disorder.  While eating disorder symptoms are vast, these questions will indicate if there is a problem.

Do you make yourself sick because you feel uncomfortably full?

Clearly this question will indicate bulimic behaviors.  It is important to note, you do not necessarily have to make yourself

vomit in order to be bulimic.  There are many other ways a person tries to get rid of food when they feel they have

overeaten.  These methods include:  exercise, laxative use, restriction, etc.

Do you worry you have lost control over how much you eat?

Feeling out of control with food is a solid indicator that there is some type of eating disorder involved.  It may mean binge

eating disorder or compulsive overeating, as well as bulimia.  This common eating disorder symptom is very chaotic and

uncomfortable and should be treated professionally.

Have you recently lost more than 15 pounds in a three-month period?

Obviously this question is pointing at anorexic behaviors.  Do note, this is excessive weight loss from any starting

weight.  The individual suffering with anorexic habits may not actually be underweight.  If someone starts out at a weight

above normal, they can lose a lot of weight and still appear healthy.  It is just as crucial for a person who remains in a

normal range to get treatment for their disorder.

Do you believe yourself to be fat when others say you are too thin?

This question is also important even if others are not saying you are too thin, but even just fine or not fat.  If what you see

in yourself is very different from what others see, there is a good chance you are struggling with some level of body

dysmorphic disorder.  It is important to get appropriate help with this disorder as it can be very destructive to your life.

Would you say that food dominates your life?

This question pertains to all types of eating disorders.  Food and body thoughts will take up the majority of one’s

thoughts when they are struggling with an eating disorder.  This absolutely robs a person of the opportunity to enjoy their

life.  It is a constant distraction that prevents a person from really experiencing what is happening around them.

If you answer yes to two or more of the above questions, chances are you may be struggling with an eating disorder.  It is critical to seek help for eating disorder behavior.  While some people are able to overcome the behaviors on their own, the true underlying issues must be addressed.  If you or someone you know is struggling with any of the above eating disorder symptoms, please seek help immediately.

In the past people believed eating disorders were just for young girls, and would resolve naturally by age 25. It has become clear, as more people speak out, that eating disorders have no age limit.  In fact, people who thought they were recovered often find themselves triggered again at certain points throughout the life cycle.

Eating disorders are an ineffective coping strategy.  It only makes sense, then, that they would recur in periods of increased stress.  It can be difficult to see the real issue underlying the eating disorder, especially for those stricken.  It seems to them to clearly be about weight.

College

College is a common trigger.  Many of my clients fear the mythological  ”freshman 15″. They engage in eating disorder behavior to prevent weight gain at this time.  What they do not see as the bigger picture here is the fear about moving out of their parents home, the stress of college performance, and a whole host of emotions that go along with this transitional period in their lives.

Marriage

This is another common trigger for women (and men) to engage in eating disorder behavior.  There is pressure to look perfect on your wedding day.  There are rumors about gaining weight after marriage.  Underlying these surface issues are the true causes of the behavior.  It is a big unknown to be married.  It is another major transition in one’s life.  It brings up a myriad of old baggage about being loved, being worthy, etc., that a person may not be aware exists for them.

Pregnancy

This has gotten more attention lately.  This is especially scary because of the implication on two lives instead of one.  Women feel pressure to gain only a particular amount of weight.  They are also fearful about not being able to lose it if they gain too much.  I see postpartum being a major trigger for eating disorders as well.  All of this correlates with a time of dramatic change in a woman’s life. Fears about motherhood, the feelings of overwhelm with a new baby, etc., all play into the promotion of the disorder.

Divorce, Turning 40, Empty Nest, Midlife

This time can be one that inspires weight concerns as well.  Again, this is just the superficial cause of the eating disorder.  Underneath these worries are the real feelings brought on by this time of transition.  Around this age there are often many factors at work.  The children are growing up and leaving the home.  This can present issues in the marriage if it was primarily ‘all about the kids’.  There are issues of identity and purpose in life.  This can leave a person feeling lost and disoriented.  Body focus can be the chosen distraction to avoid dealing with these issues.

Retirement, Elderly

I know this may come as a surprise, but eating issues even come very late in life.  It is not uncommon to see anorexia among the elderly.  This is often written off as a symptom of aging, or a simple decrease in appetite.  But this often correlates with depression and anxiety seen with the aging.  I previously worked in a long term care facility, and I spent much of my time begging underweight patients to eat their food and drink their supplements.  I remember my shock when a woman in her late 80’s objected with the fear it would make her fat.

Eating disorder thoughts and behaviors, often originating in youth, can continue to plague people throughout their lives. Once it is established, even after recovery it can be a person’s ‘default’ coping mechanism.  This is why it is critical for people to receive adequate treatment when they realize they have an eating disorder.  Being able to understand the thoughts and recognize the behaviors throughout the life cycle is crucial.  If and when they recur, this recognition helps to minimize the extent to which they wreak havoc at these transitional times.

