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Eating disorder symptoms: What are the early signs of an eating disorder?

Medically reviewed by Josephine Bawab, Pharm.D.
Licensed Pharmacist
Updated Oct. 27, 2023  •  Published May. 17, 2023
Fact Checked
Eating disorder symptoms

Overview: What does an eating disorder look like?

Eating disorders include a wide range of psychiatric illnesses. They all involve abnormal eating behaviors that affect physical health, mental health, daily functioning, and social relationships. The most common include severely restricting food intake (anorexia nervosa); regularly eating too much and then purging with self-induced vomiting, excessive exercise, or taking laxatives (bulimia nervosa); or regularly eating large amounts of food in a short period of time (binge eating disorder). However, there are other eating disorders, such as eating things that aren’t food or refusing to eat most foods. In some cases, eating disorders are readily apparent through eating behaviors. The problem is that many people with eating disorders learn to hide their behaviors. Physical signs of an eating disorder are sometimes apparent, like extreme weight loss or weight fluctuations, whereas some people with eating disorders have normal weight. Finally, the signs of an eating disorder often resemble other mental illnesses' symptoms. However, people with eating disorders frequently have other psychiatric disorders, such as anxiety, depression, or personality disorders. It’s not always easy to read the outward signs of an eating disorder.

Key takeaways:

  • Eating disorders are a common health condition that can affect anyone, regardless of age, sex, race, or ethnicity. Find updated eating disorder statistics here.

  • Early signs of an eating disorder will depend on the type of eating disorder. These early signs may include changes in eating behaviors, weight changes, food avoidance, increased focus on weight and body image, food and nutrition, compulsive exercise, mood swings, food hoarding, and other behavioral changes.

  • Serious symptoms of an eating disorder, such as suicide attempts, suicide planning, a slow heart rate, heart rhythm problems, hypothermia, severely low blood pressure, or signs of electrolyte imbalance, may require immediate medical attention.

  • Eating disorders are caused by many contributing factors, including genetics, brain chemistry, family and social relationships, mental health conditions, and cultural influences. You may be at risk for developing eating disorder symptoms if you are an adolescent, young adult, female, or a perfectionist in your behaviors. Other risk factors include anxiety, impulsivity, obsessive-compulsiveness, mood disorders, mental illness, distorted body image, limited social support, childhood obesity, parental, family, or peer weight concerns, a history of dieting, or childhood physical or sexual abuse. 

  • Eating disorders usually require a medical diagnosis.

  • Eating disorders generally require treatment. Eating disorder symptoms often resolve within a few months to a few years of treatment, depending on the disorder, but not always.

  • Treatment of eating disorders may include psychotherapy, group therapy, family therapy, nutritional counseling, psychiatric drugs, and hospitalization in serious cases. Read more about anorexia and bulimia treatments here and binge eating disorder treatments here.

  • An untreated eating disorder could result in complications, such as malnutrition, vitamin deficiency, heart problems, electrolyte imbalance, anemia, dental problems, weakened bones, refeeding syndrome, obesity, type 2 diabetes, depression, anxiety, and suicide. 

Use coupons for eating disorder treatments, such as Prozac (fluoxetine), Vyvanse (lisdexamfetamine), and Topamax (topiramate), to save up to 80%.

What are the early signs of an eating disorder?

The early signs of an eating disorder may be readily identifiable or well-concealed. The best way to figure out if there’s a problem is to look at the whole picture and start a dialogue to figure out what’s going on.

Some of the earliest warning signs of anorexia or bulimia include:

  • Changes in eating behaviors, such as skipping meals, eating smaller portions, food rituals (picking at food or chewing for a long time), or avoiding certain foods

  • Frequent dieting or adopting fad diets

  • Rapid or significant weight loss

  • Increased focus on food, nutrition, and calories

  • Increased focus on the body, body weight, and body issues

  • Increased or compulsive exercising

  • Frequent trips to the bathroom after eating

  • Mood swings

  • Social withdrawal

  • Digestive system problems

  • Cold sensitivity

  • Sleep disruptions

  • Weakness

  • Changes in menstruation

Early warning signs of binge eating disorder include:

  • Weight gain 

  • Food missing from the refrigerator or cupboards

  • Hidden food hoards 

  • Unexplainable or hidden food package waste

Other eating disorder symptoms

There is more than one type of eating disorder and their symptoms can vary widely. 

