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 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

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 as soon as possible. Remember, eating disorders do not have a ‘look’, and can be experienced by people in all body shapes and sizes.

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 and fitness websites and social media)
• 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

• 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
• Sudden or rapid weight loss
• 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 biological, psychological and social risk factors that may increase the likelihood of an eating disorder developing.

Risk factors

Biological factors

Emerging evidence shows that the development of an eating disorder may have a biological link relating to a person’s genetics. Studies show that eating disorders such as anorexia nervosa, bulimia nervosa and binge eating disorder have moderate-high heritability. Ongoing research into this field is analyzing hundreds of genes that may influence the chance of developing an eating disorder with the hope of improving treatment and even preventing illness. You can learn more about the Eating Disorders Genetic Initiative (EDGI), the world’s largest ever genetic investigation of eating disorders, here. 

While genetics are beyond a person’s control, there are steps that can be taken to modify risk, such as addressing psychological, social risk factors and other risk factors.

Psychological factors

• Feelings of inadequacy
• Perfectionism
• 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
• Fear or avoidance of conflict
• Low core self-esteem
• Competitiveness
• Impulsive or obsessive behaviours
• High concern with the opinions of others, often with a need to please
• Prone to extremes, such as ‘black and white’ thinking
• Difficulty coping with stress
• Depression or anxiety

It is important to note that psychological symptoms can also be present as the result of an eating disorder and the impact of starvation syndrome. Psychological symptoms may resolve with adequate re-nourishing and subsequent recovery.

Social factors

• Cultural value placed on ‘thinness’ or small bodies as a moral and health imperative
• Normalisation of intentional dieting and weight loss in pursuit of the ‘thin ideal’
• Valuing of people according to outward appearance
• Media and popular culture’s portrayal of ‘ideal’ shapes and bodies
• Professions with an emphasis on body shape and size (eg. dancers, models, athletes)

Other factors

• Significant life stages, such as puberty, pregnancy and post-partum and menopause
• 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)
• Autism, particularly in women
• Engaging in dieting 
• Poor body image
• Peer pressure
• Difficulties with personal or family relationships
• Sexual or physical abuse
• Food insecurity
• Unmet needs (emotional, psychological, social, professional, spiritual, physical or pleasure)
• History of teasing or bullying, particularly when based on weight or shape