Does My Friend or Loved One Have an Eating Disorder?

Because eating disorder symptoms are often aligned with cultural norms, it may be hard to distinguish whether a friend or loved one has an eating disorder. For example, our society considers it virtuous to “eat clean,” restrict carbs, and exercise intensively. However, these same behaviors could be symptoms of an eating disorder.

No other mental health diagnosis shares this property; people do not typically wish upon themselves symptoms consistent with depression or obsessive-compulsive disorder the way they desire to have symptoms consistent with some eating disorders. Stacey Rosenfeld, Ph.D. highlighted this phenomenon when she titled her book, Does Every Woman Have an Eating Disorder? In private communication, Dr. Rosenfeld wrote:

We have a culture that supports disordered eating, in the form of extreme dieting, overexercising, and compensating for the food we eat. People are praised for engaging in these behaviors and for losing weight at all costs. All of this makes it challenging for some individuals with eating disorders to understand and address their concerns. I've seen clients present with eating disorders who aren't even aware they have a disorder, because they view their eating behavior as within normal limits in a disordered culture. This backdrop of disorder can make diagnosis — and recovery — more challenging.

The war on obesity has made it relatively common for even medical professionals to make paradoxical recommendations. Low-calorie diets, intermittent fasting, significant weight loss, and even stomach emptying devices—red flags for an eating disorder diagnosis—are sometimes prescribed for larger patients.

Adding to the confusion, it is also not rare for people with eating disorders, especially those with restrictive eating disorders, to lack the awareness that they have an eating disorder. This condition, called anosognosia, is a frequent symptom of the illness. When confronted about whether they might have an eating disorder, many people will deny or discount it.

The prevailing stereotype is that eating disorders only affect thin affluent white teenage females. As a consequence, anyone who doesn’t fit this stereotype may not recognize their eating disorder, and their symptomatic behaviors may fail to attract the attention of family and friends. Research has shown that when presented with a set of symptoms consistent with an eating disorder, even mental health professionals are less likely to assign a diagnosis to a patient portrayed as African American than to one portrayed as Caucasian or Hispanic.

In actuality, eating disorders affect people of all sizes, ages, genders, ethnicities, and socioeconomic statuses, and are not always expressed in stereotyped ways. Eating disorders often express differently in males, ​with males commonly reporting greater concerns around muscularity. Since this attitude runs counter to that most commonly seen in females with an eating disorder (a desire for thinness), males may not realize they have an eating disorder.

While patients with anorexia nervosa are expected to always appear very thin, restrictive eating disorders can occur in people who are larger. This means that larger patients who remain in an overweight category despite losing a significant amount of weight can exhibit the same medical issues as a patient who meets full criteria for anorexia nervosa. Yet merely due to their size, they rarely get the proper medical or mental health attention that thinner patients do.

The most recent Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists four primary diagnoses that affect adolescents and adults:

• Binge eating disorder 
• Bulimia nervosa
• Anorexia nervosa 
• ​​​Other specified feeding and eating disorder (OSFED)

This last category exists because many people with eating disorders do not fully meet the criteria for one of the other three main disorders. They may present with symptoms similar to one or the other or a combination of them. Furthermore, the line between disorder and well-being is not well-defined:  between the extremes, there is a group of people who suffer from various degrees of disordered eating but are not diagnosable. These people may suffer similarly to those who meet full criteria and more often go untreated.

The following symptoms may indicate that someone has an eating disorder:

• Frequent weight fluctuations, significant weight loss, or being significantly underweight
• Frequent dieting behavior and/or preoccupation with dieting
• Presence of purging, laxative or diuretic use
• Presence of binge eating (eating a large amount of food in a discrete period of time with a seeming loss of control)
• Presence of excessive exercise
• Poor body image
• Avoidance of eating or excuses for not eating
• Using the bathroom or showering after meals
• Disappearance of food (which may indicate binge eating)

Dieting, weight fluctuations, excessive exercise, and poor body image, each on their own, may not be a sign of an eating disorder. Eating disorders may also look different in children.

If a loved one is showing the above signs, the next questions to ask are whether a preoccupation with eating, shape, and weight are negatively impacting their life. For example, does it interfere with their ability to concentrate, sleep, socialize, or work? Has there been a recent noticeable shift in these behaviors? If so, further evaluation is advised.

Do not be put off if your loved one insists there is not a problem. This is often a symptom of the illness. Even if you feel that they might not be sick enough, it is best to err on the side of caution. Early intervention and treatment can reduce the length of illness and improve chances for a full recovery.

We're glad you're reaching out to learn more about eating disorders. Friends and family members can play an important role in their loved one's eating disorder recovery. It is important to understand that recovery from an eating disorder can be challenging and takes time, but, especially with treatment, the chances for full recovery are good.

The National Eating Disorders Association also provides tips on talking to a family member or friend.