An eating disorder is a serious mental illness characterised by disturbances to thoughts, behaviours and attitudes to food and eating. For some, this extends to pre-occupation with exercise and body weight/shape.

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 emotional, physical and social health. The Diagnostic and Statistical Manual of Mental Disorders (DSM) recognises the following 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

Within the medical profession, eating disorders are usually clinically defined and diagnosed according to the criteria laid out in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5).

Note: the information given below is to help you understand the information you may be given if an eating disorder is diagnosed. It is not intended to be used for self-diagnosis.
If you think you, or someone you know, may have an eating disorder, it is important to seek medical help and get a professional assessment and diagnosis.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) recognises categories of eating disorders:

• Anorexia nervosa
• Bulimia nervosa
• Binge eating disorder
• Avoidant/restrictive food intake disorder (ARFID)
• Pica
• Rumination disorder
• Other Specified Feeding or Eating Disorder (OSFED)
• Unspecified Feeding and Eating Disorders (UFED)

About the DSM-5

What is it?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a publication of the American Psychiatric Association. The DSM which contains sets of diagnostic criteria (symptoms being experienced) grouped into categories (disorders) to assist clinicians with the effective diagnoses and care of people with mental health disorders. There are several diagnostic criteria manuals used worldwide, but the DSM is the one used most commonly in Australia.

Who uses it?

During an assessment, a GP or psychiatrists will usually use the criteria from the DSM to match against an individual’s symptoms. This matching process will help them to decide whether the individual meets the diagnosis for a mental health disorder.

This diagnostic information can then be passed on to clinicians, who will be treating the individual, such as a psychologist or dietitian. In some ways, the DSM criteria are a form of shorthand for health professionals to briefly summarise what problems a person is experiencing. This information is then used to assist the treating clinician in selecting the treatments with the best evidence for good outcomes that are associated with the disorder symptoms.

Learn more about the DSM-5 

Eating disorders do not have a single, identifiable cause. There are psychological, physiological and social risk factors that may increase the likelihood of an eating disorder developing, as well as behaviours and traits that can be changed.

Risk factors

Psychological factors

• Low self-esteem
• Feelings of inadequacy
• Depression or anxiety
• A belief that love from family & friends is dependent on high achievement
• Difficulty expressing emotions and feelings, particularly negative emotions such as anger, sadness, anxiety or fear
• Ineffective coping strategies
• Perfectionism
• Fear or avoidance of conflict
• Competitiveness
• Impulsive or obsessive behaviours
• Highly concerned with the opinions of others, often with a need to please
• Prone to extremes, such as ‘black and white’ thinking

Social factors

• Cultural value placed on thinness as an inextricable part of beauty
• Current cultural emphasis on the goal to strive for a ‘perfect’ body
• Valuing of people according to outward appearance and not inner qualities
• Media and popular culture’s unrealistic portrayal of people’s shapes and bodies
• Pressure to achieve and succeed
• Professions with an emphasis on body shape and size (eg. dancers, models, athletes)

Biological factors

Scientists are currently researching possible biochemical and biological factors and their role in the development of eating disorders. Research has indicated that in some people with eating disorders, there is an imbalance of certain chemicals in the brain.

Genetic or familial factors, for example a person who is exposed to a parent or sibling with an eating disorder, is at a higher risk of developing an eating disorder themselves. While no conclusive outcome has been reached, research has provided evidence that in some cases this is due to genetic predisposition, rather than learned behaviour.

External factors

• Life events, particularly those involving major changes (e.g. loss of a family member or friend, the divorce or separation of parents, moving schools or jobs)
• Dieting
• Peer pressure
• Inability to effectively deal with stress
• Personal or family history of obesity, depression, substance abuse or eating disorders
• Troubled personal or family relationships
• Sexual or physical abuse
• History of teasing or bullying, particularly when based on weight or shape

Behaviours and traits

Dieting

Weight-loss and fad diets involve restricting food intake to levels that often leave a person constantly hungry and in some cases, lacking the necessary nutrients they need to maintain physical health and energy levels. The restrictive nature of dieting does not work, as fad diets do not provide a sustainable meal plan for the long term. In fact, 95% of people who diet regain the weight and more within two years.

Self-esteem

While self-esteem and body image are linked, self-esteem represents a person’s perception of their internal and external faculties as a whole — an all-inclusive sense of self-worth. Low self-esteem is a central theme in the development of an eating disorder, and it often manifests as a critical voice that creates and feeds perceptions of poor body image. Low self-esteem naturally leads to negative perceptions of one’s physical appearance. A person’s distorted body image is reconciled only when internal issues with low self-esteem are corrected.

Perfectionism

Perfectionism goes beyond setting personal goals and doing your best. People with perfectionist traits set extremely high standards that are unrealistic, and feel distressed when they fail to meet these impossible standards. They mistakenly believe that if they can meet these high standards, they will have a sense of control and be ‘worthwhile’ and ‘successful’. They may strive for perfection in their academic or work performance, morality, relationships, cleanliness and order, or dieting, exercise, body weight or shape. Perfectionism is a common personality trait in people with an eating disorder, who may feel the need to maintain complete control over their weight.

Body image

Body image refers to how a person perceives, thinks and feels about their body and appearance. These thoughts and feelings can be positive, negative, or a combination of both. A person’s body image can change over time, and can be strongly influenced by what a person reads, sees and hears. People’s psychological perceptions of their bodies are not always accurate, and this can affect what they see. For example, some people may believe their body is larger or fatter than it actually is, or become fixated on a particular body part and start to see it as being very unattractive. When people feel dissatisfied about their body, this can affect their behaviour; for example, someone who thinks they are overweight may choose not to exercise in public.