Understanding Eating Disorders

As warm weather rolls in, so do the commercials for diet plans, liposuction, fat freezing, gym memberships, fat shedding supplements, and on and on. An overwhelming number of advertisements identify aspects of our appearance as flaws and encourage expensive steps to improve those flaws in order to achieve happiness. This message of striving (and starving) for an unrealistic physical appearance is sometimes as blatant as “stop letting that stubborn fat keep you from being happy”. Other times it is the more subtle advertisements and entertainment with portrayals of the happy human with an unrealistic body. The body, they don’t tell the audience, has been enhanced and altered through airbrushing, lighting, and make up (both body and facial).

All of this exposure and how often does the message “these are altered and unrealistic body images” come up in daily life? Look around and we find it is no where near the hundreds of thousands of negative images which are seen over the course of a day or week. Some of these are so subliminal we don’t even realize we are seeing them, they are just running in the background like barely noticeable music played in a mall.

So why is this concerning? These images can contribute to dangerous eating disorders. The Diagnostic and Statistical Manual, the guide to identifying mental health related disorders, even states that the culture of valuing body image is one of the factors which contributes to the development of eating disorders. Such disorders can lead to malnutrition, dehydration, irreversible bone mineral loss, organ damage and other ill effects on health. Mental health related concerns are the continued diminish of self-esteem, neglect of prosocial areas of life due to progressive obsession over food and weight, ongoing negative self-image, increased depression and anxiety, isolation due to fear of being overweight, lack of enjoyment in life, and a number of other mental health related issues. The most common age group in which eating disorders occur is teenage years through the 20’s. This is a critical time related to the development of a healthy body and the development of the brain. Lack of necessary nutrition can negatively impact this process.

One positive aspect is that parental involvement still vey much exists within the age group most afflicted. This offers the opportunity for support in prevention and recovery. Empowering parents with education regarding the signs, and ways to reduce the risk of eating disorders, hopefully, will reduce the rate of these disorders and make for healthier adults.

The following educational piece starts with understanding that each disorder has their own unique distinguishing behaviors. The two main weight related disorders are Anorexia and Bulimia.

Anorexia is the most commonly acknowledged eating disorder. This may be do the shock of the rapid weight loss and sickly appearance of Anorexia. Anorexia has multiple root causes. The most common roots can be an attempt to establish a sense of control, a response to distressing events, or exposure to body shaming or unrealistic expectations of how an attractive body is defined. At first, Anorexia can appear as healthier eating or superficial focus on appearance, which may come with the increased self-awareness accompanying puberty and teenage years. The distinction can be made when:

  • There is rapid and extreme weight loss

  • Inability to see weight loss

  • Obsessive focus on weight (e.g., complaining about body image, pinching of areas to measure how much fat they can grab, constant criticism of body shape)

  • Extreme reduction of food intake

  • Obsessive calorie counting

  • Overuse of laxatives, diuretics, or exercise (differs from Bulimia in there is no binging and are used despite low calorie intake)

  • Detailed food diary

  • Use of diet pills or engagement in fad diets when at a low weight

  • Somatic issues such as stomach pains, constipation, dizziness, headaches, fatigue on a regular basis

  • Lack of engagement of activities, such as swimming, where body shape is more easily observed by others

  • Justification of weight loss due to extracurricular activities (dance, wrestling, gymnastics)

  • Stunted puberty (girls show delayed menstruation or discontinuation of menstruation)

  • Hanging posters (or following on social media) of idealized body types rather than their talent or attraction to the person

  • Struggle to or hiding eating due to shame

  • Consistent use of the bathroom following a meal (indicative of self-induced vomiting)

  • Daily weighing, sometimes multiple times in a day

  • Extreme intolerance to cold


Bulimia is known, but less common. Bulimia is more about not gaining weight than losing weight. It also comes with a fear of being overweight. The distinguishing factor of Bulimia vs Anorexia is that there are bouts of uncontrolled eating of an extreme quantity of food in a short period of time followed by some type of purging to avoid weight gain. This usually does not come with an extreme loss of weight or noticeable change in weight. The lack of change in body shape makes it less noticeable that Bulimia is present. The signs to look for:

  • Times of extreme eating within approximately 2 hours or less, sometimes consuming food they normally would not eat or to the point of being ill

  • Consistent use of the bathroom following a large meal (indicative of vomiting)

  • Excessive use of laxatives, diuretics, diet pills or stimulants

  • Diary of food consumed vs what is purged (extreme versions include weighing what was purged such as vomit, urine and feces excreted)

  • Development of “chipmunk cheeks”, which is due to the swelling of salivary glands

  • Referred to as Exercise Bulimia, obsessive exercise as a form of purging noted by longer than reasonable engagement in one exercise session (e.g., running up and down stairs for hours rather than sets or the use of exercise equipment beyond the standard hour session)

  • Erosion of the esophagus

  • Tooth erosion

  • Constant irritation of the lips

  • Severe acid reflux


Additional tips:

  • In some cases, the use of vomiting can lead to uncontrolled reflexive vomiting upon eating without the intention of purging.

  • There is a trend among those who support the engagement in Eating Disorders to don red beaded bracelets in order to identify themselves to others with eating disorders.

  • Another clear sign is involvement in ProAna or ProMia websites. ProAna are sites dedicated to providing tips and support on how to maintain anorexia. ProMia are sites encouraging Bulimia. Both of these sites maintain the position that eating disorders are a lifestyle choice rather than a disorder. ProAna sites label those with an eating disorder as a “Rexie” or an “Anorexie”. A “Rexie” is someone who defines their Anorexia as achieving success in developing a high level of self-control, power over self, and strength. An “Anorexie” is someone who uses Anorexia for sympathy rather than manifesting the strengths of a “Rexie”.

If you have concerns, exploring your child’s search history may be eye opening regarding these sites and other weight loss sites they have been exploring.

Just like addiction, Eating Disorders can be a lifelong recovery process with the risk of some relapses in the process. Just like addiction, Eating Disorders come with a high level of denial, manipulative behaviors to maintain the disorder, and justification of their behaviors.

There are inpatient and outpatient clinics specific to the treatment of eating disorders. There are support groups, unlike ProAna and ProMia groups, focused on recovery. Eating Disorders can be difficult to watch in the people we care about. It can bring about anger and fears in the loved ones of those struggling with this condition. There is significant information to help understand Anorexia and Bulimia.

This article was broken up into two separate articles; Understanding Eating Disorders and Prevention of Eating Disorders. Click here to read about Prevention

Some quick tips to remember when dealing with the dynamics of an eating disorder:

  • Don’t engage in a power and control struggle as it may increase the severity

  • Remember, the desire for control is one facet feeding their behaviors. Don’t increase their resistance by constantly insisting that they eat.

  • Discussing food with someone who is food obsessed is not the best approach

  • Don’t express anger at them or withdraw; they already carry enough shame

  • Do try to express understanding of how they are feeling, identify the pressure our society unfairly places on them, and work together to find ways to improve their health and begin recovery.