don’t think I would feel anything at all. I’m empty inside."
  • "I knew I didn’t have what it took to succeed at anything. As long as I was fat, I figured people wouldn’t expect much from me. I didn’t have to expect much from myself either, or try for anything that made me nervous. My fat was my shield."
  • "I just couldn’t handle my feelings. When I felt bad, eating was the only thing that made the feelings go away. After I ate, I felt even worse—until I discovered that purging made the guilt and anxiety go away, and let me get back to business as usual again."
  • "I was angry all the time, and I felt bad about that. I ate whatever I wanted, whenever I wanted it, because I deserved it. And if that made me fat and miserable, that was fine, because I deserved that, too."
The common theme in all these statements (and many others) is that disordered eating almost always starts out as an effort to manage feelings, thoughts and worries that aren’t really about food and eating. Most often, they are about basic human needs like fitting in, being valued and wanted for who you are, having control over your own life and having the power to influence how other people see and treat you.

When these problems grow larger and persistent enough to pave the way for the development of disordered eating (or a full-blown eating disorder), it is because other factors have also conspired to make this the "path of least resistance." It is not because the individual is stupid, defective or incompetent.

Getting Help When You Need It

The good news is that recovering from an eating disorder is possible. You can find much better ways to deal with your original concerns or needs; you can learn the skills you need to manage difficult feelings and "thought storms" without turning to overeating or not eating. There are also effective treatments (like good nutrition and medication) for many of the biochemical problems involved.

It’s not impossible to do all or most of this on your own. There is plenty of good information and support available from books and websites, and there are good self-help programs available.

But doing it on your own is not the easiest or fastest way, and often it's not enough. You can’t hang a picture straight on a wall when you’re right up against the wall yourself. You need someone with a different perspective to tell you when one side is higher or lower than it should to be. That’s not a reflection on you—it’s just a fact of life. The same can be true when it comes to seeing your own behaviors and attitudes clearly enough to start changing them.

These days, there are many counselors, dietitians and doctors who know a lot about disordered eating. These helpful professionals won’t pass judgment on you, but they can help you sort things out so that your decisions will help you get what you really want for yourself. If you find yourself having a hard time changing your behavior (or wanting to change), even though it is causing you problems, ask for some help.