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Signs of an eating disorder
Eating disorders are often hidden, by shame, by secrecy, and by the false belief that a person has to look a certain way to be ill. Recognizing the warning signs is what gets someone to help sooner. The signs fall into three groups: changes in behavior, changes in the body, and changes in mood and thinking. No one shows every sign, and the absence of any single one does not rule out a problem.
This page is a practical guide to those signs and what to do about them. For an overview of the conditions, see what is an eating disorder.
The three groups of warning signs
Behavioral
Preoccupation with food, weight, calories, or dieting · skipping meals or making excuses to avoid eating with others · cutting out whole food groups · food rituals (eating in a set order, excessive chewing) · secrecy around eating · trips to the bathroom after meals · driven, excessive exercise · withdrawing from friends and activities.
Physical
Weight changes up or down · stomach cramps and other gut complaints · dizziness, especially on standing, or fainting · feeling cold all the time · trouble sleeping (insomnia) · dental erosion and tooth sensitivity · fine downy hair (lanugo) · calluses across the knuckles · missed or irregular periods.
Emotional and psychological
Intense concern with body size and shape · frequent mirror-checking for perceived flaws · distorted body image · mood swings, anxiety, or low mood · increasing social withdrawal.
These lists draw on the warning signs described by the National Eating Disorders Association.1
You cannot tell by looking
A dangerous myth is that an eating disorder always shows up as a very thin body. It does not. As the National Institute of Mental Health puts it, even people who appear healthy can have an eating disorder and be extremely ill, and people with eating disorders can be underweight, average weight, or higher weight.2 Eating disorders affect people of every gender, age, race, body size, and background.3 That is why so many cases are missed, and why the warning signs above matter more than the number on a scale.
When it is more than dieting
Ordinary attention to food is common; an eating disorder is different in degree. The shift to watch for is when eating, weight, or body image starts to dominate a person's thoughts, hide itself, produce physical symptoms, or interfere with school, work, relationships, and daily life. When food and body move from background to foreground in those ways, it is worth a closer look.
What to do if you notice the signs
A worry that something is wrong is reason enough to act. You do not need to be certain, and you do not need the person to have "enough" symptoms. The next step is an assessment with a clinician or an eating-disorder program, which can tell whether what you are seeing is an eating disorder and, if so, what level of care fits. Seeking help sooner rather than later is worthwhile. If you are supporting someone, see how to help a loved one start treatment, or search for programs.
References
References
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National Eating Disorders Association: Warning Signs and Symptoms. Source for the behavioral, physical, and emotional warning-sign lists, including food rituals, amenorrhea, dizziness and fainting, dental problems, lanugo, calluses on the knuckles (Russell's sign), and body-image preoccupation. ↩
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National Institute of Mental Health, Eating Disorders: What You Need to Know (revised 2024). "Even people who appear healthy can have eating disorders and be extremely ill," and people with eating disorders "can be underweight, average weight, or overweight." ↩
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Schaumberg K, et al. The Science Behind the Academy for Eating Disorders' Nine Truths About Eating Disorders. European Eating Disorders Review. 2017;25(6):432-450. Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses. ↩
Common questions
What are the warning signs of an eating disorder?
Signs fall into three groups. Behavioral: preoccupation with food, weight, or calories, skipping meals or avoiding eating with others, food rituals, secrecy, and excessive exercise. Physical: weight changes, stomach complaints, dizziness or fainting, feeling cold, trouble sleeping, dental damage, and missed periods. Emotional: intense concern with body shape, frequent mirror-checking, mood changes, and withdrawal.
Can you have an eating disorder at a normal weight?
Yes. According to the National Institute of Mental Health, even people who appear healthy can have an eating disorder and be extremely ill, and people with eating disorders can be underweight, average weight, or higher weight. Weight is not a reliable test of whether someone is sick.
Who do eating disorders affect?
Anyone. Eating disorders affect people of every age, gender, race, ethnicity, body size, and background. The stereotype of a thin young woman leads many people to be missed, including men, people of color, older adults, and people in larger bodies.
How do I know if it is an eating disorder or just dieting?
The line is harm and preoccupation. Ordinary attention to food does not dominate a person's thoughts, hide itself, cause physical symptoms, or disrupt daily life. When eating and body image start doing those things, it is worth an assessment, which a clinician can provide.
What should I do if I notice these signs?
Treat the concern as reason enough to act. You do not need to be certain. Encourage an assessment with a clinician or eating-disorder program, and if there are signs of medical danger such as fainting or chest pain, seek emergency care.
Talk to a licensed eating disorder program
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