How can you spot eating disorders?

Worried about a loved one's food-related behavior? How can you spot eating disorders that often show no clear symptoms? How should you approach the situation after seeing the danger signs?

Changes in the eating habits of your relatives can have serious consequences if left untreated. In their articles published on the Psyche website , psychologists Phillip Aouad and Sarah Maguire describe how you can recognize eating disorders and how you can support your relatives who have this problem.

We quote some parts of the article:
However, you can observe that some of their behaviors have changed. These changing behaviors are associated with eating in many people. Some obscure and hidden tendencies may be symptoms of an eating disorder. However, when someone you care about experiences these, you may not know what to do for them.

Eating disorders are complex conditions that cause changes in behavior, thoughts and attitudes related to nutrition and body image. They can have serious and life-threatening consequences, especially if left untreated. Although eating disorders can affect people of all ages, genders, ethnicities, cultures or religions, they usually take root during adolescence or early adulthood. They can also progress insidiously, causing people to go to great lengths to avoid being questioned about their illness. If the person with an eating disorder confronts the issue directly, they may become defensive, angry, or apathetic.

The consequences are as varied as the eating disorders

Most people have heard of bulimia nervosa (also known as bulimia) or anorexia nervosa (also known as anorexia). However, there are other eating disorders that many people are unfamiliar with and can have equally devastating effects."

The author states that disordered eating is a term used to describe the behaviors or symptoms that may lead to an eating disorder diagnosis: “In a process where there is eating disorders at one extreme and 'normal diet' at the other extreme, we can say that 'disordered eating' falls somewhere in the middle. Both disordered eating and eating disorders should be taken seriously, and both require attention and intervention.

While eating disorders are often thought to begin as a preoccupation with food and weight, it is unlikely that they are solely related to eating or weight. It is definitely not a 'choice' made. There is a multi-faceted interaction between biological, social and psychological factors that can combine over time and result in an eating disorder. Biological factors that may increase the risk include genetic predisposition and health conditions that affect what a person can eat (for example, diabetes or Crohn's disease).

Social factors can include cultural norms and ideals, marginalization and stigma, and past or current traumatic or highly distressing situations. Psychological factors may include low self-esteem and co-occurring mental health conditions such as depression or anxiety.

All eating disorders have negative effects on the person. They can affect the function of every organ in the body, causing irreparable damage and life-threatening conditions. Some of the psychological and social consequences are social isolation, difficulty in regulating emotions and a high risk of suicide. All these risks underscore the need to identify an eating disorder when it occurs and to provide treatment and support for recovery at the earliest possible opportunity. Eating disorders can be difficult to treat, but with early intervention, the chances of recovery increase significantly.

Get the truth about eating disorder myths

There are many misconceptions about eating disorders. Understanding these myths and why they can do more harm than good can be helpful in maintaining a relationship with someone with an eating disorder and knowing what kind of support to provide. Here are some:

All eating disorders lead to overweight

Eating disorders are not determined by weight, and weight alone cannot reveal the severity or impact of the eating disorder. Some eating disorders, such as anorexia, are characterized by drastic weight loss, while others are not. Some people with restricted eaters have lost excess weight, but are still in the normal weight range. Other eating disorders, such as bulimia and binge eating disorder, do not necessarily require being underweight. You can't tell someone has an eating disorder just by looking at them.

Those with eating disorders should eat more

While achieving a normal weight is an important part of the recovery process, reaching a normal weight does not mean that the person has fully recovered, especially if the eating disorder has resulted in significant weight loss. Assuming that it is would undermine the complex medical and psychological effects of an eating disorder. Also, eating disorders are not just a matter of being a 'picky eater'. But the complex relationship between food and self can sometimes cause someone with an eating disorder to prefer only a limited variety of foods.

Eating disorders only affect young women

The most common age of onset of eating disorders is 12-25, and women are at higher risk than men. These trends have led to the common misconception that eating disorders are a 'girl's disease'. However, recent studies show that eating disorders are more common in men than previously thought. The truth is, eating disorders can affect anyone at any stage of life.

Pay attention to changes in relationship with eating

If you're eating with your loved one as part of a regular routine (eg, family meals), eating behavior changes can be relatively easy to spot. The intensity and severity of these behaviors may increase gradually over time. For example:

Making excuses not to eat, 

Removing all food groups from the diet, 

Restricting or excessively limiting the diet to purely healthy foods; 

Leaving evidence of sneaking or binge eating (e.g., empty containers left outside, storing food, large amounts of food being lost from a communal storage area), 

Frequent going to the bathroom near the end of the meal, 

Drinking instead of eating, 

Rigid food behavior or rituals and/or 

Much more attention and focus on food preparation.

These behaviors often go beyond 'regular' dieting and can manifest in different ways (or different combinations) depending on the type of eating disorder the person is experiencing. Some of the behaviors mentioned above (such as increased attention to food preparation) may not be cause for concern. But repeated patterns of behavior can signal a problem. Notable examples: going to the bathroom within half an hour after finishing dinner most nights of the week; routinely playing with the food on the plate instead of eating it; Breaking food into smaller pieces for no valid reason, or not wanting to mix or come into contact with different types of food. These behaviors, if stress is involved, may be saying something.”