Do not be fooled.  No matter what happens with weight, the disorder will continue.  If weight is lost, one will continue to want to be lower and lower, regardless of what preset ‘goals’ they had in mind.

Eating disorders serve a much deeper purpose for the individual.  Like any ineffective coping strategy (perfectionism, alcoholism, drug addiction, etc.), they regulate emotions in a destructive way.  These individuals are unaware of the emotional aspect of the disorder.

Following is a list of functions of the eating disorder, adapted from the book The Eating Disorder Sourcebook by Carolin Costin.

• Comfort, soothing, nurturance
• Numbing, sedation, distraction
• Attention, cry for help
• Discharge tension, anger, rebellion
• Predictability, structure, identity
• Self-punishment or punishment of ‘the body’
• Cleanse or purify self
• Create small or large body for protection/safety
• Avoidance of intimacy
• Symptoms prove ‘I am bad’ instead of blaming others (for example,  abusers)

Often clients will tell me they don’t know what they are feeling.  This is the numbing aspect of the disorder.  Restriction, purging and binging (or emotional eating) all bring an emotional numbness to the individual.  This prevents one from feeling bad, but also inhibits any positive feelings.  People report just feeling sort of ‘flat’.

Eating disorders can be a cry for help.  The sufferer may not even realize they are not okay.  They do not have the ability to reach out for help, so the body ends up being the expression.  I have had many clients who were relieved to be ‘caught’ in their disorder so they could finally get help out of it (and ultimately get help for whatever was underlying the behaviors).

Identity plays a major role in eating disorders.  In those who do lose weight, there is a sense of being special because they are thinner than others.  Often they receive compliments (to a point), and this really fuels the drive.  Many of my clients struggle with the fear of not knowing who they are without the eating disorder.

There are many purposes an eating disorder can serve, but its purpose is never really about weight.  Those who are struggling with these issues must receive professional help to recover.  Though some people have managed to stop the behaviors on their own (atypical), the underlying issues are never addressed.  This leads to other ineffective coping habits.  When seeking help, insist the therapist, dietitian, and psychiatrist are experienced in treating those with eating disorders.  This is a highly specialized area, and it requires considerable experience to provide appropriate care.

Bulimia Nervosa has three primary symptoms:

• Regular intake of large amounts of food accompanied by a sense of loss of control over eating behavior.
• Regular use of inappropriate compensatory behaviors such as self-induced vomiting, laxative or diuretic abuse, fasting, and/or obsessive or compulsive exercise.
• Extreme concern with body weight and shape.

Warning Signs of Bulimia Nervosa:

• Evidence of binge-eating, including disappearance of large amounts of food in short periods of time or the existence of wrappers and containers indicating the consumption of large amounts of food.
• Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics.
• Excessive, rigid exercise regimen–despite weather, fatigue, illness, or injury–the need to “burn off” calories taken in.
• Unusual swelling of the cheeks or jaw area.
• Calluses on the back of the hands and knuckles from self-induced vomiting.
• Discoloration or staining of the teeth.
• Creation of complex lifestyle schedules or rituals to make time for binge-and-purge sessions.
• Withdrawal from usual friends and activities.
• In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.

Health Consequences of Bulimia Nervosa:

• Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death. Electrolyte imbalance is caused by dehydration and loss of potassium and sodium from the body as a result of purging behaviors.
• Inflammation and possible rupture of the esophagus from frequent vomiting.
• Tooth decay and staining from stomach acids released during frequent vomiting.
• Chronic irregular bowel movements and constipation as a result of laxative abuse.
• Gastric rupture is an uncommon but possible side effect of binge eating.

About Bulimia Nervosa:

• Bulimia nervosa affects 1-2% of adolescent and young adult women.
• Approximately 80% of bulimia nervosa patients are female (Gidwani, 1997).
• People struggling with bulimia nervosa will often appear to be of average body weight.
• Many people struggling with bulimia nervosa recognize that their behaviors are unusual and perhaps dangerous to their health.
• Bulimia nervosa is frequently associated with symptoms of depression and changes in social adjustment.

Binge Eating Disorder is characterized by:

• Frequent episodes of eating large quantities of food in short periods of time.
• Feeling out of control over eating behavior.
• Feeling ashamed or disgusted by the behavior.
• There are also several behavioral indicators of BED including eating when not hungry and eating in secret.

Health Consequences of Binge Eating Disorder:
The health risks of BED are most commonly those associated with clinical obesity. Some of the potential health consequences of binge eating disorder include:

• High blood pressure
• High cholesterol levels
• Heart disease
• Diabetes mellitus
• Gallbladder disease

About Binge Eating Disorder:

• The prevalence of BED is estimated to be approximately 1-5% of the general population.
• Binge eating disorder affects women slightly more often than men–estimates indicate that about 60% of people struggling with binge eating disorder are female, 40% are male (NIH, 1993).
• People who struggle with binge eating disorder can be of normal or heavier than average weight.
• BED is often associated with symptoms of depression.
• People struggling with BED often express distress, shame, and guilt over their eating behaviors.