The most common symptoms of anorexia nervosa include:

  • Abnormal eating behaviors, such as skipping meals, eating small portions, or performing ritualized behaviors (picking at food)

  • Rapid weight loss

  • Body weight below normal body mass index (BMI)

  • Symptoms of malnutrition and vitamin deficiency

  • Gastrointestinal symptoms, such as acid reflux

  • Heart problems such as slow heart rate or heart rhythm abnormalities

  • Symptoms of electrolyte imbalance

  • Dry skin

  • Thin hair (lanugo)

  • Menstrual changes

  • Sleep disturbances

  • Weakness

  • Fainting

  • Fatigue

  • Extreme concerns about dieting, food, body weight, and body image

  • Social withdrawal

  • Mood changes

The symptoms of bulimia nervosa may include:

  • Weight loss is possible, but body weight usually remains normal

  • Evidence of purging behaviors, such as frequent trips to the bathroom, constipation (from laxative use), or vomit odors

  • Evidence of binging behaviors, such as food hoards, missing food, large amounts of food packaging waste, or hidden stashes of discarded food packaging

  • Dental problems due to vomiting

  • Cuts or calluses on the backs of fingers

  • Gastrointestinal problems

  • Symptoms of electrolyte imbalances

  • Swelling on the sides of the face (swollen parotid glands)

The symptoms of binge eating disorder may include:

  • Weight gain

  • Evidence of binge eating, such as missing food, food hoarding, and hidden food packaging waste

  • Excessive focus on dieting, body image, and exercising

  • Low self-esteem and shame

  • Dental problems

Other eating disorders are less common. Some will have symptoms similar to anorexia, bulimia, or binge eating disorder, but some will have completely different symptoms.

Eating disorder vs. disordered eating symptoms

Although they sound alike, disordered eating is not an eating disorder. Disordered eating is any abnormal eating or purging behavior. This includes dieting, skipping meals, fasting, food avoidance, severe food restrictions, self-induced vomiting, laxative use, diuretic use, over-exercising, and so on. That’s right–dieting is disordered eating. The symptoms look much like those of an eating disorder, such as changes in eating behaviors, a focus on food and nutrition, a focus on body image and body weight, and even physical symptoms if a diet is too restrictive. 

Here’s the best way to understand the difference: disordered eating is related to eating disorders, just as occasionally drinking is related to alcohol abuse disorder. In many ways, eating disorders resemble addiction. That doesn’t mean disordered eating is okay. Frequent bouts of disordered eating, particularly frequent dieting, raise the risk of developing a full-blown eating disorder.

Types of eating disorders: How can I tell which one I have?

There are three major types of eating disorders: anorexia nervosa, bulimia nervosa, and binge eating disorder. They are all potentially dangerous and require medical treatment.

  • Anorexia nervosa is a severe food restriction, resulting in body weight below a healthy body mass index (BMI). It is accompanied by an intense fear of gaining weight and an obsession with body shape.

  • Bulimia nervosa is characterized by at least once-per-week episodes of binge eating, followed by purging behaviors, such as self-induced vomiting, laxative use, diuretic use, or over-exercising. Bulimia is also accompanied by a distorted body image and anxiety about weight gain.

  • Binge eating disorder is characterized by episodes of uncontrolled overeating, followed by shame and embarrassment.

There are less common eating disorders as well.

  • Avoidant/restrictive food intake disorder (ARFID) is diagnosed when infants, toddlers, or children either lose interest in eating or avoid most foods. As a result, they eat only a limited number of preferred foods.

  • Pica is an eating disorder in which people compulsively eat things that aren’t food, such as ice, paste, dirt, or paper.

  • Rumination disorder is an eating disorder in which people vomit up their food and either swallow it, chew it, play with it, or spit it out

  • Other specified feeding and eating disorders (OSFED) refers to a variety of eating disorders, including purging disorder (normal eating followed by occasional purging), night eating syndrome (binge eating at night), atypical anorexia nervosa (anorexia eating behaviors and psychological symptoms without the weight loss), and subthreshold bulimia and binge eating (eating behaviors similar to bulimia or binge eating disorder, but not severe enough for a diagnosis).

RELATED: Anorexia vs. bulimia: causes, symptoms, treatments

When to see a doctor for eating disorder symptoms

Talk to a primary care doctor if you believe that you or a loved one has an eating disorder. Diagnosing an eating disorder may be easy in some cases, but it will require more in-depth inquiry in others.

In the initial visit, the doctor will ask about eating habits, attitudes towards eating, the body, weight, stress, mood problems, sleep, physical problems, social relationships, and family issues. A complete physical examination is needed to determine vital signs, nutritional status, BMI, and possible physical complications. If there’s a question about malnutrition or electrolyte imbalances, the doctor may order an electrocardiogram. Doctors also have various screening questionnaires that allow them to identify anorexia, bulimia, or binge eating disorders. They aren’t foolproof, but they do help. Eventually, a person with an eating disorder will need to be evaluated by a mental health professional.

