Eating disorders are not a lifestyle choice, a diet gone wrong or a cry for attention. Eating disorders can take many different forms and interfere with a person’s day to day life. The Diagnostic and Statistical Manual of Mental Disorders (DSM) recognises four eating disorders:

• Anorexia nervosa
• Bulimia nervosa
• Binge eating disorder
• ARFID
• Other eating disorders

Many people with an eating disorder do not realise they have a problem, or if they do, they may go to extraordinary lengths to hide the signs of their behaviour.

Below are lists of behavioural, physical and psychological signs or changes that often accompany an eating disorder. If you, or somebody you know, is experiencing several of the following symptoms, it is important to seek help immediately to determine if you or they have a problem.

It is also important to realise that these warning signs may not be as easy to detect as they sound. The person with the eating disorder often experiences shame or guilt about their behaviour, and will try to hide it. Many people with eating disorders do not realise they have a problem, or even if they do, they might not want to give up their behaviour at first, because it is their mechanism for coping with an issue. Thus, they will go to extraordinary lengths to hide the signs of their behaviour from people who care about them.

Please note that any combination of these symptoms can be present in an eating disorder, because no eating disorder is exactly the same as another. It is also possible for a person to demonstrate several of these signs and yet not have an eating disorder. It is always best to seek a professional opinion.

Behavioural warning signs

• Constant or repetitive dieting (e.g. counting calories/kilojoules, skipping meals, fasting, avoidance of certain food groups or types such as meat or dairy, replacing meals with fluids)
• Evidence of binge eating (e.g. disappearance of large amounts of food from the cupboard or fridge, lolly wrappers appearing in bin, hoarding of food in preparation for bingeing)
• Evidence of vomiting or laxative abuse (e.g. frequent trips to the bathroom during or shortly after meals)
• Excessive or compulsive exercise patterns (e.g. exercising when injured or in bad weather, refusal to interrupt exercise for any reason, insistence on performing a certain number of repetitions of exercises, exhibiting distress if unable to exercise)
• Making lists of ‘good’ and ‘bad’ foods
• Changes in food preferences (e.g. refusing to eat certain foods, claiming to dislike foods previously enjoyed, sudden interest in ‘healthy eating’)
• Development of patterns or obsessive rituals around food preparation and eating (e.g. insisting meals must always be at a certain time, only using a certain knife, only drinking out of a certain cup)
• Avoidance of all social situations involving food
• Frequent avoidance of eating meals by giving excuses (e.g. claiming they have already eaten or have an intolerance/allergy to particular foods)
• Behaviours focused around food preparation and planning (e.g. shopping for food, planning, preparing and cooking meals for others but not consuming meals themselves, taking control of the family meals, reading cookbooks, recipes, nutritional guides)
• Strong focus on body shape and weight (e.g. interest in weight-loss websites, dieting tips in books and magazines, images of thin people)
• Development of repetitive or obsessive body checking behaviours (e.g. pinching waist or wrists, repeated weighing of self, excessive time spent looking in mirrors)
• Social withdrawal or isolation from friends, including avoidance of previously enjoyed activities
• Change in clothing style, such as wearing baggy clothes
• Deceptive behaviour around food (e.g. secretly throwing food out, eating in secret (often only noticed due to many wrappers or food containers found in the bin) or lying about amount or type of food consumed)
• Eating very slowly (e.g. eating with teaspoons, cutting food into small pieces and eating one at a time, rearranging food on plate)
• Continual denial of hunger

Physical warning signs

• Sudden or rapid weight loss
• Frequent changes in weight
• Sensitivity to the cold (feeling cold most of the time, even in warm environments)
• Loss or disturbance of menstrual periods (for females)
• Signs of frequent vomiting — swollen cheeks or jawline, calluses on knuckles, damage to teeth
• Fainting, dizziness
• Fatigue — always feeling tired, unable to perform normal activities

Psychological warning signs

• Increased preoccupation with body shape, weight and appearance
• Intense fear of gaining weight
• Constant preoccupation with food or with activities relating to food
• Extreme body dissatisfaction/ negative body image
• Distorted body image (e.g. complaining of being, feeling or looking fat when actually a healthy weight or underweight)
• Heightened sensitivity to comments or criticism about body shape or weight, eating or exercise habits
• Heightened anxiety around meal times
• Depression or anxiety
• Moodiness or irritability
• Low self-esteem (e.g. feeling worthless, feelings of shame, guilt or self-loathing)
• Rigid ‘black and white’ thinking (viewing everything as either ‘good’ or ‘bad’)
• Feelings of life being ‘out of control’
• Feelings of being unable to control behaviours around food