Signs and Symptoms of Eating Disorders

The signs and symptoms of the different types of eating disorders may vary significantly, depending on the nature of the disorder. Since most eating disorders are linked to an underlying psychological disturbance, there is usually  common psychological features present in all of these disorders.

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Differentiating between the signs and symptoms of the eating disorder and that of any featuring psychological disorder will allow for a more conclusive diagnosis. The effects of different types of eating disorders may also assist with a final diagnosis.

Signs and Symptoms of Eating Disorders

Common Psychological Features of Eating Disorders

  • A sense of low self-worth is usually a common finding in most types of eating disorders and there is often a constant need for acceptance and approval from others.
  • A combination of anxiety, depression, personality disorders and obsessive compulsive features may also be present to varying degrees in the individual, irrespective of the eating disorder.
  • Substance abuse may be found in a person with an eating disorder and this does not only relate to alcohol, narcotic or nicotine abuse, but even the misuse of pharmaceutical drugs, both scheduled and OTC (over-the-counter).
  • A past history of obesity may often be present and this is usually the initiating factor for many types of eating disorders.
  • A tendency to be secretive, similar to drug and alcohol abusers, as well as a need to purge may be noticed.

In the three most common types of eating disorders, other features that may be evident (in addition to those above) include :

Anorexia Nervosa

Not all signs and symptoms mentioned below will be evident in a case of anorexia nervosa.

  • Obsession about the quantity and frequency of food intake with an excessive fear of gaining weight.
  • Tendency to measure and allocate exact (usually very small) portions of food during a meal and only eat certain types of food.
  • Being thin to the point of emaciation, yet the person is convinced that they are overweight or obese.
  • Change in usual apparel in order to hide the emaciation behind baggy, loose fitting clothing and hiding heavy objects in their clothing when being weighed on a scale.
  • Excessive or constant dieting with episodes of purging and a tendency to exercise excessively despite being underweight.
  • There may be some hyperactivity noticed in these individuals initially but as the condition progresses, abnormal fatigue and a reduced ability to concentrate may be noticed.
  • Amenorrhea (no period) for more than 3 months.
  • Altered mental and emotional state, change in the pattern of sleep, mood swings and tendency to withdraw socially.
  • Feeling of fullness after eating small meals and altered bowel movements, usually constipation.
  • Psychosexual problems.
  • Dental caries linked to poor nutrition and frequent episodes of vomiting.
  • Anemia.
  • Extreme sensitivity to cold.
  • Increase in the amount of lanugo hair (soft, fine type of body hair) on the arms and chest (hypertrichosis) and female facial hair (hirsutism).
  • Hypotension (low blood pressure) and bradycardia (slow pulse rate).
  • Electrolyte imbalance due to frequent binging and purging.
  • Hormonal imbalance – decreased estrogen, LH (luteinizing hormone), TSH (thyroid stimulating hormone) and increased blood levels of cortisol and the thyroid hormones, T3 (triiodothyronine) and T4 (thyroxine).
  • Difficulty falling pregnant or infertility.
  • Abnormal ECG – prolonged QT interval.
  • Arrhythmias – heart rate abnormalities.

Bulimia Nervosa

  • A normal body weight is usually maintained.
  • Episodes of binging followed by purging and severe dieting.
  • Tiredness and lethargy.
  • Constipation.
  • Feeling of fullness.
  • Abdominal pain.
  • Arrhythmias.
  • Irregular periods.
  • Swelling of the hands and feet.
  • GERD – gastro-esophageal reflux disease.
  • Erosion of dental enamel and dental caries.
  • Russell’s sign – calluses on the back of the hands, from tooth marks during induction of vomiting.
  • Electrolyte imbalance.
  • Abnormal ECG.
  • Severe dehydration.

Binge-Eating Disorder and Compulsive Overeating

  • Obesity is usually present although some compulsive over-eaters may maintain a normal body weight.
  • Feelings of guilt and shame after a binge but there is no attempt to induce vomiting or resort to other methods of purging, like laxative use.
  • Prefers to eat in isolation.
  • Relies heavily on food as a means of emotional support (‘comfort eating’).
  • Tendency to hide or store food for later consumption.
  • Other associated psychological problems, usually depression.
  • Fatigue.
  • Insomnia.

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