If caught early, eating disorders are not an emergency. However, if left for too long, an eating disorder can be life-threatening and require emergency treatment. Very rapid weight loss or extreme thinness both require immediate medical care. Symptoms of electrolyte imbalance or heart problems are signs that an emergency department is needed. Always call 911 if there is meaningfully talk about suicide or if a suicide attempt is made.

Complications of an eating disorder

The complications of an eating disorder depend on the type of eating disorder.

Complications of anorexia include:

  • Slowed growth

  • Failure to thrive

  • Delayed puberty

  • Heart rhythm problems (slow or irregular heartbeats)

  • Kidney problems

  • Brain fog

  • Peripheral nerve damage

  • Osteoporosis

  • Pregnancy complications

  • Infertility

  • Constipation

  • Mood disorders

  • Substance abuse

  • Suicide

Complications of bulimia include:

Complications of binge eating disorder include:

How to treat eating disorder symptoms

Eating disorders require treatment. The preferred treatment for the most common eating disorders (anorexia, bulimia, and binge eating disorder) is outpatient psychotherapy. The treatments that work are cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), group therapy, and, for adolescents, therapy with family members. A dietitian or nutritionist will also be needed to provide nutritional counseling. In some cases, psychiatric medications may be prescribed. There is no FDA-approved medication to treat anorexia, but fluoxetine is approved for treatment of bulimia. Binge eating disorder can be treated by Vyvanse (lisdexamfetamine). Other drugs are sometimes used off-label, such as antipsychotics or antidepressants. They’re not FDA-approved and have limited studies, but they may help.

For severe cases of anorexia or bulimia, inpatient hospital care may be required. The goal of treatment is to restore body weight and reverse medical complications, such as electrolyte imbalances. Suicidal patients will require psychiatric hospitalization.

RELATED: How does Vyvanse work for binge eating?

Signs an eating disorder is getting better

Eating disorders are complex. They typically take months or years of treatment to completely remit. Improvement is choppy. There will be recurrences and backsliding. In some cases, there may not be complete remission, just improvement. It’s a slow and steady path. 

The most positive signs that an eating disorder is getting better include:

  • Recovery of a normal weight

  • Realistic body image

  • Realistic perceptions about food, nutrition, and calories

  • Healthy eating patterns and habits

  • Increased focus on aspects of life other than body weight, body image, and food

Most importantly, talk to a doctor if there’s any doubt

Most of us have some problems with eating and dieting. These problems typically come and go, but they don’t interfere with our lives or make us sick. An eating disorder isn’t so benign. Eating disorders seriously interfere with daily life and threaten the body’s health. When is the line crossed between having problems with eating and having an eating disorder? It’s not always clear. If there’s any doubt about eating behaviors, yours or a loved one’s, talk to a healthcare provider or mental health professional. Even if it’s not an eating disorder, there are effective ways to manage our eating, handle stress, control our reactions, and learn healthy behaviors.

RELATED: Finding the right medication for your mental health starts with finding the right doctor

FAQs about eating disorder symptoms

Which is a classic psychological symptom associated with eating disorders?

There are a variety of eating disorders. The most common—anorexia, bulimia, and binge eating—are often associated with anxiety, perfectionism, impulsivity, low self-esteem, distorted body image, and depression.

Can you get stomach pain from not eating enough?

The stomach tells us when it’s empty. It secretes a hormone called ghrelin, the “hunger hormone.” Ghrelin tells your brain you’re hungry and stimulates the stomach to secrete acid. Since there’s nothing in the stomach, that acid can irritate the stomach lining and maybe even the esophagus, which usually hurts.

What are the side effects of not eating enough in a day?

Not eating enough for a day isn’t a severe problem. Your body is evolved to handle the occasional lack of food. The main side effect of skipping meals and not eating enough in a day is low blood sugar. Energy levels will be low and it’ll be harder to control moods. Staying focused, concentrating, and remembering things may be difficult to do. These side effects are a good sign that it’s time to eat something.

What’s next? Additional resources for people with eating disorder symptoms

Test and diagnostics

Treatments

Scientific studies and clinical trials

Medically reviewed by Josephine Bawab, Pharm.D.
Licensed Pharmacist

Josephine Bawab, Pharm.D., graduated from Virginia Commonwealth University School of Pharmacy. She began working in community pharmacy in 2012 and has worked for multiple chain pharmacies since then. She is passionate about helping patients and precepting students. She currently works and resides in Virginia, where she is just a few minutes away from the beach.

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