Think you know what an eating disorder is all about? You may not.
Research by Oxford University suggests that eating disorders remain poorly understood by the general public and even health professionals.
Sure, some symptoms are obvious–say, weight loss or purging after eating–but others are less so.
In order to identify the sometimes subtle symptoms of an eating disorder and encourage someone to seek help, here are five surprising facts you should know.
It's not just teens and young womenMany people assume that only teenage and young adult women develop eating disorders–but increasingly, doctors are seeing more and more cases in women and men of all ages, even in children and the middle aged. A recent study published in the Canadian Medical Association Journal found a lack of awareness about male eating disorders often prevented diagnosis and treatment–even though men and boys account for about 25% of cases.
“I have started to see a lot more women in their 40s and up who come to me with eating disorders,” says Jodi Rubin, a therapist in New York City and adjunct lecturer at the NYU Silver School of Social Work. Often times, these later-in-life disorders are triggered by a major life change–leaving or re-entering the work force, getting a divorce, or having a baby, for example.
You can't tell by looking at someoneAn eating disorder can be hard to spot: Bulimia and anorexia symptoms traditionally include dramatic weight loss, but it’s also possible to have disordered eating while maintaining a normal body weight, says Rubin. Binge eaters, in fact, may even be overweight, or may repeatedly shed and then pack on pounds.
“Eating disorders are about control and self esteem as much as they are about the number on the scale,” she says. Someone with an eating disorder may work hard to keep their weight at a certain number as to not “let on” that he or she has a problem, for example.
There are as many emotional symptoms as there are physicalSure there are plenty of visible cues that someone might have an eating disorder: Along with weight loss, people who severely restrict calories or nutrients may experience thinning hair, dry skin, and–in the case of a purging disorder–swollen cheeks.
But the emotional signs of an eating disorder may be easier to spot, if you know what to look for. At their root, almost all eating disorders are symptoms of or self-esteem issues, says Rubin. You may notice that a friend or loved one has become moody, uptight, anxious, or is expressing self-doubt and shame–either about his or her body, or about life in general.
Strange behaviors might be a clueNewly adopted rituals can also be a sign that a person’s relationship with food has taken an unhealthy turn. A friend may begin to obsessively count calories, focus only on specific foods or food groups, or avoid making spontaneous plans, or stop eating with other people altogether. When you do eat together, he or she may exhibit unusual food behaviors–using a lot of condiments, or fixating on strange food combinations, for example.
For people hyper-focused on their weight and body image, a preoccupation with exercise often goes along with an eating disorder, as well. It’s normal to want to burn off excess calories after a big meal, but if a friend seems to panic after missing one workout, that’s a red flag.
Calling someone out may not helpMany people with eating disorders are in denial about their problem, says Rubin; some are even proud of the control they are able to exert over their bodies. By bringing up food or weight issues you’ve noticed with a friend, he or she may tell you that you’re imagining it, or that there’s nothing to worry about.
Instead, try talking about the emotional issues: “If you say, ‘I’ve noticed you seem depressed lately,’ they’re not really able to deny that,” says Rubin. And even if they don’t come clean and agree to seek help then and there, they’ll remember that you’ve expressed concern and that you’re a safe place to go when they’re ready to talk.