Notice increased focus on body image

The author emphasizes that eating disorders are often associated with body image concerns, which can be combined with attempts to focus and control weight, body shape or appearance.

• Weight changes in a relatively short period of time or multiple changes over time,
• Wearing looser clothing than usual,
• Feeling cold in unchanging or hot environments,
• Repeated negative comments about one’s own body, weight or shape,
• Checking one’s own body frequently and/or
• Increased frequency or intensity of exercise for no apparent reason (such as joining a new sports team).

Many of the above signs may not be immediately noticeable, especially on their own, and may have alternative explanations. However, such repetitive behaviors may be indicative of an eating disorder and should be monitored.

Watch for negative changes in mood or social behavior

A person's mood and expression can tell a little more about the possibility of an eating disorder. Signs to watch out for:
– Withdrawal or isolation from social life
– Rapid changes in mood
– Increased anxiety and/or
– High levels of control or obsession (may or may not be related to food or the body).

Not all people with eating disorders show all of the above symptoms. (…) Noticing a few of the signs may not be a cause for concern either. When these changes begin to be bothersome to the person or the people around them, they should be monitored more closely.

Have a compassionate talk about your concerns

If you notice some of the behaviors mentioned and they are worrying you, you may want to talk to your loved one about them. These conversations are not always easy. You may be unsure of when and where to start or what to say. This condition may be accompanied by a feeling of anxiety, frustration, confusion, helplessness, or powerlessness. These feelings are important and can form part of your conversation.

However, it is important not to let these feelings get in the way of the clear message or goal of the conversation. For example, your primary goal may be to 'check in' with your loved one to see if there is anything you can do to support them. Depending on how the conversation is going, you may be able to voice your concerns about recent changes in their behavior or attitude, including those related to food.

Keep these points in mind that can make the conversation easier:
– Use non-judgmental and non-blaming language. Try to use 'I' statements when discussing your concerns. For example: Instead of 'You no longer eat with your family', say 'I miss having dinner together like I used to.

– Do not criticize or focus on their weight or appearance. Instead, take a broader approach to asking how they're doing, for example: 'I've noticed that you haven't been as talkative as usual lately…how is it going?' If possible, ask open-ended questions (rather than yes or no questions) and be prepared for a cautious response. Give the person the opportunity to talk about their feelings if they want to.

– Let them know you are there for them. Knowing that you are ready to offer support if they ask can help them now or in the future.

– Kindly encourage professional support. Try to refer the person to a GP or another healthcare professional (such as a clinical psychologist) for evaluation. If you feel resistance and the person's condition is not critical, be patient and persistent. If it is ultimately your responsibility to ensure that the person receives care (for example, if you are the parent), you may need to tolerate some negative feedback and resistance as part of the process.

– Do not try to offer a simple solution. Things not to say include 'If you eat it, you'll feel better' and 'Don't worry about your body'. People with eating disorders have trouble eating and feel bad about their bodies, but the main thing is to provide them with the help they need to heal. It is not as simple as suggesting that their thinking or behavior is wrong.

Build a supportive environment

The first conversation may not lead to any sudden or obvious changes. An eating disorder can be difficult to spot and will likely disguise itself. At this stage, you may face situations of denial, frustration, anger, or avoidance. This means that your message is neither heard nor you have run out of options.

There are other ways to support someone with an eating disorder:

– Model healthy behaviors and attitudes, even if you think they go unnoticed. For example, avoid talking about certain foods, such as chocolate, as 'bad'.

– Do not be ashamed of your body. Avoid making judgmental comments about yourself or other people's appearance, body, or food, even if your intentions or comments seem positive to you. (…) People with eating disorders are often very sensitive to such comments, which can make it easy for them to fear being judged.

- Don't blame. Blaming yourself or that person for someone's eating disorder does no one any good.

– Be consistent. Stick to routines and rules that apply to all members of the household, rather than isolating the person who may have an eating disorder. For example, if family meals are common, don't change the routine to accommodate the person with the eating disorder, whether they attend or not. Such special treatment in the early stages of an eating disorder can reinforce unhelpful behaviors.

– Get professional help. The best time to seek professional help is when you realize or suspect something is wrong. You can talk to a GP, pediatrician, or other healthcare professional you trust to learn more about eating disorders, learn about their perspective, or create a plan for how to help your loved one get professional support.

Take care of yourself while supporting your loved ones

It is frightening and alarming to see a loved one struggling with an illness that does not manifest itself. When supporting someone with an eating disorder, you should keep your own well-being and needs in mind.

Take time each day to take care of your needs that are not related to caring for others or any outside demands. Aim for at least one uninterrupted hour of 'me' time if possible. If it will be difficult, start for less time (15-20 minutes) and increase gradually if possible. Whether you want to go out for coffee with friends or alone, read a book, paint, watch TV, play games, solve puzzles, take a bath or do something else, this is your time.

Also be on the lookout for warning signs of burnout. For example: Do you feel more restless? Are you angry? Are you starting to get emotional? Are you tired more quickly? Being aware of these can help you monitor and manage your own needs.