Eating Disorders: Identifying the Signs

By: Indira Maurer, DNP, FNP-C

Eating disorders stand as the third most common chronic illness affecting our adolescent population³.  Eating disorders are associated with the highest risk of fatality than any mental health disorder³ and only 31% of patients with anorexia nervosa recover within 10 years of diagnosis². Despite these alarming statistics, there is a greater need for the education of primary care providers regarding the identification and diagnosis of eating disorders.

Eating disorders do not discriminate as people of all ages, racial and ethnic backgrounds, and genders can be affected¹. Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life¹.

There are multiple types of eating disorders we must be aware of: 

Anorexia nervosa occurs when individuals avoid food, restrict food, or eat limited types of foods. They tend to weigh themselves often and may see themselves as overweight even when dangerously underweight¹.

There are two subtypes of anorexia nervosa: a “restrictive” subtype and a “binge-purge” subtype.

• In the restrictive subtype of anorexia nervosa, people severely restrict the quantity and type of food they eat¹.
• In the binge-purge subtype of anorexia nervosa, people also greatly restrict the quantity and type of food they eat. However, they may also have binge-eating and purging episodes where they eat large amounts of food followed by vomiting and the use of laxatives to “purge” what was consumed¹.

Symptoms we can look out for include:

• Mild anemia and muscle wasting and weakness
• Brittle hair and nails
• Dry and yellow-tinged skin
• Growth of fine hair all over the body
• Constipation
• Low blood pressure
• Slowed breathing and pulse

Bulimia nervosa occurs when individuals have episodes of eating abnormally large quantities of food and experiencing a lack of control during the episodes. These episodes are followed by vomiting, use of laxatives and/or diuretics, fasting, or excessive exercise to eliminate or “work off” the calories consumed¹.

Symptoms we can look out for include:

• Chronically inflamed and sore throat
• Swollen salivary glands i
• Worn tooth enamel and decaying
• Acid reflux disorder
• Intestinal distress and irritation
• Severe dehydration
• Electrolyte imbalance

The binge-eating disorder occurs when an individual experiences episodes of eating unusually large amounts of food. However, unlike bulimia nervosa, these episodes are not followed by vomiting, the use of laxatives and/or diuretics, fasting, or excessive exercise. Individuals with binge-eating disorder are likely overweight or obese. It is important to know that binge-eating disorder is the most common eating disorder in the United States¹.

Avoidant restrictive food intake disorder (ARFID), occurs when individuals limit the quantity or types of food consumed. Unlike anorexia nervosa, this is not associated with a distorted body image or anxiety around weight gain¹. The best way to describe this condition is to consider a young child that goes through phases of picky eating, however, an individual with ARFID does not “outgrow” this phase and ultimately does not consume enough calories to grow and develop normally¹.

Increasing awareness of eating disorders and identifying the symptoms that present with these disorders will alert us when greater steps need to be taken to ensure prompt diagnosis and treatment measures.  

References:

1. Eating disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/eating-disorders.
2. Volpe KD. A perfect storm: Rise in eating disorders among teens during covid-19. Clinical Advisor. https://www.clinicaladvisor.com/home/topics/pediatrics-information-center/a-perfect-storm-rise-in-eating-disorders-among-teens-during-covid-19/. Published August 1, 2022.
3. Reynolds K, Lucrezia S, Reese J. Eating disorder facts. Johns Hopkins All Children’s Hospital. https://www.hopkinsallchildrens.org/Services/Pediatric-and-Adolescent-Medicine/Adolescent-and-Young-Adult-Specialty-Clinic/Eating-Disorders/Eating-Disorder-Facts. Published 2023.