Beyond the Scale: Recognizing the Symptoms and Dangers of Eating Disorders

By Rachel Hines, PLPC, NCC

Distressed woman sits on the ground with a scale in front of her.
Eating disorders (EDs) impact approximately nine percent of the U.S. population, according to the National Eating Disorders Association. Meaning that 28.8 million Americans will have an eating disorder at some point in their lives. Despite such prevalence, the true experiences of those with eating disorders remain relatively unknown. Instead, stereotypical portrayals of what an eating disorder “looks like” overshadow the real manifestations and impacts of these conditions.

For many experiencing symptoms of an ED, shame and fear of judgment keep them silent and secretive about their behaviors. As such, providers who treat or who may encounter individuals with EDs must understand the signs, symptoms and dangers — both overt and hidden.

Eating Disorder Warning Signs

Eating disorders can vary in presentation. Here are some signs to look for:

  • Restricting certain food groups or food intake
  • Rigid rules around food, mealtime or eating behaviors
  • Lack of interest in food and denying being hungry
  • Reducing or restricting foods due to texture or consistency
  • Preoccupation with food, calories or dieting
  • Weight loss or weight gain
  • Loss of or irregular menstrual periods
  • Decrease in socialization, refusing social events
  • Hyper-fixation on body shape, size and/or weight; wearing baggy clothes or layers
  • Excessive exercise; other compensatory behaviors

Predominant ED Diagnoses

  • Anorexia Nervosa: Restriction plus overvaluation of body weight/shape plus low or suppressed body weight
  • Bulimia Nervosa: Binge/purge behaviors plus overvaluation of body weight/shape
  • Binge Eating Disorder: Binge eating without regular compensatory behaviors plus shame related to binges
  • Avoidant-Restrictive Food Intake Disorder: Restriction and/or malnutrition not related to body image concerns. Restriction is driven by one or more of the following: fear of adverse consequences, sensory sensitivity, lack of interest
  • Other Specified Feeding or Eating Disorder: Atypical Anorexia, Bulimia Nervosa of low frequency, Binge Eating Disorder of low frequency, Purging Disorder, Night Eating Syndrome

Common co-occurring disorders include mood disorders, anxiety disorders and substance use disorders. Many individuals with EDs have a trauma history. Non-suicidal self-injury and suicidal ideation are common among this clinical population.

Common Biopsychosocial Etiological Factors

Biological Psychological Social
Family history of EDs or other mental health conditions Perfectionism Weight stigma
Genetic predisposition Over-control tendencies Bullying, teasing, body shaming
Altered levels of serotonin and/or dopamine Psychological rigidity Trauma, particularly sexual abuse
Disruptions in certain hormone function Black-and-white thinking Drive for perceived ideal body type
Metabolic differences Reduced interoceptive awareness Social media images and pressures
History of dieting Low self-worth Proximity to body-focused jobs, sports, performing arts, etc.

Health Impacts of EDs

  • Low or irregular heartbeat, low blood pressure
  • Muscle loss, including the heart
  • Gastrointestinal issues, including bloating, nausea, constipation
  • Excessive fatigue, dizziness, and fainting spells
  • Hormonal changes (estrogen, testosterone, thyroid)
  • Weak bones and risk of osteoporosis
  • Loss of or irregular menstruation and risk of infertility
  • Delayed onset of puberty and slowed or stunted growth
  • Difficulty concentrating and impaired cognitive function
  • Problems with sleep
  • Skin dryness, hair thinning, nail brittleness, enamel decay
  • Anemia, kidney failure, reduced immune response
  • Premature death

When Should a Provider Refer a Patient to an Eating Disorder Intensive Outpatient Program?

Here are just a few instances when a provider should refer a patient to intensive outpatient programming (IOP) for eating disorders treatment:

  • Observed or reported signs and symptoms of disordered eating are present.
  • Symptoms are interfering with the person’s life and ability to function.
  • The individual has a clear potential to decline further without increased intervention.
  • The person would benefit from a structured environment for meal completion support, skills practice, and therapy goal achievement.
  • Co-occurring medical conditions or substance use disorders, if present, can be safely managed at an outpatient setting.

Saint Louis Behavioral Medicine Institute

SLBMI’s Eating Disorders Program offers IOP and outpatient treatment options for individuals struggling with eating disorders and disordered eating. For more information about the program or to schedule an intake appointment, please email us at [email protected] or call 314-289-9411.