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What is an Eating Disorder?
Overt Behaviors by Carolyn Costin, MFT
When Exercise is Excess-Ersize by Dr. Margo Maine

What is an eating disorder?

Eating disorders include extreme emotions, attitude, and behavior surrounding weight and food issues experienced by both women and men. They include anorexia nervosa, bulimia nervosa, and binge eating disorder. All are serious emotional and physical problems that can have life-threatening consequences.

Anorexia Nervosa is characterized by self-starvation and excessive weight loss. Anorexia does not mean you have stopped eating completely. This is a myth that people with anorexia have. Look at the pre-warning signs and one will see how innocuously the illness begins.

Symptoms include:

• Refusal to maintain body weight at or above a minimally normal level weight for height, body type, age, and activity level
• Intense fear of weight gain or being "fat"
• Feeling "fat" or overweight despite dramatic weight loss
• Loss of menstrual periods
• Extreme concern with body weight and shape
• Significant weight loss over a period of time

Bulimia Nervosa is characterized by a secretive cycle of binge eating followed by purging. Bulimia includes eating large amounts of food-more than most people would eat in one meal- in short periods of time, then getting rid of the food and calories through vomiting, laxative abuse, or over-exercising. Bulimia also encompasses purging that starts after a person has had weight loss surgery, or a person that is dependent on diet pills, ephedra or non-ephedra type substances to keep weight in check.

Symptoms include:

• Repeated episodes of bingeing and purging
• Feeling out of control during a binge and eating beyond the point of comfortable fullness
• Purging after a binge, typically by self-induced vomiting, abuse of laxatives, diet pills and/ or diuretics, excessive exercise, or fasting
• Frequent dieting
• Extreme concern with body weight and shape

Compulsive Overeating is characterized primarily by periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling comfortably full. While there is no purging, there may be sporadic fasts or repetitive diets and often feeling of shame or self-hatred after a binge. People who overeat compulsively may struggle with anxiety, depression, and loneliness which can contribute to unhealthy episodes of binge eating. Body weight may vary from normal to mild, moderate, or severe obesity.

Other Eating Disorders can include some combination of the signs and symptoms of anorexia, bulimia, and/ or compulsive overeating. While these behaviors may not clinically considered a full syndrome eating disorder, they can still be physically dangerous and emotionally draining. All eating disorders require professional help.

National Eating Disorders Association, NEDA (1998), Basic Facts Handout.

Overt Behaviors by Carolyn Costin, MFT 

1. Does your daughter constantly go on diets and/or make excuses for not eating?
2. Does she exhibit bizarre food rituals or behaviors?
3. Is she preoccupied with food and weight?
4. Does she express herself in all-or-nothing, black and white, thinking?
5. Does she avoid social situations, especially if they involve food?
6. Has she started to lose friends and withdraw?
7. Have you found hidden food, laxatives, diuretics, and/or diet pills?
8. Does your daughter go to the bathroom or otherwise disappear after eating?
9. Is she eating a great quantity of food but losing weight or not gaining?
10. Has she started wearing baggy clothing and layers of clothes?
11. Did you notice extreme mood swings in her that have no apparent source?
12. Is food missing from the house with no explanation?
13. Is she spending money with nothing to show for it?
14. Does she fast occasionally with various excuses?
15. Does she get up late at night and have trouble sleeping?
16. Have her face and neck glands become swollen and puffy?
17. Does she have signs of scars on the back of the hand (due to teeth marks from forced vomiting)?
18. Does she seem tired and lack vitality?
19. Does she get depressed and angry for no apparent reason?
20. Do you feel as though you never see her eating?
21. Is she losing weight and is defensive about it?
22. Has your daughter become a vegetarian and/or otherwise avoid specific foods?
23. Is your daughter almost illogical and paranoid about eating certain foods?
24. Does she take showers after meals?
25. Have there been signs of vomiting, although she never said anything about being ill?
26. Are there any signs of enema or laxative abuse?
27. Does she seem to feel cold all the time?
28. Is her hair falling out and showing up on her hairbrush or in the shower?
29. Does your daughter obsess over what others eat and does she want to cook for, bake for, and feed others?
30. Is she preoccupied with or does she obsess over pictures of thin people?
31. Does she obsessively weigh herself, panicking at your suggestion of taking the scale away?
32. Does her diet contain an excessive amount of gum, coffee, diet soda, mustard, spices, and other non-calorie items?
33. Has she become a calorie computer?
34. Is she steadily gaining weight?
35. Does she always want and/or use food as a reward?
36. Has she had temper tantrums over food not being :just right"?
37. Have you seen her with bloodshot eyes and burst blood vessels (from vomiting)?
38. Has she had a increased number of cavities and/or discoloration of the teeth?

*Source: Your Dieting Daughter by Carolyn Costin, MFT, 1997. Carolyn Costin is the director of the Monte Nido Treatment Center and the Eating Disorder Center of CA, for more information visit her websites at www.montenido.com and www.edcca.com.

When Exercise is Excess-Ersize  by Dr. Margo Maine